Category: Cardiovascular

NEW YORK – Researchers from Quest Diagnostics and collaborators have found that changes in levels of the cardiovascular risk marker free myeloperoxidase (MPO) appear correlated with an individual’s overall mortality risk. The finding, described in a study published last month in PLOS One, indicate that longitudinal measurement of MPO could help physicians assess patients’ mortality risk and response to interventions. It also suggests that MPO could prove useful outside the cardio-metabolic context in which it has most commonly been used, including potentially for identifying patients at elevated risk of conditions like cancer and Alzheimer’s disease, said Marc Penn, senior advisor and medical director of Quest’s cardio metabolic endocrine franchise and first author on the study. MPO is an enzyme released by white blood cells in response to infection and inflammation. It was originally used primarily to help assess patients presenting with symptoms indicative of a potential heart attack but in whom heart injury markers like troponin were negative. This application stemmed from the realization that in such cases, patients were often suffering not from a heart condition, but from a vascular problem, Penn said. “We were looking at heart markers to determine if someone had a vascular problem,” he said, noting that this prompted the question of, “Could we develop a vascular marker for vascular events?” Today, MPO is most commonly used in the ambulatory setting to help assess the likelihood of cardiovascular events in high risk individuals, Penn said, noting that the marker provides information on cardiometabolic health not captured by traditional measures. He cited the example of a patient with LDL cholesterol levels just above optimal and a hemoglobin A1c at the high end of normal. “The patient doesn’t really want to go on a statin, but they measure MPO and it is elevated and maybe then the physician is more adamant about that patient lowering their lipids, lowering weight, [improving] diet and exercise,” he said. While MPO’s value as a marker of cardiovascular risk has been established through a number of studies, researchers had not previously shown that longitudinal changes in MPO levels reflected a change in a person’s risk of cardiovascular events. “The most important finding in this study is that we’ve shown for the first time that if you lower MPO, you lower risk, and if you let MPO go up, you raise risk,” Penn said. To establish that relationship, the researchers collected demographic and lab data (MPO, LDL cholesterol, hemoglobin A1c, and ApoB lipoprotein) from a cohort of 3,658 patients seen between 2011 and 2015 by doctors in the national primary care network MDVIP. They analyzed both the correlation between an individual’s baseline MPO level and their risk of adverse events including myocardial infarction, stroke, coronary revascularization, and all-cause death and the correlation between changes in MPO level and risk of adverse events. Running counter to prior studies, the authors found that at baseline the “risk of cardiovascular death did not differ significantly between patients with high and low MPO” once they had adjusted for age, sex, and other cardiovascular risk factors. Penn said that this was due to the fact that incidences of cardiovascular death was small in the relatively healthy population looked at in the study. The researchers did find, however, that patients with high MPO levels were at elevated risk for death due to non-cardiovascular conditions and had higher levels of all-cause mortality. Additionally, as Penn noted, the study found that decreasing MPO levels were linked to mortality reduction, with, the authors wrote, “a 100 pmol/L decrease in MPO correlated with a 5 percent reduction in mortality over five years.” That finding could allow physicians to better assess whether or not particular interventions are mitigating a patient’s mortality risk, Penn said. “It’s a reflection of vascular health,” he said. For instance, “we’ve known for years that there is a link between gum disease and heart disease. In people with periodontal abscesses, gingivitis, things of that nature, MPOs are very high. Sending someone to the dentist and having their mouth cleaned up actually lowers MPO. Getting on top of inflammatory bowel disease, rheumatoid arthritis, things that are known to be associated with heart disease… MPO reflects that.” “The real goal of this study was, we have a population where we lowered MPO. Does that have an impact on health and outcomes?” he said. “And I think this study shows that it does.” The fact that baseline MPO levels and longitudinal changes in levels were corelated with non-cardiovascular health and death from non-cardiovascular conditions suggests the marker could prove useful in other patient populations. For instance, Penn said that elevated MPO in a patient with no signs of elevated cardiovascular risk could lead doctors to more closely examine them for other potential causes, like cancer or Alzheimer’s disease. He suggested that liquid biopsy-based cancer detection is one area that could benefit from such an approach, given the relatively low sensitivity of such tests. Patients with high MPO but