Category: Cardiovascular

We all have the habit of not sleeping well during the weekdays due to work, study, or any other purpose. We try to adjust to this lack of sleep during the weekends, which now has been proven to be insufficient to bring our normal sleep cycle back. When our sleep is restricted to 5 hours per day during the week, it leads to declining cardiovascular health including deteriorating heart rate or blood sugar, according to a recent research published by Penn State.The research published in the Journal of Psychosomatic Medicine, states that only 65% of the Americans stick to the 7 hour sleep cycle.This deprivation of sleep increases the risk of cardiovascular diseases. The co-author of the research Anne Marie Chang, an associate professor of bio-behavioral health, reveals a potential mechanism for this longitudinal relationship, whereby sufficient repeated shocks to your Cardiovascular health, while younger, could increase your risk ofcardiovascular disease in the future. 15 healthy men between the ages of 20 to 35 participated in the study. The participants were allowed to sleep for 10 hours per night for the first 3 nights; 5 hours for the next 5 nights and for the rest 2 nights they were allowed to recover the sleep with a 10 hour sleep night. During the period of assessment, researchers assessed the resting heart rates of the participants every 2 hours to look upon the impact of the sleep cycle on cardiovascular disease. The heart rate and blood sugar of all the participants were monitored regularly and any slightest change in the cardiovascular health was noted. This means that even if the heart rate would have been naturally slow in the morning but after 2 hours the change would come into notice. An increase in the heart rate of nearly one beat per minute (BPM) each day of the study was found. The average baseline heart rate was 69 BPM, while the average heart rate by the end of the study on the second day of recovery was nearly 78 BPM, the researchers found.Roughly 1 in 3 adults report not getting adequate rest on a regular basis. It’s estimated that about 50-70 million Americans have chronic or ongoing sleep disorders, the American Heart Association has said in a recent report. It highlights the unhealthy sleep pattern which is daytime sleepiness and says that, “excessive daytime sleepiness, which is a symptom of many sleep disorders, including hypersomnia, can lead to a greater risk of cardiovascular disease.” Poor sleep habit can trigger heart disease risk factors like obesity, high blood pressure and diabetes.

A new mouthwash could detect the early signs of heart disease (Picture: Getty Images) A quick mouth rinse could reveal whether people are likely to develop heart disease. Gum inflammation has been linked with cardiovascular disease, leading scientists to develop an oral swill to pick up whether our mouths are inflamed. Dentists say swollen and easy-to-bleed gums could be a sign of inflammation, which in turn could precede the tissue becoming diseased. The gum disease – known as periodontitis – is linked with heart conditions. As a result, high quantities of the white blood cells in the saliva fighting the periodontitis could be a warning sign of heart disease. A high number of white blood cells picked up by the rinse is also associated with the arteries struggling to widen when more blood pumps through, according to scientists at Mount Royal University in Canada. Struggling arteries could be a sign that the fluid-carrying tubes are unhealthy, which is another indicator of heart disease. The mouth rinse could become routine in patients’ annual check-ups at the dentist, according to the study authors. ‘Even in young healthy adults, low levels of oral inflammatory load may have an impact on cardiovascular health – one of the leading causes of death,’ said Dr Trevor King, of Mount Royal University. The gum disease periodontitis is linked with heart conditions (Picture: Getty) ‘Optimal oral hygiene is always recommended in addition to regular visits to the dentist, especially in light of this evidence. ‘But this study was a pilot study. We are hoping to increase the study population and explore those results. ‘We are also hoping to include more individuals with gingivitis and more advanced periodontitis to more deeply understand the impact of different levels of gingival inflammation on cardiovascular measures.’ The team recruited 28 non-smokers, between the ages of 18 and 30, who had no cardiovascular risks or history of gum disease. More: Trending Each participant was asked to fast for six hours before testing, though they were permitted to drink water. At the lab they rinsed their mouths with water before gargling saline, to be tested. After washing out their mouths, the group lay down for 10 minutes for an electrocardiogram and remained there for a further 10 while the experts took their blood pressure, flow-mediated dilation, and pulse-wave velocity. Flow-mediated dilation measures how well arteries can dilate when more blood is pumped through, and pulse-wave velocity tests how stiff they are. Stiff and poorly functioning arteries raise the risk of cardiovascular disease. Participants’ blood pressure was monitored as part of the trial (Picture: Getty) ‘The mouth rinse test could be used at your annual checkup at the family doctors or the dentist,’ said co-author Dr Michael Glogauer of the University of Toronto. ‘It is easy to implement as an oral inflammation measuring tool in any clinic.’ The team found there was no link between white blood cells and pulse-velocity, suggesting longer-term impacts on arteries’ health was yet to take place when the rinse picked up a higher white blood cell count. The experts suggest that inflammation in the mouth leaks into the vascular system and impacts the arteries’ ability to produce nitric oxide, the molecule that allows them to respond to blood flow. First author Ker-Yung Hon, who is now studying dentistry at the University of Western Ontario, added: ‘We are starting to see more relationships between oral health and risk of cardiovascular disease. ‘If we are seeing that oral health may have an impact on the risk of developing cardiovascular disease even in young healthy individuals, this holistic approach can be implemented earlier on.’ The findings were published in the journal Frontiers in Oral Health. MORE : Blood test that can detect over 50 types of cancer ‘shows promise’ in NHS trial MORE : A new AI tool may predict Parkinson’s disease up to 15 years before diagnosis Get your need-to-know latest news, feel-good stories, analysis and more This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Discovering your risk of heart disease is just a rinse away. A new study published in Frontiers in Oral Health suggests that a simple mouthwash could determine a person’s chances of developing heart disease. “We are starting to see more relationships between oral health and risk of cardiovascular disease,” Ker-Yung Hong, first author of the study, now studying dentistry at the University of Western Ontario, said in a media release. “If we are seeing that oral health may have an impact on the risk of developing cardiovascular disease even in young healthy individuals, this holistic approach can be implemented earlier on.” Since gum inflammation leads to a gum disease called periodontitis, which is linked to cardiovascular disease, scientists believe they can identify early warning signs of heart disease with just a saliva sample. Periodontitis is a common but preventable gum infection that damages the soft tissue around the teeth, according to Mayo Clinic. Scientists at Mount Royal University in Canada tested a simple oral rinse to see if signals for cardiovascular disease can be linked to levels of white blood cells — an indicator of gum inflammation — in healthy adults. “Even in young healthy adults, low levels of oral inflammatory load may have an impact on cardiovascular health — one of the leading causes of death in North America,” Dr. Trevor King of Mount Royal University, corresponding author of the study, said. Researchers analyzed 28 non-smokers between the ages of 18 and 30 with no comorbidities — when more than one condition is in a person at the same time — or medications that could affect cardiovascular health, as well as no recorded history of periodontal disease. A new study suggests that a simple mouthwash could determine a person’s chances of developing heart disease.Getty Images/iStockphoto Participants were instructed to fast for six hours, besides drinking water, before coming into the lab. Upon arriving at the lab, they rinsed their mouth with water before rinsing with saline, which was collected for examination. They then laid down for 10 minutes for an electrocardiogram, a test used to evaluate the heart, then remained lying down for an additional 10 minutes so their blood pressure, flow-mediated dilation (a measure of how well arteries can dilate to allow for higher blood flow) and pulse-wave velocity (measures the stiffness of arteries) could be recorded. The team found that high levels of white blood cells were associated with compromised flow-mediated dilation, an early sign of poor arterial health — suggesting a higher risk of cardiovascular disease. Higher levels of white blood cells could have a greater effect on vascular (endothelial) dysfunction, a type of coronary artery disease that narrows arteries, according to Cleveland Clinic. Levels found in the study were not considered “clinically significant.” Scientists at Mount Royal University in Canada tested a simple oral rinse to see if signals for cardiovascular disease can be linked to levels of white blood cells — an indicator of gum inflammation — in healthy adults.Getty Images/iStockphoto Scientists believe that the gun inflammation, which leaks into the vascular system, impacts the arteries’ ability to produce nitric oxide which allows for a response in changes to blood flow. However, the authors noted that there was no link between white blood cells and pulse-wave velocity, which shows that the long-term effects of artery health had not yet shown up. Use of the mouth rinse would be easy to carry out in regular dental care visits. “The mouth rinse test could be used at your annual checkup at the family doctors or the dentist,” Dr. Michael Glogauer of the University of Toronto, a co-author of the study, said. “It is easy to implement as an oral inflammation measuring tool in any clinic.” “Optimal oral hygiene is always recommended in addition to regular visits to the dentist, especially in light of this evidence,” King added. “But this study was a pilot study. We are hoping to increase the study population and explore those results. We are also hoping to include more individuals with gingivitis and more advanced periodontitis to more deeply understand the impact of different levels of gingival inflammation on cardiovascular measures.”

