Tag Archives: #heartattack

Survival After Cardiac Arrest – Freiburg Cardiovascular Surgeons Develop New Technique (Medicine)

Around 50,000 people suffer sudden cardiac arrest in Germany every year. When occurring outside a hospital, the chances of survival are only ten percent. Survivors often suffer from severe permanent neurological damage. On July 21st, 2021, researchers from the Faculty of Medicine – University of Freiburg, Germany, published together with German and US colleagues a review article in the journal Nature Reviews Neuroscience. They describe the most important therapeutic factors for successful resuscitation. The scientists name the therapy concept based on these factors CARL (Controlled Automated Reperfusion of the whoLe body). In recent years, the Freiburg physicians and perfusionists have already developed a special and mobile heart-lung machine for resuscitation that allows a CARL therapy for the first time. One of the first persons treated with CARL therapy successfully survived a cardiac arrest after about 120 minutes of resuscitation. The affected person suffered no brain damage.

“After decades of research, we were able to develop a new treatment method to reduce the physical damage that would otherwise occur after cardiac arrest and resuscitation. Our findings and the device we developed could be of great importance for emergency medicine,” said Prof. Dr. Friedhelm Beyersdorf, Medical Director of the Department of Cardiovascular Surgery at Medical Center – University of Freiburg. „The CARL method incorporates the latest basic research and state-of-the-art cardiac surgical techniques. Through innovative medical technology developments of our own, we now have the opportunity to apply this new treatment principle inside and outside the hospital. This raises the prospect of people surviving much longer and better after cardiac arrest than was previously thought,” Beyersdorf said.

Success factors for resuscitation

As a result of cardiac arrest, blood vessels in the brain swell, making them less permeable to gas exchange. „By maintaining a high, pulse-like blood pressure during controlled whole-body reperfusion (CARL therapy), we can resuscitate the brain most quickly,” Beyersdorf says. Oxygen levels must be low and increased only slowly. Otherwise, free radicals are generated in the tissues. These very aggressive molecules can then attack, among other things, the mitochondria, the power plants of the cells. A reduced calcium concentration in the blood also helps to protect the mitochondria. „It is very important to lower the body temperature of the patients as quickly as possible in order to slow down metabolic processes,” explains the Freiburg cardiac surgeon, who published the study together with colleagues from Yale University, USA, and Max Planck Institute for Metabolic Research, Germany.

CARL – For the first time, resuscitation therapy in its complexity is possible

Some of the aspects were known in principle, but not in the depth of detail. In addition, various aspects of therapy were not technically feasible until now. That is why scientists at the Medical Center – University of Freiburg founded the startup Resuscitec a few years ago, where they developed a device that specifically meets the complex requirements of resuscitation: the CARL system.

„To our knowledge, CARL is the first device that was developed specifically for resuscitation and can take over the complete cardiopulmonary function of the patient. With CARL we can treat the damage caused by cardiac arrest and the associated lack of oxygen. This is possible because we can immediately measure and control all the important parameters, such as blood values, that are necessary for successful resuscitation,” says Prof. Dr. Christoph Benk, Head of Perfusion at the Department of Cardiovascular Surgery at Medical Center – University of Freiburg.

A unique dual-pump control system enables the necessary high pulsatile blood flow and realizes a high blood pressure, oxygen levels can be precisely controlled, and a mobile cooling unit allows the patient’s body to be cooled down quickly and safely. „The device is designed relatively small and light so that it can fit in the ambulance and be carried directly to the patients,” explains Benk.

First CARL deployments give great hope

In an initial pilot study, the doctors were able to save many of the patients treated with CARL therapy even though resuscitation time was very long, ranging from 50 to 120 minutes. „In the case of a 43-year-old patient, resuscitation was successful after 70 minutes. The patient has fully recovered and is back to working as a teacher,” says Prof. Dr. Georg Trummer, Head of cardiovascular surgical Intensive Care Unit in the Department of Cardiovascular Surgery at Medical Center – University of Freiburg. In another case, a patient suffered cardiac arrest at home and was brought to the Medical Center – University of Freiburg by helicopter after first responder resuscitation. „Here, the patient was immediately connected to the CARL device and – after 120 minutes – successfully resuscitated,” Trummer said. The patient suffered no brain damage and was able to return to her job. To back up these initial promising results, a study is now planned at three European universities as part of the European Commission’s Horizon 2020 program.