no apparent cardiovascular condition might, for instance, be prioritized for more intensive cancer testing or additional follow-up. Penn said he and his colleagues have not begun any studies exploring the usefulness of MPO in this context but that they are “thinking about looking at patients who have MPO [test results] who go on to get a liquid biopsy to see if higher MPO patients are more likely to have a true positive liquid biopsy.” He noted that the MDVIP network offers its patients liquid biopsies for cancer detection and that he and his collaborators are in discussions with the network about possibly using their patient data to look at correlations between MPO levels and liquid biopsy results. MPO tests cost $50.86 under the current Centers for Medicare and Medicaid Services Clinical Laboratory Fee Schedule and is widely available. Penn said the primary challenge in testing MPO levels is with sample collection and the requirement that samples be spun down within 10 to 20 minutes after collection. “Otherwise, the white blood cells sit in the

So, laughter really is the best medicine. A mere chuckle is enough to expand cardiac tissue and increase the flow of oxygen throughout the body, thus exercising a weakened heart, according to a new study. Scientists in Brazil set out to prove that “laughter therapy” can improve cardiovascular health and ease symptoms of heart disease. “Our study found that laughter therapy increased the functional capacity of the cardiovascular system,” said lead author professor Marco Saffi, of the Hospital de Clínicas de Porto Alegre in Brazil, via the Guardian. “Laughter therapy could be implemented in institutions and health systems like the NHS [National Health System of the UK] for patients at risk of heart problems.” The research was presented at the annual meeting of the European Society of Cardiology in Amsterdam, the world’s largest heart conference. Scientists in Brazil wanted to see if “laughter therapy” could improve cardiovascular health and ease symptoms of heart disease.Getty Images/iStockphoto Researchers looked at 26 adults, at an average age of 64 who had previously been diagnosed with coronary artery disease. Every week for three months, half of the group viewed comedy programs while the other half watched serious documentaries about topics such as the Amazon rainforest or politics. Results showed that the group who watched comedies had a 10% advancement in the amount of oxygen the heart could pump into the body as well as an improvement in their arteries’ ability to expand. Blood testing also detected notable reductions in inflammatory biomarkers, which can indicate if people are at risk for heart attack or stroke and show how much plaque is built up in blood vessels. “When patients with coronary artery disease arrive at hospital, they have a lot of inflammatory biomarkers,” Saffi said. “Inflammation is a huge part of the process of atherosclerosis when plaque builds up in the arteries.” It’s believed that laughter has this effect because it releases endorphins, which are needed to maintain healthy blood pressure and reduce strain on the heart by keeping stress hormones low. “This study found that laughter therapy is a good intervention that could help reduce that inflammation and decrease the risk of heart attack and stroke,” Saffi said. He suggested that laughter therapy could eventually reduce reliance on medications. Saffi noted that these results don’t have to be a result of TV programs alone — it can also come from live comedy shows or fun evenings with friends and family. “People should try do do things that make them laugh at least twice a week,” Saffi said. “Laughing helps people feel happier overall, and we know when people are happier they are better at adhering to medication.”

Credit: Pixabay/CC0 Public Domain Scientists of the Global Cardiovascular Risk Consortium under the auspices of the Department of Cardiology at the University Heart & Vascular Center of the Medical Center Hamburg-Eppendorf (UKE) and the German Center for Cardiovascular Research (DZHK) have proven that the five classic cardiovascular risk factors—excess weight, high blood pressure, high cholesterol, smoking, and diabetes mellitus—are directly connected to more than half of all cardiovascular diseases worldwide. High blood pressure is the most significant factor for the occurrence of heart attacks and strokes. The study’s results were published August 26 in the New England Journal of Medicine and are based on the data from 1.5 million persons from 34 countries. Cardiovascular diseases cause approximately a third of all deaths worldwide. They often develop silently over decades. Frequently without being recognized, the vascular walls change, giving rise to arteriosclerosis, in the wake of which coronary heart disease may occur, including complications such as heart attacks, acute cardiac death, or strokes. “Our study clearly shows that over half of all heart attacks and strokes are avoidable by checking and treating the classic risk factors. These results are of the highest significance for strengthening prevention in this area. At the same time, approximately 45% of all cardiovascular cases cannot be explained with these risk factors; they