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12th January 2024
Heart treatments given to patients with takotsubo cardiomyopathy do not protect them and the condition is not being treating correctly, according to a new study comparing these patients with myocardial infarction patients and the general population.
Published in the journal JACC: Advances and funded by the British Heart Foundation, the researchers analysed health records from 3,720 people in Scotland to investigate cardiovascular mortality and medication use after takotsubo cardiomyopathy – for which there is no expert consensus on treatment.
They found that takotsubo cardiomyopathy patients were prescribed the same medication as patients with myocardial infarction despite having unobstructed coronary arteries.
Cardiovascular therapies were consistently associated with better survival in patients with myocardial infarction but not in those with takotsubo syndrome.
These patients were found to be more likely to die than the general population and just as vulnerable to dying as patients who had suffered a myocardial infarction.
A total of 153 (25%) patients with takotsubo cardiomyopathy died over the median of 5.5 years follow-up. This exceeded mortality rates in the general population (N = 374 [15%]; HR: 1.78 [95% CI: 1.48-2.15], P < 0.0001), especially for cardiovascular (HR: 2.47 [95% CI: 1.81-3.39], P < 0.001) but also non-cardiovascular (HR: 1.48 [95% CI: 1.16-1.87], P = 0.002) deaths.
Mortality rates were lower for patients with takotsubo cardiomyopathy than those with myocardial infarction (31%, 195/620; HR: 0.76 [95% CI: 0.62-0.94], P = 0.012), which was attributable to lower rates of cardiovascular (HR: 0.61 [95% CI: 0.44-0.84], P = 0.002) but not non-cardiovascular (HR: 0.92 [95% CI: 0.69-1.23], P = 0.59) deaths.
The only cardiovascular therapy associated with lower mortality in patients with takotsubo cardiomyopathy was angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy (P = 0.0056), but unlike in myocardial infarction, cardiovascular medications were not consistently associated with better long-term survival.
Professor Dana Dawson, professor of cardiovascular medicine and consultant cardiologist at the University of Aberdeen and Aberdeen Royal Infirmary, who led the study, said: ‘Our data shows quite starkly that we are not treating this condition correctly. It is vital that we identify precise ways to treat this unique group of people, and that is what we plan to do as we continue our research.
‘This study has identified one drug as a potential breakthrough with promising therapeutic benefit, however, further research is needed to establish if this is the key to treating this devastating illness.’
11th August 2023
Elevated levels of cardiac troponin in those for whom there was no clinical indication for testing is independently associated with medium-term cardiovascular and non-cardiovascular mortality, according to a large study by researchers at the University of Southampton, UK.
Cardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) and without a clinical presentation consistent with type 1 myocardial infarction, has been linked to a 76% higher risk of death, the study found.
The prospective, observational study, published in the journal Heart, was designed to assess the relationship between medium-term mortality and cTn concentration in a large consecutive hospital population, regardless of whether there was a clinical indication for performing the test.
It‘s rationale was based on prior research showing how increased cTn levels were associated with an increased mortality risk. For example, even among patients with dyspnoea and without a cardiac cause, there is a three-fold higher risk of death when cardiac troponin levels are elevated.
The study included 20,000 hospital patients over the age of 18 years who underwent a troponin blood test for any reason between June and August 2017 at a large teaching hospital, regardless of the original clinical indication. Their average age was 61 and 53% were women.
In 91.4% of these patients, there was no clinical indication for cardiac troponin testing.
The mortality was significantly higher if the cTn concentration was above the ULN (45.3% vs 12.3% p < 0.001 log rank). Using multivariable Cox regression analysis, the log10 cTn concentration remained independently associated with mortality (Hazard ratio, HR = 1.76, 95% CI 1.65 – 1.89).
In addition, multivariable analysis revealed a significant and independent association between the log10cTn concentration with non-cardiovascular (HR =1.99, 95% CI 1.861 – 2.118) as well as cardiovascular mortality (HR = 2.53, 95% CI 2.198 – 2.90).
The researchers concluded on how ‘a snapshot cTn in a hospital population may represent a biomarker of overall medium-term mortality’.
