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Tag: American Heart Association (AHA)

  • What to know about melatonin use and heart failure

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    (CNN) — Long-term use of melatonin supplements may be linked with a higher risk of heart failure, according to new research — but does that mean people taking it as a sleep aid should stop using it now?

    In a review of electronic medical records, thousands of adults who had chronic insomnia and took melatonin for a year or longer had a 90% higher chance of heart failure over the next five years, compared with participants who had the same health factors but didn’t take melatonin. Melatonin users were also more than three times as likely to be hospitalized for heart failure and about twice as likely to die from any cause.

    But experts suggest holding off on seeing melatonin as a definite danger. The research had significant limitations, was not designed to be able to prove cause and effect, and contradicts previous studies that indicated positives for heart health.

    The research also hasn’t yet been peer-reviewed or published in a journal but will be presented at the American Heart Association’s Scientific Sessions 2025 meeting taking place November 7-10.

    “Melatonin supplements are widely thought of as a safe and ‘natural’ option to support better sleep, so it was striking to see such consistent and significant increases in serious health outcomes, even after balancing for many factors,” Dr. Ekenedilichukwu Nnadi, lead research author and chief resident in internal medicine at SUNY Downstate/Kings County Primary Care in Brooklyn, said in a news release.

    However, “while the association we found raises safety concerns about the widely used supplement, our study cannot prove a direct cause-and-effect relationship,” Nnadi said. “This means more research is needed to test melatonin’s safety for the heart.”

    Naturally occurring melatonin in the brain is a hormone produced by the pineal gland in response to darkness, to help the body wind down for sleep.

    The melatonin in supplements can be extracted from the pineal glands of animals or synthetically produced via a chemical process.

    In the United States, because melatonin is sold as a dietary supplement, manufacturers aren’t subject to the level of scrutiny involved in the US Food and Drug Administration’s safety measures and approval processes for drugs. This means melatonin supplements can contain significantly more of the active ingredient than advertised or necessary, as well as harmful hidden additives.

    Chronic insomnia, experienced by 10% of the global population, is defined by taking more than 30 minutes to fall asleep or fall back to sleep up to three times weekly for more than three months. It can lead to problems with memory, daytime energy, mood, thinking and concentration, work or school performance, and one’s social life.

    A doctor can help one determine whether insomnia is occurring on its own or because of an underlying factor, such as a medical condition or stressful life circumstance, and therefore determine the best ways to treat it — whether that’s adjusting your sleep routine, undergoing therapy for mental or emotional distress or cognitive behavioral therapy for insomnia, taking medication, or treating a medical condition.

    Melatonin use and heart health

    Melatonin supplements are often marketed as a safe sleep aid, but there hasn’t been sufficient data on long-term safety for cardiovascular health, the authors said.

    The research team assessed more than 130,000 adults with health records in the TriNetX Global Research Network, a large international electronic database. They were about 55 years old on average, and 61.4% were women. Participants with melatonin use documented in medication entries in their health records for more than a year were classified as the melatonin group, whereas those without any record of melatonin use were in the “non-melatonin group.”

    These factors lend themselves to a few important limitations, the authors and independent experts pointed out.

    The database includes patients in countries that require a prescription for melatonin, such as the United Kingdom, and those that don’t, including the United States — so the control group may unknowingly include adults who take melatonin without a prescription, which wouldn’t be reflected in their medical records, Dr. Carlos Egea, who wasn’t involved in the research, said in a statement provided by the Science Media Centre. Egea is president of the Spanish Federation of Sleep Medicine Societies.

    The researchers also didn’t have details on the severity of participants’ insomnia or whether they had any mental health issues, both of which can influence melatonin use and heart health risks, Nnadi said.

    Insomnia has been associated with a higher risk of having a heart attack or stroke. Disrupted circadian rhythms — our body clocks in which melatonin plays a role — and insufficient sleep have been linked with greater odds of cardiovascular issues including heart failure.

