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Tag: Heart Disease

  • More Heart Disease Deaths on Very Hot, Very Cold Days

    More Heart Disease Deaths on Very Hot, Very Cold Days

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    Dec. 13, 2022 — Extremely hot and extremely cold days are tied to an increase in the risk of death from heart disease, a new study suggests. 

    People with heart failure were most at risk when temperatures were extremely hot or cold.

    Climate change, which is linked to substantial swings in extreme hot and cold temperatures, is likely a key culprit, according to lead study author Barrak Alahmad, MD, PhD, of the Harvard T.H. Chan School of Public Health in Boston. 

    “Investigating the burden of extreme temperatures from now on will enable us to further understand what climate change might hold for cardiovascular risks,” he says. “In this rapidly changing climate and unprecedented pace of warming, it is not the time to be asleep at the wheel.”

    No specific temperatures are considered extreme, Alahmad notes. “Heat and cold are context-specific and location-specific.” For example, a 104 F day in Kuwait is a typical summer day, whereas a 104 F day in London resulted in “widespread, incalculable damage.”

    For the study, published Dec. 12 in the journal Circulation, the researchers looked at more than 32 million cardiovascular deaths over 4 decades in countries around the world. They compared cardiovascular deaths on the hottest and coldest 2.5% of days in each city with cardiovascular deaths on the days with optimal temperatures. 

    The relative risks of death increased gradually for cold temperatures, but somewhat faster for hot temperatures – especially for heart failure, where the risk in extremely hot weather climbed quickly to as much as 12% higher, according to the analysis.

    Extremely cold temperatures appeared even more dangerous. They were associated with a 33% greater risk of dying from ischemic heart disease (caused by narrowed arteries); a 32% greater risk of death from ischemic strokes caused by blood clots in the brain; and a 37% greater risk of dying from heart failure. 

    Overall, extreme temperatures accounted for 2.2 additional deaths per 1,000 on hot days and 9.1 additional deaths per 1,000 on cold days.

    The results were similar even after the researchers adjusted for temperature variability, heatwaves, long-term trends, relative humidity, and air pollutants, including ozone, nitrogen dioxide, and particulate matter.

    Protect Your Heart

    American Heart Association expert volunteer Nieca Goldberg, MD, medical director of Atria New York and a professor at the New York University School of Medicine in New York City, says everyone needs to take steps to stave off the effects of climate change.  

    To protect your heart on extremely hot and cold days, “avoid outdoor activities,” she advises. “If you must go out for an appointment on a very cold day, remember to bundle up, wear gloves, and a hat and a scarf that covers your mouth. Keep your outdoor time to a minimum.” 

    “On hot days, do not exercise outdoors, stay indoors as much as possible, and stay hydrated,” she says.

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  • Michigan Medicine receives $50M; will name new hospital after philanthropists D. Dan and Betty Kahn

    Michigan Medicine receives $50M; will name new hospital after philanthropists D. Dan and Betty Kahn

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    Newswise — ANN ARBOR, Mich. – Celebrating one of the largest gifts ever to Michigan Medicine of $50 million, the health system will name its new hospital for longtime philanthropists D. Dan and Betty Kahn.

    On Dec. 8, the University of Michigan Board of Regents approved a new name for University of Michigan Health’s 264-bed, 690,000-square-foot hospital — The D. Dan and Betty Kahn Health Care Pavilion — to honor Betty and Dan’s dedication to the University of Michigan and the public good.

    “Patients and families who come to Michigan Medicine see their lives changed,” said U-M President Santa J. Ono. “We are deeply grateful to the D. Dan and Betty Kahn Foundation for its extraordinary generosity, which will enable us to further develop and advance the highly specialized care, innovative research and comprehensive medical training that make our health system so exceptional.”

    The D. Dan and Betty Kahn Health Care Pavilion is scheduled to open in fall 2025. The $920 million facility will include 264 private inpatient rooms capable of converting into intensive care, a top-notch neurosciences center, and specialty services for cardiovascular and thoracic care. It will also feature 20 surgical and three interventional radiology suites.

    “This hospital is so important to the legacy of Betty and Dan Kahn and their focus on improving lives through advancements in health and science,” said Larry Wolfe, president and trustee of the D. Dan and Betty Kahn Foundation and son-in-law of the Kahns.

    “This gift is aligned perfectly with the Kahns’ vision and dedication to improving lives. This transformational gift will enhance the ability of Michigan Medicine to provide increased services to the people of the state of Michigan, as well as a wide cross section of our country,” Wolfe said. “The pandemic amplified the need for increased high-quality medical care, training, research and innovation — this is exactly what Michigan Medicine will do. To give to the University of Michigan is based on the trust and confidence that we at the Foundation have in the university and its leadership. The Kahn Foundation is proud to make this impactful gift based on need, proper stewardship and management.”

    The new hospital will allow for the relocation of beds currently in semi-private rooms at University Hospital, improving patient safety and experience while offering more space for family members. When all is complete, a total of 154 new beds will be added to the medical campus in Ann Arbor.

    “The generosity of the D. Dan and Betty Kahn Foundation will allow Michigan Medicine to provide essential increased access for patients to receive the highest quality medical care from our world-class providers,” said Marschall Runge, M.D., Ph.D., CEO of Michigan Medicine, dean of the U-M Medical School and executive vice president of medical affairs for the University of Michigan.

    “By relieving high capacity at University Hospital and having more ICU-capable beds, the facility will improve the patient experience for so many,” Runge said. “This will be yet another distinction that strengthens our academic medical center.”

    The D. Dan and Betty Kahn Foundation has a near-20-year history of transformational giving to the University of Michigan.

    In 2011, Dan Kahn created the Kahn Symposium, a collaboration between U-M and the Technion – Israel Institute of Technology. In 2018, the foundation established and expanded the Michigan-Israel Partnership for Research and Education, an alliance among U-M, Technion and the Weizmann Institute of Science that was envisioned by Dan Kahn and facilitates collaboration in medicine, science and engineering among these institutions.  

    The foundation also has supported cardiovascular research and care at Michigan Medicine, with gifts in 2009 and 2004, the latter made by Dan in memory of his beloved wife, Betty. The auditorium at U-M’s A. Alfred Taubman Biomedical Science Research Building and the Patient and Family Reception Area at the Frankel Cardiovascular Center are named in the Kahns’ honor.

    “My parents placed immense value on the power of education and continual learning,” said Patti Aaron, daughter of Dan and Betty Kahn, and vice president and trustee of the Kahn Foundation. “My father was especially inspired by scientific discovery and the possibilities for humankind, and he encouraged the same in his children and grandchildren. My parents’ philanthropy, in part, reflected those interests through support for world-class health science research institutions, such as Michigan Medicine.”

    The new hospital is being constructed adjacent to the Frankel Cardiovascular Center, and the two are set to be linked with bridge and tunnel connections. The facility is designed for sustainability to meet LEED (Leadership in Energy and Environmental Design) Platinum Building Certification, the highest possible rating.

    “With the Pavilion, Michigan will have one of the most state-of-the-art hospitals in the country — that also demonstrates environmental and social responsibility,” said David Miller, M.D., president of U-M Health. “The D. Dan and Betty Kahn Health Care Pavilion will be a game changer for Michigan and our patients, as well as the faculty, staff and learners who are committed to caring for them.”

    “Michigan Medicine is all about people — their faculty and staff are outstanding, and the care is patient-centered,” said Arthur Weiss, secretary/treasurer and trustee of the Kahn Foundation. “This gift will ensure that they have the tools to continue the transformative work they do here and assist in the retention of high-quality medical professionals at Michigan Medicine. Having had the privilege to represent Betty and Dan, this gift falls perfectly in line with their legacy.”

    About the Pavilion:  

    The D. Dan and Betty Kahn Health Care Pavilion is a 12-floor, 264-bed inpatient facility being built on the University of Michigan Health, Michigan Medicine, medical campus in Ann Arbor. The $920 million, 690,000-square-foot hospital was approved for construction by University of Michigan Board of Regents in September 2019.

