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Category: CVD Prevention

Cardio Killers

Heart disease and tobacco ranked with conflict and violence among the world’s biggest killers in 2016, while poor diets and mental disorders caused people the greatest ill health, a large international study has found.

The Global Burden of Disease (GBD) study, published on Friday in The Lancet medical journal, found that while life expectancy is increasing, so too are the years people live in poor health. The proportion of life spent being ill is higher in poor countries than in wealthy ones.

“Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates. But we’ve been much less motivated to address issues leading to illnesses,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which led the study. He said a “triad of troubles” – obesity, conflict, and mental illness – is emerging as a “stubborn and persistent barrier to active and vigorous lifestyles”.

The IHME-led study, involving more than 2,500 researchers in around 130 countries, found that in 2016, poor diet was associated with nearly one in five deaths worldwide. Tobacco smoking killed 7.1 million people.

Diets low in whole grains, fruit, nuts and seeds, fish oils and high in salt were the most common risk factors, contributing to cases of obesity, high blood pressure, high blood sugar and high cholesterol.

The study found that deaths from firearms, conflict and terrorism have increased globally, and that non-communicable, or chronic, diseases such as cardiovascular disease and diabetes caused 72 percent of all deaths worldwide.

Heart disease was the leading cause of premature death in most regions and killed 9.48 million people globally in 2016. Mental illness was found to have a heavy toll on individuals and societies, with 1.1 billion people living with psychological or psychiatric disorders and substance abuse problems in 2016. Major depressive disorders ranked in the top 10 causes of ill health in all but four countries worldwide.

The GBD is funded by the Bill & Melinda Gates Foundation global health charity and gives data estimates on some 330 diseases, causes of death and injuries in 195 countries and territories.

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Pick Up the Pace!

According to a new study, healthy adults who are slow walkers are twice as likely to die from heart disease as those of us who walk at a more brisk pace. “This suggests that habitual walking pace is an independent predictor of heart-related death,” lead author Professor Tom Yates said.

Researchers from the University of Leicester followed 420,727 people over a period of six years to assess death rates.  Those who were slow walkers were found to be between 1.8 and 2.4 times more likely to die of heart disease – which is the world’s biggest killer – during the timeframe.

The researchers took into account risk factors including smoking, BMI and diet, but found that the conclusion still applied to both men and women. However, it was actually adults with the lowest BMIs who were found to have the highest risk from walking slowly.

The study’s authors believe that walking pace is an indicator of overall health and fitness as it’s strongly linked to exercise tolerance.

“Self-reported walking pace could be used to identify individuals who have low physical fitness and high mortality risk,” said Professor Yates. The researchers also looked into whether walking pace could be linked to cancer, but no connection was found.

This is not the first study to link heart disease and walking pace though – research from 2009 concluded that walking slowly is “strongly associated” with an increased risk of dying from cardiovascular disease, including heart disease and stroke.

Heart disease is often a result of high blood pressure, obesity and high cholesterol, and is the leading cause of death in the US, second only to dementia in the UK.

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Heart Disease: Linked to Dementia

A recent NIH-funded study suggests that middle-aged people with risk factors for cardiovascular disease, including heart attacks and stroke, are more likely to develop dementia in old age than people without vascular risk factors.

The study, published in JAMA Neurology, included factors like diabetes, high blood pressure and smoking. “With an aging population, dementia is becoming a greater health concern. This study supports the importance of controlling vascular risk factors like high blood pressure early in life in an effort to prevent dementia as we age,” said Walter J. Koroshetz, MD, director of NIH’s National Institute of Neurological Disorders and Stroke.

The NIH has funded a public health campaign titled “Mind Your Risks,” with the goal of raising awareness of the strong correlation between cardiovascular and brain health. “What’s good for the heart is good for the brain,” says Koroshetz. Among the study’s participants, smoking in middle age was associated with 41% higher odds of dementia; diabetes was linked to a 77% greater risk.

The study’s results contribute to a growing body of evidence and scientific literature that links midlife vascular health to dementia, including the potential of modifying the vascular risk factors to lessen the possibility of dementia. Factors like obesity, diabetes, high blood pressure, and smoking can all be controlled–over time, reducing the risk of dementia.

By focusing on risk factors before middle age, patients have an opportunity to treat and reverse these factors, with the ultimate goal of reducing dementia risk before it is too late.

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Risks of Poor Medication Adherence

A recent study published in the journal Diabetes Care indicates that poor medication adherence in adults diagnosed with type 2 diabetes is strongly associated with increased risks for “cardiovascular disease, all-cause mortality, and hospitalizations.” Conversely, when patients have good medication adherence, these risks are reduced.