Provided by University of Freiburg

COVID-19 Increases Rate of Heart Attacks in People At Genetic Risk For Heart Disease (Medicine)

New research from FH Foundation underscores importance of diagnosing and treating familial hypercholesterolemia

Individuals with genetic high cholesterol, heart disease or both, who were infected with COVID-19 had more heart attacks according to new research by the FH Foundation. While previous studies have speculated about poorer outcomes if a person with genetic high cholesterol – called familial hypercholesterolemia (FH) contracts COVID-19, this study from the FH Foundation’s national healthcare database is the first to demonstrate higher heart attack rates in the real world. Published online in the American Journal of Preventive Cardiology, the study also importantly confirms that COVID-19 increases heart attack rates in individuals with established atherosclerotic cardiovascular disease (ASCVD).

The FH Foundation performed an analysis of 55,412,462 individuals, separating groups into six matched cohorts including diagnosed FH, probable FH, and ASCVD, with and without COVID-19 infection (as identified by the U07.1 ICD-10 code). The researchers found that rates of heart attacks were highest in those with a COVID-19 diagnosis and the presence of diagnosed FH or probable FH with known ASCVD.

“These results are significant because these data underscore the importance of understanding if individuals have underlying cardiovascular disease or genetic high cholesterol when treating for COVID-19 infection or considering vaccination,” said Kelly Myers, study author and chief technology officer of the FH Foundation.

Familial hypercholesterolemia is a common genetic condition that increases an individual’s risk for cardiovascular disease by up to 20-fold due to lifelong elevated low density lipoprotein cholesterol (LDL-C) levels. Today, only 10% of the 1.3 million Americans with FH are diagnosed, due to lack of awareness in the medical community and public. To understand the effect of COVID-19 on these individuals, the researchers applied the FIND FH® machine learning model on the dataset.

The study findings have important implications for individuals with FH who are not diagnosed today, say the researchers. “Probable FH” individuals with pre-existing ASCVD who contracted COVID had heart attacks at a seven-times greater annual rate than their counterparts who did not contract the virus (AIDR 15.4% vs 2.1% p-value <0.002).”

“The highest heart attack rates occurred in individuals infected with COVID-19 who had preexisting cardiovascular disease and were flagged by the FIND FH model as probable FH. We speculate that because these individuals have yet to receive an FH diagnosis, they may not be receiving appropriate lipid lowering treatment placing them at significantly higher risk,” added Dr. Mary McGowan, study author and chief medical officer for the FH Foundation. “This study is a call to action to diagnose individuals with this deadly genetic condition who are hiding in plain sight within our healthcare system, and take particular precautions related to COVID-19 infections. FH is an untapped opportunity for heart disease prevention.”

The FH Foundation plans to leverage this and other ongoing research to continue to advocate to prioritize FH as a public health concern.

Reference: Kelly D. Myers, Katherine Wilemon, Mary P. McGowan, William Howard, David Staszak, Daniel J. Rader, COVID-19 associated risks of myocardial infarction in persons with familial hypercholesterolemia with or without ASCVD, American Journal of Preventive Cardiology, 2021, 100197, ISSN 2666-6677, https://doi.org/10.1016/j.ajpc.2021.100197. (https://www.sciencedirect.com/science/article/pii/S2666667721000519)

Provided by FH Foundation

Heart Attack Recovery Aided By Injecting Heart Muscle Cells That Overexpress Cyclin D2 (Medicine)

In a large-animal study, researchers have shown that heart attack recovery is aided by injection of heart muscle cells derived from human induced pluripotent stem cell line, or hiPSCs, that overexpress cyclin D2. This research, published in the journal Circulation, used a pig model of heart attacks, which more closely resembles the human heart in size and physiology, and thus has higher clinical relevance to human disease, compared to studies in mice. 

An enduring challenge for bioengineering researchers is the failure of the heart to regenerate muscle tissue after a heart attack has killed part of its muscle wall. That dead tissue can strain the surrounding muscle, leading to a lethal heart enlargement.

