Any activity is better for your heart than sitting -- even sleeping

The study, supported by the British Heart Foundation (BHF) and published in the European Heart Journal, is the first to assess how different movement patterns throughout the 24-hour day are linked to heart health. It is the first evidence to emerge from the international Prospective Physical Activity, Sitting and Sleep (ProPASS) consortium.

Cardiovascular disease, which refers to all diseases of the heart and circulation, is the number one cause of mortality globally. In 2021, it was responsible for one in three deaths (20.5m), with coronary heart disease alone the single biggest killer. Since 1997, the number of people living with cardiovascular disease across the world has doubled and is projected to rise further.

In this study, researchers at UCL analysed data from six studies, encompassing 15,246 people from five countries, to see how movement behaviour across the day is associated with heart health, as measured by six common indicators*. Each participant used a wearable device on their thigh to measure their activity throughout the 24-hour day and had their heart health measured.

The researchers identified a hierarchy of behaviours that make up a typical 24-hour day, with time spent doing moderate-vigorous activity providing the most benefit to heart health, followed by light activity, standing and sleeping compared with the adverse impact of sedentary behaviour.

The team modelled what would happen if an individual changed various amounts of one behaviour for another each day for a week, in order to estimate the effect on heart health for each scenario. When replacing sedentary behaviour, as little as five minutes of moderate-vigorous activity had a noticeable effect on heart health.

For a 54-year-old woman with an average BMI of 26.5, for example, a 30-minute change translated into a 0.64 decrease in BMI, which is a difference of 2.4%. Replacing 30 minutes of daily sitting or lying time with moderate or vigorous exercise could also translate into a 2.5 cm (2.7%) decrease in waist circumference or a 1.33 mmol/mol (3.6%) decrease in glycated haemoglobin.

Dr Jo Blodgett, first author of the study from UCL Surgery & Interventional Science and the Institute of Sport, Exercise & Health, said: "The big takeaway from our research is that while small changes to how you move can have a positive effect on heart health, intensity of movement matters. The most beneficial change we observed was replacing sitting with moderate to vigorous activity -- which could be a run, a brisk walk, or stair climbing -- basically any activity that raises your heart rate and makes you breathe faster, even for a minute or two."

The researchers pointed out that although time spent doing vigorous activity was the quickest way to improve heart health, there are ways to benefit for people of all abilities -- it's just that the lower the intensity of the activity, the longer the time is required to start having a tangible benefit. Using a standing desk for a few hours a day instead of a sitting desk, for example, is a change over a relatively large amount of time but is also one that could be integrated into a working routine fairly easily as it does not require any time commitment.

Those who are least active were also found to gain the greatest benefit from changing from sedentary behaviours to more active ones.

Professor Emmanuel Stamatakis, joint senior author of the study from the Charles Perkins Centre and Faculty of Medicine and Health at the University of Sydney, said: "A key novelty of the ProPASS consortium is the use of wearable devices that better differentiate between types of physical activity and posture, allowing us to estimate the health effects of even subtle variations with greater precision."

Though the findings cannot infer causality between movement behaviours and cardiovascular outcomes, they contribute to a growing body of evidence linking moderate to vigorous physical activity over 24 hours with improved body fat metrics. Further long-term studies will be crucial to better understanding the associations between movement and cardiovascular outcomes.

Professor Mark Hamer, joint senior author of the study from UCL Surgery & Interventional Science and the Institute of Sport, Exercise & Health, said: "Though it may come as no surprise that becoming more active is beneficial for heart health, what's new in this study is considering a range of behaviours across the whole 24-hour day. This approach will allow us to ultimately provide personalised recommendations to get people more active in ways that are appropriate for them."

James Leiper, Associate Medical Director at the British Heart Foundation, said: "We already know that exercise can have real benefits for your cardiovascular health and this encouraging research shows that small adjustments to your daily routine could lower your chances of having a heart attack or stroke. This study shows that replacing even a few minutes of sitting with a few minutes of moderate activity can improve your BMI, cholesterol, waist size, and have many more physical benefits.

"Getting active isn't always easy, and it's important to make changes that you can stick to in the long-term and that you enjoy -- anything that gets your heart rate up can help. Incorporating 'activity snacks' such as walking while taking phone calls, or setting an alarm to get up and do some star jumps every hour is a great way to start building activity into your day, to get you in the habit of living a healthy, active lifestyle."

Read more at Science Daily

Researchers uncover why light-to-moderate drinking is tied to better heart health

A new study led by investigators from Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system, offers an explanation for why light-to-moderate alcohol consumption may be associated with lower risk of heart disease. For the first time, researchers found that alcohol, in light to moderate quantities, was associated with long-term reductions in stress signaling in the brain. This impact on the brain's stress systems appeared to significantly account for the reductions in cardiovascular events seen in light to moderate drinkers participating in the study. Findings are published in the Journal of the American College of Cardiology.