    Work on the project was paused due to the COVID-19 pandemic in 2020 but resumed in spring 2021. Construction crews will work to enclose the building’s exterior in winter 2023, and the hospital is scheduled to open fall 2025.

    About Michigan Medicine:

    At Michigan Medicine, we advance health to serve Michigan and the world. We pursue excellence every day in our five hospitals, 125 clinics and home care operations that handle more than 2.3 million outpatient visits a year, as well as educate the next generation of physicians, health professionals and scientists in our U-M Medical School.

    Michigan Medicine includes the top ranked U-M Medical School and University of Michigan Health, which includes the C.S. Mott Children’s Hospital, Von Voigtlander Women’s Hospital, University Hospital, the Frankel Cardiovascular Center, Kellogg Eye Center, University of Michigan Health West and the Rogel Cancer Center. The U-M Medical School is one of the nation’s biomedical research powerhouses, with total research funding of more than $500 million.

     

    More information is available at www.med.umich.edu 

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  • Black Patients Fare Worse Than White Patients After Angioplasty, Stents

    Black Patients Fare Worse Than White Patients After Angioplasty, Stents

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    By Alan Mozes 

    HealthDay Reporter

    WEDNESDAY, Nov. 30, 2022 (HealthDay News) — Black adults who undergo a common procedure to open up clogged arteries are readmitted to the hospital more often than their white peers. They’re also more likely to die in the years after treatment, a new study finds.
     

    Researchers looked at how patients fared following balloon angioplasty and coronary stenting — “one of the most common cardiovascular procedures performed in the U.S.,” said study co-author Dr. Devraj Sukul.

    “We found significant differences in post-discharge outcomes such as readmission and long-term mortality,” said Sukul, an interventional cardiologist at the University of Michigan.

    The minimally invasive treatment is routinely offered to adults diagnosed with a narrowing of the coronary arteries. Doctors use a balloon to stretch open the artery, and often insert a short, wire mesh tube (stent) to keep the artery open.

    Researchers analyzed data on 29,000 men and women in Michigan over age 65. They found that during the first 90 days post-procedure, Black patients were 62% more likely to be readmitted to a hospital. And over roughly four years, Black patients were 45% more likely to die than white patients.

    In addition, three-quarters of white patients were referred for cardiac rehabilitation, compared with less than 60% of Black patients.
     

    The results were published in the January 2023 issue of the American Heart Journal.

    Delmonte Jefferson, executive director of the national nonprofit Center for Black Health & Equity, expressed little surprise at the findings.

    “African American health and wellness is not valued in the U.S.,” Jefferson said.

    “Once we start to value optimal health for all,” said Jefferson, “we’ll see changes in our nation’s infrastructure that will lead to greater access to care, and better mechanisms for prevention in order to reduce health disparities.”

    The study involved more than 26,000 white patients and about 3,000 Black patients. All underwent the artery-widening procedure between 2013 and 2018 at one of 48 Michigan-based hospitals.

    Investigators found no large differences in post-procedure outcomes while patients were still in a hospital.

    But after taking into account age and gender differences, they found a clear racial gap in the patient experience following discharge.

    “There are many factors that likely explain this gap,” said Sukul, pointing to stark differences in wealth, overall health status and access to health care. By each measure, Black patients, on average, were worse off than their white peers when they underwent stenting.
     

    These factors are interconnected and accumulate over time, he added.

    For example, Sukul noted, “Lower socioeconomic status can potentially lead to worse health status, just as illness may undermine financial security and economic opportunity.”

    As to what might help close the gap, the researchers called for better heart health care, both by reducing heart disease risks before procedures and by ratcheting up follow-up care.

    More broadly, Sukul said “getting at the root cause of the structural barriers to health equity, such as access to high quality health care, economic mobility and adequate health insurance coverage, will remain critical.
     

    “None of these are easy [fixes],” Sukul acknowledged, “but they are important.”

    More information

    University of Chicago Medicine has more on racial disparities and heart health.

     

    SOURCES: Devraj Sukul, MD, MSc. interventional cardiologist and clinical assistant professor, department of internal medicine, division of cardiovascular medicine, University of Michigan, Ann Arbor; Delmonte Jefferson, executive director, Center for Black Health & Equity, Durham, N.C.; American Heart Journal, January 2023

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  • Move Faster, Live Longer? A Little More Effort Goes a Long Way

    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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  • Heart Disease Deaths Spiked During COVID

    Heart Disease Deaths Spiked During COVID

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    Nov. 29, 2022 – Deaths from heart disease and stroke among adults living in the United States have been on the decline since 2010. But the COVID-19 pandemic reversed that downward trend in 2020, new research shows. 

    It was as if COVID had wiped out 5 years of progress, pushing rates back to levels seen in 2015, the researchers say.

    Non-Hispanic Black people and those who were younger than 75 were affected more than others, with the pandemic reversing 10 years of progress in those groups. 

    Rebecca C. Woodruff, PhD, presented these study findings at the American Heart Association 2022 Scientific Sessions.

    The rate of death from heart disease had been falling for decades in the United States due to better detection of risk factors, such as high blood pressure, and better treatments, such as statins for cholesterol, she said.

    The decrease in deaths from heart disease from 1900 to 1999 “has been recognized as a top public health achievement of the twentieth  century,” said Woodruff, who is an epidemiologist for the CDC.

    The reversal of this positive trend shows that it is important that people “work with a health care provider to prevent and manage existing heart disease, even in challenging conditions like the COVID-19 pandemic,” she said. 

    Woodruff advised that “everyone can improve and maintain their cardiovascular health and reduce the risk of cardiovascular disease by following the American Heart Association’s Life’s Essential 8 – eating better, being more active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure.” 

    “COVID-19 vaccines can help everyone, especially those with underlying heart disease or other health conditions, and protect people from severe COVID-19,” she stressed.

    Andrew J. Einstein, MD, PhD, from Columbia University Irving Medical Center in New York City, who was not involved with this research, says the results show “very disturbing changes” to the decline in deaths from heart disease over the past decade. 

    The study findings underscore that “as a society, we need to take efforts to ensure that all people are engaged in the health care system, with one aim being improving heart health outcomes, which worsened significantly in 2020,” he says. 

    “If you don’t actively see a primary care provider, it’s important to find one with whom you can have a good relationship and can discuss with you heart-healthy living; check your blood pressure, sugar, and cholesterol; ask you about symptoms and examine you to detect disease early; and refer you for more specialized heart care as needed,” he says. 

    Some Study Findings

    The researchers analyzed data from the CDC’s WONDER database.

    They identified adults ages 35 and older with heart disease as cause of death.

    They found that the number of people who died from heart disease in every 100,000 people (heart disease death rate) dropped each year from 2010 to 2019, but it increased in 2020, the first year of the pandemic.

    This increase was seen in the total population, in men, in women, in all age groups, and in all race and Hispanic ethnicity groups.

    In the total population, the heart disease death rate dropped by 9.8% from 2010 to 2019. But this rate increased by 4.1% in 2020, going back to the rate it had been in 2015.

    Among non-Hispanic Black people, the heart disease death rate fell by 10.4% from 2010 to 2019, but it increased by 11.2% in 2020, going back to the rate it had been in 2010.

    Similarly, among adults ages 35 to 54 and those ages 55 to 74, the rates of heart disease deaths decreased from 2010 to 2019 and increased in 2020 to rates higher than they had been in 2010.

    In 2020, about 7 years of progress in declining heart death rates was lost among men and 3 years of progress was lost among women, the researchers said. 

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  • Holiday Travel: How to Get Where You’re Going (and Stay Well)

    Holiday Travel: How to Get Where You’re Going (and Stay Well)

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    As the busy holiday season approaches, thousands of people head to the airports, jetting to see loved ones or just to get away from it all. Many more will take trains or buses — or pack up the car and cruise onto the highways. But whether by land, sea, or sky, there are likely to be delays  along the way.

    For people with serious health problems like diabetes and heart disease — and for young children — those travel glitches can be more than an inconvenience. To stay well when you’re traveling, you’ll need to plan well. Here’s how. 