    Other limitations include a lack of information on dosage, the Council for Responsible Nutrition, a trade association for the dietary supplement and functional food industry, said in a statement. “Decades of consumer experience and multiple clinical studies indicate that low-dose, short-term supplementation is safe for healthy adults when used as directed,” the association added.

    The research challenges previous studies, including a March analysis of four studies that found melatonin supplementation improved heart failure patients’ quality of life and cardiac function, Egea said.

    Melatonin is also an antioxidant, and antioxidants help protect against damage to DNA by oxidative stress, an imbalance between free radicals and antioxidants in the body.

    Before you take sleep aids

    Many people turn to melatonin as a short- or long-term solution to sleep woes. But for some people, the supplement has been linked to various side effects including headaches, nausea, dizziness, drowsiness, stomach aches, confusion or disorientation, tremors, low blood pressure, irritability, mild anxiety and depression.

    Before resorting to supplements, “speak to your doctor first about, for one, getting a proper diagnosis for your sleep difficulty and then discussing the appropriate course of treatment,” Dr. Marie-Pierre St-Onge, director of the Center of Excellence for Sleep & Circadian Research in the department of medicine at Columbia University Irving Medical Center, said in the American Heart Association news release. “People should be aware that (melatonin) should not be taken chronically without a proper indication.”

    Healthy sleep hygiene involves limiting light exposure, screen time and consumption of food and alcohol in the few hours before bed. Your bedroom should be dark, cool and quiet.

    If you still choose to supplement melatonin, pharmaceutical grade melatonin is best, experts told CNN in a 2022 report — look for a stamp showing that the independent nonprofit US Pharmacopoeia’s Dietary Supplement Verification Program has tested the product.

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    Kristen Rogers and CNN

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  • New insights into heart disease risk, prevention, and management

    New insights into heart disease risk, prevention, and management

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    Newswise — DALLAS, Oct. 9, 2023 — Health experts are redefining cardiovascular disease (CVD) risk, prevention and management, according to a new American Heart Association presidential advisory published today in the Association’s flagship journal Circulation.

    Various aspects of cardiovascular disease that overlap with kidney disease, Type 2 diabetes and obesity support the new approach. For the first time, the American Heart Association defines the overlap in these conditions as cardiovascular-kidney-metabolic (CKM) syndrome. People who have or are at risk for cardiovascular disease may have CKM syndrome.

    The new approach detailed in the presidential advisory includes:

    • CKM syndrome stages ranging from 0, or no risk factors and an entirely preventive focus, to Stage 4, the highest-risk stage with established cardiovascular disease. Stage 4 may also include kidney failure. Each stage correlates to specific screenings and therapies.
    • Screening for and addressing social factors that impact health.
    • Collaborative care approaches among multiple specialties to treat the whole patient.
    • Suggested updates to the algorithm, or risk calculator, that helps health care professionals predict a person’s likelihood of having a heart attack or stroke. The update adds a risk prediction for heart failure, which estimates risk for “total cardiovascular disease” — heart attack, stroke and/or heart failure.
    • The writing group suggest the updated algorithm provide both 10- and 30-year cardiovascular disease risk estimates.

    According to the American Heart Association’s 2023 Statistical Update, 1 in 3 U.S. adults have three or more risk factors that contribute to cardiovascular disease, metabolic disorders and/or kidney disease. CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver. However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart and more.

    “The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, writing committee chair and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore. “Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”

    CKM syndrome is a consequence of the historically high prevalence of obesity and Type 2 diabetes in both adults and youth, according to the advisory. Type 2 diabetes and obesity are metabolic conditions — the “M” in CKM — that are also risk factors for cardiovascular disease. Moreover, the most common cause of death for people with Type 2 diabetes and chronic kidney disease is cardiovascular disease.

    “We now have several therapies that prevent both worsening kidney disease and heart disease,” Ndumele said. “The advisory provides guidance for health care professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome.”