<!– –> Figure 1: UK, Diagnosed prevalent cases of type 2 diabetes in both sexes, all ages, 2023–28 (N). Source: GlobalData; Janssenmedicalcloud.net. © GlobalData Plc.. Cardiovascular disease (CVD) is a medical term encompassing conditions affecting the heart and circulation. There is a long-established link between people with diabetes and an increased risk of developing CVD. However, it was not until recently that the sex-specific differences in risk across the full glycemic spectrum were quantified in a UK-based research study by Christopher T Rentsch and colleagues. This large-scale observational cohort study using data from UK Biobank was undertaken with the aim of examining the differences in incident adverse CVD outcomes in men and women in relation to baseline glycated haemoglobin levels. The study, published in The Lancet in 2023, recruited 195,752 men and 231,682 women ages 40–69 years between 2006 and 2010 across England, Scotland, and Wales. Participants had their baseline glycated haemoglobin (HbA1c) levels measured and then categorised using standard clinical cut-off points into five groups: low-normal, normal, pre-diabetes, undiagnosed diabetes, and diagnosed diabetes. Six CVD outcomes were measured: coronary artery disease (CAD), atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and heart failure. The study found that both men and women in higher HbA1c groups had more negative health associations, such as higher body mass index, poorer renal function, and greater prevalence of hypertension compared to their counterparts with low-normal or normal HbA1c levels. Compared to their normal HbA1c counterparts, women with pre-diabetes were 1.47 times more likely to be at risk of CVD and women with undiagnosed diabetes were 1.33 times more likely to be at risk. In men, the pre-diabetes group was 1.30 more likely to be at risk of CVD compared to the normal HbA1c group, and the undiagnosed diabetes group was 1.31 more likely to be at risk. Both men and women with low-normal HbA1c were at similar decreased risk of CVD. Men and women with diagnosed diabetes were more at risk of developing CAD, stroke, and heart failure compared to their counterparts with normal HbA1c. In the mentioned CVD outcomes, women were at higher risk of developing CAD and heart failure, and the risk of developing stroke was the same in men as in women. Having low-normal HbA1c was slightly more protective against the risk of CAD for women than men, although the difference is minimal. Notably, women with diagnoses of diabetes had more of an excess of adverse risk factors compared to men, particularly for adverse waist-to-hip ratio and obesity. Addressing the issue of an already large population of diabetic men and women, which has been steadily growing since the 1980s, is important for preventing continued health burdens associated with CVD and diabetes. GlobalData epidemiologists predict that in the UK alone, there will be 4.2 million cases of diagnosed prevalent cases of type 2 diabetes in men and women by the end of 2023. That number is forecasted to rise to five million by the end of 2028 (Figure 1, above). This study shows that having abnormally high levels of HbA1c most notably increases the risk of CAD, stroke, and heart failure. However, despite being of the same HbA1c categories, men and women experience the risk of CVD differently, which could be taken into consideration by public health policymakers when they decide to implement prevention strategies to reduce CVD incidence by decreasing the incident cases of pre-diabetic or undiagnosed diabetic individuals. <!– GPT AdSlot 3 for Ad unit 'Verdict/Verdict_In_Article' ### Size: [[670,220]] — googletag.cmd.push(function() { googletag.display(‘div-gpt-ad-8581390-1’); }); !– End AdSlot 3 –> Share this article

A heart drug that combines three medications in one pill — otherwise known as a polypill — has been included in the List of Essential Medicines from the World Health Organization (WHO). The unique polypill is designed for those who have had a prior heart attack or other heart-related event, with the goal of preventing a repeat occurrence. It took 15 years of intense study and several versions to create it. The List of Essential Medications are those that meet the population’s “priority health care needs” and can save lives, improve health and decrease suffering, according to the WHO’s website. “This cardiovascular polypill could become an integral part of global strategies to prevent cardiovascular events in patients who have suffered a heart attack and who are currently already being treated with separate mono-components,” said Valentin Fuster, M.D., Ph.D., president of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital in New York City, in a news release. “This