Month: December 2022

Global CVD Almanac

Posted on by Madeline Kane

JACC released a special “almanac-style” issue highlighting the growing burden of cardiovascular disease worldwide. 

The Global Burden of Disease, Injuries, and Risk Factors study (GBD) is the world’s largest effort to track population cardiovascular health, recording global, regional, and national trends in mortality and disability since 1990. 

The analysis found that CVD remains the leading cause of death worldwide, responsible for 20M deaths and 400M disability-adjusted life-years lost in 2021. Here are the ACC’s main 2021 takeaways:

  • Ischemic heart disease was the leading cause of CV death, accounting for 9.4M deaths.
  • High systolic BP remained the leading modifiable risk factor for CV deaths, accounting for 10.8M. 
  • Dietary risks (like too few healthy and too many unhealthy foods) accounted for 6.6M CV deaths. 
  • CVD risk attributable to elevated systolic blood pressure was highest in Central Asia, Central Sub-Saharan Africa, and Eastern Europe.
  • CVD burden attributable to dietary risks was highest in Central Asia, Oceania, and Eastern Europe.
  • Central Asia had the highest age-standardized total CVD mortality at 517 deaths per 100k people, nearly 7 times higher than in Asia Pacific. 

On a brighter note, Australasia had the largest reduction (64.2%) in age-standardized CVD per 100k out of all other regions since 1990, driven by decreases in ischemic heart disease. 

The Takeaway

The ACC hopes to bring renewed attention to troubling trends related to the global CVD burden. The multi-year collaboration helps move the field forward by not only tracking CV risk and disease but also gauging whether interventions are actually effective. 

Heart Disease Care in an Aging Population

Posted on by Madeline Kane

The American Heart Association released a 31-page scientific statement offering expert insight into heart disease treatment for an aging US population. 

Considering Age-Related Changes – Cardiovascular changes that occur with normal aging make diagnosing and treating heart disease more complex: large arteries become stiffer, the heart muscle pumps less effectively, and blood vessels are less flexible and less able to respond to changes in the heart’s oxygen needs.

Here are some considerations AHA highlights: 

  • ACS is more likely to occur without chest pain in older adults, presenting with symptoms such as shortness of breath, fainting, or sudden confusion.
  • Measuring levels of circulating troponin is standard to diagnose heart attacks in younger people, but troponin levels may already be higher in older people. Evaluating the rise and fall patterns of troponin may be more appropriate. 
  • Although many clinicians avoid cardiac rehab for frail patients, these are the patients who often benefit the most.
  • Older adults are vulnerable to complications when transferred to outpatient centers; ensuring medications and other therapies are continued among these patients is particularly important. 

Quality of Life Emphasis – The authors note that the goals of care for older people with ACS should extend beyond clinical outcomes like bleeding, stroke, or another heart attack. Goals focused on quality of life may be more important to the patient, placing emphasis on concrete metrics such as pain relief and days spent at home.

The Takeaway

With the US facing an aging population, the AHA’s latest scientific statement provides timely information on the diagnosis and management of ACS in adults over 75. The organization emphasizes clinical considerations for age-related changes and the importance of prioritizing quality of life.

Childhood Lp(a) Predicts Adult CVD Risk

Posted on by Madeline Kane

Individuals who had high Lp(a) levels when they were young were twice as likely to develop atherosclerotic cardiovascular disease in middle age, a new study in Circulation reveals. 

Lp(a) levels are almost entirely genetic (as opposed to being dictated by lifestyle choices), and this new study underscores the value of measuring Lp(a) in childhood, rather than waiting till middle age to identify those most at-risk.

The authors examined Lp(a) data from the 1970s YFS study (n=3596), which investigated the determinants of CV disease in Finnish children, as well as data from the 1980s Bogalusa Heart Study (n=587) out of Tulane University.  

In the YFS analysis, the authors found that…

  • Those with high childhood Lp(a) levels (defined as 30 mg/dL or higher) were about twice as likely to develop adult ASCVD (hazard ratio: 2.0).
  • The risk of coronary heart disease and noncoronary atherosclerotic events were both similarly increased.

In the BHS analysis, researchers found that…

  • Individuals with high childhood Lp(a) were 2.5 times more likely to develop adult ASCVD.
  • The risk associated with Lp(a) remained the same, even after adjusting for BMI and LDL-C.

In neither study was Lp(a) in youth associated with increased carotid artery thickness in adulthood, which may suggest that elevated Lp(a) levels do not confer CV risk by contributing to early preclinical vasculopathy.

The generalizability of these findings is unclear. The results observed in the Finnish study were replicated with data exclusively from White participants in the BHS “because the original YFS included only White participants.” Cardiovascular risk is known to differ across racial/ethnic groups, causing risk equations to consistently underperform in Black adults. So take these findings with a grain of salt.  

The Takeaway

Elevated Lp(a) is a known atherosclerotic CVD risk factor, and these data suggest that measuring Lp(a) in youth would help identify individuals at higher risk for future ASCVD. Although Lp(a) levels cannot be modified by lifestyle or diet, it appears to be important to emphasize heart-healthy lifestyle choices if elevated levels are detected during childhood.

Interventional Cardiology Joins The Match for 2025

Posted on by Madeline Kane

Prospective interventional cardiology fellows can breathe a sigh of relief. Starting in 2025, three-quarters of interventional cardiology fellowship programs will transition to a voluntary match system.

“The Match” uses an algorithm to place resident and fellowship applicants into their most preferred programs that also prefer them. 

  • While all other CV specialty fellowships already use a match system to place candidates, IC has been the lone exception. That will change in the 2024-2025 application cycle. 

The Society for Cardiovascular Angiography and Interventions (SCAI) initiated the change, hoping that the match system will promote “fairness, equity, and thoughtfulness.” 

  • Of the 177 accredited IC training programs, 136 signed on to SCAI’s initiative in support of the match– just surpassing the 75% threshold needed to change the precedent.

The current system, which will be phased out in 2024, can be chaotic and anxiety-inducing for applicants. There is no central information hub to find out key details about available programs and positions, which prompts both the applicants and programs to waste a lot of effort.

  • When a candidate is offered a position, they have a certain amount of time to either accept or decline the offer – sometimes as little as 48 hours – and often don’t have the opportunity to complete interviews at other institutions. Cardiologists have made it clear that they hate this. 

The Takeaway

The Match should help shift the decision-making power in favor of the candidate, rather than the program. In the next couple of years, candidates will have the opportunity to interview and assess the programs that might best meet their professional, personal, and logistic objectives without the pressure of an unreasonable deadline to commit.

Is 8 Minutes of Exercise Enough?

Posted on by Madeline Kane

A mere eight minutes of exercise a day – 54 minutes a week – is enough to lower the risk of early death and heart disease. 

In a study published in the European Heart Journal, scientists examined data from fitness trackers worn by nearly 72k people in the UK. After a 6-year mean follow-up, researchers found that eight minutes of vigorous physical activity a day lowered the risk of early death by 36%, and the risk of CVD by 35%. 

Here’s a sample of how different weekly exercise lengths correlated with mortality and cardiovascular disease incidents : 

  • 15 minutes/week → 16-18% lower all-cause mortality
  • 20 minutes/week → 40% lower CVD mortality
  • Further beneficial associations observed for up to 50-57 minutes per week. 

The people who exercised even more saw greater improvements, but the protective effects of vigorous exercise began to plateau around 54 minutes. 

The Takeaway

The CDC recommends at least 150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise each week. But still, a majority of Americans fail to meet these guidelines. Perhaps aiming for eight minutes of intense movement each day may help make exercise more accessible and achievable.

It’s hard to keep up with all the data pertaining to optimal exercise routines for health and longevity. But all studies seem to agree that getting your body moving – even for just a handful of minutes – has life-changing effects. 

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