Tag: cardiovascular disease

What is an aortic aneurysm? | CNN
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CNN
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Sports reporter Grant Wahl died of a rupture of an ascending aortic aneurysm with hemopericardium – an accumulation of blood in the sac around his heart – his wife, Dr. Céline Gounder announced on Wednesday. The aneurysm was slowly growing and had gone undetected, she wrote in a statement on Substack.

“The chest pressure he experienced shortly before his death may have represented the initial symptoms. No amount of CPR or shocks would have saved him. His death was unrelated to COVID. His death was unrelated to vaccination status. There was nothing nefarious about his death,” Gounder wrote.

An aneurysm occurs when a weak spot in a blood vessel bulges or balloons out. In Wahl’s case, the bulge was in the aorta, the largest artery carrying blood away from the heart. An ascending aortic aneurysm happens when the bulge is located in the section of the aorta that is close to the heart, right where it begins to climb out of the lower left pumping chamber.

If left untreated, aneurysms can cause the wall of a blood vessel to split or burst, leading to death.

It’s very rare to survive an event like the one that happened to Wahl, said CNN Medical Correspondent Dr. Tara Narula, who is a practicing cardiologist.

Narula said the blood in the sac around the heart is an indication that the artery wall had ruptured.

“Normally there’s no blood in that space. And what can happen is if there’s enough blood that gets in there, the heart essentially can’t beat because it sort of compresses the heart, and you can have a cardiac arrest,” she said, adding that she couldn’t comment specifically on what with Wahl, because she didn’t have any personal knowledge of his case.

Aortic aneurysms were the cause of death for about 10,000 people in 2019, according to the US Centers for Disease Control and Prevention.

Aneurysms in the chest become more common as people age. They are slightly more common among men than women, according to the American Heart Association. They are usually caused by high blood pressure or sudden injury, or a history of high cholesterol or smoking.

Certain inherited conditions such as Marfan syndrome or Ehlers-Danlos syndrome can make it more likely for a person to experience one.

Symptoms of an aortic aneurysm include:
Sudden sharp pain the back or chest
Trouble breathing or swallowing
Not everyone will experience symptoms, even with a large aneurysm. Actor John Ritter died suddenly in 2003 from an aortic aneurysm while he was rehearsing on set.

If an aneurysm is caught in time, it may be able to be treated with medication or surgery.

Aortic aneurysms have become more common over the last decade, increasing about 75%, according to the American Heart Association. Still these events are rare, occurring in about two out of every 100,000 people.

Because of their association with tobacco use, the U.S. Preventive Services Task Force recommends that all men who have ever smoked have an ultrasound screening between the ages of 65 and 75, for abdominal aortic aneurysms, even if they don’t have symptoms. Abdominal aortic aneurysms are bulges of that artery that could rupture in the abdomen.
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December 14, 2022
Move Faster, Live Longer? A Little More Effort Goes a Long Way
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Nov. 30, 2022 – If there’s one public health message Americans have heard loud and clear, it’s this one:

Move more.

Take more steps.

Spend more time doing physical activity – at least 150 minutes a week, according to the latest guidelines.

But hearing the message doesn’t mean we act on it. A whopping 25% of Americans don’t get any physical activity beyond what they do in their job, according to a CDC survey.

A new study suggests a different approach: You don’t have to do more. Just do what you’re already doing, but with a little more effort.

The study builds on growing evidence that suggests exercise intensity matters just as much as the amount. So, something as simple as turning a leisurely stroll into a brisk walk can, over time, lead to significant reductions in your risk of cardiovascular disease. No additional moves, steps, or minutes needed.

Step It Up

Researchers at Cambridge University and the University of Leicester in England looked at data from 88,000 middle-aged adults who wore an activity tracking device for 7 days.
The devices tracked both the total amount of activity they did and the intensity of that movement – that is, how fast they walked or how hard they pushed themselves.

The researchers then calculated their physical activity energy expenditure (the number of calories they burned when they were up and moving) and the percentage that came from moderate to vigorous physical activity.

What’s the difference?

Physical activity means any and every movement you do throughout the day. Mostly it’s mundane tasks like shopping, walking to the mailbox, playing with your dog, or cooking.

Moderate-intensity physical activity includes things you do at a faster pace. Maybe you’re walking for exercise, doing yardwork or household chores, or maybe you’re running late and just trying to get somewhere faster. You’re breathing a little harder and possibly working up a sweat.