approach has the potential to reduce the risk of recurrent disease and cardiovascular death,” he added. A heart drug that combines three medications in one pill is otherwise known as a polypill.Getty Images WHO selects the essential drugs based on their relevance to public health, the prevalence of disease, evidence of clinical efficacy and safety, and comparative costs and cost-effectiveness, according to the global health organization’s website. “This really, I think, is a change in medicine,” Fuster, who is also general director of the Spanish National Center for Cardiovascular Research (CNIC), which spearheaded the research, told Fox News Digital in an interview. “The inclusion of this therapeutic solution in the WHO’s List of Essential Medicines confirms our aim to make a positive impact in society and is an important step in our mission to bring significant and differential value to people with cardiovascular disease,” Oscar Pérez, chief marketing, and business development officer at Ferrer, a Spain-based pharmaceutical company involved in the polypill research, said in a news release. The new pill has been included in the List of Essential Medicines from the World Health Organization (WHO). Getty Images The polypill contains three medications that are typically used to treat patients after they suffer their first heart attack, as Fox News Digital previously reported. Researchers found it to be effective in preventing secondary adverse cardiovascular events in those who have previously had a cardiac event, according to the SECURE trial led by Fuster that was published in The New England Journal of Medicine in August 2022. The polypill also reduced cardiovascular mortality by 33% among patients who had previous heart attacks, the study found. The polypill contains three medications that are typically used to treat patients after they suffer their first heart attack, according to reports.Getty Images “The SECURE results showed for the first time that the cardiovascular polypill that we helped develop led to clinically relevant reductions in recurrent cardiovascular events in patients who had suffered a myocardial infarction,” Fuster said in the release. The three drugs contained in the polypill include acetylsalicylic acid, which helps thin the blood to prevent blood clots; ramipril, an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure; and a cholesterol-lowering drug called atorvastatin, according to Fuster. Keep up with today’s most important news Stay up on the very latest with Evening Update. A patient is less likely to take the three separate pills on a daily basis, Fuster said, which increases the risk for another cardiovascular event. The polypill helps patients remain compliant with taking the prescribed medications because it is only one pill. Fuster’s research team found that the polypill was also just as effective as the separate pill regimen commonly given to patients after a heart attack. “Adherence to treatment after an acute myocardial infarction is essential for effective secondary prevention,” he told Fox News Digital. “This cardiovascular polypill, as a strategy that combines three of the baseline treatments for these patients, has proven its value, because increased adherence means that patients are being treated for longer and, as a result, have a lower risk of cardiovascular events,” Fuster noted in the release. It took 15 years of intense study and several versions to develop this polypill, Fuster told Fox News Digital. WHO selects the essential drugs based on their relevance to public health, the prevalence of disease, evidence of clinical efficacy and safety, and comparative costs and cost-effectiveness. AP It is sold under the brand names Trinomia, Sincronium, and Iltria, depending on the country. “The 3% reduction in cardiovascular mortality demonstrates the efficacy of treatment with Trinomia compared to standard treatment,” Ferrer’s Perez said in the report. The polypill is commercially available right now in 25 countries, but the Food and Drug Administration (FDA) has not yet cleared it for use in the U.S. “This cardiovascular polypill could become an integral part of global strategies to prevent cardiovascular events,” said Dr. Valentin Fuster, president of Mount Sinai Heart. Getty Images/iStockphoto “Since our groundbreaking study was published, we have seen an increase in polypill usage across the world, and we are looking forward to having this medicine available in the United States and the rest of the countries where it is not available yet,” Fuster said. Each year in the United States, 805,000 people suffer a heart attack. Among those individuals, 200,000 previously had a cardiac event, according to the Centers for Disease Control and Prevention (CDC).