23rd June 2023
Wine drinking is linked to a lower risk of death from cardiovascular disease but also reduces the risk of developing both cardiovascular and coronary heart disease, according to the findings of a recent meta-analysis.
Previous studies have hinted that the polyphenolic content of wine confers a cardio-protective effect whereas consumption of spirits, increases the risk of ventricular arrhythmias. In fact, evidence points to a J-shaped relationship between wine consumption and vascular risk.
Whether these purported benefits of wine are influenced by potential confounders such as age, gender, smoking status and the duration of follow-up within studies is uncertain. For the present study published in the journal Nutrients, researchers undertook a meta-analysis to examine the association between wine consumption and cardiovascular outcomes and assessed if this association was influenced by personal and study factors. The researchers looked for studies in adults and where the reported outcomes were cardiovascular mortality, cardiovascular disease (CVD) and coronary heart disease (CHD).
There were 25 studies with 1,443,245 subjects included in the final analysis.
Wine consumption was associated with a 24% reduced risk of CHD (relative risk, RR = 0.76, 95% CI 0.69 – 0.84). In addition, there were also significant reductions in the risk of CVD (RR = 0.83, 95% CI 0.70 – 0.98) and for cardiovascular mortality (RR = 0.73, 95% CI 0.59 – 0.90).
In a sensitivity analysis, these associations remained statistically significant. However, publication bias was evidence for the link between wine and CVD but not for either CHD or cardiovascular mortality.
In further analysis, the effects of participants’ mean age, the proportion of women in studies, the duration of follow-up or if whether individuals currently smoked, did not impact on the reported associations.
The researchers did caution that increasing wine consumption could be detrimental for patients who are vulnerable to alcohol due to age, medication or pathology. They also suggested that further research is required to differentiate the observed effects by the type of wine.
27th April 2023
The benefits of seafood (SF) intake such as fish exceed the potential risks from contaminants. In fact, an umbrella review identified the beneficial effect of fish intake for a range of chronic diseases. However, another review suggests only a small effect on cardiovascular mortality from eating fish. In addition, other and more recent work, proposes that the health benefits are only due to fatty fish, e.g., sardines, salmon etc.
In the current study, researchers wanted to tease out the benefits of a higher SF intake. They considered total servings of seafood and small fatty fish rich in omega-3 fatty acids separately. Using a self-reported questionnaire, SF intake was categorised as high (>2 servings/week) or low (≤2 servings/week) intake). Similarly, intake of small fatty acid fish was also high or low (> 1 serving or < 1 serving/week). The incidence of both non-fatal and/or fatal CVD events served as the outcomes of interest after 10- and 20-years.
Seafood intake and cardiovascular events
There were 2,020 individuals with a mean age of 45.2 years (50.2% female) with data for analysis. Furthermore, only 32.7% and 9.6% of the entire cohort had a high SF and small fish intake respectively.
Those consuming a high seafood intake, had a 27% lower risk of developing CVD over the next 10 years. However, this risk became non-significant in fully-adjusted models (hazard ratio, HR = 0.76, 95% CI 0.65 – 1.02). In contrast, the 10-year CVD-related mortality was significantly lower in those with a high SF intake (HR = 0.26, 95% CI 0.11 – 0.58). This was also true for a high intake of fatty fish (HR = 0.24, 95% CI 0.06 – 0.99). In addition, the 20-year CVD-related deaths were also lower for a high SF intake (HR = 0.76, 95% CI 0.55 – 0.98).
Therefore a high intake of seafood and particularly fish rich in omega-3 fatty acids, was associated with a lower risk of 10-year fatal and non-fatal CVD.
Citation
Critselis E et al. High fish intake rich in n-3 polyunsaturated fatty acids reduces cardiovascular disease incidence in healthy adults: The ATTICA cohort study (2002-2022) Front Physiol 2023
25th April 2023
Data for 2021 suggests that globally, 537 million were living with diabetes. In addition cardiovascular disease (CVD) is the main cause of death in those with type 2 diabetes (T2D). Moreover, sugar-sweetened and artificially sweetened beverages increase all-cause and CVD-related mortality. Nevertheless, the effect of different beverages on either all-cause mortality or CVD risk in those with T2D is largely unknown. There is also a lack of clarity on whether changes to beverage intake following a T2D diagnoses effects CVD risk.