should motivate us and the academic funders to further research efforts,” says Professor Doctor Stefan Blankenberg, the medical director of the University Heart & Vascular Center at the UKE. The Global Cardiovascular Risk Consortium assessed the individual-level data of 1.5 million persons who took part in 112 cohort studies and originate from the eight geographical regions North America, Latin America, Western Europe, Eastern Europe and Russia, North Africa and the Middle East, Sub-Saharan Africa, Asia and Australia. The objective of the study was to gain a better understanding of the global distribution, the significance of the individual risk factors and their effects on cardiovascular diseases, and overall mortality in order to derive targeted preventive measures. “In principle, the five classic risk factors that we examined are modifiable, and thus responsive to preventive measures. So far, the proportion of preventable risk attributed to these five risk factors is still matter of debate,” lead author and associate professor Dr. Christina Magnussen, Department of Cardiology at the University Heart & Vascular Center of the UKE, explains. Regional differences in risk factors The study showed differences in the eight global regions regarding the frequency of the risk factors. The scientists saw the highest rates for overweight in Latin America, and the highest values for high blood pressure and high cholesterol in Europe. The risk factor smoking is particularly decisive in Latin America and Eastern Europe, diabetes mellitus in North Africa and in the Middle East. All five risk factors combined (excess weight, high blood pressure, high cholesterol, smoking, and diabetes mellitus) amount to 57.2% of women’s cardiovascular risk and to 52.6% of men’s. Thus, a substantial share of cardiovascular risk remains unexplained. In comparison, the five risk factors merely account for about 20% of the risk to die (overall mortality). Furthermore, the study also clearly shows a linear relation between high blood pressure, and high cholesterol, and the occurrence of cardiovascular diseases. The higher the values, the higher the likelihood of the occurrence of cardiovascular diseases. This result applies to all examined regions in the world. The scientists also identified a remarkable connection between cholesterol levels and overall mortality: Very low as well as high cholesterol levels increase overall mortality. The significance of all risk factors decreases with age; e.g., high blood pressure is more damaging to a 40 year old than an 80 year old. The body mass index (BMI) is the only exception and remains equally significant at any age. “This raises the question to which extent the target values for treating cardiovascular risk factors for the most elderly should be identical with those for the middle to older age bracket,” says Professor Blankenberg. Study identifies extensive range of starting points for preventive measures The study provides an extensive dataset to avoid cardiovascular diseases or reduce their effects for at-risk persons, or patients with cardiovascular diseases, by improving their lifestyle and by lowering blood pressure or cholesterol. “High systolic blood pressure accounts for the largest share of cardiovascular risk. We should place a particular focus on the therapy of patients with high blood pressure to avoid cardiovascular diseases as much as possible,” says associate professor Dr. Magnussen. More information: Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality, New England Journal of Medicine (2023). DOI: 10.1056/NEJMoa2206916 Provided by Universitätsklinikum Hamburg-Eppendorf Citation: Modifiable risk factors found to be responsible for half of cardiovascular diseases (2023, August 28) retrieved 28 August 2023 from https://medicalxpress.com/news/2023-08-factors-responsible-cardiovascular-diseases.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Prasugrel monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents is not superior to dual-antiplatelet therapy (DAPT) for major bleeding but is non-inferior for cardiovascular events in patients with acute coronary syndrome (ACS) or high bleeding risk (HBR), according to late breaking research presented in a Hot Line session today at ESC Congress 2023. Very short (1 to 3 months) durations of DAPT followed by P2Y12 inhibitor monotherapy has been shown to reduce bleeding events without increasing cardiovascular events compared with standard durations of DAPT after PCI using drug-eluting stents. However, the incidence of major bleeding events within the 1-month mandatory DAPT period after PCI remains high in real clinical practice, particularly in patients with ACS or HBR. In single-arm studies, aspirin-free prasugrel or ticagrelor monotherapy following successful new-generation drug-eluting stent implantation was not associated with any stent thrombosis in selected low-risk patients with or without ACS. Removing aspirin from the DAPT regimen might reduce bleeding events early after PCI without compromising the risk of cardiovascular events. However, the efficacy and safety of this strategy has not been proven in randomized trials. ESC guidelines recommend 6 months of DAPT in HBR patients with ACS and 12 