    If You Have Diabetes

    Eat close to your regular schedule. “That’s especially important for diabetics,” says Inyanga Mack, MD, assistant professor of family and community medicine at Temple University School of Medicine in Philadelphia.

    Since meal service has been discontinued on most flights, getting to the airport early leaves you time to eat before the flight. Also, bring along healthy snacks to offset the risk of hypoglycemia, whether on the road or in the air, she says.

    Wear an appropriate medical alert bracelet. Carry the name of an emergency contact person and your primary care physician, Mack suggests. Keep a list of your medications and doses, so someone can get access to your medication in an emergency.

    Take medications with you, not packed in luggage. Carry a few days’ supply of your medications. Then if luggage gets lost, or if you’re trapped in the airport or on the plane for extended periods, your health won’t be in jeopardy. Always eat and take medications according to your regular schedule, even if everything else is in turmoil.

    Make sure medications are properly labeled. All prescriptions must have the pharmaceutical label or professionally printed label identifying the drug. If you are not permitted to board with your medications and supplies, ask to speak with the airport’s FAA representative or the security director. You may even want to call ahead of time to be sure you can get on board with what you need.

    FAA requirements: Diabetic people carrying syringes and/or needles must also carry the injectable medication. Diabetic people traveling in the U.S. can bring syringes and other such equipment in carry-on bags, but insulin vials must have a professional, printed medication label. Better yet, keep insulin in its original box, since it has the pharmaceutical company label. Needles must be capped. The glucose meter must have the manufacturer’s name on it. Injectable glucagon should also be in its original plastic kit with the pre-printed pharmaceutical label.

    If You Have Heart Disease

    Don’t get dehydrated or fatigued. Get plenty of rest, says Ronald Krone, MD, professor of medicine and cardiology at Washington University School of Medicine in St. Louis. “If you feel fatigued, find someone to carry your bags. Don’t rush. Getting around a long airport can be like a stress test. Carry as little as possible on board, so you’re not struggling to lift something overhead. Minimize your workload.”

    If traveling abroad, give yourself a day to recover. “You should not be on a go-go schedule,” Krone says. “Allow time to get plenty of rest, and make sure you’re well hydrated.”

    Carry a copy of your ECG. If you’ve had heart bypass surgery, get a note from your surgeon. This should detail the number of veins and arteries that were used to do the bypass, Krone says. If you’re in a foreign country and need an emergency catheterization, “the cardiologist at your destination would know exactly how to perform the catheterization,” Krone says. “It would make the whole thing much simpler.”

    If you’re taking Coumadin and will be abroad a month or more, consider making arrangements at your destination to have your blood checked. Many countries require that you see a local doctor to monitor your blood and write a prescription if necessary. The U.S. embassy can easily make these arrangements, Krone says.

    If You’re Traveling with Kids

    Have a game plan. “Really consider the amount of time you’re going to be waiting,” says Andrea McCoy, MD, director of primary care at Temple University Children’s Medical Center in Philadelphia. “It’s tough to travel with kids to begin with, and delays and changes in time zones make it even more difficult,” she says.

    Let kids run when there’s a chance. “You can’t expect young kids to sit like little soldiers,” McCoy says. “Mom can let kids run in a hallway while Dad stands in line. It’s thankless enough to stand there as a grown-up; you can’t expect your kids to do it.”

    Take along snacks, drinks, and activities. Books to read, puzzle books, game boys, and portable checkers keep kids busy. For younger kids, coloring books, little games, action figures will work. Plan activities you know they will like, says McCoy. “Also plan something new and different, something they don’t see every day, or have never seen before. The novelty will help a little bit.” Another idea: keep individual toys wrapped, then bring them out at just the right moment.

    Take light snacks. Carry something like bagels, which are starchy and don’t require refrigeration, to offset both hunger and airsickness.

    Carry prescription medications on board. Remember to put medications in an icepack if they need to be refrigerated. Let your doctor know ahead of time that you will be traveling, in case a second-choice medicine is more convenient to carry.

    Carry  acetaminophen — something kids can suck or swallow. These are for normal aches and pains, plus ear pain, McCoy says. The swallowing or sucking action will help clear a child’s ears if you’re flying.

    Make sure booster or car seats are available. If you’re renting a car, make the appropriate arrangements at your destination. Also, consider having a car seat on board for a safer flight.

    Check at your destination — is it child proof? The same things that apply at home still count when you’re away. Are there gates at the tops of stairs? If you’re staying with someone who has a gun, is it  stored out of children’s reach? When you’re done unwrapping gifts, make sure the ribbons and wrappings picked up, so little children won’t suffocate or choke on them. And make sure that  leftover party food gets stored safely,  so kids won’t get into it if they wake up before you. 

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  • Cutting Table Salt Tied to Lower Heart Disease Risk

    Cutting Table Salt Tied to Lower Heart Disease Risk

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    Nov. 28, 2022 – Simply limiting shakes of salt at the table may help lower the risk of heart disease, new research suggests.

    Using less added salt appeared to have the biggest effect on two common kinds of heart disease: heart failure and ischemic heart disease, also known as hardening of the arteries, which slows blood flow to the heart. But the research found that putting such limits on salt did not affect the risk of having a stroke.

    The new research, from the School of Public Health and Tropical Medicine at Tulane University in New Orleans, was published today in the Journal of the American College of Cardiology.

    “Overall, we found that people who don’t shake on a little additional salt to their foods very often had a much lower risk of heart disease events, regardless of lifestyle factors and pre-existing disease,” says co-author Lu Qi, MD, PhD, a professor at Tulane.

    You Don’t Have to Eliminate It Altogether

    That’s good news, because it suggests that just adding less salt to food – not removing it entirely – can make a difference without too big a sacrifice, Qi said in a statement.

    Even those who followed a DASH-style diet to lower their blood pressure further reduced their heart disease risk when they held back the salt at the table, the researchers found.

    DASH stands for Dietary Approaches to Stop Hypertension, and people following it focus on foods rich in protein, calcium, potassium, fiber, and magnesium and avoid foods high in sodium, added sugar, and saturated fat.

    People who didn’t add salt at the table very often and also followed the DASH diet had the lowest heart disease risk of the people studied, the researchers say.

    The researchers found there was an even stronger link between adding salt to foods and heart disease risk when people were current smokers or had a lower social and economic status. 

    Conflicting Results

    There’s already lots of evidence linking high sodium to high blood pressure, which is a major risk factor for cardiovascular disease. But studies looking at the link have had conflicting results because it’s been hard for researchers to find out how much salt people consume over many years. 

    A previous study by the same research team reported that people who added salt to foods more often had a higher risk of dying early from any cause and a lower life expectancy. This study builds on that and focuses on how more added salt over the long term affects heart disease risk.

    For the study, researchers surveyed 176,570 people from the United Kingdom Biobank database who did not have cardiovascular disease at the beginning of the study. They were asked about how often they added salt to their food, not including salt used in cooking. They could answer never/rarely; sometimes; usually; or always. 

    They also were asked if they had made major changes to their diet in the last 5 years and were asked to recall what they ate and drank over the last 24 hours.

    The researchers analyzed heart disease events through medical histories, data on hospital admissions, answers on questionnaires, and death register data.

    Sara Ghoneim, MD, a gastroenterology fellow at the University of Nebraska Medical Center in Omaha, wrote in an editorial that this study is promising for people in both high- and low-income countries.

    “The economic burden of CVD [cardiovascular disease] is considerable and continues to increase in prevalence,” she wrote. 

    Ghoneim pointed out that a drawback of the study is that people were asked to report their own level of salt use and that they came from the database in the United Kingdom, so it’s uncertain whether other populations would have the same results.

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  • Vitamin D fails to reduce statin-associated muscle pain

    Vitamin D fails to reduce statin-associated muscle pain

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    • About 30 to 35 million Americans are prescribed statins to lower cholesterol
    • It’s common for patients to complain of muscle pain when taking statins 
    • Some doctors recommend vitamin D to ease these muscle aches, but new study found no benefit 

    Newswise — CHICAGO — Patients who take statins to lower high cholesterol levels often complain of muscle pains, which can lead them to stop taking the highly effective medication and put them at greater risk of heart attack or stroke. 