In a recent BMJ study, researchers set out to investigate the relationship between beverage intake and all-cause mortality in T2D. They also considered if a change in what people drank following their T2D diagnosis affected their subsequent CVD risk. Data were collected from two large US prospective studies (the Nurses’ Health Study and Health Professionals Follow-Up Study). The researchers set the primary outcome as all-cause mortality. Secondary outcome measures were CVD incidence and mortality.
Beverages and all-cause mortality
There were 15,486 men and women with a mean age of 61.3 years (73.6% female) who had a diagnosis of type 2 diabetes at baseline. These individuals were followed for an average of 18.5 years. During this time, 22.3% developed incident CVD and 49.3% died.
When comparing the highest and lowest drink intake, there was a 20% greater all-cause mortality risk for those drinking sugar-sweetened drinks (hazard ratio, HR = 1.20, 95% CI 1.04 – 1.37). In contrast, the all-cause mortality risk was significantly lower in those drinking higher amounts of coffee (HR = 0.74, 95% CI 0.63 – 0.86). This relationship was also apparent for tea (HR = 0.79), plain water (HR = 0.77) and low-fat milk (HR = 0.88). Higher intake of coffee also significantly lowered the risk of CVD incidence (HR = 0.82).
The researchers also considered the effect of changes to beverage intake after an individual had their T2D diagnosis. For example, replacing one serving/day of a sugar sweetened drink with coffee, gave rise to an 18% lower risk of all-cause mortality. Similar trends occurred with tea, plain water and low-fat milk.
6th April 2023
US researchers have found that achieving 8,000 daily steps on only one to two days in a week appears to provide the same all-cause mortality benefit as undertaking the same number of steps for between 3 and 7 days per week.
It has become increasing recognised that a greater number of daily steps is significantly associated with a lower all-cause mortality. However, the mortality benefits appear to plateau for adults older than 60 years at approximately 6000–8000 steps/day and between 8000 – 10 000 steps/day for those under 60 years. Nevertheless, with a lack of time identified as a barrier to undertaking more physical activity by nearly two-thirds of respondents in a recent survey, whether the same mortality benefits could be achieved through undertaking 8,000 daily steps but on less days remains uncertain.
In the current study, researchers set out to evaluate the dose-response association between the number of days an individual takes 8,000 or more daily steps and mortality among US adults. The study included a representative sample of US participants aged 20 years or older, who wore an accelerometer for 1 week. These individuals were then categorised into three groups, based on the number of days that they undertook 8,000 or more daily steps: 0 days, 1 – 2 days and 3 – 7 days. The main outcome of interest was all-cause and cardiovascular mortality over a 10-year follow-up period and the results adjusted for potential confounders such as age, sex, race and ethnicity, insurance status, marital status, smoking, comorbidities and average daily step counts.
One to two days of 8,000 daily steps and all-cause mortality
A total of 3,101 participants with a mean age of 50.5 years (51% female) were included in the analysis. Overall, 20.4% did not take 8,000 steps or more any days of the week, 17.2% took 8000 steps or more 1 to 2 days per week and 62.5% undertook 8000 steps or more 3 to 7 days per week.
Over the 10-year period of follow-up, compared to those who did not walk 8,000 daily steps on any day per week, the all-cause mortality risk was lower among those who took 8000 or more daily steps on one to two days per week (adjusted risk difference, aRD = -14.9%, 95% CI -18.8% to -10.9%). However, among those walking 8,000 or more daily steps for between 3 and 7 days per week, the risk difference was similar (aRD = -16.5%, 95% CI, -20.4% to -12.5%). There were also similar reductions in cardiovascular mortality between the one to two day and three to seven day groups.
The authors concluded that individuals may receive substantial health benefits by walking just a couple days a week.