    With multiple conditions to manage, Ndumele noted fragmented care is a concern in treating patients with CKM syndrome, particularly for those with barriers to care. “The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient.” Additionally, the advisory emphasizes the importance of systematically screening for and addressing social factors that act as determinants, or drivers, of health, such as nutrition insecurity and opportunities for exercise,  as key aspects of optimal CKM syndrome care.”

    A companion article published with the presidential advisory, a new American Heart Association scientific statement, “A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome,”, documents the evidence for the writing committee’s proposed approach. The scientific statement brings together evidence from current guidelines and large research studies and describes where gaps remain in knowledge needed to further improve CKM health.

    CKM screening, stages and treatment

    CKM-related screening is intended to detect cardiovascular, metabolic and kidney health changes early; identify social and structural barriers to care; and prevent progression to the next stage of CKM syndrome.

    The advisory addresses care for adults. However, studies suggest CKM syndrome is progressive and begins early in life. Therefore, the advisory aligns with the American Academy of Pediatrics’ recommendations for children and youth to have annual assessments of weight, blood pressure, and mental and behavioral health, starting at age 3.

    Stage 0 – No CKM risk factors. The goal at this stage is preventing CKM syndrome by achieving and maintaining ideal health based on the American Heart Association’s Life’s Essential 8 recommendations. The recommendations include healthy eating, physical activity and sleep habits; avoiding nicotine; and maintaining optimal weight, blood pressure, blood sugar and cholesterol levels. The advisory suggests screening adults in Stage 0 every three to five years to assess blood pressure, triglycerides, HDL (good) cholesterol and blood sugar.

    Preventing unhealthy weight gain is important for CKM syndrome prevention because of the connection of obesity to Type 2 diabetes, high blood pressure and high triglycerides. At all stages, the advisory proposes yearly measurement of waist circumference and body mass index. Healthy lifestyle behaviors are also encouraged at every stage.

    Stage 1 – Excess body fat and/or an unhealthy distribution of body fat, such as abdominal obesity, and/or impaired glucose tolerance or prediabetes. Support for healthy lifestyle changes (healthy eating and regular physical activity) and a goal of at least 5% weight loss in people with Stage 1 are suggested, with treatment for glucose intolerance if needed. Screening every two to three years is advised to assess blood pressure, triglycerides, cholesterol and blood sugar.

    Stage 2 – Metabolic risk factors and kidney disease. Stage 2 includes people with Type 2 diabetes, high blood pressure, high triglycerides or kidney disease, and indicates a higher risk for worsening kidney disease and heart disease. The goal of care at this stage is to address risk factors to prevent progression to cardiovascular disease and kidney failure. Treatment may include medications to control blood pressure, blood sugar and cholesterol. In those with chronic kidney disease and in some people with Type 2 diabetes, SGLT2 inhibitors are advised to protect kidney function and reduce the risk of heart failure. SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with Type 2 diabetes. Glucagon-like peptide 1 (GLP-1) receptor agonists are also suggested for consideration in people with Type 2 diabetes to help reduce high glucose, facilitate weight loss and reduce risk for CVD. Other therapies to prevent worsening kidney function are also advised. Screening suggestions for Stage 2 CKM syndrome align with AHA/ACC guidelines, which include yearly assessment of blood pressure, triglycerides, cholesterol, blood sugar and kidney function.

    For those with increased risk of kidney failure based on kidney function assessments, more frequent kidney screening is recommended.

    Stage 3 – Early cardiovascular disease without symptoms in people with metabolic risk factors or kidney disease or those at high predicted risk for cardiovascular disease. The goal of care in Stage 3 is to intensify efforts to prevent people who are at high risk of progressing to symptomatic cardiovascular disease and kidney failure. This may involve increasing or changing medications, and additional focus on lifestyle changes. The writing committee advises coronary artery calcium (CAC) measurement in some adults to assess narrowing of the arteries when treatment decisions are unclear. CAC screening is used to guide decisions about cholesterol-lowering statin therapy. Test results indicating asymptomatic heart failure should lead to intensified therapy to prevent heart failure symptoms.