"We are not advocating the use of alcohol to reduce the risk of heart attacks or strokes because of other concerning effects of alcohol on health," says senior author and cardiologist Ahmed Tawakol, MD, co-director of the Cardiovascular Imaging Research Center at Massachusetts General Hospital. "We wanted to understand how light to moderate drinking reduces cardiovascular disease, as demonstrated by multiple other studies. And if we could find the mechanism, the goal would be to find other approaches that could replicate or induce alcohol's protective cardiac effects without the adverse impacts of alcohol."

Previous epidemiological studies have suggested that light to moderate alcohol consumption (1 drink per day for women and 1 to 2 drinks per day for men) is associated with a lower risk of cardiovascular disease. But it was unknown whether alcohol was inducing cardiovascular benefits, or whether light/moderate drinkers' health behaviors, socioeconomic status, or other factors protected their hearts.

The study, led by K Mezue and M Osborne, included more than 50,000 individuals enrolled in the Mass General Brigham Biobank. The first part of the study evaluated the relationship between light/moderate alcohol consumption and major adverse cardiovascular events after adjusting for a range of genetic, clinical, lifestyle, and socioeconomic confounders. The researchers found that light/moderate alcohol consumption was associated with a substantial reduction in the risk of cardiovascular disease events, even after accounting for those other factors.

Next, they studied a subset of 754 individuals who had undergone previous PET/CT brain imaging (primarily for cancer surveillance) to determine the effect of light/moderate alcohol consumption on resting stress-related neural network activity.

The brain imaging showed reduced stress signaling in the amygdala, the brain region associated with stress responses, in individuals who were light to moderate drinkers compared to those who abstained from alcohol or who drank little. And when the investigators looked at these individuals' history of cardiovascular events, they found fewer heart attacks and strokes in light to moderate drinkers. "We found that the brain changes in light to moderate drinkers explained a significant portion of the protective cardiac effects," says Tawakol.

It's long been known that alcohol reduces the amygdala's reactivity to threatening stimuli while individuals are drinking. The current study is the first to indicate that light to moderate alcohol consumption has longer-term neurobiological effects in dampening activity in the amygdala, which may have a significant downstream impact on the cardiovascular system.

"When the amygdala is too alert and vigilant, the sympathetic nervous system is heightened, which drives up blood pressure and increases heart rate, and triggers the release of inflammatory cells," explains Tawakol. "If the stress is chronic, the result is hypertension, increased inflammation, and a substantial risk of obesity, diabetes, and cardiovascular disease."

Finally, the investigators examined whether light/moderate alcohol would be even more effective at reducing heart attacks and strokes in people who are prone to a chronically higher stress response, such as those with a history of significant anxiety. They found that, within the 50,000-patient sample, light to moderate drinking was associated with nearly double the cardiac-protective effect in individuals with a history of anxiety compared with others.

Yet while light/moderate drinkers lowered their risk for cardiovascular disease, the study also showed that any amount of alcohol increases the risk of cancer. And at higher amounts of alcohol consumption -- more than 14 drinks a week -- heart attack risk started to increase while overall brain activity started to decrease (which may be associated with adverse cognitive health).

The authors concluded that research should focus on finding new interventions that reduce the brain's stress activity without the deleterious effects of alcohol. The research team is currently studying the effect of exercise, stress-reduction interventions such as meditation, and pharmacological therapies on stress-associated neural networks and how they might induce cardiovascular benefits.

Read more at Science Daily

Heart-healthy lifestyle linked to a longer life, free of chronic health conditions

Two new studies by related research groups have found that adults who live a heart-healthy lifestyle, as measured by the American Heart Association's Life's Essential 8 (LE8) cardiovascular health scoring, tend to live longer lives free of chronic disease. The preliminary studies will be presented at the American Heart Association's Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023, held in Boston, February 28-March 3, 2023. The meeting offers the latest science on population-based health and wellness and implications for lifestyle and cardiometabolic health.

In June 2022, the American Heart Association updated the metrics for optimal cardiovascular health to include sleep -- Life's Essential 8. The tool measures 4 indicators related to cardiovascular and metabolic health status (blood pressure, cholesterol, blood sugar and body mass index); and 4 behavioral/lifestyle factors (smoking status, physical activity, sleep and diet).

"These two abstracts really give us some nice new insight into how we can understand at different stages across the life course just how important focusing on your cardiovascular health is going to be, particularly using the new American Heart Association Life's Essential 8 metrics," said Donald M. Lloyd-Jones, M.D., Sc.M., FAHA. Lloyd-Jones led the advisory writing group for Life's Essential 8 and is immediate past president of the American Heart Association President and chair of the department of preventive medicine, the Eileen M. Foell Professor of Heart Research and professor of preventive medicine, medicine and pediatrics at Northwestern University's Feinberg School of Medicine in Chicago. "The cardiovascular health construct studied in these two abstracts really does nail what patients are trying to do, which is find the fountain of youth. Yes, live longer, but more importantly, live healthier longer, and extend that healthspan so that you can really enjoy quality in your remaining life years."

Life's Essential 8 And Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, And Dementia in Adults

The first study investigated whether levels of cardiovascular health estimated by the Association's Life's Essential 8 metrics were associated with life expectancy free of major chronic disease, including cardiovascular disease, Type 2 diabetes, cancer and dementia.

