Category: Cardiovascular

November 29, 2023 3 min read Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio Key takeaways: The new AHA PREVENT equations are designed to predict long-term absolute risk tied to CV-kidney-metabolic syndrome. An online calculator to estimate benefit of specific preventive therapies is in development. PHILADELPHIA — A speaker unveiled the American Heart Association’s new PREVENT equations to evaluate 10- and 30-year absolute risk associated with cardiovascular-kidney-metabolic syndrome. Details on the PREVENT equations were presented at the AHA Scientific Sessions and simultaneously published in Circulation. Sadiya Sana Khan “The current guidelines for primary prevention released in 2019 offer several recommendations focusing on risk assessment of cardiovascular disease for U.S. adults. This framework … is to calculate risk for U.S. adults aged 40 to 79 years using the pooled cohort equations or the [atherosclerotic] CVD risk calculator to identify individuals who are at high risk. Now, this risk-based framework continues to be the foundation of how we move forward for prevention, but there are significant limitations in 2023 with the [pooled cohort equation] model,” Sadiya Sana Khan, MD, MSc, FACC, FAHA, associate professor of medicine and preventive medicine, associate program director of the cardiovascular disease fellowship and director of research in the section of heart failure at Northwestern University Feinberg School of Medicine, said during a press conference. “First, they were developed only in Black and white adults in a relatively small sample, so they may not be generalizable to the diverse U.S. population. They begin at age 40 and so can’t be used in younger adults when we know the burden of [cardiovascular-kidney-metabolic disease] is increasing, particularly in young adulthood. Third, they relied on historical data from the ’80s and ’90s, and the population-level burden of risk factors has changed, as have treatments to address these gaps. The [cardiovascular-kidney-metabolic] working group on risk prediction, co-led by myself and Josef Coresh, MD, PhD, FAHA, developed the AHA predicting risk of CVD events, or the AHA PREVENT, equations.” As Healio previously reported, the AHA coined the term “cardiovascular-kidney-metabolic syndrome” to highlight the ties between metabolic and renal risk factors and CVD risk. The PREVENT equations were developed using real-world contemporary datasets including more than 6 million adults and includes HF risk in addition to risk for MI and stroke; omit race from CVD clinical care algorithms; include kidney function on top of traditional CVD risk factors for heart disease; and include components such as social determinants of health, blood glucose and kidney function, when clinically available. “A key conceptual advance in the PREVENT equations is this endorsement of the life course perspective of prediction and prevention,” Khan said during the press conference. “Importantly, this framework highlights the upstream drivers or social determinants of health that are critical to the determinants or [cardiovascular-kidney-metabolic] factors and lead to subclinical disease and disease manifestations.” With use at age 30 years, the PREVENT equations would enable 10- and 30-year total CV risk estimates and aid clinical decision-making in terms of intervention strategy based on predicted risk and expected benefit, Khan said. “We are developing an online calculator that will support clinicians to start these conversations with patients to guide holistic and patient-centered preventive care,” Khan said during the press conference. “The amount of benefit of a specific therapy is directly related to that predicted risk. … This will help us guide if, when and which therapies should be considered and allow us to move beyond statins as a solo approach for prevention. It’s not a question of replacing statins, but ‘statins and?’” Khan said. “We need to take the long view to target upstream social determinants of health. As we know those are upstream of the drivers and determinants of disease as we think and move forward in how we can optimize [cardiovascular-kidney-metabolic] health for everyone in the U.S. population.” References: Published by: Sources/Disclosures Collapse Source: Khan SS. A confluence of risk: Navigating the intersection of cardiovascular, kidney and metabolic health. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia. Disclosures: Khan reports no relevant financial disclosures. Read more about Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio American Heart Association

Abstract Vitamin D is an essential nutrient that plays a crucial role in calcium homeostasis and bone health. Recent research suggests that vitamin D may also have an impact on lipid metabolism, specifically the level of circulating lipids in the blood. We aim to investigate it role among healthy participate. We conducted a cross-sectional study of 15,600 patients who were referred to the laboratories of university hospitals. We measured the serum levels of Vitamin D as well as triglycerides, total cholesterol, LDL, and HDL using ELISA. We found that the mean serum level of Vitamin D was 40.31 ± 20.79 ng/mL. Of the participants, 16.7% had a serum level of Vitamin D less than 20 ng/mL, 57.7% had a level between 21 and 40 ng/mL, and 13.5% had a level between 41 and 60 ng/mL. Additionally, 12.2% had a level greater than 60 ng/mL. We performed a one-way analysis of variance and found that as the serum level