    The advisory also describes CKM syndrome regression, an important concept and public health message in which people making healthy lifestyle changes and achieving weight loss may regress to lower CKM syndrome stages and a better state of health. The best opportunity for patients to experience regression is in Stages 1, 2 and 3. Some may see improvements in glucose control, cholesterol and blood pressure levels, weight, kidney function and types of heart dysfunction.

    Stage 4 – Symptomatic cardiovascular disease in people with excess body fat, metabolic risk factors or kidney disease. Stage 4 CKM syndrome is divided into two subcategories: (4a) for those without kidney failure or (4b) for those with it. In this stage, people may have already had a heart attack or stroke or may already have heart failure. They also may have additional cardiovascular conditions such as peripheral artery disease or atrial fibrillation. The goal of care is individualized treatment for cardiovascular disease with consideration for CKM syndrome conditions.

    Predicting Risk

    A critical step in assessing risk and managing CKM syndrome is updating the risk prediction algorithm to help health care professionals predict cardiovascular disease in a way that includes CKM components: cardiovascular disease, chronic kidney disease and metabolic disorders.

    The Pooled Cohort Equation, the current risk calculator for atherosclerotic cardiovascular disease, established in 2013, estimates the risk of a heart attack or stroke in the next 10 years for people ages 40-75. It includes health and demographic factors about a person and is used to guide lifestyle recommendations and treatment decisions for people at risk for cardiovascular disease. The risk factors are age, sex and race (as white, Black and other); cholesterol levels; and systolic blood pressure. The equation also includes yes/no responses to whether a person is receiving treatment for high blood pressure Type 2 diabetes, or smokes cigarettes.

    The advisory proposes updating the risk calculator to include measures of kidney function, Type 2 diabetes control (using blood test results instead of a yes/no response) and social determinants of health for a more comprehensive risk estimate. Kidney function assessments include a measure of how well the kidneys filter waste from the blood and urine albumin levels, a measure of how well the kidneys reabsorb protein. Individual health measures in addition to demographic information will allow the calculator to produce an individual’s total CVD risk estimate.

    The writing group recommends the risk calculator updates be expanded to assess risk in people as young as age 30 and to calculate both 10- and 30-year CVD risk. More comprehensive CVD risk assessment at younger ages will allow for earlier preventive strategies to mitigate progression to advanced stages of CKM syndrome. In the long term, this will help to reduce gaps in treatment and health equity and improve outcomes.

    Calls to Action

    The advisory calls for systemic changes to optimize CKM health.

    “There is a need for fundamental changes in how we educate health care professionals and the public, how we organize care and how we reimburse care related to CKM syndrome,” Ndumele said. “Key partnerships among stakeholders are needed to improve access to therapies, to support new care models and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health.”

    Investing in research is important for advancing CKM care. Key research gaps include:

    1. better understanding the pathways leading to heart disease in CKM syndrome;
    2. better understanding of why some people may advance more quickly along CKM stages, while others may progress more slowly; and
    3. understanding the best way to use newer therapies with multiple effects on CKM syndrome, including to improve metabolic factors such as obesity and Type 2 diabetes, and to reduce worsening kidney disease and prevent heart disease.

    Co-authors and their disclosures are listed in the manuscript.

    This presidential advisory was prepared by the volunteer writing group on behalf of the American Heart Association. Presidential advisories and scientific statements promote greater awareness about cardiovascular diseases and stroke and help facilitate informed health care decisions. They outline what is known about a topic and what areas need additional research. While scientific statements and advisories inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide official clinical practice recommendations.