    Some clinicians have recommended vitamin D supplements to ease the muscle aches of patients taking a statin, but a new study from scientists at Northwestern University, Harvard University and Stanford University shows the vitamin appears to have no substantial impact.

    The study will be published Nov. 23 in JAMA Cardiology.

    Although non-randomized studies have reported vitamin D to be an effective treatment for statin-associated muscle symptoms, the new study, which is the first randomized clinical trial to look at the effect of vitamin D on statin-associated muscle symptoms, was large enough to rule out any important benefits.

    In the randomized, double-blind trial, 2,083 participants ingested either 2,000 units of vitamin D supplements daily or a placebo. The study found participants in both categories were equally likely to develop muscle symptoms and discontinue statin therapy. 

    Over 4.8 years of follow-up, statin-related muscle pain was reported by 31% of the participants assigned vitamin D and 31% assigned a placebo. 

    “We had high hopes that vitamin D would be effective because in our clinic and across the country, statin-associated muscle symptoms were a major reason why so many patients stopped taking their statin medication,” said senior author Dr. Neil Stone, professor of medicine in cardiology and preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist. “So, it was very disappointing that vitamin D failed a rigorous test. Nevertheless, it’s important to avoid using ineffective treatments and instead focus on research that can provide an answer.” 

    Statins and vitamin D supplements are two of the most commonly used medications in American adults. About 30 to 35 million Americans are prescribed statins, and about half of the population aged 60 and older take a vitamin D supplement. 

    “We took advantage of a large placebo-controlled randomized trial to test whether vitamin D would reduce statin-associated muscle symptoms and help patients keep taking their statins,” said lead study author Dr. Mark Hlatky, a professor of health policy and cardiovascular medicine at Stanford. “The placebo control in the study was important because if people think vitamin D is supposed to reduce their muscle pains, they just might feel better while taking it, even if vitamin D has no specific effect.”                                                                                               

    Trial was a sub study within a larger clinical trial

    The 2,083 patients were among the larger cohort of participants in the VITamin D and Omega-3 Trial (VITAL), which randomized nearly 26,000 participants to double-blind vitamin D supplementation to determine whether it would prevent cardiovascular disease and cancer. This provided researchers a unique opportunity to test whether vitamin D reduces muscle symptoms among participants who initiated statins during the follow-up period of the larger VITAL trial. The mean age of the study participants was 67, and 51% were women.

    “Randomized clinical trials are important because many very good ideas don’t work as well as we had hoped when they are put to the test,” Hlatky said. “Statistical associations do not prove a cause-and-effect relationship. Low levels of vitamin D are associated with many medical problems, but it turns out that giving people vitamin D does not generally fix those problems.”

    For patients who report statin-associated muscle pains

    Dr. Stone noted that sometimes the secret for understanding patients who have difficulty with statins is analyzing other medications they’re taking, determining whether or not they have associated metabolic or inflammatory conditions, counseling them on their ability to hydrate adequately and, importantly, discussing “pill anxiety.” 

    “For those who have difficulties with statins, a systematic appraisal by a physician with experience in dealing with these matters is still very important,” Stone said.

    The idea for this sub study arose out of conversations between study co-author Dr. Pedro Gonzalez, then a resident at Northwestern Memorial Hospital, and Dr. Stone, who runs a large lipid clinic at Northwestern.

    Other authors of the study include JoAnn E. Manson and the VITAL study group at Brigham and Women’s Hospital, Harvard Medical School and the Harvard T. H. Chan School of Public Health.

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  • Exámenes de detección guiados por inteligencia artificial usan datos de electrocardiogramas para detectar factores de riesgo ocultos de accidente cerebrovascular

    Exámenes de detección guiados por inteligencia artificial usan datos de electrocardiogramas para detectar factores de riesgo ocultos de accidente cerebrovascular

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    Newswise — ROCHESTER, Minnesota —Los investigadores de Mayo Clinic utilizaron inteligencia artificial para evaluar electrocardiogramas de pacientes en el marco de una estrategia dirigida para detectar fibrilación auricular, un trastorno frecuente del ritmo cardíaco. La fibrilación auricular es un latido cardíaco irregular que puede provocar coágulos sanguíneos que podrían viajar al cerebro y causar un accidente cerebrovascular, y suele ser difícil de diagnosticar. En el estudio descentralizado realizado a través de medios digitales, la inteligencia artificial identificó nuevos casos de fibrilación auricular que no se habrían observado clínicamente en la atención médica de rutina. 

    En investigaciones anteriores, ya se había desarrollado un algoritmo de inteligencia artificial para identificar a los pacientes con una probabilidad alta de tener fibrilación auricular previamente desconocida. nference y Mayo Clinic otorgaron la licencia del algoritmo para detectar la fibrilación auricular en un ritmo sinusal normal a partir de un electrocardiograma a Anumana Inc., una empresa de tecnología médica impulsada por inteligencia artificial. 

    El Dr. Peter Noseworthy, cardiólogo electrofisiólogo en Mayo Clinic y autor principal del estudio, declaró: “Creemos que los exámenes de detección de la fibrilación auricular tienen mucho potencial, pero actualmente los resultados son muy pocos, y los costos son muy altos como para posibilitar la detección generalizada. El estudio demuestra que un algoritmo de inteligencia artificial aplicado a un electrocardiograma puede ayudar a dirigir los exámenes de detección a los pacientes que tengan más probabilidades de beneficiarse con ellos”. 

    Del estudio participaron 1003 pacientes, a quienes se les realizaron controles constantes, y otros 1003 pacientes de atención médica habitual funcionaron como controles del mundo real. Los hallazgos, que se publicaron en The Lancet, mostraron que la inteligencia artificial puede identificar un subgrupo de pacientes de alto riesgo que recibirían más beneficios al hacerse controles cardíacos intensivos adicionales para detectar fibrilación auricular, lo que apoyó la estrategia de detección dirigida y guiada por inteligencia artificial. 

    Habitualmente, los electrocardiogramas se hacen para diagnosticar una variedad de trastornos, pero como la fibrilación auricular puede durar poco, es baja la posibilidad de detectar un episodio durante un rastreo por electrocardiograma de 10 segundos. Los pacientes pueden someterse a enfoques de control cardíaco intermitentes o continuos que tienen tasas de detección más altas, pero se requieren muchos recursos para aplicarlos a todo el mundo, y los controles pueden ser molestos y costosos para los pacientes. 

    En este punto, puede ser útil el electrocardiograma guiado por inteligencia artificial. El algoritmo de inteligencia artificial puede identificar pacientes que, aunque tengan un ritmo cardiaco normal el día en que se hacen el electrocardiograma, puedan tener un riesgo mayor de episodios de fibrilación auricular no detectada en otros momentos. Luego, estos pacientes pueden hacerse controles adicionales para confirmar el diagnóstico. 

    “Los programas de exámenes de detección tradicionales seleccionan pacientes según la edad (mayores de 65 años) o la presencia de afecciones como la hipertensión arterial. Estos enfoques tienen sentido porque la edad avanzada es uno de los factores de riesgo de fibrilación auricular más importantes. Sin embargo, no es factible realizar controles cardíacos intensivos de manera reiterada a más de 50 millones de adultos mayores en todo el país”, señaló la Dra. Xiaoxi Yao, investigadora de resultados médicos del Departamento de Medicina Cardiovascular y del Centro Robert D. y Patricia E. Kern para la Ciencia de Brindar Atención Médica de Mayo Clinic. La Dra. Yao es autora sénior del estudio. 

    “El estudio muestra que un algoritmo de inteligencia artificial puede seleccionar un subgrupo de adultos mayores a los que los controles intensivos podrían beneficiar más. Si esta nueva estrategia se implementara de forma generalizada, podría reducir la fibrilación auricular sin diagnosticar y prevenir accidentes cerebrovasculares y la muerte de millones de pacientes alrededor del mundo”, indicó la Dra. Yao. 