Sleep-deprived people that try to rebound by snoozing longer on weekends don’t see improvements to the harmful effects that too little rest has on the heart, new research shows. Adults who get less than seven hours of sleep each night are more likely to have high blood pressure and an increased heart rate, the U.S. Centers for Disease Control and Prevention says. Over time, a poor sleep regimen increases the risk for cardiovascular disease, heart attack and stroke. Lack of sleep also is tied to higher rates of type 2 diabetes and unhealthy weight gain. To make up for lost sleep during the week, many people choose to stay in bed longer on weekends in hopes of restoring their energy. But behavioral health researchers at Penn State University say the heart doesn’t easily recover from a poor sleep schedule. When people develop these habits at a young age, they could potentially be setting themselves up for heart problems. Only about 65% of adults maintain a sleep schedule that gets them seven hours per night. “Our research reveals a potential mechanism for this longitudinal relationship, where enough successive hits to your cardiovascular health while you’re young could make your heart more prone to cardiovascular disease in the future,” said researcher Anne-Marie Chang, an associate professor of biobehavioral health. The Penn State study examined 15 healthy men, ages 20-35, as they wen through an 11-day, inpatient sleep experiment. On the first three nights, the men were allowed to sleep up to 10 hours to establish baselines for their heart functions. Over the next five nights, they were restricted to five hours of sleep, followed by two nights when they again were allowed to sleep up to 10 hours. Each day, the researchers measured the participants’ resting heart rates and blood pressure every two hours. This enabled the study to account for heart activity during different periods of the day, since heart rates lower when people wake up. During each day of the study, the mens’ heart rates increased by an average of nearly a beat per minute. The average baseline heart rate was 69 beats per minute. By the end of the study, even after two consecutive nights of unrestricted sleep, the average heart rate was 78 beats per minute. Systolic blood pressure, which measures pressure in the arteries when the heart beats, also increased over the course of the study. Chang said the results of the study don’t necessarily mean that people shouldn’t try to catch up on sleep after long weeks. But the findings suggest people should work toward establishing healthier sleep schedules on a consistent basis. “Sleep is a biological process, but it’s also a behavioral one and one that we often have a lot of control over,” Chang said. “Not only does sleep affect our cardiovascular health, but it also affects our weight, our mental health, our ability to focus and our ability to maintain healthy relationships with others, among many other things.” Another factor to consider with sleep health is not just how many hours people get, but the time of day they get it. Social jet lag is a common effect people experience when their sleep schedules vary during the week compared to the weekend. The concept is similar to jet lag from traveling, except that different sleep patterns can have chronic impacts on circadian rhythms and work performance. This is true even when people are getting at least seven hours of sleep, researchers have found. The Penn State study follows recent research that examined why night owls tend to live shorter lives than early risers. That study of 23,000 people concluded that behaviors like smoking and drinking alcohol were significant factors. “As we learn more and more about the importance of sleep, and how it impacts everything in our lives, my hope is that it will become more of a focus for improving one’s health,” Chang said.