of Vitamin D increased, the mean LDL level decreased significantly. Our study provides evidence of a significant relationship between serum levels of Vitamin D and LDL levels in patients. The findings suggest that vitamin D status may play a role in regulating lipid metabolism and may have implications for the prevention and treatment of cardiovascular disease. Further research is needed to elucidate the underlying mechanisms of this relationship and to determine optimal levels of vitamin D intake for maintaining lipid profiles. Introduction Recently, due to the multiple effects of vitamin D on health, its status in different individuals has become a growing research topic1. The classic effects of vitamin D are mediated by its active metabolite, 1,25-dihydroxy vitamin D, which enables the absorption of calcium in the intestines, maintenance of adequate phosphate levels for bone mineralization, bone growth, and remodeling2. The biological effects of vitamin D are regulated by vitamin D receptors present in other tissues that are not related to calcium metabolism3. Various studies have shown that vitamin D can be stored in adipose tissue4. Adipose tissue has the potential to accumulate a significant amount of vitamin D, particularly when fat mass expands(such as in overweight and obesity)5. It has been demonstrated that obese individuals have lower circulating concentrations of (OH)D25 compared to non-obese individuals. However, it can be said that body fat mass and percentage of body fat are strong predictors of vitamin D status in different individuals6. Initial studies proposed a hypothetical mechanism suggesting that increased vitamin D in circulation with obesity decreases hepatic synthesis of (OH)D25 through a negative feedback mechanism, leading to a decrease in serum (OH)D257. Assessing vitamin D status is reflected by measuring its metabolite in circulation compared to the active form. However, the prevalence of deficiency or sufficiency of serum (OH)D25 varies greatly depending on the criteria used to define it, including population, season, dietary habits, ethnicity, physical activity, and age range8. In general, dyslipidemia refers to an imbalance in the levels of blood lipids, including triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c)9. This disorder is recognized as a risk factor for the development of atherosclerosis-related diseases such as coronary heart disease, ischemic cerebrovascular disease, and peripheral vascular disease10. Various factors, such as aging, increased intake of fats, especially saturated and trans fats, and decreased intake of antioxidant-rich foods like fruits and vegetables, play a role in its etiology11. Vitamin D has multiple roles in addition to its role in regulating calcium homeostasis and contributes to maintaining human health. Recent years have seen an upward trend in vitamin D deficiency. The primary source of vitamin D is sunlight exposure, and certain protein-rich foods also contain vitamin D. However, it should be noted that dietary intake alone may not meet individuals’ vitamin D needs. Observational studies have shown that low serum vitamin D levels are an independent risk factor for hypertension and cardiovascular diseases12. Vitamin D is a fat-soluble hormone that is naturally synthesized in the body through subcutaneous synthesis upon exposure to sunlight. This vitamin plays a crucial role in maintaining the health of bones, muscles, and also prevents various diseases such as cancer, diabetes, cardiovascular diseases, and autoimmune diseases13. Based on available evidence, vitamin D deficiency is directly associated with mortality in patients with cardiovascular diseases (CVD), and improving the vitamin D status has been reported to reduce the risk of myocardial infarction and stroke through multiple studies14. Dyslipidemia is one of the major risk factors for developing CVD, and significant associations have been found between serum vitamin D levels and lipid profiles according to conducted studies15. Although multiple mechanisms have been proposed to explain the effects of vitamin D on lipid profiles, the impact of this vitamin on blood lipid levels is still not clear16. Proposed mechanisms suggest that vitamin D may directly affect serum lipid profiles, including triglycerides, total cholesterol, and LDL cholesterol, by increasing the production of bile salts and reducing the activity of lecithin-cholesterol acyltransferase, as well as indirectly through its influence on calcium absorption, resulting in decreased fat absorption and increased synthesis of hepatic bile acids from cholesterol17. Considering the vital role mentioned for serum vitamin D levels, it can be inferred that improving the serum vitamin D level may have a significant role in improving associated conditions such as hyperlipidemia in affected individuals. Therefore, we aim to investigate the relationship between vitamin D levels and blood lipid levels in this study. Patients We confirm that all methods were carried out in accordance with relevant guidelines and regulations, and that all experimental protocols were approved by the Institutional Review Board (IRB) of the Tehran Islamic Azad University of Medical Sciences. Informed consent was obtained from all subjects and/or their legal guardian(s). In this research data from healthy patients were collected and we confirm that Cardiovascular diseases and metabolic diseases such as liver and kidney diseases, as well as autoimmune patients and patients using vitamins, were excluded from this study. Methods This is a descriptive, cross-sectional study conducted on people who visited the

