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22nd June 2023
Almost 100,000 more people have died with cardiovascular disease in England than expected in the three years since the pandemic began, a new analysis from the British Heart Foundation (BHF) shows.
The data up to this month shows an average 500 additional deaths a week involving cardiovascular disease since the start of the pandemic.
A range of factors are likely to contribute to the figures, which came from the Office for Health Improvement and Disparities (OHID), including Covid-19 itself, extreme pressure on the NHS and disrupted healthcare as well as changing patient behaviour and worsening population health, the charity said.
It noted that the number of patients waiting for time-sensitive cardiac care was at a record high of nearly 390,000 at the end of April in England, while average ambulance response times for heart attacks and strokes have consistently been above 30 minutes since the beginning of 2022.
The analysis found at 96,540 excess deaths involving cardiovascular disease between March 2020 and May this year – more than any other disease group.
Rates also changed over time with Covid-19 infection driving high numbers of excess deaths involving cardiovascular disease in the first year where more than 50% of the higher than expected deaths occurred.
Excess deaths involving cardiovascular disease then dropped significantly in the second year of the pandemic before increasing again in year three by 13,000.
In the third year of the pandemic, the number of excess deaths involving cardiovascular disease outnumbered the number of deaths where cardiovascular disease was mentioned but where Covid-19 was the underlying cause by around 19,400 deaths, the BHF said.
The charity warned the UK Government must take charge of the increasingly urgent cardiovascular disease crisis.
Dr Charmaine Griffiths, BHF chief executive, said: ‘It is deeply troubling that so many more people with cardiovascular disease have lost their lives over the last three years. My heart goes out to every family who has endured the pain of losing a loved one, all too often in distressing circumstances.
‘For years now, it has been clear that we are firmly in the grip of a heart and stroke care emergency. If little changes, we could continue to see a sustained rise in death rates from cardiovascular conditions that undoes decades of scientific progress to reduce the number of people who die of a heart attack or stroke.’
Dr Sonya Babu-Narayan, associate medical director at the BHF and consultant cardiologist, said Covid-19 no longer fully explains the significant numbers of excess deaths involving cardiovascular disease.
‘Other major factors are likely contributing, including the extreme and unrelenting pressure on the NHS over the last few years.
This story was originally published by our sister publication Pulse.
6th June 2022
Drinking coffee sweetened with sugar provides broadly similar mortality benefits to consumption of unsweetened coffee although benefits from drinking coffee sweetened with artificial agents are much less consistent.
This was the finding of a prospective cohort study by a team of researchers based at the Department of Epidemiology, School of Public Health, Southern Medical University, Guangdong, China.
A 2019 meta-analysis concluded that moderate coffee consumption, for example, 2 to 4 cups every day, was associated with reduced all-cause and cause-specific mortality in comparison to those who did not consume the beverage. In fact, consumption of 8 or more cups of coffee per day, even among those with slower or faster caffeine metabolism, has been shown to be inversely associated with mortality.
Nevertheless, what has not been explored in the literature is the extent to which sweetened coffee retains these health benefits, given the potential adverse health effects of sweetened beverages.
For the present study, the researchers turned to data held in the UK Biobank to determine the association between consumption of coffee sweetened with either sugar or artificial agents and overall and specific cause mortality. A further objective was to explore whether sweetening affected any mortality benefits depending on how the coffee was prepared, e.g., instant, ground, or decaffeinated.
Participants in the UK Biobank completed dietary recall data using a web-based questionnaire from which the researchers collected information on whether sugar or artificial sweeteners were used in coffee. The level of coffee consumption was categorised as 0 – 1.5 cups/day, > 1.5 – 2.5 cups/day, > 2.5 – 3.5 cups/day and > 4.5 cups/day and the type of coffee drank was classed as instant, ground or decaffeinated.
Regression analysis was used to estimate the hazard ratios for coffee consumption and mortality, adjusted for several factors such as age, gender, co-morbidities etc.
Coffee sweetened with sugar/artificial agents and mortality outcomes
A total of 171,616 individuals with a mean age of 55.6 years (44.6% male) were included in the final analysis and followed for a median of 7 years. Among this cohort, 24.2% were non-coffee drinkers, 55.4% drank unsweetened coffee with the remainder adding either sugar (14.3%) or artificial sweeteners (6.1%). Those who sweetened their coffee added an average of 1.1 teaspoons of sugar and 1.4 teaspoons of a sweetener.
During the follow-up period there were 3177 deaths, 1725 from cancer and 628 from CVD. Compared with those who did not drink coffee, after adjustment, the risk of death associated with drinking > 3.5 to 4.5 cups of unsweetened coffee/day was 29% lower (hazard ratio, HR = 0.71, 95% CI 0.60 – 0.84).
For those drinking a similar amount of coffee sweetened with sugar, there was a similar reduced risk of death (HR = 0.79, 95% CI 0.60 – 1.06). For the same level of consumption, drinking coffee sweetened with an artificial agent had a significant all-cause mortality benefit (HR = 0.65, 95% CI 0.45 – 0.92).