Heart experts thus have sought to create new tissue — applying a patch of heart muscle cells or injecting heart cells — to replace damaged muscle. Similarly, they have tried to stimulate division of existing heart muscle cells near the damaged area. This current study, led by researchers at the University of Alabama at Birmingham, shows progress in both goals. 

After the experimental heart attack, heart tissue around the infarction site was injected with about 30 million bioengineered human cardiomyocytes that were differentiated from hiPSCs. These cells also overexpress cyclin D2, part of a family of proteins involved in cell division. 

Compared to control human cardiomyocytes, the cyclin D2-cardiomyocytes showed enhanced potency to repair the heart. They proliferated after injection, and by four weeks, the hearts had less pathogenic enlargement, reduced size of dead muscle tissue and improved heart function. 

Intriguingly, the cyclin D2-cardiomyocytes stimulated not only their own proliferation, but also proliferation of existing heart muscle cells around the infarction site of the pig heart, as well as showing angiogenesis, the development of new blood vessels. 

“These results suggest that the cyclin D2-cardiomyocyte transplantation may be a potential therapeutic strategy for the repair of infarcted hearts,” said study leader Jianyi “Jay” Zhang, M.D., Ph.D., the chair of Biomedical Engineering, a joint department of the UAB School of Medicine and the UAB School of Engineering.

This ability of the graft cyclin D2-cardiomyocytes to stimulate the proliferation of nearby existing heart cells suggested paracrine signaling, a type of cellular communication where a cell produces a signal that induces changes in nearby cells.

Exosomes — small blebs or tiny vesicles that are released by human or animal cells and contain proteins and RNA from the cells that release them — are one common form of paracrine signaling. 

Zhang and colleagues found that exosomes that they purified from the cyclin D2-cardiomyocyte growth media indeed promoted proliferation of cultured cardiomyocytes. In addition, the treated cardiomyocytes were more resistant to programmed cell death, called apoptosis, induced by low oxygen levels. The exosomes also induced proliferation of various other cell types, including human umbilical vein endothelial cells, human vascular smooth muscle cells and 7-day-old rat cardiomyocytes that have almost undetectable proliferation.

Part of the cargo that exosomes carry are microRNAs, or miRNAs. These short pieces of RNA have the ability to interact with messenger RNA in target cells, and they are robust players of gene regulation in cells. Humans have more than 2,000 miRNAs with different RNA sequences, and these are thought to regulate a third of the genes in the genome. 

So, the researchers documented which microRNAs were present in exosomes from the cyclin D2-overexpressing cardiomyocytes and in exosomes from non-overexpressing cardiomyocytes.  As expected, they found differences. 

Jianyi “Jay” Zhang, M.D., Ph.D. © UAB

Together, the exosomes from both types of cells contained 1,072 different miRNAs, and 651 were common to the two exosome groups. However, 332 miRNAs were found only in the cyclin D2-overexpressing cardiomyocytes, and 89 miRNAs were specific for the non-overexpressing cardiomyocytes. In preliminary work of characterizing the effects of specific miRNAs, one particular miRNA from the cyclin D2-overexpressing exosomes was shown to stimulate proliferation when delivered into rat cardiomyocytes. 

“Thus, as the therapeutic potential of exosomes for improving cardiac function becomes more evident, combining an exosome-mediated delivery of proliferative miRNAs with transplantation of cyclin D2-overexpressing cardiomyocytes, or cell products, could become a new promising strategy for upregulating proliferation of the recipient cardiomyocytes and reducing cardiac fibrosis,” Zhang said. “Altogether, our data suggest that cardiac cell therapy, involving cardiomyocytes with enhanced proliferation capacity, may become an efficacious future strategy for myocardial repair and prevention of congestive heart failure in patients with acute myocardial infarctions.”

UAB Department of Biomedical Engineering co-authors with Zhang, in the study “Cyclin D2 overexpression enhances the efficacy of human induced pluripotent stem cell-derived cardiomyocytes for myocardial repair in a swine model of myocardial infarction,” are Meng Zhao, Yuji Nakada, Yuhua Wei, Weihua Bian, Anton V. Borovjagin, Yang Zhou and Gregory P. Walcott.

