Having more than one chronic disease amplifies costs of diseases

Having two or more non-communicable diseases (multimorbidity) costs the country more than the sum of those individual diseases would cost, according to a new study published this week in PLOS Medicine by Tony Blakely from the University of Otago, New Zealand, and colleagues.

Few studies have estimated disease-specific health system expenditure for many diseases simultaneously. In the new work, the researchers used nationally linked health data for all New Zealanders, including hospitalization, outpatient, pharmaceutical, laboratory and primary care from July 1, 2007 through June 30, 2014. These data include 18.9 million person-years and $26.4 billion US in spending. The team calculated annual health expenditure per person and analyzed the association of this spending to whether a person had any of six non-communicable disease classes — cancer, cardiovascular disease, diabetes, musculoskeletal, neurological, and lung/liver/kidney (LLK) diseases — or a combination of any of those diseases.

59% of publically-funded health expenditures in New Zealand were attributable to non-communicable diseases. Nearly a quarter (23.8%) of this spending was attributable to the costs of having two or more diseases above and beyond what the diseases cost separately. Of the remaining spending, heart disease and stroke accounted for 18.7%, followed by musculoskeletal (16.2%), neurological (14.4%), cancer (14.1%), LLK disease (7.4%) and diabetes (5.5%). Expenditure was generally the highest in the year of diagnosis and the year of death.

Full story at Science Daily

Weightlifting is good for your heart and it doesn’t take much

Lifting weights for less than an hour a week may reduce your risk for a heart attack or stroke by 40 to 70 percent, according to a new Iowa State University study. Spending more than an hour in the weight room did not yield any additional benefit, the researchers found.

“People may think they need to spend a lot of time lifting weights, but just two sets of bench presses that take less than 5 minutes could be effective,” said DC (Duck-chul) Lee, associate professor of kinesiology.

The results — some of the first to look at resistance exercise and cardiovascular disease — show benefits of strength training are independent of running, walking or other aerobic activity. In other words, you do not have to meet the recommended guidelines for aerobic physical activity to lower your risk; weight training alone is enough. The study is published in Medicine and Science in Sports and Exercise.

Lee and his colleagues analyzed data of nearly 13,000 adults in the Aerobics Center Longitudinal Study. They measured three health outcomes: cardiovascular events such as heart attack and stroke that did not result in death, all cardiovascular events including death and any type of death. Lee says resistance exercise reduced the risk for all three.

Full story at Science Daily

Trial for gout drug meets primary endpoint, raises safety

Febuxostat, a gout drug that has been in use for nearly a decade, was found to significantly increase the risk of death, even though it did not raise the risk of the trial’s primary endpoint, a combined rate of fatal and nonfatal adverse cardiovascular events, according to research presented at the American College of Cardiology’s 67th Annual Scientific Session.

It is unusual for a clinical trial to reveal an increased risk of death without also showing a heightened risk of other cardiovascular outcomes such as nonfatal heart attack and stroke. The findings, which showed an uptick in deaths after patients had been taking febuxostat for two years or longer, call into question the safety of long-term febuxostat use in patients with cardiovascular disease, researchers said.

“This finding was entirely unexpected, and we’re at a loss at this time to explain why this finding was seen,” said William B. White, MD, professor of medicine at the Calhoun Cardiology Center of the University of Connecticut School of Medicine and the study’s lead author. “The results were consistent across many subgroups; there was no evidence of a relationship with age, sex, race or ethnicity, history of cardiovascular disease, or duration or severity of the gout.”

Full story at Science Daily

Eating yogurt may reduce cardiovascular disease risk

A new study in the American Journal of Hypertension, published by Oxford University Press, suggests that higher yogurt intake is associated with lower cardiovascular disease risk among hypertensive men and women.

High blood pressure is a major cardiovascular disease risk factor. Clinical trials have previously demonstrated beneficial effects of dairy consumption on cardiovascular health. Yogurt may independently be related to cardiovascular disease risk.

High blood pressure affects about one billion people worldwide but may also be a major cause of cardiovascular health problems. Higher dairy consumption has been associated with beneficial effects on cardiovascular disease-related comorbidities such as hypertension, type 2 diabetes, and insulin resistance.

Full story at Science Daily

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

Starting periods early — before the age of 12 — is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

It is one of several reproductive risk factors, including early menopause, complications of pregnancy, and hysterectomy, that seem to be associated with subsequent cardiovascular disease, the findings show.