When considering how the coffee was prepared, there were significant mortality benefits associated with drinking > 3.5 to 4.5 cups/day of unsweetened coffee. In contrast, the mortality benefits for a similar level of consumption of sugar-sweetened coffee were slightly less and non-significant for all three methods of preparation.
Among those using artificial sweeteners, benefits were derived from instant (HR = 0.66, 95% CI 0.46 – 0.96) and ground coffee (HR = 0.51, 95% CI 0.27 – 0.95) but not decaffeinated (HR = 0.52, 95% CI 0.23 – 1.17).
The authors concluded that taking the data as a whole, it seemed that consumption of either unsweetened or sugar-sweetened coffee provided broadly similar mortality benefits. In contrast, the effect of sweetening coffee with artificial agents was less consistent, possibly due to the smaller number of people in this group.
Citation
Liu D et al. Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality. A Large Prospective Cohort Study Ann Intern Med 2022
16th March 2022
Radiotherapy use in cancer has been found to be associated with an increased risk of death from cardiovascular disease. This was according to the findings of a study by researchers from the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiovascular diseases are responsible for an estimated 17.9 million deaths each year and cardiovascular disease and cancer are the leading causes of premature death across the world.
In the past few years, it has become recognised that there is actually a significant overlap in the risk factors for the development of both cardiovascular disease and cancer, providing opportunities for joint risk factor modification.
Despite the fact that radiotherapy use has become an increasingly integral part of much modern-day cancer therapy, it can increase the risk of cardiovascular events.
For example, in a 2017 meta-analysis that investigated the link between radiotherapy and long-term cardiovascular morbidity and mortality in patients with breast cancer, it was found that exposure of the heart to ionising radiation during radiotherapy increased the subsequent risk of coronary heart disease and cardiac mortality.
Given the potential heightened risk of cardiovascular disease death from radiation use in cancer therapy, the Chinese researchers set out to perform a comprehensive analysis to further examine the nature of this relationship in comparison to the general population.
They used data held within the Surveillance, Epidemiology and End Results (SEER) database and included individuals with a primary solid tumour at six different tumour sites and with a diagnostic data of between 1975 and 2014.
Radiation use and subsequent cardiovascular disease death
The team identified 2,214,944 patients with cancer from the SEER database, of whom 292,102 (13.2%) had died from a cardiovascular disease. A total of 718,979 patients had received radiotherapy and 1, 495,965 were in the ‘no radiotherapy’ group.
Overall, 67,003 (9.3%) of the radiotherapy group had subsequently died from a cardiovascular disease compared to 225,099 (15.1%) in the no radiotherapy group.
Using a standardised mortality ratio (SMR) to compare cardiovascular deaths among those who had cancer, the SMR was increased by 13% (SMR = 1.13, 95% CI 1.13 – 1.14). In other words, there was a higher incidence of cardiovascular disease deaths among those who had cancer compared to the general population.
In the multivariable analysis, radiotherapy use was considered to be an independent risk factor for some, but not all, forms of cancer. For example, lung and bronchus (hazard ratio, HR = 1.09, 95% CI 1.06 – 1.13), cervix uteri (HR = 1.47), corpus uteri (HR = 1.13) and bladder cancer (HR = 1.13).
In contrast, there was no significant association for several others such as stomach (HR = 1.03, 95% CI 0.93 – 1.13) and prostate cancer (HR = 0.99, 95% CI 0.97 – 1.00).
The authors concluded that radiotherapy use in patients with cancer does lead to an overall increased risk of cardiovascular death compared to the general population but that the risk is only significant for the certain cancers.
Nevertheless, they highlighted the importance of cardiovascular care in patients with cancer undergoing radiotherapy.
Citation
Liu E et al. Association Between Radiotherapy and Death From Cardiovascular Disease Among Patients With Cancer: A Large Population‐Based Cohort Study J Am Heart Assoc 2022.
11th March 2022
Undertaking muscle-strengthening activities, independently of aerobics, reduces the risk of cardiovascular disease (CVD), total cancer and all-cause mortality. This was the main finding from a meta-analysis by researchers from the Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Miyagi, Japan.
Increasing muscle strength is recognised as a marker of good health and the World Health Organization recommends regular muscle-strengthening activity for all age groups.
The importance of muscle-strengthening activities was highlighted in a 2018 review which concluded that higher levels of upper- and lower-body muscular strength are associated with a lower risk of mortality in the adult population, regardless of age and follow-up period.
Although aerobic activities have become an established route for reducing both CVD and all-cause mortality risk, the relationship with muscular strength has been less well studied. For the present analysis, the Japanese team looked at the strength of the association between muscle-strengthening activities and the risk of CVD, cancer and mortality in adults.
In addition, they were wanted to determine the dose-response relationship with health outcomes and also whether there were synergistic benefits from combing muscle strengthening and aerobic activities.