"Our study looked at the association of Life's Essential 8 and life expectancy free of major chronic disease in adults in the United Kingdom," said lead author Xuan Wang, M.D., Ph.D., a postdoctoral fellow and biostatistician in the department of epidemiology at Tulane University's School of Public Health and Tropical Medicine in New Orleans.

Wang and colleagues analyzed health information for 136,599 adults in the U.K. who did not have cardiovascular disease, Type 2 diabetes, cancer or dementia when they enrolled in the study and as measured by the Life's Essential 8 tool.

"We categorized Life's Essential 8 scores according to the American Heart Association's recommendations, with scores of less than 50 out of 100 being poor cardiovascular health, 50 to less than 80 being intermediate, and 80 and above being ideal," Wang said. Life's Essential 8 scores of 80 and above are defined as "high cardiovascular health" by the Association.

When the researchers compared life expectancy and disease-free years among the groups, they found:

•     Adults who scored as having ideal cardiovascular health lived substantially longer than those scored in the poor heart health category. Men and women with ideal cardiovascular health at age 50 had an average 5.2 years and 6.3 years more of total life expectancy, respectively, when compared to the men and women who scored as having poor cardiovascular health.
•     Adults with ideal cardiovascular health scores lived longer without chronic disease. Disease-free life expectancy accounted for nearly 76% of total life expectancy for men and more than 83% for women who had ideal cardiovascular health -- in contrast, disease-free life expectancy was only 64.9% of men and 69.4% of women with poor cardiovascular health.

"Moreover, we found disparities in disease-free life expectancy due to low socioeconomic status may be offset considerably by maintaining an ideal cardiovascular health score in all adults," Wang said. "Our findings may stimulate interest in individual self-assessment and motivate people to improve their cardiovascular health. These findings support improving population health by promoting adherence to ideal cardiovascular health, which may also narrow health disparities related to socioeconomic status."

The study's limitations were that the researchers only included CVD, diabetes, cancer and dementia in their definition of "disease-free life expectancy;" information on e-cigarettes was not available in the U.K. Biobank, which may lead to a slight overestimation of the LE8 score in this study; and participants in the U.K. Biobank are overwhelmingly white race, therefore, further studies are needed to confirm if these results are consistent among people from diverse racial and ethnic backgrounds who may experience negative social determinants of health throughout their lifetime.

"What's really important is that people maintaining high cardiovascular health into midlife are avoiding those chronic diseases of aging, things like cancer and dementia that we also worry about, not just cardiovascular disease," Lloyd-Jones said. "They're delayed until much later in the lifespan, so people can enjoy the life in their years as well as the years in their life."

Co-authors with Wang are Hao Ma, M.D., Ph.D.; Xiang Li, M.D., Ph.D.; Yoriko Heianza, R.D., Ph.D.; JoAnn E. Manson, M.D., M.P.H., Dr.P.H..; Oscar H. Franco, M.D., Ph.D.; and Lu Qi, M.D., Ph.D. Authors' disclosures are listed in the abstract.

The study was funded by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases, which are divisions of the National Institutes of Health; the Fogarty International Center; and Tulane Research Centers of Excellence Awards.

Life's Essential 8 And Life Expectancy Among Adults in the United States

The second study focused on whether the association of Life's Essential 8 with total life expectancy differed by sex or race in U.S. adults.

The researchers analyzed health information, including Life's Essential 8 scores, for more than 23,000 U.S. adults who took part in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018.

The analysis found:

•     Life expectancy for adults at age 50 was an average of an additional 33.4 years for those with ideal cardiovascular health, or scores of 80 or greater; in comparison, additional life expectancy was 25.3 years for adults with poor cardiovascular health, LE8 scores of less than 50.
•     Adults with ideal cardiovascular health gained an estimated 8.1 years (7.5 additional years for men and 8.9 for women) of life expectancy at age 50, compared with those in the poor cardiovascular health category.

"We found that more than 40% of the increased life expectancy at age 50 from adhering to ideal cardiovascular health may be explained by the reduced incidence of cardiovascular disease death," said lead author Hao Ma, M.D., Ph.D., a postdoctoral fellow and biostatistician in epidemiology at Tulane University and co-author on Wang's study.

According to Ma, this indicates that maintaining one's cardiovascular health may improve one's lifespan. However, more research needs to be done on the impact of cardiovascular health on lifespan among people from diverse racial and ethnic groups, he said.

The study had several limitations such as the researchers did not consider potential changes of cardiovascular health during the follow-up because information on the cardiovascular health metrics was only available at baseline. Additionally, the researchers' analyses of different racial/ethnic groups only included non-Hispanic white, non-Hispanic Black and people of Mexican heritage due to the limited sample size for additional racial/ethnic groups.

"What struck me about this abstract particularly was that there's a really big jump going from individuals who have poor cardiovascular health to just intermediate levels of cardiovascular health," Lloyd-Jones said. "Overall, we see this seven-and-a-half-year difference going from poor to high cardiovascular health. That's a really big difference in life expectancy, and I think what it tells us is that we need to try to move people and get them to improve their cardiovascular health in mid-life, because that's really going to have a major influence on their total life expectancy."