Previous research has suggested that certain reproductive risk factors may be linked to an increased risk of heart disease or stroke, but the findings have been somewhat mixed.

Full story at Science Daily

Gestational diabetes and cardiovascular disease risk

A history of gestational diabetes was associated with a modest higher long-term risk of cardiovascular disease in women in a new study, although the absolute rate of cardiovascular disease was low in the study’s younger group of predominantly white women and adhering to a healthy lifestyle over time appeared to help mitigate the risk, according to a new article published by JAMA Internal Medicine.

Gestational diabetes is impaired glucose tolerance in pregnancy. The American Heart Association identifies gestational diabetes as a risk factor for cardiovascular disease in women based on evidence for the relationship between gestational diabetes and markers of cardiometabolic risk, according to study background.

Full story at Science Daily

Pneumonia or sepsis in adults associated with increased risk of cardiovascular disease

Pneumonia or sepsis in adults that results in hospital admission is associated with a six-fold increased risk of cardiovascular disease in the first year, according to research published today in the European Journal of Preventive Cardiology. Cardiovascular risk was more than doubled in years two and three after the infection and persisted for at least five years.

“Severe infections in adulthood are associated with a contemporaneously raised risk of cardiovascular disease,” said last author Professor Scott Montgomery, director of the clinical epidemiology group, Örebro University, Sweden. “Whether this raised risk persists for several years after infection is less well established.”

Full story at Science Daily

Adolescent obesity linked to early mortality from cardiovascular diseases

While there is solid evidence that adolescent overweight and obesity are associated with coronary heart disease (CHD) and stroke, less is known about the association between body mass index (BMI) and rarer cardiovascular diseases. A new large-scale, 45-year Israeli study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism found that higher BMI as well as BMI in the accepted normal range in late adolescence may be related to a higher risk of death in mid-adulthood from non-coronary non-stroke cardiovascular diseases such as fatal arrhythmia, hypertensive heart disease, cardiomyopathy, arterial disease, heart failure and pulmonary embolism.

Obesity, the most common nutritional disorder in industrialized countries, is associated with an increased mortality and morbidity of cardiovascular disease. This study specifically looked at adolescent BMI and death attributed to cardiovascular diseases other than CHD and stroke.

Full story of adolescent obesity linked to cardiovascular diseases at Science Daily

Paradigm shift in type 2 diabetes treatment urged

Heart disease is a leading cause of death worldwide and exacerbated by type 2 diabetes, yet diabetes treatment regimens tend to focus primarily on blood sugar maintenance. This common approach to type 2 diabetes management can leave patients at risk for heart attack and stroke. But results from four recent randomized clinical trials suggest that using medications that offer glucose control while reducing the risk for cardiovascular disease could improve patient outcomes.

“Strong evidence provided by the four recent trials published within the past 1.5 to 2 years in the New England Journal of Medicine has shown that some of the modern available therapeutic agents that control blood glucose also help reduce the risk for cardiovascular disease,” said Faramarz Ismail-Beigi, MD, PhD, Professor of Medicine at Case Western Reserve University and Endocrinologist at University Hospitals Cleveland Medical Center and Louis Stokes Cleveland VA Medical Center. “Based on this evidence, we propose that we must shift from our previous paradigm with its monocular focus on control of blood glucose and hemoglobin A1c, to one of control of blood glucose plus preventing cardiovascular disease and death from cardiovascular causes.” Hemoglobin A1c is a common test used to determine a patient’s average blood sugar levels over the previous 2-3 months.

Full story of diabetes treatment change needed at Science Daily

‘Healthy’ obese people still at higher risk of cardiovascular disease events than general population

New research presented at this year’s European Congress on Obesity (ECO) in Porto, Portugal (17-20) May shows that so called ‘metabolically healthy’ obese people are still at higher risk of cardiovascular disease events such as heart failure or stroke than normal weight people. The study is by Dr Rishi Caleyachetty and colleagues at The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK.

People with metabolically healthy obesity (MHO) are clinically obese in terms of their body mass index (BMI) (more than 30 kg/m2), but do not have metabolic complications that usually come with obesity, such as abnormal blood fats, poor blood sugar control or diabetes, and high blood pressure. Whether MHO is associated with excess risk of cardiovascular disease (CVD) events is a subject of debate. Important limitations in the evidence to date include inconsistent definitions of metabolic health, inconsistent control for other factors (confounders), and small sample sizes. In this new study, the authors address these limitations in a large contemporary cohort, based on linked primary care electronic health records.