Aug. 18 (UPI) — Scientists from Canada said they have found a link between high white blood cells in the saliva of healthy adults and an early cardiovascular disease warning sign. The research, led by Trevor King of Mount Royal University, was published Friday in the peer-reviewed health journal Frontiers in Oral Health. Advertisement The foundation of the study is that gum inflammation can lead to periodontitis, which is linked with cardiovascular disease, according to researchers. King and his team used a simple oral rinse to see if levels of white blood cells, an indicator of gum inflammation, in the saliva of healthy adults, could be linked to warning signs for cardiovascular disease. The scientists discovered that high levels correlated with compromised flow-mediated dilation were an early indicator of poor arterial health. “Even in young healthy adults, low levels of oral inflammatory load may have an impact on cardiovascular health, one of the leading causes of death in North America,” King said. Advertisement Researchers believe that periodontitis, a common infection of the gums, has previously been linked to the development of cardiovascular disease. Scientists believe that inflammatory factors may get into the bloodstream through the gums and damage the vascular system. The scientists concentrated on examining healthy young people to determine whether lower levels of oral inflammation can be relevant to cardiovascular health. “We are starting to see more relationships between oral health and risk of cardiovascular disease,” said Ker-Yung Hong, first author of the study, now studying dentistry at the University of Western Ontario. “If we are seeing that oral health may have an impact on the risk of developing cardiovascular disease even in young healthy individuals, this holistic approach can be implemented earlier on.” The researchers used what is called pulse-wave velocity to measure the stiffness of the arteries. Stiff and poorly functioning arteries raise patients’ risk of cardiovascular disease. The scientists recruited 28 non-smokers between ages 18 and 30 with no comorbidities or medications that could affect cardiovascular risk. They were asked to fast for six hours, except for drinking water, before visiting the lab. The volunteers then rinsed their mouths with water before rinsing their mouths with saline which was collected for analysis. The volunteers then laid down for 10 minutes for an electrocardiogram. Then they were tested for blood pressure, flow-mediated dilation and pulse-wave velocity. Advertisement “The mouth rinse test could be used at your annual checkup at the family doctor or the dentist,” said Michael Glogauer, from the dental faculty of the University of Toronto and a co-author of the study. “It is easy to implement as an oral inflammation measuring tool in any clinic.”

The impact of metabolic syndrome (MetS) along with its components displayed differently in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA), with the link between risk factors and cardiovascular events presenting stronger in PsA compared with RA. Investigators believe these findings suggest different mechanisms and reveal a need for distinct strategies to prevent cardiovascular events in these patient populations, according to a study published in Journal of Clinical Medicine.1 Fabiola Atzeni, MD Credit: MediFind RA is linked to an increased risk of cardiovascular morbidity and is considered an independent risk factor for cardiovascular disease (CVD). Similarly, patients with PsA are at an increased risk of cardiovascular and cerebrovascular events when compared with the general population. This is likely due to a combination of chronic systemic inflammation, side effects of certain medications, and traditional risk factors for CVD, which include hypertension, dyslipidemia, diabetes, smoking, older age, and male gender.2 “Overall, the epidemiologic evidence confirms the association between chronic inflammatory joint diseases and traditional cardiovascular risk factors and suggests that this association may differ among diseases,” wrote Fabiola Atzeni, MD, Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Italy, and colleagues. “These differences need to be further investigated as they may have an impact on the prevention and management of cardiovascular disease in RA and PsA.” To compare the prevalence of MetS and the impact it has on the cardiovascular disease in RA and PsA, a retrospective analysis of real-world data of patients referred to a tertiary level rheumatology clinic was performed. Demographic and clinical data, the presence of traditional cardiovascular risk factors, and MetS diagnosis were collected at baseline and patients were followed-up for an additional 12 months. Both univariate and multivariate models compared the impact of MetS and its factors in both arthritis groups. In total, 170 patients were analyzed, including 78 patients with PsA and 92 patients with RA. Although most variables were comparable, patients in the PsA cohort were younger and reported a shorter disease duration. MetS was reported in 51.3% of patients with PsA compared with 27.2% of patients with RA (P = .002), and 71.8% of patients in the PsA cohort had dyslipidemia compared with 28.3% of patients with RA (P <.001). The history of cardiovascular events was comparable between both groups. Analysis revealed hypertension in PsA and dyslipidemia in RA as distinct predictors of MetS. Cardiovascular events were predicted by MetS and most of its components in patients with PsA, while dyslipidemia was the strongest predictor in patients with RA. However, associations were stronger in PsA when compared with RA, which were validated by the greater coefficient of determination in the PsA cohort. Investigators