Additional co-authors are Yuxin Chu and Min Xie, Division of Cardiovascular Disease, UAB Department of Medicine; Wuqiang Zhu, Department of Cardiovascular Diseases, Physiology and Biomedical Engineering, Mayo Clinic Arizona, Scottsdale; Thanh Nguyen, UAB Informatics Institute; and Vahid Serpooshan, Emory University and Georgia Institute of Technology, Atlanta.

Support came from National Institutes of Health grants HL114120, HL131017, HL149137 and HL134764.

At UAB, Zhang holds the T. Michael and Gillian Goodrich Endowed Chair of Engineering Leadership.

Featured image: Researchers used a pig model of heart attacks, which more closely resembles the human heart in size and physiology, and thus has high clinical relevance to human disease. © UAB

Reference: Meng Zhao, Yuji Nakada, Yuhua Wei, Weihua Bian, Yuxin Chu, Anton V. Borovjagin, Min Xie, Wuqiang Zhu, Thanh Nguyen, Yang Zhou, Vahid Serpooshan, Gregory P. Walcott, and Jianyi Zhang, “Cyclin D2 Overexpression Enhances the Efficacy of Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes for Myocardial Repair in a Swine Model of Myocardial Infarction”, Circulation, 2021. https://doi.org/10.1161/CIRCULATIONAHA.120.049497

Provided by UAB

Breathing Problems Are The Second Most Common Symptom Of Heart Attacks (Medicine)

One in four heart attack patients have atypical symptoms such as breathing difficulties, extreme exhaustion, and abdominal pain, according to a study published today in European Heart Journal – Acute Cardiovascular Care, a journal of the European Society of Cardiology (ESC). Patients with atypical symptoms were less likely to receive emergency help and more likely to die within 30 days compared to those with chest pain.

“We found that atypical symptoms were most common among older people, especially women, who called a non-emergency helpline for assistance,” said study author Ms. Amalie Lykkemark Møller, PhD student, Nordsjællands Hospital, Hillerød, Denmark. “This suggests that patients were unaware that their symptoms required urgent attention.”

Heart attacks require fast treatment to restore blood flow and reduce mortality. Symptom recognition by patients and health staff is crucial to reduce delays. Ms. Møller said: “Little is known about how symptoms influence the actions of patients and medical services and impact survival.”

The study examined the associations between initial heart attack symptoms, the medical service response and 30-day mortality. The researchers collected data on all calls to a 24-hour medical helpline and an emergency number in the Capital Region of Denmark from 2014 to 2018. At the two services the primary symptom is registered along with the response. The researchers identified adults aged 30 and over who received a heart attack diagnosis within 72 hours of the call. Patients were divided into groups according to their primary symptom.

During the five-year period, a specific primary symptom was recorded for 7,222 of 8,336 heart attacks – chest pain was the most common (72%) while 24% of patients had atypical symptoms, the most frequent being breathing problems. The prevalence of chest pain was highest among men aged 30-59 calling the emergency number and lowest among women older than 79 calling the medical helpline. Atypical symptoms were mainly found among older patients, especially women, who called the helpline.

Among heart attack patients with chest pain, 95% and 76% received an emergency dispatch from the emergency number and medical helpline, respectively. In comparison, just 62% and 17% of heart attack patients with atypical symptoms received an emergency dispatch from the emergency number and medical helpline, respectively.

The 30-day mortality rate for heart attack patients with chest pain was 5% among those who called the emergency number and 3% among those who called the helpline. Rates were higher among heart attack patients with atypical symptoms: 23% and 15% died within 30 days after calling the emergency number and helpline, respectively.

To make a more like-for-like comparison of mortality between patients with chest pain versus atypical symptoms, the researchers standardised for age, sex, education level, diabetes, previous heart attack, heart failure, and chronic obstructive pulmonary disease. The standardised 30-day mortality was 4.3% for patients with chest pain and 15.6% for those with atypical symptoms.

Ms. Møller said: “Taken together, our results show that heart attack patients with chest pain were three times more likely to receive an emergency ambulance than those with other symptoms. People with atypical symptoms more often called the helpline, which could indicate that their symptoms were milder, or they were not aware of the severity. Vague symptoms may contribute to health staff misinterpreting them as benign.”