    El próximo paso en esta investigación es un ensayo híbrido multicéntrico enfocado en la eficacia de la implementación del proceso de trabajo del electrocardiograma guiado por inteligencia artificial en diversos entornos clínicos y poblaciones de pacientes. 

    “Esperamos que este enfoque sea especialmente valioso en entornos de pocos recursos, en los que las tasas de fibrilación auricular sin diagnosticar pueden ser particularmente altas y pueden ser limitados los recursos para detectarla. Sin embargo, hace falta más trabajo para superar los obstáculos de implementación, y los estudios futuros deben evaluar las estrategias de exámenes de detección dirigidos en estos entornos”, expresó el Dr. Noseworthy. 

    “Ahora que demostramos que son posibles los exámenes de detección de fibrilación auricular dirigidos por inteligencia artificial, también debemos mostrar que los pacientes con fibrilación auricular detectada mediante exámenes se benefician del tratamiento para prevenir accidentes cerebrovasculares”, señaló el Dr. Noseworthy. “Nuestro objetivo final es prevenir los accidentes cerebrovasculares. Creo que el estudio actual nos ha llevado un paso más cerca”. 

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    Información sobre Mayo Clinic 

    Mayo Clinic es una organización sin fines de lucro comprometida con la innovación en la práctica clínica, la educación y la investigación que ofrece atención experta y respuestas a todos los que necesitan recobrar la salud. Visite la Red Informativa de Mayo Clinic para obtener más noticias de Mayo Clinic. 

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  • Doctor’s Office Stress Test Could Gauge Your Heart Risk

    Doctor’s Office Stress Test Could Gauge Your Heart Risk

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    By Cara Murez 

    HealthDay Reporter

    WEDNESDAY, Nov. 9, 2022 (HealthDay News) — Evaluating a person’s psychological stress can be a good way to gauge their risk of heart and blood vessel disease, new research suggests.

    And a brief questionnaire could help with the assessment, the study findings showed.

    “Our study is part of the accumulating evidence that psychological distress is a really important factor in a cardiovascular diagnosis, such as the other health behaviors and risk factors, like physical activity and cholesterol levels, that clinicians monitor,” said co-author Emily Gathright. She is an assistant professor of psychiatry and human behavior at Brown University’s Warren Alpert Medical School, in Providence, R.I.

    For the study, the team looked at research published within the past five years that included adults without a psychiatric diagnosis who were screened for depression, anxiety, post-traumatic stress disorder, stress or general mental health symptoms, and followed for more than six months. About 58% were women.

    In all, Gathright and her colleagues analyzed findings from 28 studies that included more than 658,000 patients. Those reporting high levels of psychological distress had a 28% higher risk of heart disease, the investigators found.

    According to study co-author Carly Goldstein, an assistant professor of psychiatry and human behavior, a brief mental health questionnaire can give clinicians a better idea not only of a patient’s mental health risks, but also their associated risk for heart disease.

    Based on the results of the questionnaire, the clinician can immediately advise the patient about how improving their mental health can help them improve their heart health, she added.

    “This analysis shows that a patient’s psychological distress is directly associated with their cardiovascular risk, providing opportunities for clinicians to help a patient manage their risks over time, for better overall health, right at the point of care,” Goldstein said in a Brown University news release.

    Before the study it was not known whether a brief mental health screening would help predict heart disease risk, she noted.

    Most research examining links between psychological health and heart disease has focused on people who have already been diagnosed, said study co-author Allison Gaffey, a clinical psychologist at Yale School of Medicine in New Haven, Conn., who completed her predoctoral internship at Brown’s medical school.

    “Certainly we know that psychological health is important within the scope of managing care,” Gaffey said.

    The screeners used in the studies were brief and well-known, and could be administered with confidence by any clinical provider, she noted.

    “We believe that using these brief screeners, whether in a hospital or a community health care setting, provides feedback that is helpful in understanding risk for cardiovascular disease in a very multidimensional way compared to only using more standard assessments like blood pressure or cholesterol levels,” Gaffey said.

    Even without meeting criteria for high psychological distress, patients exhibiting any distress may still benefit from additional support to help prevent heart disease, she added.

    The researchers noted that while updated American Heart Association guidelines added “healthy sleep” as an essential aspect of good heart health, they did not include “managing stress and mental health.”

    That checklist should be expanded to include good mental health, the team suggested.

    Depression was the most common aspect of psychological distress gauged in the studies analyzed, Goldstein said, indicating that screening should also attempt to gauge anxiety.

    “I would encourage all providers, cardiovascular and specialty providers as well as primary care providers, to do some kind of brief screening for psychological distress to assess cardiovascular risk,” she advised. “And I would argue that every provider’s office can make brief recommendations to patients who warrant them, which may be as simple as pointing towards free, publicly available mental health resources.”

    Mental health support recommendations can also make a difference in the patient’s overall health, Goldstein said.

    The findings were published Nov. 7 in the Journal of Cardiopulmonary Rehabilitation and Prevention.

    More information

    The World Health Organization has more on heart and blood vessel disease.

     

    SOURCE: Brown University, news release, Nov. 7, 2022

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  • Don’t bother with dietary supplements for heart health, study says | CNN

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

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    CNN
     — 

    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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  • Chest Pain Patients Benefit from Precision Diagnostic Testing Approach

    Chest Pain Patients Benefit from Precision Diagnostic Testing Approach

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    Newswise — DURHAM, N.C. –  A study comparing two approaches for diagnosing heart disease found that a risk analysis strategy is superior to the usual approach of immediately performing functional tests or catheterization for low- to intermediate-risk patients with new-onset chest pain.

    Presented Nov. 6 at the American Heart Association’s 2022 Scientific Sessions, the study bolsters a risk-analysis strategy that either defers testing among low-risk patients, or uses coronary computed tomography angiography (CTA), a CT scan with a contrast agent to assess for blockages.

    The risk analysis approach has been outlined in guidelines and is championed as a means of reducing often unnecessary and costly tests. It has never been tested rigorously in a randomized trial, however, and its clinical application has lagged without definitive evidence of its effectiveness compared to various functional stress tests.

    “New onset chest pain is a common clinical problem that involves a lot of testing, work and expense,” said study lead Pamela S. Douglas, M.D., a member of the Duke Clinical Research Institute and the Ursula Geller Professor of Research in Cardiovascular Diseases at Duke University School of Medicine.

    “Our study provides evidence that, among low-risk patients, the tests will likely be negative for coronary artery disease and patients will go on to do well,” Douglas said. “As a result, we should be deferring testing in these low-risk people.”

    Douglas and colleagues enrolled more than 2,100 patients across the U.S. and Europe with new-onset chest pain in the PRECISE clinical trial. Participants’ average age was 58, with roughly equal numbers of men and women.

    Half of the patients were randomly assigned to receive usual testing — including stress echocardiogram, nuclear stress test, stress MRI or catheterization — which physicians selected at their discretion.

    The other half of participants were randomized to the precision strategy, which uses a pre-test probability assessment to guide next steps, including deferred testing or CTA, with selective use of image analysis software to determine the significance of any blockages.

    Within both groups, about 21% of symptomatic patients were assessed to be at low risk of heart disease. Of these low-risk patients in the usual testing group, 86% underwent some sort of test, compared to 37% in the precision strategy group.

    The primary focus was whether, within a year, there were any differences between the two diagnostic approaches for any combination of the following outcomes: deaths from any cause, nonfatal myocardial infarction, or catheterizations that did not show blockages and may have been unnecessary.

    The researchers found that the precision strategy substantially reduced the incidence of the composite endpoint compared to the usual stress testing approaches.

    To provide a full picture of clinical value, the investigators balanced this demonstrated effectiveness with examination of any safety concerns. There were no differences in death or the composite of death and myocardial infarction, but there was a small, non-significant difference in nonfatal myocardial infarction in the precision group.

    “In stable, symptomatic patients with suspected heart disease who physicians feel require testing, a precision strategy incorporating a set of actions based on guideline recommendations, will improve outcomes compared to usual testing,” Douglas said.