Citation
Inoue K et al. Association of Daily Step Patterns With Mortality in US Adults. JAMA Netw Open 2023
9th January 2023
A large prospective study by Chinese researchers has found that both separately and combined, coffee and tea consumption is inversely associated with a reduced cardiovascular disease (CVD) and all-cause mortality, highlighting the potential importance of incorporating both into an individual’s diet, provided that these observed associations are causal.
Long-term and moderate consumption of coffee is known to be significantly and inversely associated with cardiovascular disease risk, with the greatest reduction seen with 3 to 5 cups per day. In addition, evidence from China also suggests that daily green tea consumption is associated with a lower risk of incident type 2 diabetes and a lower risk of all-cause mortality in diabetics though the associations for other types of tea is less clear. Nevertheless, emerging data suggests that higher green tea and coffee consumption is inversely associated with a lower risk of cardiovascular disease and stroke in the general population. To date, however, only one study has examined the mortality benefit from coffee and tea consumption, finding that higher consumption of both was associated with reduced all-cause mortality, although the study was restricted to patients with type 2 diabetes. Consequently, it remains unclear whether the benefits of consuming both drinks are more generalisable. In the present study, the Chinese researchers aimed to examine the separate and combined associations of consuming the two beverages, with total and cause-specific mortality (including cardiovascular disease, CVD, respiratory and digestive disease using data from a population-based longitudinal cohort of individuals registered with the UK Biobank.
Intake of coffee and tea were assessed at baseline using a self-reported questionnaire but the researchers also collected information on a range of factors including age, gender, sociodemographic, behavioural (e.g., smoking, exercise, alcohol intake and dietary intake). Intake of both drinks categorised as coffee: none, < 1–2, 3–4 and ≥ 5 cups/day and tea: none, < 1–1, 2–4 and ≥ 5 cups/day.
Coffee and tea intake and mortality outcomes
A total of 498,158 participants with a median age of 58 years (54% female) were included in the analysis. These individuals were followed up for a median of 12.1 years, during which time 34,699 deaths were identified.
In a separate analysis and after adjusting for potential confounders, drinking less than 1 – 2 cups/day of coffee, was inversely associated with a lower risk of all the health outcomes assessed. For example, a 9% lower risk for all-cause mortality (hazard ratio, HR = 0.91, 95% CI 0.88–0.93)and a 6% reduced risk for cardiovascular mortality (HR = 0.94, 95% CI 0.88–1.00). Among those drinking tea, 2 – 4 cups/day was associated with a lower risk for all-cause (HR = 0.86, 95% CI 0.83–0.88) as well as CVD mortality (HR = 0.88 95% CI 0.81–0.94).
However, in joint analyses and compared to those who did not drink either beverage, the combination of < 1 – 2 cups/day of coffee and 2 – 4 cups/day of tea, significantly lowered all-cause mortality (HR = 0.78 95% CI 0.73-0.85) and CVD mortality (HR = 0.76 95% CI 0.64-0.91). Interestingly, the lowest mortality occurred for gastrointestinal disease from drinking both < 1 – 2 cup/day of coffee and ≥ 5 cups/day of tea (HR = 0.42, 95% CI 0.34-0.53).
The authors concluded that consumption of both drinks were both separately and jointly, inversely associated with all-cause and cause-specific mortality.
Citation
Chen Y et al. Consumption of coffee and tea with all-cause and cause-specific mortality: a prospective cohort study. BMC Med 2022
2nd December 2022
An olive oil intake of around 20g/day is associated with a reduced risk of both cardiovascular and all-cause mortality according to the results of a meta-analysis of prospective studies by Greek and Chinese researchers.
Olive oil contains a number of plant polyphenols that have health benefits including anti-mutagenic, anti-inflammatory, anti-thrombotic, anti-atherogenic, and anti-allergic effects. In addition, the monounsaturated fatty acids present in olive oil and in particular, oleic acid, might have positive impacts on lipid peroxidation. In fact, a 2019 network meta-analysis examining the role of olive oil in the modification of metabolic factors such as glucose and circulating lipids, found that olive oil polyphenols increased HDL-cholesterol and that overall, the beneficial effect of olive oil were more pronounced in subjects with an established metabolic syndrome or other chronic conditions/diseases. Furthermore, while some analyses indicate that a higher olive oil intake is associated with lower risk of coronary heart disease, other studies that have examined the link between dietary fat intake (including olive oil) and cardiovascular disease (CVD) events, have found no association.
