Women and men share most of the same risk factors for cardiovascular disease (CVD), a large international study has found – the first such study to include people not only from high income countries, but also from low- and middle-income countries where the burden of CVD is the greatest.
The global study assessed risk factors, including metabolic (such as high blood pressure, obesity and diabetes), behavioral (smoking and diet), and psycho-social (economic status and depression) in about 156,000 people without a history of CVD between the ages of 35 and 70. Living in 21 low, middle and high-income countries on five continents, they were followed for an average of 10 years.
“Women and men have similar CVD risk factors, which emphasizes the importance of a similar strategy for the prevention of CVD in men and women,” said the paper’s first author Marjan Walli-Attaei, a research fellow at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences (HHS).
Overall, women had a lower risk of developing CVD than men, especially at younger ages.
However, diet was more strongly associated with CVD risk in woman than men – “something that’s not been previous described, and which requires independent confirmation,” said Salim Yusuf, lead investigator of the study, senior author, executive director of PHRI, professor of medicine at McMaster University, and cardiologist at HHS.
High levels of bad (LDL) cholesterol and symptoms of depression were more strongly associated with CVD risk in men than in women.
The patterns of these findings were generally similar in high-income countries and upper-middle-income countries, and in low-income and lower-middle-income countries.
Researchers tracked the incidence of heart failure over six years in more than 94,000 middle-aged adults in the U.K. Biobank who wore wrist accelerometers to record the amount and intensity of their physical activity over seven days between 2013-2015.
Participants who engaged in 150-300 minutes of moderate physical activity or 75-150 minutes of vigorous physical activity during the week of observation reduced their risk of being hospitalized for or death from heart failure by two-thirds compared to participants who did not engage in the same amounts of moderate or vigorous physical activity during the week.
A six-year analysis of more than 94,000 adults in the U.K. Biobank with no history of heart failure at enrollment has found that engaging in moderate or vigorous physical activity may lower the risk of developing heart failure, according to new research published today in the American Heart Association’s flagship journal Circulation.
The study is one of the first to use objectively measured activity levels to estimate heart failure risk. The results are consistent with previous studies finding that performing 150-300 minutes of moderate exercise or 75-150 minutes of vigorous exercise each week may reduce the incidence of heart attack and stroke.
Many people with heart failure also have diabetes or high blood pressure. But new research suggests those conditions, even when treated, aren’t well controlled, placing people at risk for worsening heart problems, according to the American Heart Association (AHA).
“We know that controlling hypertension and diabetes is critical for people with heart failure,” said Dr. Madeline Sterling, a primary care physician at Weill Cornell Medicine in New York City. “But few studies have been able to ascertain how well those risk factors have been controlled. This study really takes a big step forward in doing that.”
Sterling wrote an editorial accompanying the study that appeared in the American Heart Association’s journal Circulation: Heart Failure.
Heart failure occurs when the heart can’t pump as well as it should and fails to deliver enough oxygen to the body, making it harder for people to perform everyday tasks. Hypertension, another name for high blood pressure, and diabetes are major risk factors for heart failure, which affects more than 6 million people in the U.S., especially those who have other heart problems or who have had heart attacks.
In the new study, researchers analyzed 18 years of data from the National Health and Nutrition Examination Survey, a series of federal studies assessing the prevalence of major diseases and their risk factors among U.S. adults.
While just 8% of 1,423 people diagnosed with heart failure had poor glycemic control, defined in the study as a hemoglobin A1C level of 8% or higher, 21% of those being treated for diabetes failed to meet blood glucose goals. This did not vary by race or ethnicity.
Researchers also found 48% of people with heart failure had uncontrolled hypertension, which the researchers defined as a systolic blood pressure, the top number in a reading, of at least 130. Among people prescribed blood pressure-lowering medication, poor control was even higher, at 51%. Black adults had higher uncontrolled rates than their white peers, at 53% compared to 47%.
That higher rate of poor blood pressure control among Black adults with heart failure was not surprising since it mirrors racial disparities in blood pressure control in the general population, said Dr. Sadiya Khan, senior author of the study, funded in part by the AHA.
“This speaks to a larger problem, which is a systemic failing to control the leading risk factors that account for the greatest number of non-communicable deaths worldwide,” said Khan, an assistant professor of medicine at Northwestern University Feinberg School of Medicine in Chicago.
“The reasons for these disparities are manifold,” said Dr. Leah Rethy, a resident physician at the University of Pennsylvania Perelman School of Medicine and lead author of the study. They include the history of structural racism in the U.S., which is largely responsible for disparities in access to health care, proximity to green spaces where people can safely meet exercise goals and “all sorts of things that influence somebody’s life course up until the time they get heart failure,” she said.
While the vast majority of people in the study had insurance, they also reported incomes below the poverty line, which could affect their access to quality care or the ability to pay for medications, said Sterling, who was not involved in the research. The study also did not track whether people being treated for high blood pressure and diabetes were actually taking the medications prescribed to them.
The study documented only the prevalence of uncontrolled blood pressure and poor glycemic control, not why those risk factors were uncontrolled, Rethy said.
“We think there’s probably a number of reasons that include a lack of understanding or focus from providers about the importance of blood pressure control, but also perhaps a lack of accessibility to consistent and affordable primary and specialty care for adults with heart failure,” she said, “particularly those under age 65 who don’t qualify for Medicare.”
Sterling added that “it’s actually quite hard to control these risk factors. It’s not just a matter of giving people medications. This study is shedding light on this.”
Many people who have heart failure are older, frail and may have cognitive issues, so it may be difficult for them to perform the extensive self-monitoring needed to manage their health, she said. “A lot is put on patients to manage this at home, and it’s a challenge.”
But that doesn’t mean it’s an insurmountable one, Rethy said. The key is finding ways to help health care professionals and patients put into practice what researchers know about how to get blood pressure and blood glucose levels under control.
“There are many good medications and lifestyle interventions that we know work,” she said. “We shouldn’t think of it as too lofty to achieve. We have access to lots of tools to help fix it.”
While women who enter menopause before age 45 are known to be at higher risk of heart failure, obesity significantly increased heart failure risk among women who experienced late menopause – at age 55 or older, according to a new study.
The findings indicate that maintaining a healthy weight and avoiding abdominal obesity may protect against developing heart failure, especially among women who experience late menopause.
While women who enter menopause before age 45 are known to be at higher risk for heart failure, obesity significantly increased heart failure risk among women who experienced late menopause – at age 55 or older, according to new research published in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
Like the gift that keeps on giving, COVID-19 is the plague that keeps on taking. It turns out that the affliction can cause complications with other medical conditions.
COVID-19 can cause serious cardiovascular complications including heart failure, heart attacks and blood clots that can lead to strokes, emergency medicine doctors report in a new scientific paper. They also caution that COVID-19 treatments can interact with medicines used to manage patients’ existing cardiovascular conditions.
The new paper from UVA Health’s William Brady, MD, and colleagues aims to serve as a guide for emergency-medicine doctors treating patients who may have or are known to have COVID-19. The authors note that much attention has been paid to the pulmonary (breathing) complications of COVID-19, but less has been said about the cardiovascular complications that can lead to death or lasting impairment. Continue reading →
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