November 29, 2023 2 min read Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio Key takeaways: Influenza vaccination was associated with a 20% reduced risk for cardiovascular death. Researchers said providers should target patients with CVD for vaccination to mitigate risks. Influenza vaccination was linked to significant decreased risks for major cardiovascular events and death, according to a study published in Scientific Reports. “Differing viewpoints exist regarding the impact of influenza vaccination on CVDs,” Fatemeh Omidi, MD, an assistant professor in the department of cardiology at Shahid Beheshti University of Medical Sciences in Iran, and colleagues wrote. “While certain observational investigations suggest a favorable correlation between influenza vaccination and the reduction in occurrences of cardiovascular incidents like acute [myocardial infarction (MI)], contrasting epidemiological studies propose the limited efficacy of influenza vaccines.” The researchers said an updated and comprehensive review on the association between influenza vaccination and CVD outcomes is “imperative.” So, they conducted a systematic review and meta-analysis of five studies with 9,059 patients who were randomly assigned to receive either a standard intramuscular influenza vaccination (n = 4,529) or intramuscular placebo (n = 4,530). Overall, there were 517 cases of major cardiovascular events among patients who received influenza vaccination, compared with 621 cases among those who received placebo (RR = 0.7; 95% CI, 0.55-0.91). The analysis also revealed a risk reduction for MI (RR = 0.74; 95% CI, 0.56-0.97) and a 20% risk reduction for cardiovascular death events (RR = 0.67; 95% CI, 0.45-0.98) among vaccinated patients. Such findings “underscore the potential impact of influenza vaccination in safeguarding against adverse cardiovascular outcomes among vulnerable patient populations,” the researchers wrote. They highlighted several possible mechanisms behind the findings. For example, influenza infections can weaken the immune system and make it susceptible to secondary infections, which “can exacerbate cardiovascular conditions,” Omidi and colleagues wrote. “Influenza vaccination’s role in preventing these secondary infections may indirectly contribute to the reduction in CVDs,” they wrote. The researchers added that influenza infections likely cause systemic inflammation, which can contribute to the progression of CVDs and atherosclerosis. “By targeting patients with recent CVDs for influenza vaccination, health care providers have a potential opportunity to mitigate the risk of cardiovascular death in a cost-effective and widely available manner,” Omidi and colleagues wrote. “Influenza vaccination programs could be tailored to prioritize this high-risk group, thus potentially reducing the overall burden on health care systems and improving patient outcomes.” They concluded that further research is still needed “to elucidate the precise mechanisms driving this association and to explore the long-term impact of influenza vaccination on cardiovascular outcomes.” Read more about Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio

People who get the flu vaccine may have improved heart health, according to a recent study published in Scientific Reports. Researchers from the Shahid Beheshti University of Medical Sciences in Tehran, Iran, concluded that patients who received flu vaccinations had a 26% reduced risk of having a heart attack and were 33% less likely to die from cardiovascular disease. This finding is based on a review of five randomized controlled trials that focused on myocardial disease and influenza vaccines. CHILDHOOD PNEUMONIA SURGE REPORTED IN NETHERLANDS AMID OUTBREAK IN CHINA The patients who participated in the studies had all been diagnosed with cardiovascular disease previously and were 61 years old, on average. Out of the total of 9,059 patients, 4,529 of them received the flu vaccine, while 4,530 received a placebo shot. People who get the flu vaccine may have improved heart health, according to a recent study published in Scientific Reports. (iStock) After a nine-month period, 621 of the people who received the placebo shot experienced “major cardiovascular events,” compared to 517 of the patients who received the flu vaccine. Those outcomes included myocardial infarction, cardiovascular death and stroke. WHEN MEASURING HEART ATTACK RISK, ONE IMPORTANT RED FLAG IS OFTEN OVERLOOKED, DOCTORS SAY “Revealing a compelling insight into the potential benefits of influenza vaccination, our comprehensive meta-analysis, based on the latest randomized controlled trial data, demonstrates a significant interaction between influenza vaccination and the reduction of major cardiovascular events,” wrote the researchers of the study. “Notably, patients who received the influenza vaccine experienced a remarkable risk reduction of over 20% in cardiovascular death.” Patients who received flu vaccinations had a 26% reduced risk of having a heart attack and were 33% less likely to die from cardiovascular disease. (Joe Raedle/Getty Images) As for why influenza vaccines seem to reduce the risk, the researchers noted that the shot could prevent inflammation and secondary infections, while also stabilizing plaque amounts in the heart. The vaccine could also help stimulate the immune system, which the study authors noted is essential for cardiovascular health. SHOULD YOU GET THE COVID AND FLU VACCINES AT THE SAME TIME? Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, called the study “important” and said it “builds on what we already knew.” He was not involved in the research. Heart disease is the primary cause of death among U.S. adults, killing one person every 33 seconds, according to the CDC. (iStock) “It is not surprising that flu shots would decrease the risk of heart attacks,” Siegel told Fox News Digital. “The flu is one of the great enablers,” he went on. “It adds stress and inflammation to the body and decreases the overall immune response, all of which can lead to acute cardiac events.” The flu “adds stress and inflammation to the body and decreases the overall immune response.” The researchers called for further research to “elucidate the precise mechanisms driving this association and to explore the long-term impact of influenza vaccination on cardiovascular outcomes.” CLICK HERE TO SIGN UP FOR OUR HEALTH NEWSLETTER In the meantime, they recommended that “health care providers and policymakers should take heed of these findings and consider prioritizing influenza vaccination for patients with recent cardiovascular disease as a feasible and potentially life-saving preventive measure.” Fox News Digital reached out to the study authors for additional comment. CLICK HERE TO GET THE FOX NEWS APP Heart disease is the primary cause of death among U.S. adults, killing one person every 33 seconds, according to the Centers for Disease Control and Prevention (CDC). For more Health articles, visit www.foxnews.com/health. <!–> Melissa Rudy is health editor and a member of the lifestyle team at Fox News Digital. –>

by Beth Donovan | Special to the Courier No one wants to talk about cardiovascular disease around the holidays, but what better time to bring up the conversation than when you are with the people you love the most? Maybe we should talk more about how to determine your own risk and what we are doing to protect ourselves. Perhaps that will motivate someone you love to consider their own risk and whether they should be doing more. Cardiovascular disease is a broad term which can largely be equated to coronary heart disease leading to heart attacks, and ischemic stroke, and causes more disease and death than any other disease in the United States. That may seem unlikely, but not so much when you consider it is the complication resulting from numerous other very common conditions: diabetes, obesity, and a sedentary lifestyle. Genetics can be a factor as well. What we do every day contributes to or diminishes our risk of cardiovascular disease. There are many lifestyle factors that increase our risk, including smoking and eating foods high in cholesterol. There are also ways that we can reduce our risk including eating fresh fruits and vegetables, exercising, and keeping our blood sugar and blood pressure under control. You may think that if you are doing these things that your risk is low. But there is a better way to quantify your risk if you are between 40 and 75 years old. There is a free calculator which can predict your risk of having a cardiovascular disease event (heart attack or stroke) in the next 10 years at clincalc.com/cardiology. You just need to know your systolic blood pressure (the top number of your blood pressure calculation), total cholesterol, and HDL or “good” cholesterol. You simply plug those numbers into the calculator, answer a couple questions, hit calculate, and out comes the risk evaluation along with an interpretation. It goes on to recommend the statin dose that may be right for you, if needed. You can easily print the results to take to your next appointment to discuss with your healthcare provider. The U.S. Preventive Services Taskforce recommends clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 who have one or more risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 10% or greater. Furthermore, it recommends it may be appropriate for those with a 7.5% risk to take a statin medication even though the benefit is smaller in this group. A statin medication is not for everyone, but it could be lifesaving. Studies have shown that taking a statin medication can significantly lower the risk of death from a cardiovascular event such as a heart attack or stroke. Statins are not recommended to replace a healthy diet, regular exercise, maintaining a normal weight, and refraining from smoking. Because these medications are recommended by the USPSTF and are given a B rating, the medications should be covered for eligible adults by your health insurance company at no cost to you. Not every statin is required to be covered, but at least one must be available as a preventive medication for those adults who have an increased risk of cardiovascular disease. The U.S. Preventive Services Task Force is a panel of preventive medicine experts who volunteer to review literature and clinical guidelines; develop recommendations for preventive screenings, medications, and counseling; and assign grade recommendations. You can download an app or go the uspreventiveservicestaskforce.org/webview to learn which preventive screenings, medications or counseling services are recommended for you. Claremont resident Beth Donovan, PA-C, practiced as a physician assistant for 20 years and served as chair of legislative affairs for the California Academy of Physician Assistants from 2004 to 2012. She is on the advisory board for Keck Graduate Institute’s Physician Assistant Program.

