Cardiology News

According to a recent study published in Science Advances, male and female hearts react differently to the stress hormone noradrenaline. The mouse study might have implications for human cardiac problems such as arrhythmias and heart failure, as well as how different sexes react to different medications.

The researchers created a novel form of fluorescence imaging device that allows them to examine how a mouse heart responds to hormones and neurotransmitters in real time using light. Noradrenaline, commonly known as norepinephrine, was given to the mice. Noradrenaline is a neurotransmitter and a hormone that is involved in the body’s “fight or flight” response.

The results reveal that male and female mouse hearts respond uniformly at first after exposure to noradrenaline. However, some areas of the female heart return to normal more quickly than the male heart, which produces differences in the heart’s electrical activity.

“The differences in electrical activity that we observed are called repolarization in the female hearts. Repolarization refers to how the heart resets between each heartbeat and is closely linked to some types of arrhythmias,” said Jessica L. Caldwell, first author of the study. Caldwell is a postdoctoral scholar in the UC Davis School of Medicine Department of Pharmacology.

“We know that there are sex differences in the risk for certain types of arrhythmias. The study reveals a new factor that may contribute to different arrhythmia susceptibility between men and women,” Caldwell said.

Doctors at Queen Mary University of London, Barts Hospital, and Cambridge University Hospital led research that used a novel form of CT scan to identify microscopic nodules in a hormone gland and remove them to correct high blood pressure. One in every twenty patients with high blood pressure has nodules.

The study, published today in Nature Medicine, tackles a 60-year-old challenge of detecting hormone-producing nodules without a rigorous catheter study that is only offered in a few institutions and frequently fails. The study also discovered that when paired with a urine test, the scan reveals a subset of patients who discontinue all blood pressure medications following therapy.

128 participants took part in a new scan research after physicians discovered that their hypertension (high blood pressure) was caused by a steroid hormone called aldosterone. The scan discovered that two-thirds of individuals with increased aldosterone secretion have a benign lesion in only one of the adrenal glands, which may be safely removed. The scan employs a low-dose of metomidate, a radioactive tracer that adheres solely to the aldosterone-producing nodule. The scan was just as accurate as the traditional catheter test, but it was faster, less painful, and technically effective in every patient.

The catheter test could not determine which individuals will be entirely cured of hypertension by surgical excision of the gland until today.

By contrast, the combination of a ‘hot nodule’ on the scan and urine steroid test detected 18 of the 24 patients who achieved a normal blood pressure off all their drugs.

The research, conducted on patients at Barts Hospital, Cambridge University Hospital, and Guy’s and St Thomas’s, and Universities of Glasgow and Birmingham, was funded by the National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership, Barts Charity, and the British Heart Foundation.

Professor Morris Brown, co-senior author of the study and Professor of Endocrine Hypertension at Queen Mary University of London, said: “These aldosterone-producing nodules are very small and easily overlooked on a regular CT scan. When they glow for a few minutes after our injection, they are revealed as the obvious cause of Hypertension, which can often then be cured. Until now, 99% are never diagnosed because of the difficulty and unavailability of tests. Hopefully this is about to change.”

Professor William Drake, co-senior author of the study and Professor of Clinical Endocrinology at Queen Mary University of London, said:”This study was the result of years of hard work and collaboration between centres across the UK. Much of the ‘on the ground’ energy and drive came from the talented research fellows who, in addition to doing this innovative work, gave selflessly of their time and energy during the national pandemic emergency. The future of research in this area is in very safe hands.”

The aetiology of Hypertension (high blood pressure) is unclear in the majority of cases, and the illness need long-term pharmacological therapy. Previous study by the Queen Mary University group found that a gene mutation in the adrenal glands causes an excess of the steroid hormone aldosterone to be generated in 5-10% of persons with hypertension. Aldosterone increases salt retention in the body, raising blood pressure. Patients with high aldosterone levels in their blood are resistant to treatment with routinely used hypertension medicines, and they are at a higher risk of heart attacks and strokes.

A recent study found that group therapy reduces psychological discomfort, improves quality of life, and leads in fewer readmissions for cardiac issues.