While breathing difficulties, extreme exhaustion, impaired consciousness, and abdominal pain were the most common heart attack symptoms after chest pain, Ms. Møller noted that in most cases these problems are not caused by a heart attack. “Unfortunately, people in this situation will not know the cause, but we hope our study improves awareness – particularly among older patients and health professionals – that it could be a heart attack,” she said.

“Death within 30 days was more than three-fold higher in those with atypical symptoms compared to chest pain,” she added. “This could be due to treatment delays caused by not receiving the appropriate emergency dispatch. However, it is unknown whether an increase in emergency dispatches alone would improve survival among heart attack patients with atypical symptoms – we aim to investigate this in future research projects.”

Reference: Møller AL, Mills EHA, Gnesin F, et al. Impact of myocardial infarction symptom presentation on emergency response and survival. Eur Heart J Acute Cardiovasc Care. 2021. doi:10.1093/ehjacc/zuab023. Link will go live on publication: https://academic.oup.com/ehjacc/article-lookup/doi/10.1093/ehjacc/zuab023

Provided by European Society of Cardiology

New Blood Markers May Reveal Heart Attack in Chest Pain Patients (Medicine)

Study reveals molecules in the blood that could provide an early warning for doctors in identifying heart attack patients

A patient arrives at hospital with chest pain. Doctors suspect heart attack and rapid diagnosis is important, but the tests to confirm it can be invasive and it could easily be something else. Could a simple blood test help to non-invasively rule heart attack in or out? A new study in open access journal Frontiers in Cardiovascular Medicine certainly suggests so. The study identified telltale markers in the blood of heart attack patients that distinguished them from patients suffering chest pain with other causes. The researchers hope that the results will lead to new diagnostic tests for heart attacks.

If you have ever suffered chest pain, the possibility of a heart attack may have popped into your head. While chest pain is an important symptom for heart attacks, there are a variety of other conditions that can cause similar symptoms, and many of them are not serious. If a patient presents with chest pain at hospital, doctors need to quickly determine if a heart attack is the culprit. Early treatment is important in limiting the damage that occurs.

At present, this may involve coronary angiography, where a catheter is placed into the blood vessels of the heart. While effective, angiography is invasive, and not something you would like to undergo if unnecessary. In addition, in busy or poorly resourced hospitals, angiography may not always be available in time. Another test involves taking a blood sample to check for proteins that indicate damage to the heart muscle. However, these markers are sometimes unreliable, and can be elevated by other conditions.

These issues inspired these researchers to look for new markers in the blood that form a unique fingerprint for a heart attack. They turned to small molecules called metabolites that are produced during biochemical processes within our bodies.

“We analyzed circulating metabolites in blood plasma samples from cardiac chest pain patients, including heart attack cases and other cardiac chest pain cases, to identify potential markers for heart attack diagnosis and early warning,” explained Dr Xiangqing Kong of the First Affiliated Hospital of Nanjing Medical University, corresponding author on the paper. “Such markers could be helpful in confirming heart attack in a timely manner when angiography is unavailable.”

The researchers collected blood samples from 146 patients who presented at hospital with chest pain and 84 healthy volunteers. Of the 146 chest pain patients, 85 were later confirmed to have suffered a heart attack and the remainder had chest pain from other causes.

Strikingly, on analyzing the samples, the researchers found an array of metabolites that were present in different amounts, and the differences were significant enough that they could successfully distinguish between the samples from heart attack patients, those with non-heart attack-related chest pain and the healthy volunteers. Three metabolites showed particular promise as diagnostic markers.

“Even after accounting for other cardiac risk factors such as hypertension, smoking and diabetes history, the metabolites deoxyuridine, homoserine and methionine scored highly as potential diagnostic and risk markers of heart attack,” explained Dr Jiye Aa of the China Pharmaceutical University, another author on the paper.

In reality, a suspected heart attack patient will likely undergo various tests before a heart attack is confirmed, but expanding the available arsenal of reliable tests will be useful for doctors in narrowing things down quickly. The researchers plan to conduct further research to assess why and how these biomarkers are involved in heart attacks.