More than 4,000 abstracts were presented during the American Heart Association’s Scientific Sessions 2023 and Resuscitation Science Symposium 2023, held earlier this month in Philadelphia. Here are some of the important scientific findings that could impact your heart and stroke health. Next wave of AI prediction models aims to predict risk of heart attack and stroke, as well as heart valve disease Artificial intelligence (AI) and deep learning models may help to predict the risk of cardiovascular disease events and detect heart valvular disease, according to two preliminary research studies. One study found that artificial intelligence analyzing sound data of the heart recorded from a digital stethoscope was able to more accurately detect heart valve disease than a health care professional who listened to the heart with a traditional stethoscope. In another study, an AI/deep learning program effectively analyzed and sorted eye images of people with prediabetes and Type 2 diabetes to determine their risk of cardiovascular disease events, like heart attack and stroke. “Computational methods to develop novel predictors of health and disease -; ‘artificial intelligence” -; are becoming increasingly sophisticated,” said Dan Roden, M.D., FAHA, professor of medicine, pharmacology and biomedical informatics and senior vice-president for personalized medicine at Vanderbilt University Medical Center, as well as chair of the Association’s Council on Genomic and Precision Medicine. “Both of these studies take a measurement that is easy to understand and easy to acquire and ask what that measurement predicts in the wider world.” Depressed? Anxious? Stressed? These could put you on the fast track to heart disease risk A study found that depression and anxiety may speed development of risk factors, like high blood pressure, high cholesterol or Type 2 diabetes, that increase heart attack and stroke risk. Participants previously diagnosed with anxiety or depression developed a new risk factor on average six months earlier than those who did not have depression or anxiety. Depression and anxiety increased the risk for a major cardiovascular event, such as a heart attack or stroke, by about 35%. A second study found that cumulative stress increased the risk of poor heart and brain health in two ways: by directly influencing physical well-being and increasing poor lifestyle behaviors, such as smoking and being sedentary, according to two new studies. “There are clear associations between psychological health and cardiovascular disease risk. These studies add to a growing body of data we have on how negative psychological health can increase the risk of heart and brain disease, They illustrate that health care professionals should be aware that negative psychological health -; things like depression or anxiety -; not only affect patient’s mental state of being, but also can impact their physical health and the risk for heart disease. So, these are not benign conditions, these are things for which we want to aggressively refer people to mental health professionals,” said Glenn N. Levine, M.D., FAHA, writing committee chair of the American Heart Associations’ 2021 Psychological Health, Well-Being, and the Mind-Heart-Body Connection scientific statement and master clinician and professor of medicine at Baylor College of Medicine, chief of the cardiology section at the Michael E. DeBakey VA Medical Center, both in Houston. AHA health information: How does stress affect the body? Heart disease risk higher among transgender adults in rural U.S. In a small study of adults living in the rural America, those who identified as transgender were more likely to have heart disease risk factors, like tobacco use, obesity and high blood pressure, than their cisgender peers. Transgender males had the highest odds of having cardiovascular disease risk factors. Transgender adults were more than six times more likely to use tobacco and almost four times more likely to have prediabetes or Type 2 diabetes. And those in the trans-male group were 13 times more likely to be obese. “The findings of this small study highlight two critical areas of concern – the potential increased cardiovascular risk among transgender people, along with the increased cardiovascular risk among people living in rural areas. These disparity gaps pack a one-two punch to our transgender patients and communities for a number of reasons,” said Carl Streed Jr., M.D., M.P.H., F.A.C.P., F.A.H.A. volunteer chair of the writing group for the American Heart Association statement on transgender and gender diverse populations, an assistant professor of internal medicine at Boston University School of Medicine and the research lead at the GenderCare Center at Boston Medical Center. “The physical risks are likely heightened by the mental stress that many LGBTQ+ people encounter due to discrimination that is often more prevalent in rural America, especially among states with policies limiting access to gender affirming care. The American Heart Association supports the need for more research and initiatives to ensure equitable health and health care for all people, especially persons and communities most at risk due to various diversity gaps in care whether they are based on racial, ethnic, sexual and/or gender identities, socioeconomic status or geography.” AHA health initiative: Pride with Heart A child’s race, ethnicity, neighborhood might influence survival after cardiac arrest Children can have cardiac arrests, too. And when they do, their race, ethnicity or neighborhood might impact survival and recovery, according to a new study. Hispanic and white children had similar odds of surviving and coming out of cardiac arrest in good neurological health. Black children were 26% less likely to survive to hospital discharge and 36% less likely to survive without neurological issues that kept them from fully resuming their daily lives. “The results from this observational work are compelling because the measured disparities in recovery are magnitudes different among white and Hispanic children in comparison to Black children,” said Sarah Perman, M.D., M.S.C.E., FAHA, an associate professor in the department of emergency medicine at Yale School of Medicine and chair of the Association’s Resuscitation Science Symposium 2023. “Exploring the drivers of these differences will be necessary to address the disparities in outcomes. Determining the reasons why Black children had cardiac arrest at a greater incidence also warrants more