The findings were published in the European Heart Publication, a journal of the European Society of Cardiology, today (ESC).

“Approximately 20 per cent of all cardiac patients have signs of psychological distress, rising to one-third of employed patients,” said study author Annette Holdgaard, a nurse at Copenhagen University Hospital – Bispebjerg and Frederiksberg, Denmark, adding, “Psychological symptoms like palpitations and chest discomfort can be difficult to distinguish from cardiac symptoms. This can lead to a vicious circle, with further distress that might limit a patient’s ability to live a normal life at home and work.”

Previous programmes for dealing with psychological concerns in heart patients were long and taught to individuals by a therapist or psychologist, making them difficult to use in real life. This study looked at the impact of five group sessions of cognitive behavioural therapy (CBT) led by nurses as an adjunct to standard cardiac rehabilitation on anxiety and depression symptoms.

The study comprised 147 working-age cardiac patients who were experiencing psychological distress, defined as a Hospital Anxiety and Depression Scale (HADS) score of 8 or higher for anxiety and/or depression. The average age was 54 years old, and 67% were men. Participants were randomly assigned to either group CBT plus conventional cardiac rehabilitation (CBT group) or cardiac rehabilitation alone for five sessions (control group).

Those in significant distress or with a mental diagnosis were not eligible.

Cardiac rehabilitation was provided over the course of eight weeks, including two 90-minute group sessions per week. Exercise, medication adjustments, and instruction on food, smoking, physical activity, body weight, blood sugar, blood pressure, blood lipids, and psychological disorders were all part of the sessions.

Following brief training, cardiac nurses led CBT sessions under the supervision of a psychologist. Five two-hour sessions were held for groups of three to four patients. Patients confirmed their values, such as family and job, in session 1, and described issues induced by heart disease, such as poor sleep and weariness.

Session 2 included a review of the anxiety circle, where a threat can cause physical reactions and catastrophising thoughts, followed by a discussion of coping strategies, such as gradual exposure to anxiety-filled situations and breathing exercises to calm the nervous system.

Session three dealt with the analysis and consequences of current behaviour. For example, working 50 hours a week may bring short-term satisfaction but leave insufficient time to recover from a heart condition, which could have serious implications in the longer term. Session 4 focused on strategies for dealing with concerns.

While worrying can lead to problem-solving, it can also lead to overthinking and patients learned more constructive behaviour. Finally, in session 5, patients saw how their coping strategies had changed throughout the course, learned how to make optimal use of their strengths, and received an individual maintenance plan for dealing with future distress.

The primary outcome of change in total HADS score from baseline to 3 months improved significantly more in the CBT group (8.0 points) than in the control group (4.1 points). Both subscales (anxiety and depression) also improved significantly more in the intervention group. The CBT group’s improvements in the total score and subscales were maintained at 6 months.

Compared with the control group, the CBT group had greater improvement in quality of life at 6 months and a 57 per cent lower risk of cardiac readmissions at 12 months. Previous research has shown that anxious or depressed patients are less likely to attend cardiac rehabilitation exercises and education sessions, and this study showed that those receiving CBT were more likely to take part than those in the control group.

Ms Holdgaard said, “The findings indicate that all patients attending cardiac rehabilitation should be screened for psychological distress and offered CBT if needed. Those in the therapy group said it was a relief being with others dealing with the same problems. They learned to evaluate and challenge their own thoughts – for example, there may be other reasons for my heart beating faster than that I am dying – and nurses helped them distinguish between cardiac and psychological symptoms. Patients also realised that they can choose how much attention to give a thought, and instead of entering the thought (fusion with it), they can maintain distance (defusion) and let thoughts pass.”

ESC spokesperson, Professor Christi Deaton, of the University of Cambridge, UK said, “This study is important for multiple reasons. It demonstrates the value of interventions for psychological distress, and that brief group-based CBT can be delivered by nurses within existing cardiac rehabilitation programmes with positive and significant effects on outcomes.”

“The study also illustrates the importance of individualising rehabilitation programmes to meet the needs of different patient groups. The results of this study and others show that group CBT is a promising intervention in patients with cardiovascular conditions and psychological distress,” she said.