    In addition to Douglas, study authors include Michael G. Nanna, Michelle D. Kelsey, Eric Yow, Daniel B. Mark, Manesh R. Patel, Campbell Rogers, James E. Udelson, Christopher B. Fordyce, Nick Curzen, Gianluca Pontone, Pál Maurovich-Horvat, Bernard De Bruyne, John P. Greenwood, Victor Marinescu, Jonathon Leipsic, Gregg W. Stone, Ori Ben-Yehuda, Colin Berry, Shea E. Hogan, Bjorn Redfors, Ziad A. Ali, Robert A. Byrne, Christopher M. Kramer, Robert W. Yeh, Beth Martinez, Sarah Mullen, Whitney Huey, Kevin J. Anstrom, Hussein R. Al-Khalidi, and Sreekanth Vemulapalli, for the PRECISE Investigators/

    The study received funding from HeartFlow, a medical technology company.

     

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  • Comparative Study of Two Heart Failure Drugs Finds No Difference in Outcomes

    Comparative Study of Two Heart Failure Drugs Finds No Difference in Outcomes

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    Newswise — DURHAM, N.C. – In a head-to-head comparison of two so-called ‘water pills’ that keep fluid from building up in patients with heart failure, the therapies proved nearly identical in reducing deaths, according to a large study led by Duke Health researchers.

    The study compared the diuretics torsemide and furosemide that were prescribed to patients with heart failure starting in the hospital setting. While prior data suggested a potential reduction in deaths among patients taking torsemide, the current study found no such benefit, providing clarity for both doctors and patients.

    “Given that the two different therapies provide the same effect on outcomes, we shouldn’t spend time switching patients from one to the other, and instead concentrate on giving the right dose and adjusting other therapies that have been proven to have long-term benefits,” said cardiologist Robert J. Mentz, M.D., chief of the heart failure section in the Division of Cardiology at Duke University School of Medicine and member of the Duke Clinical Research Institute.

    Mentz was lead author of the study, called TRANSFORM-HF and funded by the National Heart, Lung and Blood Institute. He presented the findings as a late-breaking clinical trial on Nov. 5 at the American Heart Association’s 2022 Scientific Sessions in Chicago.

    The study was designed as a direct comparison of loop diuretics, which are commonly prescribed to reduce the fluid buildup that causes swelling and breathing difficulties in patients with heart failure.

    Mentz and colleagues enrolled more than 2,800 patients hospitalized with heart failure. Participants were randomly assigned to receive either torsemide or furosemide, and doctors determined the dosing. The study group was diverse, with women comprising 37% of participants and Black patients comprising 34%.

    The main question was whether torsemide reduced patient deaths due to any cause over long-term follow-up (average of more than 17 months). The researchers found that death occurred in 373 of 1,431 study participants (26.1%) in the torsemide group and 374 of 1,428 patients (26.2%) in the furosemide group.

    A secondary outcomes analysis looked at deaths or hospitalizations within 12 months, and again found little difference, with death or hospitalization occurring in 677 patients (47.3%) in the torsemide group and 704 patients (49.3%) in the furosemide group.

    “This study has immediate clinical applications,” Mentz said. “Doctors spend a lot of time considering whether they will change from one diuretic to another, but there is no difference between the two for outcomes. This provides much-needed clarity. The insights from TRANSFORM-HF add to the evidence base that should help us improve patient care.”

    In addition to Mentz, study authors include Kevin J. Anstrom, Eric L. Eisenstein, Shelly Sapp, Stephen J. Greene, Shelby Morgan, Jeffrey M. Testani, Amanda H. Harrington, Vandana Sachdev, Fassil Ketema, Dong-Yun Kim, Patrice Desvigne-Nickens, Bertram Pitt, and Eric J. Velazquez.

    The study received support from the NHLBI (U01-HL125478, U01-HL125511, R01HL148354-04, R01HL154768-02).

     

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  • Cardiologist/Vascular Medicine Specialist Available for Interviews: AHA Scientific Sessions – University of Michigan Health

    Cardiologist/Vascular Medicine Specialist Available for Interviews: AHA Scientific Sessions – University of Michigan Health

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    Newswise — As the American Heart Association Scientific Sessions 2022 kicks off this weekend, many experts will be presenting late-breaking science that features the most highly anticipated breakthroughs of the year. As they present, we have an expert in vascular medicine from University of Michigan Health who is available to comment on several findings:

    Geoffrey D. Barnes, M.D. – cardiologist at the University of Michigan Health Frankel Cardiovascular Center, associate professor of internal medicine at U-M Medical School

    • Dr. Barnes is a cardiologist who specializes in vascular medicine. His health services research interests focus on safe and effective delivery of anticoagulation care, particularly with patients with atrial fibrillation and venous thromboembolism. He also is a national leader in the care of patients with peripheral artery disease with a focus on improving medical management. He is program director of the Michigan Anticoagulation Quality Improvement Initiative, a Blue Cross Blue Shield of Michigan sponsored collaborative QI consortium.  

    Barnes is available to speak about:

    • Preventing Limb Loss Through Vascular Interventions and Venous Therapies (11/7 at 8 a.m. CT)
      • BEST-CLI (Clinical) – Best Endovascular versus Best Surgical Therapy for Patients with Chronic Limb Threatening Ischemia – Clinical Results 
      • BEST-CLI (QOL) – Best Endovascular versus Best Surgical Therapy for Patients with Chronic Limb Threatening Ischemia – Quality of Life Analyses  
      • PREVENT-HD – Rivaroxaban to Reduce the Risk of Major Venous and Arterial Thrombotic Events, Hospitalization and Death in Medically Ill Outpatients with Covid-19: Primary Results of the PREVENT-HD Randomized Clinical Trial
      • IMPROVE – A Multicenter Clustered Randomized Trial of a Universal Electronic Health Record-Based Venous Thromboembolism Risk Assessment Model as Integrated Clinical Decision Support for Prevention of Thromboembolism in Hospitalized Medically-Ill Patients
    • Treating Atrial and Supraventricular Arrhythmias (11/7 at 11 a.m. CT)
      • ENHANCE-AF – Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision-Making Pathway

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    Michigan Medicine – University of Michigan

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  • Breast Cancer Survivorship Doubles

    Breast Cancer Survivorship Doubles

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    Newswise — It was the information she couldn’t find that led Amy Kirkham, an assistant professor in the University of Toronto’s Faculty of Kinesiology & Physical Education (KPE), to her latest discovery.

    Asked by the Canadian Women’s Heart Health Alliance to co-author a scientific statement paper in 2020 on the state of women’s heart health in Canada, Kirkham – whose research is focused on preventing and treating the risk of heart disease related to breast cancer treatment – needed to know what percentage of the Canadian female population has a history of breast cancer.

    But the most recent statistic she could find – one percent – was from 2007.

    “Nearly 15 years had passed and I could not find a more recent citation about the prevalence of breast cancer survivors in Canada,” says Kirkham. “Breast cancer mortality rates had continued to improve 26 per cent over this time period, so I suspected that this number was no longer accurate.”

    So, in collaboration with Katarzyna Jerzak, a medical oncologist at Sunnybrook Odette Cancer Centre and assistant professor in the department of medicine in U of T’s Temerty Faculty of Medicine, Kirkham embarked on a new study that would determine an up-to-date estimate of the prevalence of breast cancer survivors in Canada in 2022 using the Canadian Cancer Society’s annual cancer statistic reports.

    The study, recently published in the Journal of the National Comprehensive Cancer Network, found that in the 15-year span from 2007 to 2021, there were 370,756 patients (2.1 per cent of the adult female population in Canada in 2022) diagnosed with breast cancer and 86 per cent of these women would have survived breast cancer by 2022. 

    “This indicates that the prevalence of breast cancer survivors in the Canadian female population has doubled and that there are 2.5 times more survivors since the last estimate in 2007,” says Kirkham. 

    The prior estimate did not include the age group of survivors, but according to the new estimate provided by Kirkham and Jerzak, breast cancer survivors represent one per cent of Canadian women in the typical working and/or child-raising age group (20 to 64 years) and 5.4 per cent of senior (aged 65-plus) Canadian women. 

    But it’s not all good news.