Vigorous-intensity physical activity is usually an exercise session – a run, a strenuous hike, a tough workout in the gym. It can also be an exhausting chore like shoveling snow, which feels like a workout. You’re definitely breathing harder, and you’re probably working up a sweat, even in the middle of winter.
Over the next 6 to 7 years, there were 4,000 new cases of cardiovascular disease among the people in the study.

Those who got at least 20% of their physical activity energy expenditure from moderate to vigorous activities had significantly less risk of heart disease, compared to those whose higher-effort activities were about 10%.

That was true even for those whose total activity was relatively low. As long as higher-effort activities reached 20% of their total, they were 14% less likely to be diagnosed with a heart condition.

And for those with relatively high activity levels, there was little extra benefit if their moderate and vigorous activities remained around 10%.

That finding surprised Paddy Dempsey, PhD, a medical research scientist at Cambridge and the study’s lead author. But it also makes sense.

“People can improve their cardiorespiratory fitness to a greater degree with higher-intensity activity,” he says. “More intensity will stress the system and lead to greater adaptation.”

The key is an increase in the amount of oxygen your heart and lungs can provide your muscles during exercise, a measure known as VO2 max.

Raising your VO2 max is the best way to reduce your risk of early death, especially death from heart disease. Simply moving up from the lowest conditioning category to a higher one will cut your risk of dying in any given year by as much as 60%.

Making Strides

The study builds on previous research that shows the benefits of moving faster.

Walking faster will naturally increase your stride length, another predictor of longevity and future health. A review study published in 2021 found that older adults who took shorter steps were 26% more likely to have a disability, 34% more likely to have a major adverse event (like an injury that leads to a loss of independence), and 69% more likely to die over the next several years.

Quality vs. Quantity

We’ve focused so far on the quality of your physical activity – moving faster, taking longer strides.

But there’s still a lot to be said for movement quantity.

“It would be a mistake to say volume doesn’t matter,” Dempsey cautions.

A 2022 study in the journal The Lancet found that the risk of dying during a given period decreases with each increase in daily steps. The protective effect peaks at about 6,000 to 8,000 steps a day for adults 60 and over, and at 8,000 to 10,000 steps for those under 60.

“The relative value of the quality and quantity of exercise are very specific to a person’s goals,” says Chhanda Dutta, PhD, chief of the Clinical Gerontology Branch at the National Institute on Aging. “If performance is the goal, quality matters at least as much as quantity.”

Dempsey agrees that it’s not a cage match between two. Every step you take is a step in the right direction.

“People can choose or gravitate to an approach that works best for them,” he says. “It’s also helpful to think about where some everyday activities can be punctuated with intensity,” which could be as simple as walking faster when possible.

What matters most is that you choose something, Dutta says. “You have more to risk by not exercising.”

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November 30, 2022
Early research suggests promising use of AI to predict risk of heart attack or stroke using a single chest X-ray | CNN

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CNN
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Early research suggests a promising use of artificial intelligence to predict the 10-year risk of death from a heart attack or stroke from a single chest X-ray.

The preliminary findings were presented Tuesday at the annual meeting of the Radiological Society of North America. The research is in the final draft stages and has not been submitted for publication in a medical journal.

Researchers used nearly 150,000 chest X-rays to train an artificial intelligence program to identify patterns in the images associated with risk from major cardiovascular disease events. They tested the program on a separate group of about 11,000 people and found “significant association” between the risk level predicted by the AI and the actual occurrence of a major cardiovascular disease event.

The clinical standard for analyzing risk from cardiovascular disease is the atherosclerotic cardiovascular disease (ASCVD) risk score, a calculator that weights various patient data points that have been found to have a high association with adverse cardiovascular events, including age, blood pressure and history of smoking.

Statin medication is recommended for people with a 10-year risk of 7.5% or higher. The AI model uses the same risk thresholds as the established risk calculator, and early findings suggest that it works just as well.

“We’ve long recognized that X-rays capture information beyond traditional diagnostic findings, but we haven’t used this data because we haven’t had robust, reliable methods,” said Dr. Jakob Weiss, the lead researcher and a radiologist affiliated with Massachusetts General Hospital and the AI in Medicine program at Harvard Medical School’s Brigham and Women’s Hospital.

Sometimes, the AI findings align with a traditional radiology reading, but other times, it picks up on things that may have been missed, he said.