months of DAPT in non-HBR patients with ACS after PCI. In patients with non-ACS, 1 to 3 months of DAPT is recommended in HBR patients after PCI. STOPDAPT-3 investigated the efficacy and safety of aspirin-free prasugrel monotherapy compared with 1-month DAPT with aspirin and prasugrel in patients with ACS or HBR undergoing PCI with cobalt-chromium everolimus-eluting stents. From January 2021 to April 2023, the study enrolled 6,002 patients with ACS or HBR from 72 centers in Japan. Just before PCI, patients were randomized in a 1:1 fashion to prasugrel (3.75 mg/day) monotherapy or to DAPT with aspirin (81-100 mg/day) and prasugrel after a loading dose of prasugrel 20 mg in both groups. There were two primary endpoints: 1) major bleeding events (defined as Bleeding Academic Research Consortium [BARC] type 3 or 5) at 1 month for superiority; and 2) cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) at 1 month for non-inferiority. The major secondary endpoint was a composite of the co-primary bleeding and cardiovascular endpoints (cardiovascular death, myocardial infarction, definite stent thrombosis, stroke, or major bleeding) at 1 month representing net clinical benefit. The full analysis set population consisted of 5,966 patients (no-aspirin group: 2,984 patients; DAPT group: 2,982 patients). The average age was 71.6 years and 23.4% were women. At 1 month, the no-aspirin strategy was not superior to DAPT for the co-primary bleeding endpoint (4.47% vs. 4.71%; hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.75-1.20; p for superiority=0.66). The no-aspirin strategy was non-inferior to DAPT with a relative 50% margin for the co-primary cardiovascular endpoint (4.12% vs. 3.69%; HR, 1.12; 95% CI, 0.87-1.45; p for non-inferiority=0.01). Related Stories There was no between-group difference in the incidence of all-cause death (2.28% vs. 2.11% in the no-aspirin and DAPT groups, respectively). The major secondary endpoint occurred in 7.14% patients in the no-aspirin group and 7.38% patients in the DAPT group, with no between-group difference, indicating a similar effect on net clinical benefit for both groups. There was an excess of any coronary revascularisation (1.15% vs. 0.57%) and definite or probable stent thrombosis (0.71% vs. 0.44%) in the no-aspirin group compared with the DAPT group, while definite stent thrombosis was not different between the 2 groups (0.47% vs. 0.37%). In a subgroup analysis stratified by ACS and non-ACS, the excess risk of cardiovascular events in the no-aspirin group compared with the DAPT group was seen in patients with ACS, but not in those without ACS. The aspirin-free strategy compared with the DAPT strategy failed to reduce major bleeding within 1 month after PCI, but it was non-inferior for the co-primary cardiovascular endpoint with a relative 50% margin. Aspirin used for a limited period of 1 month after PCI as a component of DAPT might have exerted a protective effect on vulnerable coronary lesions, particularly in patients with ACS, without a large increase in major bleeding. DAPT should remain the standard strategy for PCI even in the new-generation drug-eluting stent era.” Dr. Masahiro Natsuaki, Study Author, Saga University, Japan European Society of Cardiology (ESC)

image: In the panvascular system, hypoxia-inducible factors (HIFs) can lead to excessive activity of vascular smooth muscle cells (VSMCs), presenting a phenotype of proliferation and migration in atherosclerosis and pulmonary arterial hypertension. In atherosclerosis, VSMCs influenced by HIFs may also exhibit a myofibroblast-like transformation, whereas in pulmonary arterial hypertension, noteworthy electrophysiological changes occur in HIF-affected VSMCs. In the aortic aneurysm, HIFs are associated with apoptosis and vascular remodeling in VSMCs. Regarding vascular calcification, HIFs are related to osteochondral differentiation in VSMCs. view more Credit: ©Science China Press This study is led by Prof. Junbo Ge (Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases), Prof. Hua Li (Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases), and Prof. Hao Lu (Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases). As an emerging concept, panvascular diseases encompass a group of cardiovascular disorders characterized mainly by atherosclerosis, involving crucial organs such as the heart, brain, kidneys, and limbs. Hypoxia-inducible factor (HIF) plays a pivotal role as a major regulatory factor in the cardiovascular system’s response to common stressors, such as hypoxia. Meanwhile, vascular smooth muscle cells (VSMCs) serve as key cells responsible for regulating cardiovascular system pressure and oxygen delivery. The plasticity, versatility, and interaction of these two factors with panvascular diseases warrant in-depth investigation. In the pathological state of panvascular diseases, overactive VSMCs (e.g., in atherosclerosis, pulmonary arterial hypertension) or dysfunctional VSMCs (e.g., in arterial aneurysms, vascular calcification) are closely associated with HIFs. These widespread systemic diseases also underscore the interdisciplinary nature of panvascular medicine. Furthermore, considering the similarities in proliferative characteristics between VSMCs