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heart-and-bed.webp

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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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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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



People often start a diet in order to lose weight, reduce their cholesterol levels and maintain good health. Diets that are low in fat consumption are in general perceived as the most beneficial for optimal weight control and reduction of cardiovascular risk. However, a very recently published article comes to abolish this theory.

According to this study, 148 individuals without previous history of diabetes or cardiovascular disease were randomized into either low-carbohydrate or low-fat diet.

After one year of observation, a significant weight reduction was identified in the low-carbohydrate diet group (mean reduction 3.5 Kg). Also, the same group demonstrated a significant reduction of CRP, which is known to be a marker of inflammation that is positively correlated with the risk of cardiovascular events. Arterial pressure, glucose and cholesterol levels were similar in both groups.

Diets with low consumption of carbohydrates were initially introduced in the 70s (Atkins diet). However many people argued about the beneficial effect of this particular form of diet. In fact, it was suggested to increase the cardiovascular risk despite reduction of body weight.

Carbohydrates are the main source of energy and constitute a significant proportion of our daily meals (bread, cereals, potatoes, rise, pasta and fruits). Complex carbohydrates (whole grain bread and starchy vegetables) are those that require specific process and sugar is slowly digested and absorbed. Simple carbohydrates (table sugar, soft drinks, candy and white bread) are established to have a low nutritional value and cause an accumulation of fat in the body.

As a conclusion, a diet with a low consumption of carbohydrates is established to produce a significant reduction in body weight without the previous deleterious effects that were previously suggested. However, more research and a longer follow-up are required in order to safely apply such a notion in our everyday life.

 

Source:

Annals of Internal Medicine

Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial

Bazzano LA



Scientific research often produces controversial results and this causes confusion. Such debatable data are recorded regarding the effect of alcohol consumption on the heart.

A relatively clear orientation is given by a recent review article. According to the author:

Habitual light to moderate consumption of alcohol is beneficial to the heart

  1. The recommended dosage is 1 drink per day for women and 1-2 drinks per day for men
  2. The preferred drink is red wine due to its anti-oxidant effect
  3. The suggested time of drinking is during dinner, since this has recorded the strongest reduction in cardiovascular events

However, caution is required in the following circumstances:

  1. Males aged 15-59 are the most susceptible in excessive consumption of alcohol, which is strongly interrelated with a negative effect (violent behavior, accidents, arterial hypertension, diabetes, cardiovascular events)
  2. Health care professionals should not recommend alcohol to non-drinkers because of the potential for drinking problem, even among individuals at apparently low risk.
  3. Unfortunately consumption is strongly correlated with smoking, which should be strongly discouraged.

The findings of this study were based on a systematic literature search (1997-2012).

 

Source:

Alcohol and cardiovascular health: the dose makes the poison…or the remedy.

Mayo Clin Proc.2014 Mar;89:382-393

O’Keefe JH



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Copyright by Dr Yiannis Panayiotides 2018. All rights reserved.



Copyright by Dr Yiannis Panayiotides 2018. All rights reserved.