“Part of it is anatomical alterations that we would also pick up with our naked eye and that make physiological sense. Let’s say there’s increased blood pressure or cardiac failure – these are findings that we can pick up in a normal chest radiograph as well. But I think a lot of the information captured or extracted is somewhere embedded in the scan, but we can’t make sense of it as traditionally trained radiologists as of now,” Weiss said.

“It has this black box character to it,” he said, which can sometimes make it hard to communicate risk to patients without an explanation to pinpoint.

Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University’s Feinberg School of Medicine and former president of the American Heart Association, was co-chair of the risk assessment panel when the ASCVD risk calculator was created in 2013 and a key player in 2018 when the guidelines were updated to emphasize the relationship between the risk score and personal medical history.

He was not involved in the new AI research but says it’s important to keep the field moving forward.

“This is exactly the kind of application that artificial intelligence is best for,” he said. “So we need to continue to do things like this to really understand if we can find, particularly, patients who would otherwise slip through the cracks. I think that’s where it may be most useful.”

But collecting all of the patient data points that go into the established risk calculator is still critical – because they’re actionable. And whether risk is calculated using a statistical formula or an AI model, the most successful outcomes will still require personalized patient assessments.

“We don’t cure smoking by a chest X-ray. We actually need to work with the patient to find ways to get them to stop smoking,” Lloyd-Jones said. “The risk calculator is one part of risk assessment, but it’s not the only part. It’s a process that involves both the patient and the doctor in a discussion about what is the patient’s risk and how much we think a statin would help them.”

For their research, Weiss and co-authors trained the AI using chest X-rays from participants in the National Cancer Institute’s Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. It was tested on people who had a routine outpatient chest X-ray at Mass General Brigham and were potentially eligible for statin therapy, with an average age of 60.

Additional research, including a controlled randomized trial, is necessary to validate the deep learning model.

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November 29, 2022
Don’t bother with dietary supplements for heart health, study says | CNN

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CNN
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Six supplements that people commonly take for heart health don’t help lower “bad” cholesterol or improve cardiovascular health, according to a study published Sunday, but statins did.

Some people believe that common dietary supplements – fish oil, garlic, cinnamon, turmeric, plant sterols and red yeast rice – will lower their “bad” cholesterol. “Bad” cholesterol, known in the medical community as low-density lipoproteins or LDL, can cause the buildup of fatty deposits in the arteries. The fatty deposits can block the flow of oxygen and blood that the heart needs to work and the blockage can lead to a heart attack or stroke.

For this study, which was presented at the American Heart Association’s Scientific Sessions 2022 and simultaneously published in the Journal of the American College of Cardiology, researchers compared the impact of these particular supplements to the impact of a low dose of a statin – a cholesterol-lowering medication – or a placebo, which does nothing.

Researchers made this comparison in a randomized, single-blind clinical trial that involved 190 adults with no prior history of cardiovascular disease. Study participants were ages 40 to 75, and different groups got a low-dose statin called rosuvastatin, a placebo, fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice for 28 days.

The statin had the greatest impact and significantly lowered LDL compared with the supplements and placebo.

The average LDL reduction after 28 days on a statin was nearly 40%. The statin also had the added benefit on total cholesterol, which dropped on average by 24%, and on blood triglycerides, which dropped 19%.

None of the people who took the supplements saw any significant decrease in LDL cholesterol, total cholesterol or blood triglycerides, and their results were similar to those of people who took a placebo. While there were similar adverse events in all the groups, there were a numerically higher number of problems among those who took the plant sterols or red yeast rice.

“We designed this study because many of us have had the same experience of trying to recommend evidence-based therapies that reduce cardiovascular risks to patients and then having them say ‘no thanks, I’ll just try this supplement,’ ” said study co-author Dr. Karol Watson, professor of medicine/cardiology and co-director, UCLA Program in Preventive Cardiology. “We wanted to design a very rigid, randomized, controlled trial study to prove what we already knew and show it in a rigorous way.”

Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and a co-author on the study, said that patients often don’t know that dietary supplements aren’t tested in clinical trials. He calls these supplements “21st century snake oil.”

In the United States, the Dietary Supplement and Health Education Act of 1994 sharply limited the US Food and Drug Administration’s ability to regulate supplements. Unlike pharmaceutical products that have to be proven safe and effective for their intended use before a company can market them, the FDA doesn’t have to approve dietary supplements before they can be sold. It is only after they are on the market and are proven to be unsafe that the FDA can step in to regulate them.