Read more at Science Daily

Heart health tip for older adults in 2023: Step it up a bit

The evidence-based health benefits of walking continue to accumulate, according to ongoing research by a University of Massachusetts Amherst physical activity epidemiologist, who leads an international consortium known as the Steps for Health Collaborative.

Findings from the latest study led by Amanda Paluch, assistant professor of kinesiology in the School of Public Health and Health Sciences, show that older adults who walked between 6,000 and 9,000 steps per day had a 40-50% reduced risk of a cardiovascular event, such as a heart attack or stroke, compared to those who walked 2,000 steps per day.

"We found for adults over 60, there was a strikingly lower risk of a cardiovascular event or disease over an average follow-up of six years," says Paluch, whose team's research was published this week in the journal Circulation. "When accumulating more steps per day, there was a progressively lower risk."

Earlier this year, research by Paluch and the Steps for Health Collaborative showed that more movement, even below the highly touted but unscientific "10,000 steps per day," was associated with longevity benefits. The meta-analysis of 15 studies involving nearly 50,000 people from four continents found that walking between 6,000 and 8,000 steps per day was linked with a lower risk of death from all causes among older adults.

Following those findings, Paluch and team wanted to tackle the less-charted territory of steps per day and cardiovascular disease. The results were similar, in terms of the most beneficial range of steps.

While there appears to be a continual additional benefit for those who walk more than 6,000 steps, Paluch says, encouraging the least-active older adults to take more steps is perhaps the most important public health message.

"The people who are the least active have the most to gain," she says. "For those who are at 2,000 or 3,000 steps a day, doing a little bit more can mean a lot for their heart health. If you're at 6,000 steps, getting to 7,000 and then to 8,000 also is beneficial, it's just a smaller, incremental improvement."

The meta-analysis of eight studies involved more than 20,000 people from the U.S. and 42 other countries. For younger adults, no link between steps per day and cardiovascular risk was detected.

"This is because cardiovascular disease is a disease of aging and often doesn't come to fruition until we're at older ages," says Paluch, whose project was supported by the Centers for Disease Control and Prevention (CDC). "You're not going to see many people develop cardiovascular disease after six years of follow-up in young to middle adulthood."

Future research involving younger adults and steps per day would focus on the precursors of cardiovascular disease, including high blood pressure, obesity and type 2 diabetes. "Those conditions develop in younger adults and are important for early prevention," Paluch says.

Four of the eight studies the researchers analyzed included data about walking intensity, or how fast the steps were taken. "We're interpreting these results with caution, but we did not find any striking association with walking intensity," she says. "There was no additional benefit with how fast you're walking, beyond the total number of steps that you accumulated."

Read more at Science Daily

Potential threat to heart health from extreme weather

An analysis in nearly 2.3 million Europeans has found detrimental associations between cold weather and deaths from heart disease, particularly in poor neighbourhoods. The late-breaking research is presented at ESC Congress 2022.1 Hot weather was linked with excess deaths from heart disease and stroke in patients with heart conditions.

Study author Professor Stefan Agewall of the University of Oslo, Norway said: "Climate change is leading to a rise in the average global temperature but also extreme cold in some regions. More than 70,000 excess deaths occurred across Europe during the summer of 2003 due to intense heatwaves.2 Cold weather also accounts for excess deaths and hospital admissions.3,4 Previously studies on the cardiovascular effects of heat and cold mainly used aggregated data, such as daily deaths in a city. The EXHAUSTION project used individual data, enabling us to identify vulnerable subgroups for protective interventions, thereby increasing resilience for future weather events."

The analysis included 2.28 million adults from five cohort studies conducted in Italy, Germany, the UK, Norway, and Sweden between 1994 and 2010. The average age ranged from 49.7 years to 71.7 years and the proportion of women ranged from 36.0% to 54.5%. Participants with and without cardiovascular disease at baseline were included. Data on mortality and new-onset disease were collected through death and disease registries and follow up surveys. Daily average air temperatures at participants' home addresses were collected from local weather stations or estimated using modelling of temperature data from weather stations

The relationships between temperature and cardiovascular conditions and death were analysed for all participants and in subgroups with particular characteristics. A time-stratified case-crossover study design was used where for each participant, the researchers compared the temperature on the day of the week an adverse event occurred (e.g. Monday) with the temperature on the same day of the week without an adverse event (e.g. all remaining Mondays) within the same month. Using within-participant comparisons between days in the same month eliminated the potential confounding effects of participant characteristics and time trends.

The analysis found increased risks of death from cardiovascular disease overall and ischaemic heart disease in particular, as well as an elevated risk of new-onset ischaemic heart disease, associated with cold weather. With an approximately 10°C temperature drop, from 5°C to -5°C, there was a 19% greater risk of death from cardiovascular disease (relative risk [RR] 1.19; 95% confidence interval [CI] 1.04-1.36) and a 22% elevated likelihood of death from ischaemic heart disease (RR 1.22; 95% CI 1.07-1.38). There was a 4% higher risk of new-onset ischaemic heart disease associated with an approximately 11°C temperature drop, from 2°C to -9°C (RR 1.04; 95% CI: 1.01-1.08).