Trying to provide more definitive evidence, in the present study, researchers performed a meta-analysis of prospective cohort studies to investigate the relationship between olive oil consumption and risk of CVD and all-cause mortality. The team included studies in which the exposure of interest was olive oil consumption and where the recorded outcomes were total CVD or all-cause mortality.
Olive oil intake and cardiovascular and all-cause mortality outcomes
A total of 13 prospective cohort studies were included and the duration of follow-up ranged from 4 to 28 years. Most of the studies collected the dietary data on olive oil intake from food-frequency questionnaires.
In an assessment of CVD risk, the pooled relative risk (RR) for the highest versus the lowest olive oil intake was 0.85 (95% CI 0.77 – 0.93, p < 0.001). In subgroup analysis, this relationship was independent of the region of study, sample size, follow-up duration, sex, or even the type of olive oil.
In terms of all-cause mortality and again comparing the highest and the lowest levels of intake, there was a significant reduction in all-cause mortality (RR: 0.83, 95% CI 0.77 –0.90, p < 0.001). As with CVD risk, there was no significant impact of any of the examined factors in subgroup analysis.
When the researchers looked at the amount of olive oil consumed, the relative risk for CVD for each 5g/day increment was 0.96 (95% CI 0.93 – 0.99, p = 0.005) and this was a similar order of magnitude for all-cause mortality. Interestingly, the reduction in CVD risk was largely attenuated with an intake above 20 g/day and there were also no preventive mortality effects when intake exceeded 20 g/day.
The authors concluded that consuming up to 20g/day of olive oil was associated with a reduced CVD and all-cause mortality risk but that there were no apparent benefits from exceeding this amount.
Citation
Xia M et al. Olive oil consumption and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies. Front Nutr 2022
10th October 2022
Both aerobic physical activity and muscle-strengthening activities on 2 or more days a week such as weight-lifting, are recommended to provide substantial health benefits. In fact, there is good evidence that increased levels of physical activity via aerobic type activities, are associated with a lower mortality risk. However, far less is known about the all-cause and cardiovascular mortality benefits of strength training activities. One analysis of prospective studies found that participation in strength training activities (compared to none) was associated with 21% lower risk of all-cause mortality and a borderline association with lower cardiovascular mortality. Moreover, the authors also noted in the paper that there was lack of evidence on the dose-response relationship between muscle-strengthening activities and cardiovascular risk.
For the present study, a team of US researchers set out to examine the relationship between weight-lifting and all-cause, cardiovascular and cancer mortality both independently and when combined with aerobic moderate to vigorous physical activity (MVPA). They used data from the Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial which began in 1993 and 13 years later, sent follow-up questionnaires to participants which asked about levels of weight-lifting as well as both moderate and vigorous physical activity. For the subsequent analysis of mortality data, the team adjusted for demographic and lifestyle factors which had been assessed in the follow-up questionnaire. In addition, researchers considered the mortality impact based on individual’s reported levels of aerobic MVPA, which was categorised as none, some, meets or exceeds.
Weight-lifting and cardiovascular mortality
A total of 99,713 individuals with a mean age at the start of the follow-up period of 71.3 years (52.6% female) were included in the analysis and followed over an average of 9.6 years. Overall, 23% of participants reported undertaking any weight-lifting activities.
Adults reporting any level of weight-lifting activity had a 9% lower risk of all-cause mortality (Hazard ratio, HR = 0.91, 95% CI 0.88 – 0.94) and for cardiovascular disease mortality (HR = 0.91, 95% CI 0.86 – 0.97) but the reduction in cancer mortality risk was non-significant. Without any adjustment for aerobic activity, lifting weights 1 – 2 times/week was independently associated with a 17% reduced risk of cardiovascular mortality (HR = 0.73, 95% CI 0.79 – 0.97). Interestingly however, increasing the weight-lifting frequency to between 3 and 7 or more times/week did not further reduce the risk of cardiovascular mortality (HR = 0.76, 95% CI 0.71 – 0.82).