(UroToday.com) The 2023 Society of Urologic Oncology (SUO) annual meeting held in Washington, D.C. between November 28th and December 1st, 2023, was host to a prostate cancer course. Dr. Alicia Morgans discussed the cardiac morbidity of androgen receptor (AR) agonists, compared to AR antagonists. There are two broad categories of androgen deprivation therapy (ADT) to suppress testosterone levels: Surgical castration: Bilateral orchiectomy Medical castration, using either: Gonadotropin-releasing hormone (GnRH) receptor agonists GnRH agonists compete with GnRH produced in the hypothalamus and bind to receptors in the pituitary. This ultimately leads to a downregulation of the production of LH and testosterone. They are typically associated with an initial flare that usually lasts for approximately one week. GnRH receptor antagonists It is important to remember that hormonal therapy for prostate cancer lowers both testosterone and estrogen levels, which has many physiologic sequelae. How do GnRH receptor agonists and antagonists differ? As summarized in the table below, GnRH antagonists are associated with a much shorter time to castration (96 hours versus 3 to 4 weeks), do not lead to a testosterone flare, and may have lower PSA failure rates. This comes at the ‘cost’ of increased frequency of local injection site reactions (40% versus 1%) and the requirement for monthly injections or daily oral pills, versus intramuscular/subcutaneous injections every three months with GnRH agonists.While all GnRH agonists are equally effective for cancer control, GnRH antagonists may be useful in patients who require rapid reduction of testosterone levels (e.g., patients with severe symptoms or with impending emergencies – spinal-cord compression with impending paraplegia, severe bone pain, or bladder outlet obstruction). While there remains some debate as to whether GnRH antagonists have a more favorable cardiovascular safety profile compared to GnRH agonists, what is clear is that all ADT negatively impacts cardiovascular risk factors. ADT increases total cholesterol levels, triglyceride levels, and abdominal adipose tissue and impairs glucose metabolism.1 Medical complications occur in men because of both low testosterone and low estradiol levels. Many people think of ADT as causing “male menopause” because of the associated hot flashes and changes in mood/libido. However, it is clear that the complications of ADT can significantly impact morbidity and mortality in this population. The potential mechanisms of ADT-associated increased cardiovascular risk may differ from agonists to antagonists, with the following underlying mechanisms proposed: Local inflammation via activation of T cells caused by GnRH agonists triggering plaque destabilization and rupture Pro-inflammatory effects of Follicle Stimulating Hormone (FSH) and FSH-mediated alterations in adipocyte composition and adipokine release, inducing cardiometabolic changes Cardioprotection provided by testosterone interrupted by ADT (both forms) In 2014, Albertsen et al. demonstrated that degarelix (GnRH antagonist) was associated with a lower cardiovascular risk, compared to GnRH agonists, in a cohort of patients with a history of cardiovascular disease (~30%). As demonstrated in the Kaplan Meier curve below, patients receiving degarelix had a significantly lower rate of severe cardiovascular events or death (HR: 0.44, 95% CI: 0.26 – 0.74).2 These results have been similarly corroborated by Margel et al. who demonstrated in an open-label, phase 2 trial that GnRH antagonists were associated with lower risk of cardiovascular events or major cardiovascular and cerebrovascular events.3A subsequent systematic review and meta-analysis demonstrated that there was a significant reduction in both cardiovascular events and cardiovascular death with GRH antagonists, compared to GnRH agonists.4In 2020, the phase 3 HERO trial of relugolix (oral GnRH antagonist) versus leuprolide (GnRH agonist) was published in The New England Journal of Medicine. This was a multinational, phase III, randomized, open-label, parallel-group study to evaluate the safety and efficacy of relugolix in men with advanced prostate cancer. The primary endpoint was sustained castration through 48 weeks, defined as <50 ng/dL.Notably, 93% of patients in this trial had pre-existing cardiovascular risk factors.Of men who received relugolix, 97% maintained castration through 48 weeks, as compared with 89% of men receiving leuprolide. The difference of 7.9 percentage points (95% CI: 4.1 to 11.8) showed both the non-inferiority and superiority of relugolix (p<0.001 for superiority).Significantly, patients in the relugolix arm had a 54% reduction in the risk of major adverse cardiovascular events.This benefit was most pronounced in patients with a history of a prior major adverse cardiovascular event (3.6% versus 17.8%).5In 2021, results of the PRONOUNCE randomized