Reference: Nan Aa, Ying Lu et al., “Plasma Metabolites Alert Patients With Chest Pain to Occurrence of Myocardial Infarction”, Front. Cardiovasc. Med., 23 April 2021 | https://doi.org/10.3389/fcvm.2021.652746

Provided by Frontiers

New Treatment Shows Promise in Preventing Heart Failure After Heart Attack (Medicine)

Mouse study finds molecule repairs heart tissue to avoid damage

A study in mice finds treatment with a molecule called MCB-613 repairs heart tissue after a severe heart attack, preventing damage that can lead to heart failure. The findings are being presented virtually at ENDO 2021, the Endocrine Society’s annual meeting.

“This is a remarkable discovery that may lead to effective and safe treatments to prevent the progression to heart failure after a heart attack,” said lead researcher Lisa K. Mullany, Ph.D., of Baylor College of Medicine in Houston.

Heart failure after a heart attack is the leading cause of death in humans, and currently there are no definitive therapies other than heart transplantation. 

Researchers had previously found that MCB-613 stimulates proteins called steroid receptor coactivators (SRCs). These proteins are responsible for cellular changes and growth during both normal and abnormal tissue growth. After a heart attack, the damaged tissue scars. This results in tissue loss, as well as increased inflammation, scarring and decrease in heart function—all hallmarks of heart failure caused by a heart attack.

In the new study, the researchers were able to show that when mice were given MCB-613 within hours after a heart attack, the molecule decreased inflammation and scarring, and prevented the progressive decrease in heart function.

“Our findings show us that we can directly modulate heart tissue repair to prevent heart failure,” Mullany said.


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Exhaustion Linked With Increased Risk of Heart Attack in Men (Medicine)

Men experiencing vital exhaustion are more likely to have a heart attack, according to research presented today at ESC Acute CardioVascular Care 2021, an online scientific congress of the European Society of Cardiology (ESC).1 The risk of a myocardial infarction linked with exhaustion was particularly pronounced in never married, divorced and widowed men.

“Vital exhaustion refers to excessive fatigue, feelings of demoralisation and increased irritability,” said study author Dr. Dmitriy Panov of the Institute of Cytology and Genetics, Novosibirsk, Russian Federation. “It is thought to be a response to intractable problems in people’s lives, particularly when they are unable to adapt to prolonged exposure to psychological stressors.”

This study examined the relationship between vital exhaustion and the risk of myocardial infarction in men with no history of cardiovascular disease. The study used data from the World Health Organization (WHO) MONICA Project.2 A representative sample of 657 men aged 25 to 64 years in Novosibirsk was enrolled in 1994.

Symptoms of vital exhaustion were assessed at baseline using the Maastricht Vital Exhaustion Questionnaire adopted by the MONICA protocol. Participants were classified according to their level of vital exhaustion: none, moderate, or high. Participants were followed-up for 14 years for the incidence of heart attack.

Overall, two-thirds (67%) of the men had vital exhaustion (15% had a high level and 52% had a moderate level) while 33% were unaffected. Nearly three-quarters (74%) of men with high blood pressure had vital exhaustion –  high in 58% and moderate in 16%.

In the overall group of men, the researchers analysed the association between vital exhaustion at baseline and the risk of having a heart attack. Compared to those without vital exhaustion, men with moderate or high levels had a 2.7-fold greater risk of a heart attack within five years, a 2.25 higher risk within 10 years, and a 2.1 raised risk within 14 years (p for all <0.05).

When the analysis was controlled for social factors (education, occupation, and marital status) and age, the influence of vital exhaustion on heart attack risk decreased but remained statistically significant. For example, compared to those without vital exhaustion, men with moderate or high levels were 16% more likely to have a myocardial infarction over 14 years of follow-up compared to those without after adjusting for social factors and age (p <0.05).

In the adjusted analysis, the risk of a heart attack linked with exhaustion was higher in never married, divorced, and widowed men compared to married men – with hazard ratios of 3.7, 4.7, 7.0, respectively. The risk of a heart attack related to exhaustion was 2.2-fold higher in those with an elementary school education compared to men with a university degree. Middle-aged men were more affected than younger men: compared to 24-34-year-olds, the risk of a heart attack connected with exhaustion was 3.8-fold higher in 45-54-year-olds and 5.9-fold higher in 55-64-year-olds.

