Heart Attacks Spike During Holiday Season – How Can You Minimize Your Risk?

MedicalResearch.com Interview with:

Dr. Lowell H. Steen, Jr., M.D. Interventional Cardiologist Loyola University Medical Center

Dr. Steen

Dr. Lowell H. Steen, Jr., M.D.
Interventional Cardiologist
Loyola University Medical Center

Dr. Steen discusses how holiday treats & stress can increase the risk of heart attack.

MedicalResearch.com: What are the main factors that are linked to an increase in heart related adverse events during the Christmas holiday season? Who is most at risk? 

Response: The increase in holiday season heart-related hospitalizations and deaths are due to a variety of behaviors such as putting off seeking medical help until after the holidays, overeating rich foods, strenuous travel, excessive alcohol consumption and stressful family interactions. These factors can all trigger heart issues.

Factors such as age, diabetes, high cholesterol and smoking all increase heart risk. Additionally, those with high blood pressure, which is a leading risk factor for heart disease and stroke, are exceptionally at risk and should celebrate the hectic holiday season with caution.  Continue reading

Heart Attacks Less Common in Women, But More Likely To Be Fatal

MedicalResearch.com Interview with:
Dr. Edina Cenko  MD, PhD first author  and
Dr. Raffaele Bugiardini M.D. FESC, FAHA,
Professor of Cardiovascular Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

MedicalResearch.com: What is the background for this study?

Response: Recent studies have identified younger women as “at-higher risk of mortality” after acute myocardial infarction. However, There are few studies looking at sex differences in mortality of patients with ST-Elevation Myocardial Infarction (STEMI). None of these studies have adjusted outcomes for treatment and delay to primary PCI, which may largely contribute to variations in clinical decision making and sex differences in outcomes. We used a large data set with fully risk and medications-adjusted models to investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age in this excess of risk.

MedicalResearch.com: What are the main findings? 

Response: The different twist to this manuscript is to demonstrate that even when women have the same aggressive interventional and medical therapy as men, they die more than men and much more if women are younger , less than 60 years

MedicalResearch.com: What should readers take away from your report?

Response: Younger women are less likely to have a STEMI, but when they do so they show an excess of 30-day death than men, even in primary PCI treated patients. One strategy does not fit all in terms of women and men and mortality after STEMI. We need a more personalized approach to cardiovascular care. Behind sex disparities, sex is a biological variable in myocardial infarction. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The study supports the new NIH initiative requiring researchers to factor sex into the design, analysis, and reporting of studies. Severe adverse effects in women were not recognized by clinical trials as there was not a sufficient sample of women. Studying (balancing or randomizing) both sexes may inform appropriate medical care for women.  

MedicalResearch.com: Is there anything else you would like to add? 

Response: The current study is the first investigation which demonstrates that differences between younger men and younger women in STEMI mortality rates are unrelated to disparities in treatment. This holds true even in patients undergoing primary PCI. However, more studies are needed. Findings from men could not necessarily be applied to women. It is central considering the effects of sex as a biological variable at all stages and in any type of research on ischemic heart disease.

Any disclosures? Nothing to disclose 

Citations:

Cenko E, Yoon J, Kedev S, et al. Sex Differences in Outcomes After STEMIEffect Modification by Treatment Strategy and Age. JAMA Intern Med. Published online April 09, 2018. doi:10.1001/jamainternmed.2018.0514 

 

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Increased Hospital Spending After Heart Attack Linked To Modestly Lower Mortality

MedicalResearch.com Interview with:
Dr. Rishi K. Wadhera MD
Clinical Fellow in Medicine
Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study?  

Response: The Hospital Value Based Purchasing program, in which over 3,000 hospitals participate, is a Centers for Medicare and Medicaid Services (CMS) pay-for-performance program that links hospital fee per service reimbursement to performance, through measures like 30-day mortality rates after an acute myocardial infarction (a heart attack), and other measures such as average spending for an episode of care for Medicare beneficiaries. Hospitals that perform poorly on these measures are financially penalized by CMS.

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Fewer Heart Attacks and Strokes After Trans-Fat Restriction Laws in New York

MedicalResearch.com Interview with:

Eric J. Brandt, MD Yale University Cardiovascular Disease Fellow

Dr. Eric Brandt

Eric J. Brandt, MD
Yale University
Cardiovascular Disease Fellow

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: From previous studies we know that industrial trans fatty acid (trans fat) consumption is linked to elevated risk for cardiovascular disease. Even small amounts of consumption can be deleterious to cardiovascular health. In New York state, there were 11 counties that restricted the use of trans fatty acids in eateries. We compared hospitalization for heart attacks and stroke from 2002 through 2013 in counties that did and did not have restrictions.

Our study found that when comparing populations within New York state that restricted the use of trans fat, compared to those that did not, there was an associated additional decline beyond temporal trends for heart attacks and stroke events combined by 6.2%.

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Hospital Admissions and Heart Attacks Rise After Snowfall

MedicalResearch.com Interview with:

Nathalie Auger MD MSc FRCPC Montréal, Québec

Dr. Nathalie Auger

Nathalie Auger MD MSc FRCPC
Montréal, Québec

MedicalResearch.com: What is the background for this study?

Response: Snow shoveling is a challenging cardiovascular activity. Some studies suggest a link between snowfall and myocardial infarction, but use aggregate data which are limited. We used health data for individuals in the province of Quebec, Canada to analyze the association between snowfall and likelihood of hospital admission or death due to myocardial infarction.