When researchers examined all-cause mortality based on the different MVPA categories, those undertaking weight-lifting 1 – 2 times/week and who met MVPA requirement, had 41% lower all-cause mortality (HR = 0.59, 95% CI 0.54 – 0.64). As before, among those who ‘met’ the MVPA requirements, higher levels of weight-lifting activity, did not further reduce all-cause mortality (HR = 0.61).
The authors concluded that both weight-lifting and aerobic activity were independently associated with a reduced all-cause and cardiovascular disease mortality risk and support the notion that both activities were associated with longevity in older adults.
Citation
Gorzelitz J et al. Independent and joint associations of weightlifting and aerobic activity with all-cause, cardiovascular disease and cancer mortality in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial Br J Sports Med 2022
18th July 2022
‘Weekend warriors’ who restrict physical activity to just one or two sessions per week appear to have similar levels of all-cause and cause-specific mortality compared to those who are regularly active, i.e., spread their physical activity over several days. This was the conclusion of a large, prospective cohort study by an international group of researchers.
Physical activity guidelines for Americans (and which are broadly similar across the world) recommend that adults should do at least 150 to 300 minutes a week of moderate-intensity, or 75 to 150 minutes a week of vigorous-intensity aerobic physical activity. In addition, the guidelines advocate muscle strengthening activities of moderate or greater intensity on two days or more each week.
Furthermore, the evidence to date suggests that when adults engage in the recommended levels of physical activity, there is a greatly reduced risk of all-cause and cause specific mortality. Only a single study has examined the mortality benefits achieved by weekend warriors and suggested that it may be sufficient to reduce all-cause mortality risks, in comparison to those who are insufficiently active.
However, it is less clear whether concentrating the recommended amounts of physical exercise into one or two sessions (e.g., weekend warriors) provides the same mortality benefits as observed by those who are physically active throughout the week.
In the present analysis, researchers examined the all-cause and cause-specific mortality between weekend warriors and those who were regularly active using data from the US National Health Interview Survey from 1997 to 2013 and linked this information to a national death index.
They classified individuals as physically active (150 minutes of activity/week) or inactive (< 150 minutes/week). Among those deemed physically active, individuals were sub-divided into weekend warriors (1 – 2 sessions/week) or regularly active (> 3 sessions/week).
The main outcomes of interest were all-cause, cardiovascular and cancer-related mortality. In regression models, adjustments were made for several factors including age, gender, ethnicity and various lifestyle factors such as smoking status, alcohol intake and co-morbidities.
Weekend warriors and all-cause mortality
A total of 350978 individuals with a mean age of 41.1 years (50.8% women) were followed-up for a median of 10.4 years. More than half (52.5%) were deemed physically inactive, 3% weekend warriors and the remaining 44.5% regularly active. During the period of follow-up there were 21 898 deaths including 4130 from cardiovascular disease and 6034 from cancer.
When compared to those deemed physically inactive, the adjusted hazard ratio (HR) for all-cause mortality was 0.92 (95% CI, 0.83 – 1.02) for weekend warriors and 0.85 (95% CI 0.83 – 0.88) for regularly active participants. The HR for cardiovascular disease mortality were also similar for weekend warriors (HR = 0.87) and and those who were regularly active (HR = 0.77), as were the cancer-related HRs.
But when researchers compared mortality between weekend warriors and those who were regularly active, the all-cause, cardiovascular and cancer-related mortality hazard ratios, were also very similar, even after adjustment for the amount and intensity of physical activity undertaken.
The authors concluded that there were no significant differences for any cause mortality among those who were physically active, irrespective of whether the sessions were undertaken throughout the week or concentrated into one or two sessions.
Citation
dos Santos M et al. Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality: A Nationwide Cohort Study JAMA Intern Med 2022
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