Regarding the influence of marital status on the relationship between exhaustion and heart attack, Dr. Panov said: “Living alone indicates less social support, which we know from our prior studies is an independent risk factor for myocardial infarction and stroke.”

He noted that the findings indicate a pattern whereby social disadvantage relates to vital exhaustion, which is associated with a greater risk of heart disease. “The relationship of exhaustion with threatening cardiovascular events should be taken into account when assessing risk,” he said.

Dr. Panov concluded: “Efforts to improve well-being and reduce stress at home and at work can help reduce vital exhaustion. Involvement in community groups is one way to increase social support and become less vulnerable to stress. Together with a healthy lifestyle, these measures should be beneficial for heart health.”

Funding: This survey was performed within the framework of the budgetary theme NIITPM – branch of the ICG SB RAS Reg. № AAAA-A17-117112850280-2, Gov.Task № 0324-2018-0001.

Disclosures: The authors declare no conflict of interest.

References and notes

1Reference: Gafarov VV, Gromova EA, Gagulin IV, Gafarova AV. [Study of the influence of vital exhaustion on myocardial infarction risk in a male population aged 25 to 64 years]. Klin Med (Mosk). 2005;83(5):23-6. Russian. PMID: 15984577. https://pubmed.ncbi.nlm.nih.gov/15984577/

2The analysis was part of the WHO MONICA Optional Psychosocial Substudy (MOPSY).

Provided by European Society of Cardiology

Instant Death From Heart Attack More Common in People Who Do Not Exercise (Medicine)

An active lifestyle is linked with a lower chance of dying immediately from a heart attack, according to a study published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1

Heart disease is the leading cause of death globally and prevention is a major public health priority. The beneficial impact of physical activity in stopping heart disease and sudden death on a population level is well documented. This study focused on the effect of an active versus sedentary lifestyle on the immediate course of a heart attack – an area with little information.

The researchers used data from 10 European observational cohorts including healthy participants with a baseline assessment of physical activity who had a heart attack during follow-up – a total of 28,140 individuals. Participants were categorised according to their weekly level of leisure-time physical activity as sedentary, low, moderate, or high.

The association between activity level and the risk of death due to a heart attack (instantly and within 28 days) was analysed in each cohort separately and then the results were pooled. The analyses were adjusted for age, sex, diabetes, blood pressure, family history of heart disease, smoking, body mass index, blood cholesterol, alcohol consumption, and socioeconomic status.

A total of 4,976 (17.7%) participants died within 28 days of their heart attack – of these, 3,101 (62.3%) died instantly. Overall, a higher level of physical activity was associated with a lower risk of instant and 28-day fatal heart attack, seemingly in a dose–response-like manner. Patients who had engaged in moderate and high levels of leisure-time physical activity had a 33% and 45% lower risk of instant death compared to sedentary individuals. At 28 days these numbers were 36% and 28%, respectively. The relationship with low activity did not reach statistical significance.

Study author Dr. Kim Wadt Hansen of Bispebjerg Hospital, Copenhagen, Denmark said: “Almost 18% of patients with a heart attack died within 28 days, substantiating the severity of this condition. We found an immediate survival benefit of prior physical activity in the setting of a heart attack, a benefit which seemed preserved at 28 days.”

He noted: “Based on our analyses, even a low amount of leisure-time physical activity may in fact be beneficial against fatal heart attacks, but statistical uncertainty precludes us from drawing any firm conclusions on that point.”

The authors said in the paper: “Our pooled analysis provides strong support for the recommendations on weekly physical activity in healthy adults stated in the 2016 European Guidelines on cardiovascular disease prevention in clinical practice;2 especially as we used cut-off values for physical activity comparable to those used in the guidelines.”

The guidelines recommend that healthy adults of all ages perform at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity or an equivalent combination thereof.

Dr. Hansen concluded: “There are many ways to be physically active at little or no cost. Our study provides yet more evidence for the rewards of exercise.”

The Danish Heart Foundation (18-R124-A8318-22104). The funding source was not involved in study design; collection, analysis, and interpretation of data; writing of the report; or the decision to submit the report for publication.

