Heart attacks and strokes are collectively the leading cause of death in most low- and middle-income countries (LMICs) worldwide. Treatment with four drugs — aspirin, a statin, an angiotensin converting-enzyme (ACE)-inhibitor, and a beta blocker — improves survival and quality of life among patients who have had a heart attack or stroke in the past; however, fewer than a quarter of eligible patients in LMICs receive these medications due to concerns about pill burden and cost.
To address this gap, a team of researchers led by Dhruv S. Kazi, MD, MSc, MS, Associate Director of the Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center (BIDMC) evaluated whether it would be cost-effective to combine several medications into a single “cardiovascular polypill” for patients who have had a previous heart attack or stroke, instead of prescribing the four drugs individually. The findings were published on August 30 in Lancet Global Health.
The researchers built a mathematical model that simulated all adults with a prior heart attack or stroke in five LMICs across a wide range of economic development: India, China, Mexico, Nigeria, and South Africa. These countries were chosen because they have a large burden of cardiovascular disease in their population. Kazi and colleagues used real-world data to model each country’s current rates of medication use and cardiovascular outcomes, and then examined what would happen if patients currently receiving one or more of the evidence-based therapies for cardiovascular disease were switched to the polypill instead. In this simulation model, the researchers followed individuals for their entire lifetime, keeping track of heart attacks, strokes, and deaths, as well as all health care costs. They also estimated patients’ survival and quality-of-life, allowing them to estimate, for each country, a metric called the incremental cost-effectiveness ratio (or ICER). The ICER indicates how much money it would cost to prevent the loss of one disability-adjusted life year.
Medical consensus once supported daily use of low dose aspirin to prevent heart attack and stroke in people at increased risk for cardiovascular disease (CVD). But in 2018, three major clinical trials cast doubt on that conventional wisdom, finding few benefits and consistent bleeding risks associated with daily aspirin use. Taken together, the findings led the American Heart Association and American College of Cardiology to change clinical practice guidelines earlier this year, recommending against the routine use of aspirin in people older than 70 years or people with increased bleeding risk who do not have existing cardiovascular disease.
Aspirin use is widespread among groups at risk for harm including older adults and adults with peptic ulcers — painful sores in the lining of the stomach that are prone to bleeding that affect about one in ten people. In a research report published today in Annals of Internal Medicine, researchers from Beth Israel Deaconess Medical Center (BIDMC) report on the extent to which Americans 40 years old and above use aspirin for primary prevention of cardiovascular disease.
Despite national guidelines indicating that statins can lower risk of heart attack and stroke, many patients who could benefit do not take them. More than half of eligible patients say they were never offered the cholesterol-lowering drugs; the experience of side effects or fear of side effects were reasons for stopping or refusing statins, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.
Statins lower the amount of low-density lipoprotein (LDL, or “bad” cholesterol) and have been shown to lower the risk of heart attack and strokes. Because statins are proven effective and have a low risk of side effects, guidelines from the American Heart Association/American College of Cardiology recommend doctors use an atherosclerotic and cardiovascular disease risk calculator to give a detailed assessment of a person’s 10-year risk for heart disease and to help create a personalized plan.
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.
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.
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.”
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.
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.
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.
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.”