According to new research published in Hypertension, an American Heart Association journal, high levels of lipoprotein(a), a kind of “bad” cholesterol, may be associated to an 18-20% greater risk of cardiovascular disease in hypertensive people. However, the risk of CVD was not increased in individuals who did not have hypertension.

“High blood pressure is a known cardiovascular disease risk factor, and lipoprotein(a) is a type of inherited ‘bad’ cholesterol that may also lead to cardiovascular disease,” said lead study author Rishi Rikhi, M.D., M.S., a cardiovascular medicine fellow at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “We found that among people with hypertension who have never experienced a stroke or heart attack before, lipoprotein(a) seems to increase the risk of cardiovascular disease and risk of a major cardiovascular event like a heart attack or stroke.”

Hypertension is a key risk factor for cardiovascular disease. In this study, hypertension was defined as a top number of 140 mmHg or higher, a bottom number of 90 mmHg or the use of blood pressure medication. In 2017, the Association updated its definition of hypertension to be a top number of 130 mmHg or higher or a bottom number of 80 mmHg or higher.

Previous studies have indicated that when a person has hypertension and lipid imbalance, or dyslipidemia, their cardiovascular disease risk substantially increases. According to the study’s authors, there is less information on how much of an effect lipoprotein(a) may have on cardiovascular disease risk among people with hypertension.

Lipoproteins, which are made up of protein and fat, carry cholesterol through the blood. The subtypes of lipoproteins include low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipoprotein(a), or Lp(a). Much like LDL cholesterol, lipoprotein(a) cholesterol may deposit and build up in the walls of blood vessels, thus increasing a person’s risk of a heart attack or stroke.

The research used health data from the Multi-Ethnic Study of Atherosclerosis (MESA) study, an ongoing community-based study in the U.S. of subclinical cardiovascular disease–meaning the disease is discovered before there are clinical signs and symptoms.

MESA is a research study including nearly 7,000 adults that began in 2000 and is still following participants in six locations across the U.S.: Baltimore; Chicago; New York; Los Angeles County, California; Forsyth County, North Carolina; and St. Paul, Minnesota. At the time of enrollment in the study, all participants were free from cardiovascular disease.

The current study included 6,674 MESA participants who had lipoprotein(a) levels and blood pressure assessed and for whom there was documented cardiovascular disease event data throughout MESA’s follow-up exams in approximately 2001, 2003, 2004, 2006, 2010, 2017 and in telephone interviews every 9 to 12 months to gather interim data on new diagnoses, procedures, hospitalization and deaths.

The study’s participants were from diverse racial and ethnic groups: 38.6 per cent self-identified as white adults; 27.5 per cent self-identified as African American adults; 22.1 per cent self-identified as Hispanic adults, and 11.9 per cent self-identified as Chinese American (n=791) adults. Additionally, more than half of the group was female (52.8 per cent).

To evaluate the potential correlation between hypertension and lipoprotein(a) on the development of cardiovascular disease, the researchers first categorized the participants into groups based on their lipoprotein(a) levels and blood pressure measures obtained once at baseline:

1. Group 1 (2,837 people): lipoprotein(a) levels less than 50 mg/dL and no hypertension.

2. Group 2 (615 people): lipoprotein(a) levels greater than or equal to 50mg/dL and no hypertension

3. Group 3 (2,502 people): lipoprotein(a) levels less than 50mg/dL and hypertension

4. Group 4 (720 people): lipoprotein(a) levels >= 50mg/dL and hypertension

Participants were followed for an average of approximately 14 years and cardiovascular events, including heart attack, cardiac arrest, stroke or death from coronary artery disease, were tracked.

The study’s results include:

1. A total of 809 of the participants experienced a cardiovascular disease event.

2. Lipoprotein(a) levels had an effect on hypertension status that was statistically significant (meaning it was not due to chance).

3. When compared to Group 1 (low lipoprotein(a) levels and no hypertension), Group 2 (higher lipoprotein(a) levels and no hypertension) did not have an increased risk for cardiovascular disease events.

4. Less than 10 per cent of Group 1 (7.7 per cent) and Group 2 (participants 8 per cent) had cardiovascular disease events.