Professor Agewall said: "The relationships between cold temperatures and deaths were more pronounced in men and people living in neighbourhoods with a low socioeconomic status. The links between cold and new-onset ischaemic heart disease were stronger among women and people older than 65 years."

Heat was not related to detrimental effects in the overall study population. However, temperature rises from 15°C to 24°C were associated with 25% (RR 1.25; 95% CI 1.12-1.39) and 30% (RR 1.30; 95% CI 1.10-1.53) elevated risks of death from cardiovascular disease and stroke, respectively, in people with heart disease at baseline.

Professor Agewall said: "Clinicians can use this information to provide tailored advice to those most at risk of adverse health outcomes during hot and cold days. Patients with heart conditions should stay hydrated in hot weather and adhere to advice from their cardiologist on medication use. We can all check the news for extreme heat and cold alerts and follow safety tips from local authorities."

Read more at Science Daily

Loss of male sex chromosome leads to earlier death for men

The loss of the male sex chromosome as many men age causes the heart muscle to scar and can lead to deadly heart failure, new research from the University of Virginia School of Medicine shows. The finding may help explain why men die, on average, several years younger than women.

UVA researcher Kenneth Walsh, PhD, says the new discovery suggests that men who suffer Y chromosome loss -- estimated to include 40% of 70-year-olds -- may particularly benefit from an existing drug that targets dangerous tissue scarring. The drug, he suspects, may help counteract the harmful effects of the chromosome loss -- effects that may manifest not just in the heart but in other parts of the body as well.

On average, women live five years longer than men in the United States. The new finding, Walsh estimates, may explain nearly four of the five-year difference.

"Particularly past age 60, men die more rapidly than women. It's as if they biologically age more quickly," said Walsh, the director of UVA's Hematovascular Biology Center. "There are more than 160 million males in the United States alone. The years of life lost due to the survival disadvantage of maleness is staggering. This new research provides clues as to why men have shorter lifespans than women."

Chromosome Loss and Heart Health

While women have two X chromosomes, men have an X and a Y. But many men begin to lose their Y chromosome in a fraction of their cells as they age. This appears to be particularly true for smokers. The loss occurs predominantly in cells that undergo rapid turnover, such as blood cells. (Loss of the Y chromosome does not occur in male reproductive cells, so it is not inherited by the children of men who exhibit Y chromosome loss.) Scientists previously observed that men who suffer Y chromosome loss are more likely to die at a younger age and suffer age-associated maladies such as Alzheimer's disease. Walsh's new research, however, is believed to be the first hard evidence that the chromosome loss directly causes harmful effects on men's health.

Walsh, of UVA's Division of Cardiovascular Medicine and the Robert M. Berne Cardiovascular Research Center, and his team used cutting-edge CRISPR gene-editing technology to develop a special mouse model to better understand the effects of Y chromosome loss in the blood. They found that the loss accelerated age-related diseases, made the mice more prone to heart scarring and led to earlier death. This wasn't the result of just inflammation, the scientists determined. Instead, the mice suffered a complex series of responses in the immune system, leading to a process referred to as fibrosis throughout the body. This tug-of-war within the immune system, the researchers believe, may accelerate disease development.

The scientists also looked at the effects of Y chromosome loss in human men. They conducted three analyses of data compiled from the UK Biobank, a massive biomedical database, and found that Y chromosome loss was associated with cardiovascular disease and heart failure. As chromosome loss increased, the scientists found, so did the risk of death.

Potential Treatment

The findings suggest that targeting the effects of Y chromosome loss could help men live longer, healthier lives. Walsh notes that one potential treatment option might be a drug, pirfenidone, that has already been approved by the federal Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis, a form of lung scarring. The drug is also being tested for the treatment of heart failure and chronic kidney disease, two conditions for which tissue scarring is a hallmark. Based on his research, Walsh believes that men with Y chromosome loss could respond particularly well to this drug, and other classes of antifibrotic drugs that are being developed, though more research will be needed to determine that.

At the moment, doctors have no easy way to determine which men suffer Y chromosome loss. Walsh's collaborator Lars A. Forsberg, of Uppsala University in Sweden, has developed an inexpensive polymerase chain reaction (PCR) test, like those used for COVID-19 testing, that can detect Y chromosome loss, but the test is largely confined to his and Walsh's labs. Walsh, however, can foresee that changing: "If interest in this continues and it's shown to have utility in terms of being prognostic for men's disease and can lead to personalized therapy, maybe this becomes a routine diagnostic test," he said.

"The DNA of all our cells inevitably accumulate mutations as we age. This includes the loss of the entire Y chromosome within a subset of cells within men. Understanding that the body is a mosaic of acquired mutations provides clues about age-related diseases and the aging process itself," said Walsh, a member of UVA's Department of Biochemistry and Molecular Genetics. "Studies that examine Y chromosome loss and other acquired mutations have great promise for the development of personalized medicines that are tailored to these specific mutations."