    Many of the treatments that have improved breast cancer mortality rates also cause short-term and long-term side effects, which, in turn, can raise the risk of death from other causes such as heart disease, stroke, Alzheimer’s disease, liver disease and other non-fatal health outcomes.

    “The most common cause of death in women with breast cancer is heart disease,” Kirkham says. 

    Such conditions also affect overall health-care costs.

    To demonstrate the excess health-care costs related to heart disease, Kirkham and Jerzak performed an additional analysis using Canadian data on rates of hospitalization for heart failure and their costs. They found that two per cent of the women diagnosed with breast cancer between 2007 and 2021 would likely experience heart failure hospitalization costing $66.5 million in total. As much as 25 per cent of these costs, or $16.5 million, were in excess of those costs that would be associated with women who did not have breast cancer. 

    “Given the excess health-care costs, potential for reduced contributions to the workforce and reduced quality of life associated with long-term side effects and risk of excess death among breast cancer survivors, our work highlights that there is a growing segment of the population who require services to support recovery following breast cancer treatment,” says Kirkham.

    “The goal of my research lab is to develop new therapies to improve the health of women after surviving breast cancer.” 

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    University of Toronto

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  • Happy Marriage Helps Recovery After Heart Attack

    Happy Marriage Helps Recovery After Heart Attack

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    Nov. 22, 2022 — Being less stressed in general is linked to better heart health. Now, a large study shows that having a less stressful, happier marriage is associated with better recovery in people who have a heart attack at a relatively young age — less than 55. 

    Researchers found that those who had the most stressful marriages were more likely to have more frequent chest pain or be readmitted to hospital in the year following their heart attack. 

    People with a stressful marriage had a worse recovery after a heart attack compared to other heart attack survivors of the same age, sex, education, and income level, as well as employment and insurance status, their study found. 

    “I would tell young cardiac patients that stress in their marriage or partnered relationship may adversely affect their recovery after a heart attack,” says Cenjing Zhu, a PhD candidate at the Yale School of Public Health in New Haven, CT. “Managing personal stress may be as important as managing other clinical risk factors” such as blood pressure, for example, “during the recovery process.”

    General advice for everyone is to be aware of whether you have common risk factors for heart disease including high blood pressure, high cholesterol, diabetes, obesity, or smoking, and for younger people to be aware of a family history of heart disease, particularly premature heart disease, Zhu says. 

    “Patients should know there is a link between marital stress and delayed recovery” from heart attack, says AHA spokesperson Nieca Goldberg, MD, who was not involved with this research. 

    “If they have marital stress, they should share the information with their doctor and discuss ways to get a referral to therapists and cardiac rehabilitation,” says Goldberg, a clinical associate professor of medicine at NYU Grossman School of Medicine and medical director of Atria New York City.  

    “My final thought is women have often been told [by doctors] that their cardiac symptoms are due to stress,” she says. “Now we know stress impacts physical health and is no longer an excuse but a contributing factor to our physical health.”

    Stressful Marriage

    A lot of studies have reported that psychological stress is linked with worse heart health outcomes, Zhu says. 

    However, little was known about the effect of a stressful marriage on younger survivors of a heart attack.

    The researchers analyzed data from participants in a study known as Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO).

    This included 1,593 adults — 1,020 women — who were treated at 103 hospitals in 30 U.S. states. Most of these heart attack survivors were married and 8% were living as married/living with a partner.

    Most (90%) were age 40 to 55, and the rest were younger. Their average age was 47. Three-quarters were white, 13% were Black, and 7% were Latino.

    A month after their heart attack, they replied to 17 questions in the Stockholm Marital Stress Scale about the quality of their emotional and sexual relationships with their spouses/partners. Then 1 year after their heart attack, the patients replied to several questionnaires about their health.

    A year later, those who reported severe marital stress had significantly worse scores for physical health, mental health, general quality of life, and quality of life related to their heart health, compared to the patients with no or mild marital stress. 

    The heart attack survivors with the most marital stress were 49% more likely to report more frequent chest pain/angina and 45% more likely to have been readmitted to hospital for any cause, compared to the patients with no or mild marital stress.

    Study limitations include that the findings are based on a self-reported questionnaire.  

    “Additional stressors beyond marital stress, such as financial strain or work stress, may also play a role in young adults’ recovery, and the interaction between these factors require further research,” Zhu says.

    The researchers will present their findings at the American Heart Association (AHA) 2022 Scientific Sessions, being held in Chicago this weekend. 

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  • At least 146 killed during incident at Halloween festivities in Seoul | CNN

    At least 146 killed during incident at Halloween festivities in Seoul | CNN

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    Seoul, South Korea
    CNN
     — 

    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.

    Crowds are seen in the popular nightlife district of Itaewon in Seoul on October 30, 2022.

    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.

    Emergency services treat injured people on October 30, 2022, in Seoul, South Korea.

    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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  • Short Bursts of Vigorous Activity Linked with Increased Longevity

    Short Bursts of Vigorous Activity Linked with Increased Longevity

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    Newswise — Sophia Antipolis, 28 October 2022:  Two minute bursts of vigorous activity totalling 15 minutes a week are associated with a reduced risk of death, according to research published today in European Heart Journal, a journal of the European Society of Cardiology (ESC).1

    “The results indicate that accumulating vigorous activity in short bouts across the week can help us live longer,” said study author Dr. Matthew N. Ahmadi of the University of Sydney, Australia. “Given that lack of time is the most commonly reported barrier to regular physical activity, accruing small amounts sporadically during the day may be a particularly attractive option for busy people.”

    A second study, also published today in EHJ, found that for a given amount of physical activity, increasing the intensity was associated with a reduced likelihood of cardiovascular disease.2 “Our study shows that it’s not just the amount of activity, but also the intensity, that is important for cardiovascular health,” said study author Dr. Paddy C. Dempsey of the University of Leicester and University of Cambridge, UK, and the Baker Heart and Diabetes Institute, Melbourne, Australia.

    Both studies included adults aged 40 to 69 years from the UK Biobank. Participants wore an activity tracker on their wrist for seven consecutive days. This is an objective way to measure motion, and particularly sporadic activity of different intensities during the day.

    The first study enrolled 71,893 adults without cardiovascular disease or cancer. The median age was 62.5 years and 56% were women. The investigators measured the total amount of weekly vigorous activity and the frequency of bouts lasting two minutes or less. Participants were followed for an average of 6.9 years. The investigators analysed the associations of volume and frequency of vigorous activity with death (all-cause, cardiovascular disease and cancer) and incidence of cardiovascular disease and cancer after excluding events occurring in the first year.

    The risk of all five adverse outcomes reduced as the volume and frequency of vigorous activity increased, with benefits seen even with small amounts. For example, participants with no vigorous activity had a 4% risk of dying within five years. Risk was halved to 2% with less than 10 minutes of weekly vigorous activity, and fell to 1% with 60 minutes or more.

    Compared with just two minutes of vigorous activity per week, 15 minutes was associated with an 18% lower risk of death and a 15% lower likelihood of cardiovascular disease, while 12 minutes was associated with a 17% reduced risk of cancer. Further gains were observed with greater amounts of vigorous activity. For instance, approximately 53 minutes a week was associated with a 36% lower risk of death from any cause.

    Regarding frequency, accumulating short bouts (up to two minutes) of vigorous activity on average four times a day was associated with a 27% lower risk of death. But health benefits were observed at even lower frequencies: 10 short bouts a week was associated with 16% and 17% lower risks of cardiovascular disease and cancer, respectively.

    The second study included 88,412 adults free of cardiovascular disease. The average age was 62 years and 58% were women. The investigators estimated the volume and intensity of physical activity, then analysed their associations with incident cardiovascular disease (ischaemic heart disease or cerebrovascular disease). Participants were followed for a median 6.8 years.

    The researchers found that both higher amounts and greater intensity were associated with lower rates of incident cardiovascular disease. Increasing the intensity led to greater reductions in cardiovascular disease for the same volume of exercise. For example, the rate of cardiovascular disease was 14% lower when moderate-to-vigorous activity accounted for 20% rather than 10% of activity, the equivalent of converting a 14 minute stroll into a brisk seven minute walk.