trial comparing the cardiovascular safety of degarelix versus leuprolide in patients with prostate cancer were published. No significant differences were observed between patients treated with degarelix (5.5%) versus leuprolide (4.1%; HR: 1.28, 95% CI: 0.59 – 2.79, p=0.53). However, there were several significant limitations to this trial. The recruitment was slower than originally planned, with the primary outcome event rate lower than expected. The sponsor closed enrollment with 545 of the planned 900 participants recruited.The RADICAL PC study prospectively characterized 2,492 consecutive men (mean age 68 years) with prostate cancer (newly diagnosed or with a plan to ADT for the first time) from 16 Canadian sites. Cardiovascular risk was estimated by calculating Framingham risk scores. Most (58%) were current or former smokers, 22% had known cardiovascular disease, 16% diabetes, 45% hypertension, 31% body mass index 30 kg/m2 or greater, and 24% had low levels of physical activity. Interestingly, patients with more cardiovascular risk factors were more likely to receive ADT in this study. This may have been driven by greater age and lower socioeconomic status in the group with higher risk prostate cancer who were planned to get ADT.6 The NCCN guidelines currently recommend the ‘ABCDE’ systematic approach to addressing cardiovascular risk factors in cancer patients, as summarized below:Dr. Morgans concluded her presentation with the following take home messages: Pharmacologic ADT can be delivered as GnRH agonist or antagonist therapy Differences between these include mode of administration and testosterone flare, but disease control is similar ADT negatively affects cardiovascular risk factors and is likely associated with risk of cardiovascular events GnRH antagonists may be associated with lower risk of cardiovascular events when compared with GnRH agonists Systematic management of cardiovascular risk factors is a recommended approach to providing optimal cardiovascular care for patients

GLP-1 agonists such as semaglutide and liraglutide can help patients with type 2 diabetes improve their blood sugar levels, lose weight and even improve their overall cardiovascular health. But these drugs are often taken as daily or weekly injections, meaning there is an inherent risk that adherence will suffer as time goes on. This could make the therapies less effective and cause patients to grow frustrated. According to a new study published in Cell Reports Medicine, however, those patients could potentially be taking GLP-1 agonists much less frequently in the future.[1] A team of specialists out of Stanford University have developed a new injectable hydrogel drug delivery system that helps medications slowly dissipate over time as opposed to hitting the patient all at once. This means a drug such as semaglutide could potentially be injected just once every four months and still have the same clinical impact it would have being injected weekly. “Adherence is one of the biggest challenges in type 2 diabetes management,” senior author Eric Appel, PhD, associate professor of materials science and engineering at Stanford, said in a prepared statement. “Needing only three shots a year would make it much easier for people with diabetes or obesity to stick with their drug regimens.” Appel et al. tested their new hydrogel on laboratory rats, finding significant success. Testing the new drug delivery system on pigs is the team’s next step, and then they hope they can start planning human trials. “At the very least, we have laid a pathway for the prolonged release of therapeutic GLP-1–based anti-diabetic and anti-obesity treatments that could have beneficial impact on type 2 diabetes management and, perhaps, other conditions as well,” Appel said in the same statement.

quitting smoking broken cigarette: © mbruxelle – stock.adobe.com Patients who quit smoking cut their risks of heart, cancer and lung death over time. A new study aimed to measure the decrease in cause-specific mortality among former smokers, based on years since quitting. Examining data from 438,015 American adults, researchers Blake Thomson, DPhil, and Farhad Islami, MD, PhD, analyzed characteristics 11,860 cardiovascular deaths, 10,935 cancer deaths, and 2,060 respiratory deaths over 5 million per-years of follow-up. Within 10 years of quitting, ex-smokers avoided an estimated 64% of cardiovascular mortality, 53% of cancer mortality, and 57% of respiratory mortality associated with current smoking, said the research letter, “Association of Smoking Cessation and Cardiovascular, Cancer, and Respiratory Mortality,” published in JAMA Internal Medicine. More time off tobacco led to more health benefits. “After 30 or more years of smoking cessation … former smokers avoided an estimated 100%, 93%, and 97% of the excess cardiovascular, cancer, and respiratory mortality associated with continued smoking, respectively,” the study said. Once smokers stop, the researchers noted there is conflicting evidence about whether increased risk to heart health decreases over 10 to 20 years, or decades later. Cardiovascular disease risk may remain elevated approximately 20 years after quitting, according to previous studies. Even so, “the hazards of smoking and benefits of quitting may be underestimated,” and over time, ex-smokers may have started again, while some current smokers quit, the study said. “These findings emphasize that with sustained cessation, cause-specific mortality rates among former smokers may eventually approximate those of never smokers,” the study said. The data came from the National Health Interview Survey from 1997 followed up through the end of 2019, via linkage to the National Death Index.