    The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

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    American Heart Association (AHA)

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  • Particle radioactivity linked to pollution-associated heart attack and stroke death

    Particle radioactivity linked to pollution-associated heart attack and stroke death

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    Newswise — DALLAS, Oct. 5, 2022 — Particle radioactivity, a characteristic of air pollution that reflects the colorless, odorless gas radon found in fine particulate matter (PM2.5) air pollution, enhances PM2.5 toxicity and increases risk of death from cardiovascular disease, especially from heart attack or stroke, 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.

    Previous scientific research has confirmed that PM2.5, a component of air pollution, causes cardiovascular disease and death, and that PM2.5 exposure is a modifiable cardiovascular disease risk factor. In 2021, the American Heart Association joined with three other leading cardiovascular organizations urging the medical community and health authorities to mitigate the impact of air pollution on people’s health. According to the statement, an estimated 6.7 million deaths in 2019, or 12 percent of all deaths worldwide, were attributable to outdoor or household air pollution. As many as half of these were due to cardiovascular disease. Air pollution also increases the risk of heart attack, stroke, diabetes and respiratory diseases.

    Particle radioactivity is a characteristic of particulate matter that reflects radon, which primarily comes from radon gas, a radioactive, colorless and odorless gas. The particle radioactivity occurs naturally as a product of radioactive decay of uranium found in soil and rocks. Radon migrates into the atmosphere, decaying to alpha-, beta- and gamma-radiation-emitting isotopes.

    “We know that PM2.5 are very small particles in the air that can be inhaled and cause many health problems. However, little is known about which physical, chemical or biological properties of PM2.5 fuel its toxicity,” said study author Shuxin Dong, S.M., a Ph.D. student in population health sciences at Harvard T.H. Chan School of Public Health in Boston. “We studied gross beta-activity, a property of fine particulate matter that is a result of radon that attaches to particles and makes them radioactive, resulting in particle radioactivity. When inhaled, these very small particles penetrate deeply into the lungs and enter the bloodstream and circulate throughout the body.”

    The researchers used spatiotemporal predictions of gross beta-activity, a way to use different variables across space and time, to provide refined predictions of exposure. Examining health records from more than 700,000 non-accidental deaths in Massachusetts between 2001 and 2015, they estimated how long-term (months/year) gross beta-activity exposure impacts death from cardiovascular disease, heart attack or stroke and death from all non-accidental causes. They also predicted PM2.5 on cardiovascular disease-related death and examined the interaction between PM2.5 and particle radioactivity.

    The study found:

    • Chronic particle radioactivity and PM2.5 exposure were similarly associated with increased risks of death from total cardiovascular disease, heart attack or stroke and all causes of non-accidental death.
    • Based on the middle 50% of the data spread, particle radioactivity exposure alone was associated with a 16% increased risk of death from heart attack; an 11% increased risk of death from stroke; a 7% increased risk of death from all types of cardiovascular disease; and a 4% increased risk of death from all non-accidental causes.
    • Based on the middle 50% of the data spread, PM2.5 exposure alone increased the risk of death from heart attack by 6%; death from stroke by 11%; death from all cardiovascular disease by 12%; and death from all non-accidental causes by 10%.

    “The risk of death from cardiovascular disease, heart attack or stroke and all causes due to PM2.5 was higher and, therefore, more toxic when gross beta-activity levels were higher,” Dong said. “These findings suggest that particle radioactivity increases the risk of death from cardiovascular disease and enhances the damage from particulate matter. This must be further investigated and may lead to targeted, cost-effective air quality regulations.”

    A study limitation is that the research was based on information from one state, Massachusetts, and therefore, the results may not be generalizable to the rest of the U.S.

    Co-authors are Petros Koutrakis, Ph.D.; Longxiang Li, Ph.D.; Brent A. Coull, Ph.D.; Joel Schwartz, Ph.D.; Anna Kosheleva, M.S.; and Antonella Zanobetti, Ph.D. Authors’ disclosures are listed in the manuscript.

    The study was funded by the U.S. Environmental Protection Agency and the National Institutes of Health.

    Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

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    About the American Heart Association

    The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

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