noted the retrospective design coupled with the relatively small sample size of the cohorts as limitations of the study. The groups were not matched regarding disease duration or age, due to factors such as the different pathogenesis and age of onset. Another potential limitation was not including strict clinical features as inclusion or exclusion criteria. However, this approach was taken to better capture real-world populations and avoid overly selected patient samples. “These findings are relevant for clinical practice as a disease-specific management of cardiovascular risk may be required in distinct chronic inflammatory diseases of the joints,” investigators concluded. “However, clinical validation in larger studies is needed. Further efforts are required to develop disease-specific strategies for the management of cardiovascular risk in PsA and RA.” References Atzeni F, La Corte L, Cirillo M, Giallanza M, Galloway J, Rodríguez-Carrio J. Metabolic Syndrome and Its Components Have a Different Presentation and Impact as Cardiovascular Risk Factors in Psoriatic and Rheumatoid Arthritis. J Clin Med. 2023;12(15):5031. Published 2023 Jul 31. doi:10.3390/jcm12155031 Symmons, D.P.; Gabriel, S.E. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat. Rev. Rheumatol. 2011, 7, 399–408

A new American Heart Association scientific statement highlights evidence that supports shared decision-making, a term that describes the process of ensuring patients have the knowledge and tools to make decisions about their health in collaboration with their professional health care team. The statement publishes today in the American Heart Association’s flagship, peer-reviewed journal Circulation. More than 100 trials have demonstrated that shared decision-making improves patient’s understanding, acceptance and satisfaction with their health care, yet adequate levels of shared decision-making occur in as few as 10% of face-to-face consultations across a variety of health care specialties. The statement details the key components of shared decision-making: clearly communicated, unbiased evidence about risks, benefits and reasonable alternatives to treatment; clinical expertise provided in a way that is relevant to the patient; and inclusion of the patient’s values, goals and preferences in the decision process. The statement presents models of shared decision-making and ways to measure it in research, in addition to strategies to promote its use. Potential solutions to increase shared decision-making in cardiovascular care include reimbursement for consultations, team-based care, integrating decision aids in electronic records, and training clinicians on communication skills that support shared decision-making more effectively and are sensitive to the cultural, racial, ethnic and language considerations for each patient. This statement was prepared by the writing group committee on behalf of the American Heart Association’s Council on Cardiovascular and Stroke Nursing; the Council on Clinical Cardiology; the Council on Quality of Care and Outcomes Research; the Council on Hypertension; the Council on the Kidney in Cardiovascular Disease; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts); the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; the Council on Epidemiology and Prevention; and the Stroke Council. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. For more information: www.heart.org

Examining data from each procedure, the authors determined that 56% of patients belonged in the proximal implant group and the remaining 44% belonged in the distal implantation group. Patients with permanent nonvalvular AFib and/or chronic heart failure were more likely to be in the distal implantation group than the proximal implantation group. These patients were also more likely to be prescribed direct oral anticoagulants. Procedural outcomes were not significantly different between the two groups. The combined rate of procedural major adverse events was 5.3% and there were a total of four patient deaths. After a median follow-up period of 21 months, the overall ischemic stroke and major bleeding event rates were comparable between the two groups. All-cause mortality and cardiovascular mortality were also similar. The primary focus of the team’s study, DRTs, were seen in 2.3% of proximal implantation patients and 12.2% of distal implantation patients. The research team identified a “stepwise increase in DRT incidence” as implantation depths increased. “Of note, when the LAAO device was implanted more than 15 mm from the PR, DRT rates of 21.6% and 18.6% were observed with the single-lobe and disc and lobe devices, respectively, compared with 1.5% and 2.5% in the proximal implantation group,” the authors wrote. With single-lobe devices, the rise in DRT risk was primarily seen beyond a depth of 5 mm. For the disc and lobe devices, however, the increase “became progressive beyond the first distal millimeters.” Eighty-two percent of DRTs were detected within 180 days of the LAAO procedure. Running a series of analyses, the team determined that distal implantation and nonantithrombotic or single antiplatelet therapy after LAAO were independent predictors of the patient experiencing a DRT. LAAO device type and peridevice leak were not found to be independent predictors of DRT. “To date, this is the first study to specifically evaluate the role of LAAO device implantation depth on DRT occurrence,” the authors concluded. “Our results showed that LAAO device implantation depth affects DRT rates, with a higher incidence with deeper implantation and larger uncovered areas. Given its clinical impact, proximal device implantation should be the optimal target in patients undergoing LAAO.” Read the full study here.