and cancer cells, as well as the delicate balance between angiogenesis and cancer progression, there is an urgent need for more precise regulatory targets or combination therapies to enhance the effectiveness of HIF-targeted treatments. Based on the above content, this review focuses on discussing the significance of the HIF signaling pathway in panvascular diseases related to VSMCs, taking into consideration the importance of balancing global and local, as well as temporal and spatial aspects. The review also explored the relevance of HIF-related drugs’ targets in panvascular diseases while weighing their pros and cons. The “-dustats” is a novel type of drug that can inhibit PHD, thus activating the HIF-EPO pathway, and its effect on increasing EPO in the body is gentle. In existing research, the drug “-dustats” has been found to improve iron metabolism while treating anemia, and it generally does not exhibit significant cardiovascular side effects or promote cancer occurrence. Furthermore, more precise and targeted HIF pathway-activating drugs require either more specific indirect activation of HIF (e.g., inhibitors targeting specific PHD1-3 or FIH) or more effective direct activation targeting the specific HIF isoforms. Additionally, the issue of drug resistance also needs to be addressed. Collectively, there are three key points in advancing the transformation of HIF-related treatment strategies for VSMC in panvascular medicine: (1) focusing on the commonality and specificity of HIFs in panvascular disease; (2) the overall consideration of targeting HIF-related pathways, and (3) the development of precise drugs targeting HIF-related pathways. Overall, the clinical transformation of HIFs-related therapies requires that doctors pay more attention to individual differences (eg, place of residence, gender, and disease) in diagnosis and treatment to identify underlying problems; researchers explore and clarify the different roles and interactions of HIFs in different organs/systems or different stages of the disease; and pharmaceutical experts or engineers strive to industrialize the production of personalized targeted drugs with superior pharmacodynamics and pharmacokinetics. Therefore, based on the principle of “from doctors, by engineers/researchers, for patients”, the substantial clinical transformation of HIFs-related treatment in panvascular medicine can be realized. Journal Science Bulletin Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

In iron-deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, intravenous ferric carboxymaltose (FCM) is associated with a reduced risk of the composite outcome of total cardiovascular hospitalization and cardiovascular death through 52 weeks compared with placebo, according to late-breaking research presented in a Hot Line session today at ESC Congress 2023. Iron deficiency is common in heart failure, with a prevalence of 30-80%, and is associated with increased mortality and hospitalization. Randomised controlled trials of intravenous iron in iron-deficient patients with heart failure have shown improvements in symptoms, functional capacity and quality of life, but the effect on clinical events has been unclear. The current meta-analysis evaluated the effects of FCM therapy on hospitalizations and mortality in iron-deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction. The meta-analysis pooled individual participant data from three randomized, placebo-controlled trials of FCM in adult patients with heart failure and iron deficiency with at least 52 weeks of follow up: CONFIRM-HF, AFFIRM-AHF and HEART-FID. There were two primary efficacy endpoints: 1) composite of total cardiovascular hospitalizations and cardiovascular death and 2) composite of total heart failure hospitalizations and cardiovascular death. Both endpoints were examined through 52 weeks of follow up. Key secondary endpoints included individual components of the composite endpoints. In the three trials, a total of 4,501 patients with heart failure and reduced or mildly reduced left ventricular ejection fraction and iron deficiency were randomly assigned to FCM (n=2,251) or placebo (n=2,250). The mean age of the total population was 69 years, 63% were men, and the mean left ventricular ejection fraction was 32%. FCM therapy significantly reduced the co-primary composite endpoint of total cardiovascular hospitalizations and cardiovascular death compared with placebo, with a rate ratio (RR) of 0.86 (95% confidence interval [CI] 0.75 to 0.98; p=0.029). There was a trend towards reduction of the co-primary composite endpoint of total heart failure hospitalizations and cardiovascular death but it failed to reach statistical significance (RR 0.87; 95% CI 0.75 to 1.01; p=0.076). FCM therapy was associated with a 17% relative rate reduction in total cardiovascular hospitalizations (RR 0.83; 95% CI 0.73 to 0.96; p=0.009) and a 16% relative rate reduction in total heart failure hospitalizations (RR 0.84; 95% CI 0.71 to 0.98; p=0.025). There was no effect of FCM administration on mortality. In subgroup analyses, patients in the lowest transferrin saturation (TSAT) tertile (<15%) derived greater benefit from FCM on the composite endpoint of total cardiovascular