“Patients believe studies have been done and that they are as effective as statins and can save them because they’re natural, but natural doesn’t mean safe and it doesn’t mean they’re effective,” Nissen said.

The study was funded via an unrestricted grant from AstraZeneca, which makes rosuvastatin. The company did not have any input on the methodology, data analysis and discussion of the clinical implications, according to the study.

The researchers acknowledged some limitations, including the study’s small sample size, and that its 28-study period might not capture the effect of supplements when used for a longer duration.

In a statement on Sunday, the Council for Responsible Nutrition, a trade association for the dietary supplement industry, said “supplements are not intended to replace medications or other medical treatments.”

“Dietary supplements are not intended to be quick fixes and their effects may not be revealed during the course of a study that only spans four weeks,” Andrea Wong, the group’s senior vice president for scientific and regulatory affairs, said in a statement.

Dr. James Cireddu, an invasive cardiologist and medical director of University Hospitals Harrington Heart & Vascular Institute at University Hospitals Bedford Medical Center, said the work is going to be helpful.

“They did a nice job collecting data and looking at the outcomes,” said Cireddu, who did not work on the study. “It will probably resonate with patients. I get asked about supplements all the time. I think this does a nice job of providing evidence.”

Dr. Amit Khera, chair of the AHA Scientific Sessions programming committee, did not work on the research, but said he thought this was an important study to include in the presentations this year.

“I take care of patients every day with these exact questions. Patients always ask about the supplements in lieu of or in addition to statins,” said Khera, who is a professor and director of preventive cardiology at UT Southwestern Medical Center. “I think if you have high quality evidence and a well done study it is really critical to help inform patients about the value, or in this case the lack of value, for some of these supplements for cholesterol lowering.”

Statins have been around for more than 30 years and they’ve been studied in over 170,000 people, he said. Consistently, studies show that statins lower risk.

“The good news, we know statins work,” Khera said. “That does not mean they’re perfect. That doesn’t mean everyone needs one, but for those at higher risk, we know they work and that’s well proven. If you’re going to do something different you have to make sure it works.”

With supplements, he said he often sees misinformation online.

“I think that people are always looking for something ‘natural’ but you know there’s a lot of issues with that terminology and most important we should ask do they work? That’s what this study does,” Khera adds. “It’s important to ask, are you taking something that is proven, and if you’re doing that and it’s not, is that in lieu of proven treatment. It’s a real concern.”

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November 6, 2022
At least 146 killed during incident at Halloween festivities in Seoul | CNN

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Seoul, South Korea
CNN
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At least 146 people are now reported to have been killed during an incident at Halloween festivities in Seoul’s Itaewon neighborhood Saturday night, according to Choi Seong-bum, chief of the Yongsan-gu Fire Department.

At least 150 others were also reported injured, the chief added.

Authorities are still investigating exactly what caused the incident, but the fire chief said it was a “presumed stampede” and that many people fell, resulting in casualties. The chief said they received reports of people “buried” in crowds starting around 10:24 p.m. local time Saturday night.

There was no gas leak nor fire on site, according to the chief. The cause of the deaths has not been confirmed.

Earlier, the Yonhap News Agency reported that some people had suffered from “cardiac arrest,” attributing the statement to fire authorities. Emergency officials assisted at least 81 people in Seoul’s Itaewon neighborhood reporting “difficulty breathing.”

Dozens of the injured were transferred to nearby hospitals, said Choi Jae-won, the head of Yongsan Health Center, adding that the death toll would likely increase.

The Seoul city government is also receiving reports of missing people as there are many unidentified victims. The bodies of the victims are being transferred to multiple hospital mortuaries, according to authorities.

A witness described a chaotic scene to CNN, saying he saw people jammed in a narrow street unable to breathe.

“I saw people going to the left side and I saw the person getting to the opposite side. So, the person in the middle got jammed, so they had no way to communicate, they could not breathe,” Song Sehyun told CNN.

Police closed off the area and social media videos showed people lying in the streets and on stretchers as first responders rendered aid.

The fire chief said that more than 1,700 emergency response forces have been dispatched, including 517 firefighters, 1,100 police officials, and about 70 government workers.

South Korean President Yoon Suk Yeol sent a disaster medical assistance team to the Halloween incident, according to the presidential office.

The president also ordered authorities to secure emergency beds in hospitals nearby and to implement swift rescue operations and treatment, presidential spokesman Lee Jae-Myung said in a briefing.

Yoon was in an emergency meeting regarding the situation, the office said in a statement.

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October 29, 2022