The Leicester Diabetes Center at Leicester General Hospital, in conjunction with the Diabetes Research Centre at the University of Leicester in Southmead, United Kingdom, conducted a meta-analysis surrounding eight observational studies in order to determine the correlation between medication adherence and risk for cardiovascular disease (CVD)—in addition to hospitalization and mortality rates—among adults with type 2 diabetes.

The studies’ poor adherence statistics ranged from 25% to 91%, with a mean of 37.8%; one study demonstrated that there was a decrease in CVD with good medication adherence. Other studies reported that good adherence was further associated with benefits in reduced hospitalization rates. The researchers wrote: “In conjunction with previous studies, these data should encourage health care professionals to routinely assess adherence in clinical practice and make efforts to improve it where it falls below 80%…in addition, our findings should serve to reinforce to patients the importance of taking medications as prescribed, in order to avoid premature death and preventable admissions to the hospital.”

Numerous other studies confirm that poor medication adherence is particularly common among patients with cardiovascular disease, and results in serious adverse health consequences. The American Heart Association cites that medication nonadherence results in approximately 125,000 preventable deaths per year, in addition to dramatically increased risks of hospitalization and premature death. Moreover, medication adherence leads to increased health care costs for both individuals and the health care system.

In order to address the variety of potential reasons for poor medication adherence, in addition to an assessment of solutions that could close the adherence gap, the 12th Annual CMHC will host a pre-conference Business of Medicine day on Wednesday, October 4th, featuring an expert discussion hosted by Robert H. Eckel, MD, and William H. Polonsky, PhD, CDE: “The Psychology Behind Patient Adherence.” Register for the upcoming conference in Boston from October 4-7, and learn about the various methods of diagnosis, treatment, and prevention of cardiometabolic disease.

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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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Breastfeeding May Lower Risk of Heart Disease & Stroke

While there is extensive research documenting the benefits of breastfeeding for babies, a new study published in the Journal of the American Heart Association indicates that the practice may lessen a mother’s risk of heart disease and stroke. Moreover, researchers found that a mother’s risk of cardiovascular disease further decreased with each additional 6 months of breastfeeding. Previous studies have suggested that women who breastfeed may experience short-term reductions in blood pressure, cholesterol, and weight loss, which likely benefit cardiovascular health.

The study, conducted in China, analyzed data from 289,754 Chinese women who were free of cardiovascular disease at the study’s baseline; almost all participants had children. The study required the women to provide information surrounding reproductive history, including whether or not they had breastfed children and the duration of breastfeeding.

The researchers assessed the incidence of heart disease and stroke among the women over an eight year follow-up, ultimately finding that women who had breastfed children were at a 9% lower risk of heart disease and an 8% lower risk of stroke, compared to those who had not breastfed. When looking at the results by breastfeeding duration, results revealed that women who had breastfed children for 2 years or longer were 18 percent less likely to develop heart disease and 17% less likely to have a stroke. For every 6 additional months of breastfeeding, risks of heart disease and stroke were respectively reduced by 4% and 3%.

Heart disease is the leading cause of death for both men and women in the United States; statistics from the Centers for Disease Control and Prevention report that approximately 610,000 people die from heart disease each year, accounting for 1 in every 4 deaths. Likewise, stroke is one of the country’s leading causes of disability: there are more than 795,000 people in the U.S. who have a stroke annually.

Senior author Zhengming Chen of the University of Oxford states that “the findings should encourage more widespread breast-feeding for the benefit of the mother as well as the child.”

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Type 2 Diabetes and Heart Failure: A Deadly Combination

An in-depth session titled “Heart Failure: The Frequent, Forgotten, and Often Fatal Complication of Type 2 Diabetes” was presented last week at the American Association of Clinical Endocrinology’s 26th Annual Scientific and Clinical Congress. The cited evidence and research pointed to a high frequency of heart failure, accompanied by an increased risk of mortality, for patients with diabetes.

The conclusion that heart failure requires increased scrutiny, as a risk factor and complication of type 2 diabetes, has been oft quoted and researched—yet it is still not widely known how common the condition is. While microvascular effects of type 2 diabetes are well known and understood—such as neuropathy and diabetic retinopathy—and macrovascular conditions including stroke and peripheral vascular disease, heart failure almost inevitably raises mortality.

Researchers at the University of Alabama at Birmingham School of Medicine have performed series of clinical trials in an effort to determine whether or not heart failure should be more rigorously treated, in order to alleviate and mitigate the poor outcomes often seen in patients. Conclusions indicate that between 40 and 45 percent of patients with diabetes in the United States suffer from heart failure, vs. 12 percent of non-diabetes.