5. Participants in Groups 3 and 4, all of whom had hypertension, demonstrated a statistically significant increase in risk for cardiovascular disease events when compared to those in Group 1.

6. Approximately 16.2 per cent of the people in Group 3 (lower lipoprotein(a) levels and hypertension) had cardiovascular disease events, and 18.8 per cent of the participants in Group 4 (higher lipoprotein(a) levels and hypertension) experienced cardiovascular disease events.

“We found that the overwhelming amount of cardiovascular risk in this diverse population appears to be due to hypertension,” Rikhi said. “Additionally, individuals with hypertension had even higher cardiovascular risk when lipoprotein(a) was elevated. The fact that lipoprotein(a) appears to modify the relationship between hypertension and cardiovascular disease is interesting, and suggests important interactions or relationships for hypertension, lipoprotein(a) and cardiovascular disease, and more research is needed.”

Everyone can improve their cardiovascular health by following the American Heart Association’s Life’s Essential 8 guidelines, which include eating healthy foods, being physically active, not smoking, getting enough sleep, maintaining a healthy weight, and controlling cholesterol, blood sugar, and blood pressure levels. According to the American Heart Association, cardiovascular disease claims more lives in the United States each year than all forms of cancer and chronic lower respiratory disease combined.

According to a three-month pilot research of people with hypertension published by Elsevier in the Canadian Journal of Cardiology, yoga is more advantageous than stretching activities for enhancing cardiovascular health and wellness. Yoga lowered resting heart rate and systolic blood pressure, which decreased 10-year cardiovascular risk.

Yoga is a part of the spiritual and physical habits of millions of people throughout the world. As yoga becomes a more widely practised form of exercise, study into the subject is growing. It is a versatile kind of exercise that can improve overall health and cardiovascular fitness. While there are many similarities between stretching exercises and the physical practises of yoga, there are also notable differences.

“The aim of this pilot study was to determine whether the addition of yoga to a regular exercise training regimen reduces cardiovascular risk,” explained lead investigator Paul Poirier, MD, PhD, Quebec Heart and Lung Institute – Laval University, and Faculty of Pharmacy, Laval University, Quebec, Canada.

“While there is some evidence that yoga interventions and exercise have equal and/or superior cardiovascular outcomes, there is considerable variability in yoga types, components, frequency, session length, duration, and intensity. We sought to apply a rigorous scientific approach to identify cardiovascular risk factors for which yoga is beneficial for at-risk patients and ways it could be applied in a healthcare setting such as a primary prevention program.”

For an exercise training programme, researchers included 60 people with metabolic syndrome and previously confirmed high blood pressure. Participants were split into two groups for the duration of the three-month intervention programme, and each group engaged in 15 minutes of organised yoga or stretching in addition to five sessions of 30 minutes of aerobic activity.

The Framingham and Reynolds Risk Scores, anthropometry, high-sensitivity C-reactive protein (hs-CRP), glucose, and cholesterol levels, as well as blood pressure, were all assessed. Age, sex, smoking rates, body mass index (BMI), resting systolic and diastolic blood pressure, resting heart rate, and pulse pressure did not differ across groups at the beginning of the study.

Both groups’ resting systolic and diastolic blood pressure, mean arterial blood pressure, and heart rates decreased after 3 months. Stretching only decreased systolic blood pressure by 4 mmHg, whereas yoga reduced it by 10 mmHg. Additionally, the yoga method decreased the 10-year cardiovascular risk score and resting heart rate.

Yoga has been demonstrated to help hypertension patients, although the precise mechanism by which it does so is still unclear. This pilot randomised trial demonstrates that stretching alone cannot account for all of its positive effects.

“This study provides evidence for an additional non-pharmacologic therapy option for cardiovascular risk reduction and blood pressure control in patients with high blood pressure, in the setting of a primary prevention exercise program,” noted Dr Poirier.

“As observed in several studies, we recommend that patients try to find exercise and stress relief for the management of hypertension and cardiovascular disease in whatever form they find most appealing. Our study shows that structured yoga practices can be a healthier addition to aerobic exercise than simply muscle stretching.”