Share on PinterestResearchers say sensitivity to certain foods may increase the risk of heart disease. Alejandro Moreno de Carlos/Stocksy Researchers are reporting that people with food sensitivities had a significantly higher risk of cardiovascular disease. Experts say that changes in the gut microbiome from food sensitivity can affect a person’s cardiovascular system. Food allergies are different than food sensitivities. Food allergies affect the immune system and food sensitivities involve the digestive system. In a new study, researchers report that people with a food sensitivity to cow’s milk (lactose intolerance) and other common food allergens may have a higher risk of cardiovascular disease. They published their findings today in the Journal of Allergy and Clinical Immunology. The researchers used information from the National Health and Examination Survey (NHANES) and the Multi-Ethnic Study of Atherosclerosis (MESA) to reach their conclusions. A total of 5,374 participants – 4,414 from NHANES and 960 from MESA – were followed by researchers for over a decade to determine if food sensitivities could contribute to cardiovascular disease. Previous studies have shown some food allergies are associated with higher risks of heart disease, but food sensitivities (food intolerance) have not previously been identified as contributing factors to cardiovascular disease. The NHANES study was conducted by the Centers for Disease Control and Prevention using questionnaires and laboratory tests. Participants were 20 years and older and tested for IgE antibodies at baseline. The National Heart, Lung, and Blood Institute sponsored the MESA study to look for cardiovascular disease risk factors. Participants were 45 to 84 years of age and did not have cardiovascular disease at the start of the study. The study included evaluating the presence of IgE and its relationship to heart disease. IgE measures food sensitivities and allergies to cow’s milk as well as eggs, peanuts, shrimp, alpha-gal, dust mite, and timothy grass. During the study period, there were 285 cardiovascular-related deaths – 229 in NHANES and 56 in MESA. Sensitivity to at least one food was significantly associated with cardiovascular mortality. Researchers reported that cow’s milk had the most significant association. One reason may be that most people consume cow’s milk in larger quantities in their daily diet. The researchers noted that the increased risk from food sensitivity could be comparable to the risks from smoking, diabetes, and rheumatoid arthritis. Scientists don’t yet fully understand a lot about how the different organ systems in our body overlap and how dysfunction in one might cause dysfunction in another. Research on how the gut microbiome affects heart health has been published only in recent years. A review of research published in 2022 states that the interplay between the intestinal microbiome and the human host occurs through the interaction of dietary intake (a type of environmental exposure) with the intestinal microbiota, leading to the production of metabolites that may serve as cardiac disease boosters. “We know that food allergies can prompt inflammatory reactions in the gut, which increases heart disease,” Dr. Nicole Weinberg, a cardiologist at Providence Saint John’s Health Center in California who was not involved in the study, told Medical News Today. “It is possible that food sensitivities also prompt inflammation but at a lower level.” “There is a whole spectrum of diseases that smolder in our bodies. They may not have profound disease processes, but they can cause problems with other bodily systems,” Weinberg added. “We often look at whatever part of our body is louder and address symptoms. But we do not always look at the whole body and consider that the organ systems overlap and see if we can quiet the loud noise by addressing other areas in our body.” The authors of the study examined this as well. “What we looked at here was the presence of IgE antibodies to food that were detected in blood samples,” Dr. Jeffrey Wilson, a study author and an allergy and immunology expert at the University of Virginia School of Medicine, said in a press statement. “We don’t think most of these subjects actually had an overt food allergy; thus, our story is more about an otherwise silent immune response to food. While these responses may not be strong enough to cause acute allergic reactions to food, they might nonetheless cause inflammation and over time lead to problems like heart disease.” Weinberg suggests that people with food intolerances see their primary practitioner and specialists regularly to monitor symptoms and treat them when necessary. They might also benefit from seeing a nutritionist or dietician. Food sensitivity or food intolerance is often confused with food allergy. The critical difference is that an allergy involves the immune system. In contrast, sensitivities involve the digestive system, according to the American Academy of Allergy, Asthma, and Immunology. Another important distinction is that allergies can be life-threatening if the person has a reaction called anaphylaxis. Sensitivities are typically not life-threatening but can cause discomfort. A food intolerance is when the body cannot properly break down and digest the food. Some symptoms include: Gas Bloating Nausea Diarrhea Cramping Constipation Some of the common foods that cause intolerance include: Dairy products Gluten Caffeine Chocolate Tomatoes Eggs Strawberries Citrus fruits Wine Food additives and flavor enhancers