References: (1) Hansen KW, Peytz N, Blokstra A, et al. Association of fatal myocardial infarction with past level of physical activity: a pooled analysis of cohort studies. Eur J Prev Cardiol. 2021. doi: 10.1093/eurjpc/zwaa146. https://academic.oup.com/eurjpc/article-lookup/doi/10.1093/eurjpc/zwaa146 (2) Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315–2381. https://academic.oup.com/eurheartj/article/37/29/2315/1748952

About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.

About the European Journal of Preventive Cardiology

The European Journal of Preventive Cardiology is the world’s leading preventive cardiology journal, playing a pivotal role in reducing the global burden of cardiovascular disease.

Drinking Green Tea, Coffee Lowers Risk of Death For Stroke and Heart Attack Survivors (Food)

Research Highlights:

  • Stroke survivors who drank seven or more cups of green tea each day lowered their risks of multiple causes of death by 62%.
  • Drinking one cup of coffee each day lowered the risks of death for heart attack survivors and for those without a history of stroke or heart attack.

Stroke and heart attack survivors can reduce multiple causes of death and prevent further cardiovascular events by drinking green tea, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association. The study also found daily coffee consumption helps heart attack survivors by lowering their risk of death after a heart attack and can prevent heart attacks or strokes in healthy individuals.

Previous research has examined the benefits of green tea and coffee on heart health in people without a history of cardiovascular disease or cancer. Researchers in the study “Green tea and coffee consumption and all-cause mortality among persons with and without stroke or myocardial infarction” sought to determine the effects of green tea and coffee consumption after surviving a stroke or heart attack.

“There is a strong need for scientific evidence on the lifestyles among survivors of stroke and heart attack considering the rapidly aging population and the need to improve life expectancy following these cardiovascular events,” says Hiroyasu Iso, M.D., a professor of public health at Osaka University in Suita, Japan, and the study’s corresponding author.

Researchers analyzed data of more than 46,000 participants (ages 40 to 79, 60% female) from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC study), a study conducted in 45 communities across Japan. Participants were asked to complete self-administered questionnaires that included information about demographics, lifestyle, medical history and diet. People were then divided into three groups: history of stroke; history of myocardial infarction (MI); and no history of stroke or MI. Researchers then analyzed the amount and frequency of green tea and coffee consumption. Researchers noted that a typical cup of green tea contains approximately 100mL (about 3.4 ounces) of liquid, and a typical cup of coffee contains approximately 150mL (about 5 ounces) of liquid.

Results include:

  • When compared with participants who rarely drank green tea, stroke survivors who consumed at least seven cups of green tea daily lowered their risk of all-cause mortality by approximately 62%. Researchers did not observe a statistically significant association among participants without a history of stroke or heart attack.
  • Heart attack survivors who drank one cup of coffee a day reduced their overall risk of death by approximately 22% when compared to those who did not regularly drink coffee.
  • People without a history of stroke or heart attack who consumed one or more cups of coffee a week had approximately a 14% lower risk of all-cause mortality compared to non-coffee drinkers.
  • Green tea consumption can prevent further cardiovascular events in survivors, while drinking coffee can prevent such events in healthy individuals.

“An important distinction to make is that in Japanese culture, green tea is generally prepared with water and without sugar. Additionally, coffee is prepared with water and occasionally milk and sugar,” said Iso. “The healthiest way to prepare these beverages is without an unnecessary amount of added sugars.”

Researchers note that this study was observational, and the reason why drinking green tea and coffee lowered the risk of heart attack and stroke cannot be determined. Further research is needed to understand the details in the different effects of green tea and coffee.

Co-authors are Masayui Teramoto, M.D.; Iso Muraki, M.D, Ph.D.; Kazumasa Yamagishi, M.D., Ph.D.; Akiko Tamakoshi, M.D., Ph.D.

Featured image: Cup of coffee with beans and cup of green tea with teapot. copyright American Heart Association 2021

Reference: Masayuki Teramoto, Isao Muraki, Kazumasa Yamagishi, Akiko Tamakoshi, Hiroyasu Iso, “Green Tea and Coffee Consumption and All-Cause Mortality Among Persons With and Without Stroke or Myocardial Infarction”, Stroke, 4 Feb 2021. https://doi.org/10.1161/STROKEAHA.120.032273

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