hospitalizations or cardiovascular death than those with higher baseline TSAT (interaction p=0.019). Treatment with FCM appeared to be safe and well-tolerated. This was the largest and most up-to-date analysis of the effect of FCM in iron-deficient heart failure patients with reduced or mildly reduced ejection fraction. FCM was associated with a reduction in the composite endpoint of total cardiovascular hospitalizations and cardiovascular death compared with placebo, and with significantly reduced risks of hospitalization due to heart failure or cardiovascular causes, with no effect on survival. The findings indicate that intravenous FCM should be considered in iron-deficient patients with heart failure and reduced or mildly reduced ejection fraction to reduce the risk of hospitalization due to heart failure and cardiovascular causes.” Piotr Ponikowski, Principal Investigator, Professor, Wroclaw Medical University, Poland European Society of Cardiology (ESC)

European Society of Cardiology Cardiovascular disease (CVD) cost the EU an estimated €282 billion in 2021, according to late breaking research presented at ESC Congress 2023.1 Health and long-term care accounted for €155 billion (55%) of these costs, equalling 11% of EU health expenditure. The analysis was a collaborative effort by the European Society of Cardiology (ESC) and the University of Oxford, UK. Study author Dr. Ramon Luengo-Fernandez of the University of Oxford said: “CVD had a significant impact on the EU27 economy, costing a total of €282 billion in 2021. That’s equivalent to 2% of Europe’s GDP and is significantly more than the entire EU budget2 itself, used to fund research, agriculture, infrastructure and energy across the Union.” This was the most comprehensive and up-to-date analysis of the economic costs of CVD to society in the EU since 2006. It is the first study to use Europe-wide patient registries and surveys rather than relying on assumptions and, unlike previous reports, includes the costs of long-term social care. The current analysis provides estimates of the societal economic costs of CVD for the 27 members states of the EU in 2021, including 1) health and social care; 2) informal care; and 3) productivity losses. The breakdown includes:3 €130 billion for healthcare (46%) €25 billion for social care (9%) €79 billion for informal care (28%) €15 billion in productivity losses due to illness/disability (5%) €32 billion in productivity losses due to premature death (12%). The total cost equated to €630 per EU citizen, ranging from €381 in Cyprus to €903 in Germany.4 CVD cost health and social care systems approximately €155 billion in 2021, accounting for 11% of total healthcare expenditure. There was wide variation between countries in the proportion of healthcare budgets spent on CVD, from 6% in Denmark to 19% in Hungary. Healthcare included primary care, emergency care, hospital care, outpatient care and medications, while social care included long-term institutionalised care, and care at home. The main contributor was hospital care, which cost €79 billion, representing 51% of CVD-related care costs. CVD medications accounted for €31 billion (20%) of care costs, followed by residential nursing care homes at €15 billion (9%). Informal care costs included the work or leisure time, valued in monetary terms, that relatives and friends gave up to provide unpaid care. Relatives and friends provided 7.5 billion hours of unpaid care for patients with CVD, amounting to €79 billion across the EU. Productivity losses included lost earnings due to illness/disability (early retirement/absenteeism) or premature death. In 2021, 256 million working-days were lost in the EU because of CVD illness/disability, at a cost of €15 billion. That same year, 1.7 million people died due to CVD across the EU, representing 1.3 million working-years lost, and generating productivity losses of €32 billion. ESC Board member and study author Professor Victor Aboyans of Limoges University, France said: “This study underscores the urgent need to act collectively on the European scale to better combat the cardiovascular risk of European citizens, in particular through regulations for better cardiovascular prevention and investment in research. By choosing not to invest in cardiovascular disease we are simply deferring the cost. These data force us to ask the question: do we invest in cardiovascular health today or be forced to pay more at a later stage?” Professor Panos Vardas, chief strategy officer of the European Heart Agency, the ESC’s office in Brussels, said: “Today’s presentation provides a clear understanding of the overall economic burden of cardiovascular disease across different EU countries, offering the opportunity to draw valuable conclusions that are useful for those responsible for designing healthcare plans. It is evident that there is significant fragmentation among EU countries in terms of cardiovascular disease healthcare expenditures. This necessitates a re-evaluation by the EU as a whole, and the 27 EU countries individually, to better address the outstanding needs and invest more effectively in supporting those suffering from cardiovascular disease.” /Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.