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Heart Attacks Tripled in Disaster Area Post Katrina

MedicalResearch.com Interview with:
Anand M. Irimpen MD

Associate Professor of Clinical Medicine
Tulane University Medical Center
New Orleans, LA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We did this study to look at the incidence of heart attacks post Katrina. There had been no long-term data on patients having heart attacks post major disaster and hence we decided to investigate this issue.

The main findings are that there is a three-fold increase in heart attacks post Katrina compared to pre – Katrina. There was a higher incidence of hypertension, diabetes, hypercholesterolemia and smoking in the post-Katrina group compared to the pre-Katrina group.

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Lifestyle Practices May Prevent Most Heart Attacks in Men

Agneta Åkesson Associate professor, senior lecturer  Photo by Anna Persson                                                                   Nutritional Epidemiology IMM Institute of Environmental Medicine Karolinska Institutet Stockholm, SwedMedicalResearch.com Interview with
Agneta Åkesson
Associate professor, senior lecturer                                                  Nutritional Epidemiology
IMM Institute of Environmental Medicine
Karolinska Institutet Stockholm, Sweden

Medical Research: What are the main findings of the study?

Dr. Åkesson: Our study indicates that a healthy diet together with low-risk lifestyle practices such as being physically active, not smoking and having a moderate alcohol consumption, and with the absence of abdominal adiposity may prevent the vast majority of myocardial infarctions in men.
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MI: Gender Differences Remain in Presentation, Treatment and Outcomes

Luke Kim, M.D., FACC, FSCAI Assistant Professor of Medicine Interventional Cardiac and Endovascular Laboratory  Greenberg Division of Cardiology, Department of Medicine Weill Cornell Medical College/The New York Presbyterian HospitalMedicalResearch.com Interview with:
Luke Kim, M.D., FACC, FSCAI
Assistant Professor of Medicine
Interventional Cardiac and Endovascular Laboratory
Greenberg Division of Cardiology, Department of Medicine
Weill Cornell Medical College/The New York Presbyterian Hospital

MedicalResearch: What are the main findings of this study?

Dr. Kim: The main findings of the study include:

  1. From 2007-2011, there was no significant change in the rate of acute MI in both male and female cohorts in U.S. . Although there was a decline in the rate of ST-elevation (STEMI) in those ≥55 years old, the rate remains steady in patients < 55 years old, especially in the female cohort after 2009.
  2. Female patients <55 years old with MI were sicker at baseline than the male counterparts with more likelihood of having diabetes, hypertension, chronic renal insufficiency, peripheral vascular disease, congestive heart failure and obesity.
  3. Female patients were more likely to present with non– STEMI vs. STEMI and more likely to develop shock complicating their MIs.
  4. Female patients are less likely to undergo coronary artery revascularization including percutaneous coronary intervention and coronary artery bypass surgery.
  5. Unadjusted risk of death was higher in female vs male (5.2% vs. 3.7%, p<0.001) along with higher incidence of stroke (0.5% vs. 0.3%, p<0.001), bleeding (4.9% vs. 3.0%, p<0.001), vascular complication (0.6% vs. 0.4%, p<0.001) and ARF (11.6% vs. 9.6%, p<0.001). After adjustment, death (OR 1.10 CI 1.04-1.17), stroke (OR 1.31 CI 1.10-1.55), bleeding (OR 1.30 CI 1.22-1.37), and vascular complications (OR 1.33 CI 1.15-1.55) were all significantly higher for female cohort.

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Does Testosterone Lower Risk of Heart Attacks and Stroke?

Robert S. Tan MD, MBA, AGSFMedicalresearch.com Interview with:
Robert S. Tan MD, MBA, AGSF
Clinical Director & Chief Geriatrics, Michael DeBakey VAMC
Director, Opal Medical, LLC
Clinical Professor of Family & Community Medicine, UTHSC-Houston
Associate Professor of Medicine (Geriatrics), Baylor College Medicine

Medicalresearch: What are the main findings of the study?

Dr. Tan: Our findings¹ are similar to that of an early study by Shores et al ² and other studies on endogenous testosterone that found testosterone lowered mortality. In the analysis of 39,937 patients at the Low T Centers up to 5 years, the rate ratios of new MI and strokes on testosterone as compared to general community based data sets (3,4) was 0.12 (C.I. 0.08-0.18, p<0.0001) and 0.05 (C.I 0.02-0.13, p<0.0001) respectively. Thus, there appears to be a lower risk of heart attacks and strokes with patients on testosterone. While the compared population sets are not identical or real controls; our study does suggest that rates of MI and strokes in real life practice with testosterone treated patients are even lower than the general population registries (which may include older patients).
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SPECT MPI to Predict Heart Attacks: Stress Agents Regadenoson vs Adenosine

Dr. Afshin Farzaneh-Far, M.D. University of Illinois at ChicagoMedicalResearch.com Interview with:
Dr. Afshin Farzaneh-Far, M.D.

University of Illinois at Chicago

MedicalResearch.com: What are the main findings of the study?

Answer: Traditionally SPECT MPI has been performed with adenosine which has a
significant body of published prognostic data.

Regadenoson is a selective A2A receptor agonist and is now the stress
agent most widely used in the United States. Unlike adenosine, regadenoson
is given as a bolus rather than as an infusion, simplifying the testing
protocol and is better-tolerated.

However, despite increasing use of regadenoson, there is very limited data
on risk prediction using this agent.

This study showed that the ability of SPECT MPI to predict heart attacks
and death is the same for the new stress agent Regadenoson as it is for
the old agent Adenosine.

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