The team searched all the major databases from inception to 2020 for studies which considered the health outcomes from muscle strengthening activities in those without severe health conditions such as cancer at baseline.
Muscle strengthening activities and health outcomes
A total of 16 studies were included in the final analysis which covered all-cause mortality (8), CVD (9), total cancer (7), type 2 diabetes (5) and site-specific cancers (2). The number of participants varied between 3809 to 479,856 and the median duration of follow-up was 25.2 years and included patients 18 to 97 years of age.
Among studies which considered all-cause mortality, muscle-strengthening activities were associated with a 15% reduced risk of death (relative risk, RR = 0.85, 95% CI 0.79 – 0.93, p < 0.001). With respect to the duration of activities, the lowest RR was seen at 40 minutes/week (RR = 0.83, 95% CI 0.79 – 0.86). Combing muscle and aerobic activities led to a 40% lower mortality risk (RR = 0.60, 95% CI 0.54 – 0.67) compared to no activity.
For CVD, there was a 17% lower risk from undertaking muscle-strengthening exercises (RR = 0.83, 95% CI 0.73 – 0.93) and the lowest relative risk occurred with training for at least 60 minutes/week (RR = 0.82, 95% CI 0.76 – 0.90).
Finally, muscle-strengthening activities led to a 12% lower risk of total cancer incidence (RR = 0.88) and a 17% lower incidence of diabetes (RR = 0.83).
Discussing their findings, the authors noted that there was a J-shaped relationship between muscle-strengthening activities and all-cause, CVD and total cancer mortality, with the greatest benefit (i.e., highest risk reduction) after 30 to 60 minutes/week of activities.
They concluded that the greatest benefit was accrued from combining muscle and aerobic activities although added the caveat that since the available data are currently limited, further studies are required to increase the certainty of the evidence.
Citation
Momma H et al. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies Br J Sports Med 2022
4th January 2022
Sex-related differences in mortality in patients with heart failure hospitalisations appear to be affected by the left ventricular ejection fraction according to researchers from the Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Although the risk of heart failure (HF) is similar between men and women, there are some notable sex-related differences, with men being predisposed to HF with reduced ejection fraction and women with preserved ejection fraction.
Although there is some evidence that women with HF live longer than men, they experience more psychological and physical disability. However, much of the available data is derived from patients with stable HF and what is less clear, is if there are any sex-related prognostic differences among patients hospitalised following decompensated heart failure.
For the present study, the Spanish team retrospectively examined gender differences in mortality across the left ventricular ejection fraction spectrum in a cohort of patients after a hospitalisation for acute HF.
The researchers used a multi-centre prospective registry of those hospitalised and collected demographics, medical history, laboratory and echocardiographic parameters and followed patients over a 6-month period.
The primary study endpoints were all-cause, cardiovascular and HF-related mortality. Cardiovascular death was considered secondary to a worsening of HF, acute myocardial infarction, stroke or transient ischaemic attack, whereas HF-related deaths were considered secondary to a worsening of the HF or a sudden cardiac death.
Findings
A total of 4812 patients with a mean age of 74.2 years (46.6% women) were included in the analysis. The proportion of patients with a left ventricular ejection fraction (LVEF) of < 40%, 41 – 49% and > 50% was 31.5%, 14.3% and 54.2% respectively. Women were generally older with a mean age of 76.8 years compared to 71.9 years for men and had a higher preserved ejection fraction (70.5% vs 39.9%, female vs male, p < 0.001).
After 6 months, 645 (13.4%) of the patients had died with mortality rates of 13.3% and 13.5% (women vs men, p = 0.82) and there were no significant sex-related differences in all-cause mortality. Moreover, LVEF was not an independent predictor of mortality (HR = 1.02, 95% CI 0.99 – 1.05, p = 0.13). Similarly, rates of cardiovascular mortality were not different between the sexes.
However, there was a significant interaction between sex and levels of LVEF (p for interaction = 0.030) and women had a significantly lower risk of cardiovascular mortality at lower LVEF levels (< 25%). There were also no differences between the sexes in HF-related mortality although as with cardiovascular mortality, there were differences across the levels of LVEF and women had a reduced risk of HR-related death.
For example, compared to men, women had a reduced risk of HF death at a LVEF of < 43% (HR = 0.77, 95% CI 0.59 – 0.99) In contrast, this risk of death in women became higher as the LVEF increased above 80%.
Commenting on these findings, the authors noted that while sex was not a determinant of 6 month all-cause mortality, women had a lower risk of cardiovascular and HR-related mortality where the LVEF was < 25% and < 43% but higher where the LVEF was > 80%.
They concluded that further work is required to confirm these findings and to evaluate the potential negative implications of a supra-normal LVEF in women with a preserved ejection fraction.
Citation
Santas E et al. Sex-Related Differences in Mortality Following Admission for Acute Heart Failure Across the Left Ventricular Ejection Fraction Spectrum J Am Heart Assoc 2021.
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