More than half of all cardiovascular diseases worldwide have been found to be directly connected to five classic cardiovascular disease risk factors, with high blood pressure being the most significant factor related to heart attacks and strokes. Dr. Christie Ballantyne, professor of medicine, and Dr. Vijay Nambi, associate professor of medicine, both with Baylor College of Medicine, are co-authors along with a large group of scientists who make up the Global Cardiovascular Risk Consortium who recently published these findings in the New England Journal of Medicine. The consortium, under the leadership of the University of Heart & Vascular Center of the Medical Center of Hamburg-Eppendorf and the German Center for Cardiovascular Research, used data from 112 studies consisting of 1.5 million people from 34 different countries. The group reports that two conclusions can be made from these findings: The first, that more than half of all heart attacks and strokes can be prevented by understanding, treating or preventing the five classic risk factors: weight, high blood pressure, high cholesterol, smoking and diabetes. The second, that the other half of heart attacks and strokes cannot be explained with these risk factors and more work and research is needed to find additional causes. “With lifestyle changes and medications, we have all the tools necessary to reduce heart attacks and strokes by over half in middle aged people, and I believe that the reduction could be much greater if we began earlier in life,” said Ballantyne, who also is chief of cardiovascular research at Baylor. An important aspect of the study involved understanding the global distribution of risk factors, how they affect those from each region in the study and how this information can be used to find targeted preventative measures. Eight geographical regions were examined: North America, Latin America, Western Europe, Eastern Europe and Russia, North Africa and the Middle East, Sub-Saharan Africa, Asia and Australia. Researchers saw different risk factors directly associated with heart attack and stroke in each region. In Latin America, being overweight was a high risk factor while high blood pressure and cholesterol was seen in Europe. Smoking was a high risk factor in Latin America and Eastern Europe and diabetes was affecting more people in North Africa and in the Middle East. However, across regions, high blood pressure and high cholesterol showed a linear connection to the occurrence of cardiovascular diseases. All five risk factors combined amount to 57.2% of women’s cardiovascular risk and to 52.6% of men’s. Thus, a substantial share of cardiovascular risk remains unexplained. In comparison, the five risk factors merely account for about 20% of the risk of overall mortality. “While intensifying treatment of these traditional risk factors has continued to show additional value, current research focuses on how to identify and mitigate the ‘residual risk.’” said Nambi, who also is with the Michael E. DeBakey VA Medical Center. “The role of risk factors such as inflammation and lipid markers such as lipoprotein (a) have been identified and ways to manage these are currently being investigated. Advances in genomics, proteomics and metabolomics continues to help us better understand the pathophysiology of cardiovascular disease.” Other interesting findings showed that very high and very low cholesterol levels increased overall mortality, and the significance of all risk factors decreases with age. For example, high blood pressure is more damaging to a 40-year-old than an 80-year-old. For a full list of consortium members, associated institutions and financial disclosures see the full publication. Lead author on the study is Dr. Christina Magnussen, the University Heart & Vascular Center of the Medical Center Hamburg-Eppendorf. Ballantyne and Nambi are both investigators in the Atherosclerosis Risk in Communities study, a long-term population study investigating the causes of atherosclerosis and its clinical outcomes, and variation in cardiovascular risk factors, medical care, and disease by race, gender, location and date. Data from the ARIC study was used for the current NEJM publication.