    Dr. Dempsey said: “Our results suggest that increasing the total volume of physical activity is not the only way to reduce the likelihood of developing cardiovascular disease. Raising the intensity was also particularly important, while increasing both was optimal. This indicates that boosting the intensity of activities you already do is good for heart health. For example, picking up the pace on your daily walk to the bus stop or completing household chores more quickly.”

    ENDS

     

    Follow us on Twitter @ESCardioNews 

    Funding: Please see the papers.

    Disclosures: Please see the papers.

    Notes

    References

    1Ahmadi MN, Clare PJ, Katzmarzyk PT, et al. Vigorous physical activity, incident heart disease, and cancer: how little is enough? Eur Heart J. 2022. doi:10.1093/eurheartj/ehac572.

    Link will go live on publication:

    https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehac572

    2Dempsey PC, Rowlands AV, Strain T, et al. Physical activity volume, intensity and incident cardiovascular disease. Eur Heart J. 2022. doi:10.1093/eurheartj/ehac613.

    Link will go live on publication:

    https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehac613

    Joint editorial:

    Matthews CE, Saint-Maurice PF. The hare and the tortoise: physical activity intensity and scientific translation. Eur Heart J. 2022. doi:10.1093/eurheartj/ehac626.

    Link will go live on publication:

    https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehac626

    About the European Society of Cardiology

    The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

    About European Heart Journal

    European Heart Journal (EHJ) is the flagship journal of the European Society of Cardiology. It is the world’s leading publication in general cardiology. Please acknowledge the journal as a source in any articles.

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    European Society of Cardiology

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  • Surgeon General: ‘Toxic Workplaces’ Take Toll on Worker Health

    Surgeon General: ‘Toxic Workplaces’ Take Toll on Worker Health

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    By Cara Murez 

    HealthDay Reporter

    FRIDAY, Oct. 21, 2022 (HealthDay News) — Just about anyone who’s ever dealt with a toxic work environment can tell you about the toll it takes on your physical and mental health.

    Now, the U.S. government is backing that perception up with some evidence.

    U.S. Surgeon General Vivek Murthy released a report on Thursday that links low wages, discrimination, harassment, overwork and long commutes to physical health conditions, including cancer and heart disease. Depression and anxiety can also result from these toxic workplaces.

    “The COVID-19 pandemic has changed the nature of work, and the relationship many workers have with their jobs. The link between our work and our health has become even more evident,” Murthy said in the report.

    He cited five components of a healthy workplaces, which are protection from harm, connection and community, work-life harmony, mattering at work and opportunity for growth.

    Growing a work culture to emphasize these principles can help promote inclusion, fair wages and opportunities for employees to advance, the Surgeon General’s office said.

    Instilling those values “will require organizations to rethink how they protect workers from harm, foster a sense of connection among workers, show them that they matter, make space for their lives outside work, and support their long-term professional growth,” Murthy said. “This may not be easy. But it will be worth it, because the benefits will accrue to both workers and organizations. A healthy workforce is the foundation for thriving organizations and a healthy community.”

    The report comes at a time when the pandemic and shifts to working at home helped workers find a work-life balance.

    “These [work and home] role conflicts can magnify psychological stress, increase the risk for health behaviors such as smoking, unhealthy dietary habits, alcohol and substance use, and medication overuse, and cause disruptions to relationships both at work and at home,” the report found.

    “When people feel anxious or depressed, the quality, pace and performance of their work tends to decline,” the report said.

    Gabriella Kellerman, chief product officer at corporate coaching platform BetterUp, agreed with the theory that employee well-being equals good business, CBS News reported.

    “In this day and age, given the nature of work, there is a tremendous amount of uncertainty from companies and the external environment that is inherently challenging to our mental well-being and role, and companies have a role to play in supporting their employees for moral reasons, but also because it’s good for the bottom line of their businesses,” Kellerman said.

    “The fact that this is actually recommended by the Surgeon General is extremely important as a statement,” she added. “They are giving employers concrete recommendations on what matters most to support employees’ well-being. Getting this granular and prescriptive is a new level of involvement, and of guidance, that is novel.”

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  • Immune marker suPAR high in patients with heart failure, predicts risk and death

    Immune marker suPAR high in patients with heart failure, predicts risk and death

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    Newswise — For years, cardiologists have zeroed in on a hormone called BNP as a gold standard to determine if patients with heart failure are at risk of severe illness or death. It’s released by the heart in response to when the cardiac tissue stretches due to pressure.

    While the B-type natriuretic peptide, or BNP, is a “downstream” indicator of heart failure, researchers have been looking for biomarkers focused on what leads to heart failure, such as myocardial injury or inflammation.

    A new study from Michigan Medicine and the Emory Clinical Cardiovascular Research Institute finds that levels of soluble urokinase plasminogen activator receptor, or suPAR, an immune protein known to play a role in kidney disease, are high in patients with heart failure and predict both heart failure and death. Beyond that, when suPAR is combined with BNP, the ability to predict such risks gets even stronger. The findings are published in the Journal of Cardiac Failure.

    “Several markers have been examined for heart failure and its adverse outcomes, but few have ever shown to be additive to BNP, or sometimes better than BNP, which is what we find here,” said Salim Hayek, M.D., an assistant professor of internal medicine and medical director of the University of Michigan Health Frankel Cardiovascular Center clinics.

    “BNP is marker that varies dramatically depending on the patient’s fluid status. A more stable marker, such as suPAR, that is linked to the pathophysiology of heart failure could be more useful in identifying patients at higher, long-term risk of disease progression or death.”

    The research team used the Emory cardiovascular biobank to measure both plasma suPAR and BNP levels in over 3,400 participants undergoing heart imaging, following them for more than six years.

    Results reveal that suPAR levels were 17% higher in patients with heart failure than those without across the different subgroups, including patients with ischemic or non-ischemic cardiomyopathy. Levels of the protein carried more than two times risk for all-cause death, cardiovascular death and hospitalization for heart failure.

    Additionally, when suPAR was found to be increased in patients without heart failure, they were over 3.5 times more likely to develop the condition.

    “We see that suPAR has a major role in cardiovascular disease as a marker of immune activation, which likely reflects an upstream process of stress and inflammation that can cause heart failure,” said Hayek, who is also an assistant professor of cardiovascular and internal medicine at U-M Medical School.

    “SuPAR is also known to cause kidney disease – an important component of the pathophysiology of heart failure. This may explain why suPAR levels are strongly predictive of long-term outcomes in these patients.”

    A growing body of research links suPAR and poor outcomes for an array of conditions, from coronary artery disease to cancer and kidney dysfunction. The common pathway of disease in these conditions is a persistent activation of the immune system, which is reflected in high suPAR levels, says Hayek, whose research focuses on understanding the link between inflammation, cardiovascular and kidney diseases.

    “On the practical side, there is a potential for suPAR to be among the biomarkers that we measure to create a strategy for personalizing care for individual patients,” said senior author Arshed Ali Quyyumi, M.D., FACC, Director of the Emory Clinical Cardiovascular Institute and professor of medicine in the Division of Cardiology at Emory University School of Medicine.

    “For example, we could use it to differentiate between admitted patients who are at low and high risk of worsening heart failure. Then we could better allocate post-discharge resources to those at higher risk, which would lessen the cost burden of managing disease. There are many potential opportunities to use suPAR to improve care.”

    Additional authors include Ayman Samman Tahhan, M.D., Yi-an Ko, Ph.D., Ayman Alkhoder, M.D., Shuai Zheng, Ph.D., Ravila Bhimani, Joy Hartsfield, Jonathan Kim, M.D., Peter Wilson, M.D., Leslee Shaw, Ph.D., all of Emory University, Changli Wei, Ph.D., Jochen Reiser, M.D., Ph.D., both of Rush University.

    Paper cited: “Soluble Urokinase Plasminogen Activator Receptor Levels and Outcomes in Patients with Heart Failure,” Journal of Cardiac Failure. DOI: 10.1016/j.cardfail.2022.08.010

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    Michigan Medicine – University of Michigan

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