Read more at Science Daily

Large study challenges the theory that light alcohol consumption benefits heart health

Observational research has suggested that light alcohol consumption may provide heart-related health benefits, but in a large study published in JAMA Network Open, alcohol intake at all levels was linked with higher risks of cardiovascular disease. The findings, which are published by a team led by researchers at Massachusetts General Hospital (MGH) and the Broad Institute of MIT and Harvard, suggest that the supposed benefits of alcohol consumption may actually be attributed to other lifestyle factors that are common among light to moderate drinkers.

The study included 371,463 adults -- with an average age of 57 years and an average alcohol consumption of 9.2 drinks per week -- who were participants in the UK Biobank, a large-scale biomedical database and research resource containing in-depth genetic and health information. Consistent with earlier studies, investigators found that light to moderate drinkers had the lowest heart disease risk, followed by people who abstained from drinking. People who drank heavily had the highest risk. However, the team also found that light to moderate drinkers tended to have healthier lifestyles than abstainers -- such as more physical activity and vegetable intake, and less smoking. Taking just a few lifestyle factors into account significantly lowered any benefit associated with alcohol consumption.

The study also applied the latest techniques in a method called Mendelian randomization, which uses genetic variants to determine whether an observed link between an exposure and an outcome is consistent with a causal effect -- in this case, whether light alcohol consumption causes a person to be protected against cardiovascular disease. "Newer and more advanced techniques in 'non-linear Mendelian randomization' now permit the use of human genetic data to evaluate the direction and magnitude of disease risk associated with different levels of an exposure," says senior author Krishna G. Aragam, MD, MS, a cardiologist at MGH and an associate scientist at the Broad Institute. "We therefore leveraged these new techniques and expansive genetic and phenotypic data from biobank populations to better understand the association between habitual alcohol intake and cardiovascular disease."

When the scientists conducted such genetic analyses of samples taken from participants, they found that individuals with genetic variants that predicted higher alcohol consumption were indeed more likely to consume greater amounts of alcohol, and more likely to have hypertension and coronary artery disease. The analyses also revealed substantial differences in cardiovascular risk across the spectrum of alcohol consumption among both men and women, with minimal increases in risk when going from zero to seven drinks per week, much higher risk increases when progressing from seven to 14 drinks per week, and especially high risk when consuming 21 or more drinks per week. Notably, the findings suggest a rise in cardiovascular risk even at levels deemed "low risk" by national guidelines from the U.S. Department of Agriculture (i.e. below two drinks per day for men and one drink per day for women).

The discovery that the relationship between alcohol intake and cardiovascular risk is not a linear one but rather an exponential one was supported by an additional analysis of data on 30,716 participants in the Mass General Brigham Biobank. Therefore, while cutting back on consumption can benefit even people who drink one alcoholic beverage per day, the health gains of cutting back may be more substantial -- and, perhaps, more clinically meaningful -- in those who consume more.

"The findings affirm that alcohol intake should not be recommended to improve cardiovascular health; rather, that reducing alcohol intake will likely reduce cardiovascular risk in all individuals, albeit to different extents based on one's current level of consumption," says Aragam.

Read more at Science Daily

Fewer than 1 in 5 adults with Type 2 diabetes in the U.S. are meeting optimal heart health targets

Fewer than 1 in 5 adults with Type 2 diabetes in the U.S. are meeting targets to reduce heart disease risk. Fortunately, available therapies can help when combined with new approaches that address social determinants of health and other barriers to care, according to a new American Heart Association scientific statement published today in the Association's flagship journal Circulation. A scientific statement is an expert analysis of current research and may inform future clinical practice guidelines.

"This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and to develop new best practices to advance Type 2 diabetes treatment and care and reduce CVD risk," said Joshua J. Joseph, M.D., M.P.H., FAHA, chair of the statement writing group and an assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University College of Medicine in Columbus, Ohio. "Far too few people -- less than 20% of those with Type 2 diabetes -- are successfully managing their heart disease risk, and far too many are struggling to stop smoking and lose weight, two key CVD risk factors. Health care professionals, the health care industry and broader community organizations all have an important role to play in supporting people with Type 2 diabetes."

Type 2 diabetes is the most common form of diabetes, affecting more than 34 million people in the U.S., representing nearly 11% of the U.S. population, according to the U.S. Centers for Disease Control and Prevention's 2020 National Diabetes Statistics Report, and cardiovascular disease (CVD) is the leading cause of death and disability among people with Type 2 diabetes (T2D). Type 2 diabetes occurs when the body is unable to efficiently use the insulin it makes or when the pancreas loses its capacity to produce insulin. People with T2D often have other cardiovascular disease risk factors, including overweight or obesity, high blood pressure or high cholesterol. Adults with T2D are twice as likely to die from CVD -- including heart attacks, strokes and heart failure -- compared to adults who do not have T2D.

The new scientific statement, based on the writing group's extensive review of clinical trial results through June 2020, addresses the gap between existing evidence on how best to lower cardiovascular risk in people with T2D and the reality for people living with T2D. Targets to reduce CVD risk among people with T2D include managing blood glucose, blood pressure and cholesterol levels; increasing physical activity; healthy nutrition; obesity and weight management; not smoking; not drinking alcohol; and psychosocial care. Greater adherence to an overall healthy lifestyle among people with T2D is associated with a substantially lower risk of CVD and CVD mortality.

"In the United States, less than 1 in 5 adults with T2D not diagnosed with cardiovascular disease are meeting optimal T2D management goals of not smoking and achieving healthy levels of blood sugar, blood pressure and low-density lipoprotein (LDL) cholesterol, also known as 'bad' cholesterol," Joseph said.

A surprisingly large proportion -- as high as 90% -- of factors to effectively manage CVD with T2D includes modifiable lifestyle and societal factors. "Social determinants of health, which includes health-related behaviors, socioeconomic factors, environmental factors and structural racism, have been recognized to have a profound impact on cardiovascular disease and Type 2 diabetes outcomes," he said. "People with T2D face numerous barriers to health including access to care and equitable care, which must be considered when developing individualized care plans with our patients."

Shared decision-making among patients and health care professionals is essential for successfully managing T2D and CVD. A comprehensive diabetes care plan should be tailored based on individual risks and benefits and in consideration the patient's preferences; potential cost concerns; support to effectively manage T2D and take medications as prescribed, including diabetes self-management education and support; promotion and support of healthy lifestyle choices that improve cardiovascular health including nutrition and physical activity; and treatment for any other CVD risk factors.

"One avenue to continue to address and advance diabetes management is through breaking down the four walls of the clinic or hospital through community engagement, clinic-to-community connections and academic-community-government partnerships that may help address and support modifiable lifestyle behaviors such as physical activity, nutrition, smoking cessation and stress management," Joseph said.

The statement also highlights recent evidence on treating T2D that may spur clinicians and patients to review and update their T2D management plan to also address CVD risk factors:

New ways to control blood sugar

The American Heart Association's last scientific statement on blood sugar control was published in 2015, just as research was starting to suggest that glucose-lowering medications may also reduce the risk of heart attack, stroke, heart failure or cardiovascular death.

"Since 2015, a number of important national and international clinical trials that specifically examined new T2D medications for lowering cardiovascular disease and cardiovascular mortality risk among people with Type 2 diabetes have been completed," Joseph said. "GLP-1 (glucagon-like pepdite-1) receptor agonists have been found to improve blood sugar and weight, and they have been game changers in reducing the risk of heart disease, stroke, heart failure and kidney disease." GLP-1 medications (injectable synthetic hormones such as liraglutide and semaglutide) stimulate the release of insulin to control blood sugar, and they also reduce appetite and help people feel full, which may help with weight management or weight loss.

In addition, SGLT-2 (sodium-glucose co-transporter 2) inhibitors (oral medications such as canaglifozin, dapagliflozin, ertugliflozin and empagliflozin) have also been found to be effective in reducing the risks of CVD and chronic kidney disease. SGLT-2 inhibitors spur the kidneys to dispose of excess glucose through the urine, which lowers the risk of heart failure and slows the decrease in kidney function that is common among people with T2D.

"Cost may be a barrier to taking some T2D medications as prescribed, however, many of these medications are now more commonly covered by more health insurance plans," Joseph said. "Another barrier is recognition by patients that these newer T2D medications are also effective in reducing the risk of heart disease, stroke, heart failure and kidney disease. Increasing public awareness about the link between CVD and T2D and provide support, education and tools that help improve T2D and reduce CVD risk are at the core of the Know Diabetes by Heart™ initiative, from the American Heart Association and American Diabetes Association."

Personalized blood pressure control

The statement highlights that individualized approaches to treating high blood pressure are best. These approaches should consider ways to minimize the side effects of hypertension treatment and avoid potentially over-treating frail patients.

Importance of lowering cholesterol levels

Statin medications remain the first line of lipid-lowering therapy, and the Association suggests other types of medications may be considered for people unable to tolerate a statin or who aren't reaching their LDL cholesterol targets with a statin. These medications may include ezetimibe, bempodoic acid, bile acid resins, fibrates and PCSK-9 inhibitors, depending on the individual's overall health status and other health conditions.

Re-thinking aspirin use

Older adults (ages 65 years and older) with T2D are more likely than those who do not have T2D to take a daily low-dose aspirin to help prevent cardiovascular disease. However, it may be time to review if daily low-dose aspirin is still appropriate. Recently published research suggests the increased risk of major bleeding from aspirin may outweigh the benefits, and newer, more potent antiplatelet medications may be more effective for some people.

The statement reinforces the importance of a comprehensive, multidisciplinary and individualized approach to reduce CVD risk among people with T2D. Optimal care should incorporate healthy lifestyle interventions, and medications and/or treatments including surgery that improve T2D management and support healthy weight and weight loss. Social determinants of health, structural racism and health equity are important factors that must also be considered and addressed.

Read more at Science Daily

'Broken heart' syndrome is on the rise in women

The study, published in the Journal of the American Heart Association (JAHA), suggests middle-aged and older women are being diagnosed with broken heart syndrome more frequently -- up to 10 times more often -- than younger women or men of any age.

The research also suggests that the rare condition has become more common, and the incidence has been rising steadily since well before the COVID-19 pandemic.

"Although the global COVID-19 pandemic has posed many challenges and stressors for women, our research suggests the increase in Takotsubo diagnoses was rising well before the public health outbreak," said Susan Cheng, MD, MPH, MMSc, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and senior author of the study. "This study further validates the vital role the heart-brain connection plays in overall health, especially for women."

What the Data Shows

Cheng and her research team used national hospital data collected from more than 135,000 women and men who were diagnosed with Takotsubo syndrome between 2006 and 2017. While confirming that women are diagnosed more frequently than men, the results also revealed that diagnoses have been increasing at least six to 10 times more rapidly for women ages 50 to 74 than for any other demographic.

Additional findings include:
 

• Of the 135,463 documented cases of Takotsubo cardiomyopathy, the annual incidence increased steadily in both sexes, with women contributing most cases (83.3%), especially those over 50.
• In particular, researchers observed a significantly greater increase in incidence among middle-aged women and older women, compared to younger women. For every additional diagnosis of Takotsubo in younger women -- or men of all age groups -- there were 10 additional cases diagnosed for middle-aged women and six additional diagnoses for older women.

Prior to this study, researchers only knew that women are more prone than men to developing Takotsubo syndrome. This latest study is the first to ask whether there are age-based sex differences and if case rates may be changing over time.

The Brain and Heart Connection

As Cheng, who also serves as professor of cardiology and the Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science, explains, the way the brain and nervous system respond to different types of stressors is something that changes as women age.

"There is likely a tipping point, just beyond midlife, where an excess response to stress can impact the heart," said Cheng, director of Cardiovascular Population Sciences in the Barbra Streisand Women's Heart Center. "Women in this situation are at especially affected, and the risk seems to be increasing."

The researchers are next investigating the longer-term implications of a Takotsubo diagnosis, molecular markers of risk, and the factors that may be contributing to rising case rates.

The Smidt Heart Institute has played a leading role in identifying female-pattern heart disease and conditions, developing new diagnostic tools and advancing specialized care for women.

Although medical professionals understand the connection between stress and heart disease risk are critically important, there is still a lot to discern.

Read more at Science Daily

Young adults who lost and then restored heart health had lower risk of heart attack, stroke

Preserving good cardiovascular health during young adulthood is one of the best ways to reduce risks of premature heart attack or stroke, according to new research published today in the American Heart Association's flagship journal Circulation.

The number of premature deaths from cardiovascular disease is increasing in many countries including the U.S. While there is a wealth of information available on maintaining good heart health during and after midlife to reduce the risks of heart attack and stroke, data about cardiovascular health during young adulthood is scarce.

"Most people lose ideal cardiovascular health before they reach midlife, yet few young people have immediate health concerns and many do not usually seek medical care until approaching midlife," says the study's senior author Hyeon Chang Kim, M.D., Ph.D., a professor in the department of preventive medicine at Yonsei University College of Medicine in Seoul, South Korea. "We need strategies to help preserve or restore heart health in this population because we know poor heart health in young adults is linked to premature cardiovascular disease."

Using the Korean National Health Insurance Services, a nationwide health insurer database, Kim and colleagues analyzed information collected from more than 3.5 million adults who completed routine health exams in 2003 and 2004. A subgroup of approximately 2.9 million participants underwent a follow-up health examination between 2005 and 2008. Patients' ages ranged from 20 to 39 at the time of the first exam, and 65.5% of the study participants were male.

Participants were categorized according to ideal cardiovascular health (CVH) scores based on the American Heart Association's Life's Simple 7® metrics. Patients received "one point" towards a cardiovascular health (CVH) score for each of the following measures from Life's Simple 7: well-maintained blood pressure, low total cholesterol, acceptable blood sugar levels, an active lifestyle, healthy weight and not smoking. Of note: healthy nutrition and diet, the final measure of Life's Simple 7, was not included in this analysis because dietary information was not collected from participants in this database.

Researchers evaluated the total number of first hospitalizations or death from a heart attack, stroke or heart failure by December 31, 2019 to define outcomes. The researchers found: 

• Rates of premature (younger than 55) cardiovascular events were highest among patients with a CVH score of zero.
• A higher CVH score by one point led to reduced risks for heart attack by 42%, heart failure by 30%, cardiovascular death by 25% and stroke by 24%.
• While people who improved their CVH score over time reduced their risk of hospitalizations or death from a heart attack, stroke or heart failure, people who began with and maintained a higher CVH score ultimately had the least chance of hospitalization or death from a heart attack or stroke during the study period.
• Timely and consistent monitoring of heart health among young adults is important to prevent premature onset of heart disease and reduce the risk of cardiovascular events.

The study's findings may be limited because data was routine health screening data, therefore, it may not be as robust as data collected primarily for a specific study. The study also lacks data on the participants' eating patterns, so researchers modified CVH score metrics to exclude diet. In addition, participants in this study were of Korean ancestry, so the results may not be generalizable to people from other diverse racial or ethnic groups.

From Science Daily