In a recent article published in Nutrients, researchers discuss the potential of probiotic- and prebiotic-based interventions for managing cardiovascular diseases (CVDs). Study: Probiotics and Prebiotics in Cardiovascular Diseases. Image Credit: Kateryna Kon / Shutterstock.com An overview of CVDs CVDs, which include coronary heart disease (CHD), peripheral vascular disease, and cerebrovascular disease, remain the leading cause of death worldwide. As CVDs progress, various other organ systems are at risk of damage, as demonstrated by the increased risk of chronic kidney disease, obesity, type 2 diabetes mellitus, insulin resistance, and hypertension associated with CVDs. Considerable research has indicated that the gut microbiota during early life influences the risk of CVD later in life. In fact, several in vivo studies have confirmed the efficacy of prebiotics, probiotics, and postbiotics in reducing the risk of CVDs; however, further research is needed to establish these findings in humans. Targeting the gut microbiome Despite the widespread availability of medications to treat CVDs, these agents are often associated with limited efficacy and considerable side effects. Thus, there remains an urgent need to identify novel strategies for treating CVDs. Prebiotics are non-digestible foods that promote the growth of beneficial gut bacteria. Comparatively, probiotics are live microorganisms with health benefits, whereas postbiotics are probiotic-derived bioactive compounds that also provide various physiological benefits. Previous studies have reported the potential benefits of targeting the gut microbiota through dietary or pharmacological interventions to manage the risk of CVDs. Moreover, these studies suggest that pre- and probiotics can protect against CVDs by restoring functional and structural changes in the gut microbiome to ultimately maintain immune homeostasis. Likewise, improved gut barrier function, balancing a dysbiotic gut microbiota, and attenuation of oxidative stress are some of the protective effects associated with microbiota-targeted strategies. Sources of pre- and probiotics Aside from supplementation, various functional food products comprise bioactive compounds like pre- and probiotics that have been shown to prevent the development of various cardio-metabolic disorders ranging from obesity and hyperlipidemia to hypertension. Propyl propane thiosulfinate (PTS) and propyl-propane thiosulfate (PTSO), for example, are two bioactive organosulfur compounds that can be found in vegetables like Allium and are associated with protective effects on metabolic health. The administration of PTS has been shown to prevent obesity, as well as the weight gain and metabolic dysfunction that can arise when consuming a hypercaloric diet. PTS may also reduce inflammation, improve glucose and hepatic homeostasis, regulate lipid metabolism, and improve the thermogenic activity of brown adipose tissue. Mitigating CVD risk factors Gut dysbiosis has been implicated in the development of hypertension and hypercholesterolemia, both of which are conditions that increase the risk of future CVDs. In an effort to regulate the intestinal microbiota to mitigate these disorders, several studies have investigated the potential utility of probiotic supplementation. Enterococcus faecium strain 132 and Lactobacillus paracasei strain 201 are both probiotic strains that have been shown to reduce cholesterol in vivo. In these studies, these strains reduced liver inflammation, regulated the expression of genes related to cholesterol metabolism, reduced fat accumulation, and reduced the abundance of certain bacterial strains that are related to hypercholesterolemia. Lactobacillus fermentum CECT5716 and Bifidobacterium breve CECT7263 also appear to reduce high blood pressure, which is a significant risk factor for both renal and CVDs. The anti-hypertensive effects of these strains may be attributed to their activation of Toll-like receptor 7 (TLR7), which is associated with hypertension, endothelial dysfunction, and gut dysbiosis. What are the effects of antibiotics? Although antibiotic usage, particularly when prescribed in excess, can increase the risk of gut dysbiosis, these pharmaceutical agents have been shown to mitigate hypertension. Doxycycline, which is a broad-spectrum tetracycline antibiotic, is associated with anti-hypertensive effects and improves endothelial function. By directly interacting with microorganisms within the gastrointestinal tract, doxycycline appears to improve intestinal barrier function, in addition to its anti-inflammatory and immunomodulatory effects. This antibiotic also reduces endotoxemia and vascular dysfunction, both of which are prominent in hypertension, by reducing the production of reactive oxygen species (ROS), as well as increasing the infiltration of T-regulatory cells and interleukin 10 (IL-10) from the vascular wall. Conclusions Directly targeting the gut microbiota through dietary or pharmacological interventions can lead to significant improvements in cardiovascular health, thereby reducing the risk of disease. The findings from this review emphasize the notable health benefits of prebiotics, probiotics, and antibiotics on the pathogenic mechanisms of obesity, hypertension, and hypercholesterolemia. Journal reference: