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Association of night sleep quality with episodes of atrial fibrillation

It appears that night sleep has a heavy causative impact on arrhythmias.

Atrial fibrillation is a type of arrhythmia, which is quite common in the elderly. It may cause a stroke if remained undetected. Several studies confirm that optimization of arterial blood pressure, good nutrition and abstinence from alcohol abuse may reduce the incidence of atrial fibrillation.

In a recent study, it appears that a night of suboptimal sleep quality increases the likelihood of prolonged episodes of atrial fibrillation the subsequent day.

It is therefore very important to take all necessary measures to ensure good and unobstructed night sleep in order to reduce arrhythmias.

Reference:
JACC: Clinical Electrophysiology
Preceding Night Sleep Quality and Atrial Fibrillation Episodes in the I-STOP-AFIB Randomized Trial
JACC Clin Electrophysiol 2024 Jan 01;10(1)56-64, CX Wong, MF Modrow, K Sigona, JJ Tang, E Vittinghoff, MT Hills, D
McCall, K Sciarappa, MJ Pletcher, JE Olgin, GM Marcus


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Iron replacement therapy in patients with heart failure.

Most patients with heart failure and anemia demonstrate iron deficiency, which is often accompanied by anemia. Iron deficiency is generally defined as having a serum ferritin level <100 µg/L or, provided that ferritin level was >300 µg/L, a transferrin saturation (TSAT) <20%.

The IRONMAN randomized trial showed that, overall, for patients with heart failure who fulfilled the above definition of iron deficiency, IV iron increased hemoglobin levels, improved quality of life, and reduced the rates of hospitalization for heart failure but did not improve walking distance or reduce mortality.

According to a recent publication, the clinical response appears even greater in certain individuals with anemia with TSAT < 20% and ferritin > 100 µg/L.

This might identify a specific group of heart failure patients, who may obtain a significant benefit from intravenous iron.

Reference:
European Heart Journal
Intravenous iron for heart failure, iron deficiency definitions, and clinical response: the IRONMAN trial
Eur Heart J 2024 Mar 06


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The use of aspirin as primary prevention in individuals with elevated lipoprotein a

Lipoprotein (a) is known to be increasingly important in identifying patients at increased risk of cardiovascular (CV) events.

On the horizon, there are treatments that will reduce the production of Lp(a) levels, and hopefully, will reduce the risk of CV diseases. However, until these therapies are approved, we need to use what we currently have to protect these patients.

According to a recent study, daily use of aspirin could provide some CV protection.

The researchers used data from the Multi-Ethnic Study of Atherosclerosis. They divided the patients into those with Lp(a) levels greater than 50 mg/dL and those with Lp(a) levels less than 50 mg/dL. When they looked at CV events, the group with Lp(a) levels greater than 50 mg/dL that were on aspirin had a 46% reduction in CV events compared with those not on aspirin (HR, 0.54; 95% CI, 0.32–0.94; P = .03). For the group that had Lp(a) levels less than 50 mg/dL, no benefit was associated with being on aspirin.

For our patients with Lp(a) levels greater than 50mg/dL, we should put them on aspirin based on this study. It is also very important to maximize statin therapy to lower the cholesterol risk. We should also control their blood pressure and blood glucose levels and encourage them to quit smoking. In other words, we need to optimize everything else while we wait for these new therapies that will directly reduce Journal of the American Heart Association

Reference:
Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi-Ethnic Study of
Atherosclerosis
J Am Heart Assoc 2024 Jan 31;[EPub Ahead of Print], HS Bhatia, P Trainor, S Carlisle, MY Tsai, MH
Criqui, A DeFilippis, S Tsimikas


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Which type of exercise may improve your cardiovascular risk?

In adults with overweight or obesity, aerobic exercise alone or a combined resistance plus aerobic exercise program leads to improvements in composite cardiovascular disease (CVD) risk profiles at one year, according to a study recently published in the European Heart Journal.

The study randomly assigned 406 adults (aged 35 to 70 years) with overweight or obesity and elevated blood pressure to

  1. resistance exercise (102 participants)
  2. aerobic exercise (101 participants)
  3. combined resistance plus aerobic exercise (101 participants)
  4. or a no-exercise control (102 participants)

Interventions lasted one hour, three times per week, for one year.

The researchers found that at one year, there were declines in the composite Z-score, indicating improved CVD risk profile, in the aerobic (mean difference, −0.15) and combination (mean difference, −0.16) groups. However, no improvement was seen in the resistance group (mean difference, −0.02).

Reference:
Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese
adults: the CardioRACE trial
European Heart Journal
Published: 17 January 2024


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Long-Term Physical Activity in Young Adults

Maintaining at least 150 minutes per week of moderate-to-vigorous physical activity is essential for the primary prevention of cardiovascular disease.

In a recent study including young adults, and after a median follow-up of 19 years, participants with a time in target range (TTR) of exercise of at least 75% had a 40% lower risk of cardiovascular events (HR: 0.60; 95% CI: 0.38 to 0.95) compared with the lowest TTR group (<25%).

In young adults, long-term compliance to the recommended volume of exercise may help lower the risk of cardiovascular events in later life.

Despite the busy workload, managing to maintain the guideline-recommended physical activity level for at least 75% of time across young adulthood is strongly advised.

Reference
European Journal of Preventive Cardiology
Long-term Physical Activity Time-in-Target Range in Young Adults with Cardiovascular Events in Later Life
Eur J Prev Cardiol 2023 Dec 20;[EPub Ahead of Print], Z Huang, R Huang, X Xu, Z Fan, Z Xiong, Q Liang, Y Guo, X
Liao, X Zhuang


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Treatment of Severe Symptomatic Aortic Valve Stenosis Using Noninvasive Ultrasound Therapy

Calcific aortic stenosis is commonly treated using surgical or transcatheter aortic valve replacement.

However, many patients are not considered suitable candidates for these interventions due to severe comorbidities.

A recently published study aimed to assess the safety of non-invasive ultrasound therapy and its ability to improve valvular function by softening calcified valve tissue. This prospective, multicentre, single-arm series enrolled 40 adult patients with severe symptomatic aortic valve stenosis at three hospitals in France, the Netherlands, and Serbia between March 13, 2019, and May 8, 2022.

Improved valve function was confirmed up to 6 months, reflected by a 10% increase in mean aortic valve area and a 7% decrease in mean pressure gradient. At 6 months, the New York Heart Association score had improved or stabilised in 24 (96%) of 25 patients, and the mean Kansas City Cardiomyopathy Questionnaire score had improved by 33%.

It is interesting to see if his revolutionary therapeutic approach manages in the near future to be established in daily clinical practice. Until then further research need to be done, in order to confirm its safety and efficacy.

Reference:
The Lancet
Treatment of severe symptomatic aortic valve stenosis using non-invasive ultrasound therapy: a cohort
study
Lancet 2023 Dec 16;402(10419)2317-2325, E Messas, A Ijsselmuiden, D Trifunović-Zamaklar, B Cholley, E
Puymirat, J Halim, R Karan, M van Gameren, D Terzić, V Milićević, M Tanter, M Pernot, G Goudot


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Health benefits derived from resistance training

The skeletal muscle is the largest organ in the body. They produce various cytokines that communicate with other organ systems and contribute to multiple health benefits.

It is recommended that adults should engage in resistance exercise and muscle strengthening at least two times per week.

Individuals who participate in regular resistance training sessions have a 15% lower risk of total mortality and a 17% reduction in the risk of cardiovascular disease. Resistance training reduces systolic blood pressure in adults over 40 years of age by 3 to 4 mm Hg. It reduces glucose levels by 2 to 5 mg/dL and lowers the incidence of diabetes by 17%. Resistance training programs improve HDL-C levels by 2 to 12 mg/dL and reduce the levels of total cholesterol and triglycerides by 7 to 13 mg/dL and 8 mg/dL, respectively.

The magnitude of these benefits may be underestimated and may not be reflective of life-long resistance training because few studies lasted more than 6 months.

Reference:
Paluch AE, Boyer WR, Franklin BA, et al. Resistance Exercise Training in Individuals With and Without
Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association.
Circulation. 2023 Dec 7. doi: 10.1161/CIR.0000000000001189. Online ahead of print.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001189


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The effect of Dapagliflozin in the 6-minute walk test of patients with Heart Failure with preserved EF

Heart failure with preserved ejection fraction is a clinical syndrome associated with a significant functional limitation.

No treatment has yet been found to improve exercise performance in these patients.

In a recent randomized study including 289 HFpEF patients, it was demonstrated that patients receiving dapagliflozin after a 12 week-period exhibited an improvement in 6MWT by 15 meters compared to placebo. The beneficial response to dapagliflozin was consistent across all pre-specified subgroups.

Dapagliflozin, and possibly other SGLT-2 agents, should be strongly considered in patients with HFpEF, in order to enhance their functional capacity and quality of life.

Reference:
Circulation: Heart Failure
Effect of Dapagliflozin on 6-Minute Walk Distance in Heart Failure With Preserved Ejection Fraction:
PRESERVED-HF
Circ Heart Fail 2023 Oct 23;[EPub Ahead of Print], GD Lewis, K Gosch, LP Cohen, ME Nassif, SL Windsor,
BA Borlaug, DW Kitzman, SJ Shah, T Khumri, G Umpierrez, S Lamba, K Sharma, SS Khan, MN Kosiborod,
AJ Sauer


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Smoking cessation after percutaneous coronary intervention (PCI)

Smoking is one of the most harmful habits for our health. This appears to be even more pronounced after a coronary intervention (PCI).

In a population-based retrospective cohort study involving 74,471 patients who underwent PCI, smokers had a nearly 20% higher rate of recurrent major adverse cardiovascular and cerebrovascular events compared with nonsmokers during a median follow-up period of 4 years.

A rather optimistic finding of this study, for smokers, is that in case of successful cessation after PCI there is a substantial reduction of risk which approximates the corresponding risk of non-smokers.

These findings amplify the importance of smoking cessation, especially after a coronary intervention.

Reference:
European Heart Journal
Smoking and cardiovascular outcomes after percutaneous coronary intervention: a Korean study
Eur Heart J 2023 Sep 26; YJ Ki, K Han, HS Kim, JK Han


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Daily step count: how much is enough?

Physical activity is well known to be beneficial for the cardiovascular system, and good health in general. A recent publication addresses the issue of daily step count and how it affects our health.

According to the authors if an individual walks more than 2517 steps per day, a substantial reduction of overall mortality is achieved which reaches 8%.

The benefit of physical movement is increased even more if the daily step count exceeds 8763 steps per day, with the overall mortality to be reduced by 60%. A person who walks 7126 steps per day reduces the risk of any cardiovascular event by 51%.

There is no medication or supplement that can reduce mortality and cardiovascular risk that much. With the use of smartphones and smartwatches it is now very easy to monitor our daily step count. By reaching the numbers, mentioned above, we can easily and effectively protect our health.

Reference:
Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events
Niels A. Stens, Esmée A. Bakker, Asier Mañas, Laurien M. Buffart, Francisco B. Ortega, Duck-chul Lee,
Paul D. Thompson, Dick H.J. Thijssen, and Thijs M.H. Eijsvogels
J Am Coll Cardiol. 2023 Oct, 82 (15) 1483–1494

https://www.jacc.org/doi/10.1016/j.jacc.2023.07.029



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Είναι αδύνατο να ξέρει την ιατρική, αυτός που δεν ξέρει ακριβώς τι είναι ο άνθρωπος. ΙΠΠΟΚΡΑΤΗΣ




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It is impossible for one to know medicine if he doesn’t know what a human being is. HIPPOCRATES






Copyright by Dr Yiannis Panayiotides 2018. All rights reserved.



Copyright by Dr Yiannis Panayiotides 2018. All rights reserved.