David S.H. Bell, MD showcased studies that specifically assessed and evaluated the complex effects of diabetes and contributing factors to the three primary causes of the heart failure, while other physicians highlighted relations between glycemic control and heart failure risk—focusing on strong correlations between the high incidence of heart failure and type 2 diabetes. Other researchers pointed to the fact that autonomic system dysfunction, a predictor of cardiovascular risk, often occurs in pre-diabetes—which might offer opportunities for early intervention. Technological advancements of the past decade currently allow for identification of the early stages of autonomic dysfunction, through the utilization of concrete, tangible standardized measurements.

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Empagliflozin FDA Approved for Prevention of Cardiovascular Death

In an unprecedented move, the US FDA approved the SGLT-2 inhibitor empagliflozin for the prevention of cardiovascular death in patients with type 2 diabetes and coexisting cardiovascular disease (CVD).

Empagliflozin was first approved in 2014 for the treatment of type 2 diabetes and later demonstrated cardiovascular risk reduction in the EMPA-REG trial. Specifically, treatment with empagliflozin significantly reduced the risk of myocardial infarction, stroke, and CV death, as well as death from any cause and hospitalization for heart failure, in more than 7000 adults with type 2 diabetes at high CV risk. Read more

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USPSTF Advises Lifestyle Counseling on CVD Prevention, Even for Low-Risk Adults

In its latest draft recommendation, the US Preventive Services Task Force (USPSTF) is advising primary care physicians to offer counseling regarding healthy lifestyle habits in preventing cardiovascular disease (CVD), even for adults who are at low risk. The recommendation applies to adults who are 18 years of age and older who are not obese, as well as adults without hypertension, dyslipidemia, diabetes, or abnormal blood glucose levels. The recommendation is a result of a review of 88 trials in which the USPSTF found that behavioral counseling provided at least a small benefit for cardiovascular risk reduction. These benefits included improvements in systolic and diastolic blood pressure levels, LDL-cholesterol levels, BMI, and waist circumference. They did not find evidence that behavioral counseling resulted in a reduction in mortality or CVD rates.

Methods of behavioral counseling included either print- or Internet-based materials and face-to-face individual or group counseling.

The USPSTF is accepting comments on the draft recommendation through January 2, 2017.

Reference:

USPSTF releases draft recommendation on behavioral counseling for healthy diet, CVD prevention.

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SGLT-2 Inhibitor Empagliflozin Significantly Reduces CV Risk and Mortality in CV Outcomes Trial

Results of the EMPA-REG OUTCOME trial have shown that the SGLT2-inhibitor empagliflozin significantly reduced the risk of myocardial infarction, stroke, and CV death, as well as death from any cause, in more than 7000 adults with type 2 diabetes at high CV risk. Patients in the study were given either low- or high-dose empagliflozin or placebo in combination with standard treatment (eg, glucose-lowering, lipid-lowering, and antihypertensive agents).

Expert analysis of the trial indicates the most impressive findings are the early and profound reductions both in all-cause and CV mortality as well as hospitalization for heart failure. Further speculation by Dr. James Stein, of the University of Wisconsin Medical School, points to the treatment of metabolic syndrome for these dramatic results rather than simply an effect on glycemic control. “Unclear what the mechanism is, but I suspect it is not just the lower blood sugar levels. Since waist circumference and blood pressure went down and HDL-C went up, it appears to be treating the metabolic syndrome, perhaps by reducing insulin resistance.”

Empagliflozin was approved by the FDA last year and is the first glucose-lowering agent to demonstrate CV risk reduction in a CV outcomes trial. Earlier this year, the TECOS findings were released providing reassurance on the cardiovascular safety of the DPP-4 inhibitor, sitagliptin. Previous studies (SAVOR-TIMI 53 and EXAMINE) have associated DPP-4 inhibitors with increased risk of heart failure causing some concern.

The 10th Annual CMHC provides the perfect venue to keep up to date on these and other important developments. To provide expert perspective and answer questions on the cardiovascular implications of type 2 diabetes therapies, CMHC is hosting a CME symposium titled “A Closer Look at CV Outcomes for Type 2 Diabetes Therapies: Implications for Patient Care” on Thursday, October 22. Jay S. Skyler, MD will chair, accompanied by faculty Deepak L. Bhatt, MD, MPH, Jennifer B. Green, MD, and Darren K. McGuire, MD, MHSc.

Read details of the complete EMPA-REG OUTCOME study in NEJM here and more interpretation here.

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