Diabetes raises risk of cardiovascular mortality in severe aortic stenosis

20 Dec 2022Registered users

Diabetes mellitus is strongly associated with death from heart failure and sudden death in patients with severe aortic stenosis (AS), a study from France has found. No such association was seen in patients with mild/moderate AS.

How useful is smartphone technology for detecting AF?

25 Oct 2022Registered users

Smartphone applications can allow self-detection of arrhythmias in patients with atrial fibrillation. However, current evidence of their usefulness is based on small low-quality studies, a systematic review and meta-analysis has found.

Loud noise at work and night shifts may raise risk of IHD

26 Sep 2022Registered users

Occupational exposure to high levels of noise, greater than 90 dBA, and night shift work appear to be associated with an increased risk of ischaemic heart disease, a population-based study from New Zealand has found. However, no such association was seen for long working hours and sedentary work.

Do indirect unscheduled care pathways affect outcomes in myocardial infarction?

27 Jul 2022Registered users

Indirect unscheduled care pathways were associated with higher mortality in patients admitted with myocardial infarction compared with direct pathways, a retrospective population-based study from Scotland has found.

All grades of aortic stenosis raise risk of death

24 Jun 2022Registered users

Even mild aortic stenosis is associated with an increased risk of mortality, a large study from Australia has found.

Younger age at onset of overweight associated with higher risk of hypertension

25 May 2022Registered users

Becoming overweight before the age of 60 was associated with a raised risk of hypertension, in a prospective cohort study. The risk was greatest in those who became overweight between the ages of 18 and 39.

Concomitant steroid therapy raises GI bleeding risk in AF patients on DOACs

25 Apr 2022Registered users

Oral glucocorticoids are associated with an increased risk of gastrointestinal bleeding in patients with atrial fibrillation concomitantly treated with direct acting oral anticoagulants, a nationwide study from Denmark has found.

Novel bleeding risk score for atrial fibrillation patients treated with DOACs

25 Mar 2022Registered users

A new, simple risk score for predicting major bleeding in patients with nonvalvular atrial fibrillation treated with direct acting oral anticoagulants (DOACs) has been developed by researchers in Israel.

Sex differences identified in cardiovascular outcomes

24 Jan 2022Registered users

Women who had survived a first coronary event had a significantly lower risk of major adverse cardiovascular events and recurrent coronary heart disease than men, a population-based cohort study has found. However, women had a higher risk of stroke, heart failure, and all-cause mortality compared with men.

Can choice of anticoagulant for AF influence risk of incident dementia?

20 Dec 2021Registered users

Dementia and mild cognitive impairment were less common among patients prescribed direct oral anticoagulants for newly diagnosed atrial fibrillation (AF) compared with those prescribed vitamin K antagonists, in a UK cohort study.

Depression questionnaires fail to reflect patients’ own views of mood changes

20 Dec 2021Registered users

Changes in depression questionnaire scores often disagree markedly with patients’ own ratings of changes in their mood, a prospective cohort study has found.

ECG-based tool aids rapid risk assessment for a cardiac cause of syncope

20 Dec 2021Registered users

In patients with a syncopal event, a combination of seven ECG criteria enabled a rapid assessment of the likelihood that the event was due to a cardiac cause, in a prospective multicentre trial.

Rehabilitation improves physical function in older heart failure patients

25 Sep 2021Registered users

In older patients hospitalised for acute decompensated heart failure an early tailored rehabilitation programme resulted in a greater improvement in physical function compared with usual care together with a reduction in falls and improvement in mood. However, the programme did not result in a significant reduction in readmissions or deaths.

Raised NT-proBNP predicts poor outcomes in AF without heart failure

25 May 2021Registered users

High NT-proBNP levels appear to be an independent predictor of adverse outcomes in patients with atrial fibrillation (AF) in the absence of heart failure, a study from Japan has found. Raised NT-proBNP levels were significantly associated with higher incidences of stroke/systemic embolism, all-cause death and hospitalisation for heart failure during a median follow-up period of five years.

Recreational substance use raises risk of early onset CVD

22 Apr 2021Registered users

Use of illicit drugs, as well as tobacco and alcohol, is associated with an increased risk of premature atherosclerotic cardiovascular disease (CVD), especially in women, a study from the US has shown. Those with multiple substance use had a graded response with the highest risk of premature CVD among individuals who used four or more recreational substances.

Sex differences remain in the prevalence and treatment of CVD risk factors

22 Mar 2021Registered users

Differences persist in the prevalence, treatment and control of risk factors for cardiovascular disease between men and women, an analysis of data from the Health Survey for England 2012-2017 has found. Men were more likely to have one or more risk factors than women. However, figures for both treatment and control of dyslipidaemia were significantly lower in women than men.

Which drugs should be used first line for hypertension?

21 Feb 2021Registered users

Tailoring choice of antihypertensives to the patient rather than using strict age criteria might be more beneficial, the authors of a UK observational cohort study suggest.

Childhood cancer survivors at increased risk of cardiac ischaemia

25 Jan 2021Registered users

Children who have survived cancer, particularly those treated with chemotherapy and/or radiotherapy, have a higher risk of adverse cardiac events later on, a pan-European study has found.

Can a hot bath a day keep the cardiologist away?

21 Dec 2020Registered users

Taking a hot bath every day or most days may lower the risk of cardiovascular disease (CVD), a study from Japan has suggested.

Loneliness a risk factor for cardiovascular disease

24 Sep 2020Registered users

Loneliness but not social isolation appears to be an independent risk factor for cardiovascular disease, an analysis of data from the English Longitudinal Study of Ageing suggests.

Lifestyle intervention reduces risk factors in older patients with coronary artery disease

24 Jul 2020Registered users

Patients aged 65 years and over with coronary artery disease benefitted at least as much as younger patients in improving lifestyle risk factors in a community-based trial from the Netherlands. Older patients were more likely to achieve the weight loss target and stop smoking.

Abdominal obesity post MI raises risk of recurrent MI or stroke

25 May 2020Paid-up subscribers

Abdominal obesity is an independent risk factor for a further myocardial infarction (MI) or stroke in patients who have already suffered a first MI, an observational cohort study from Sweden has shown. A total of 22,882 MI patients from the SWEDEHEART registry (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) were recruited to the study.

Exercise improves function and mortality rates in older patients following ACS

23 Apr 2020Paid-up subscribers

A largely home-based exercise intervention improved grip strength, mobility, daily activities and quality of life in older patients after acute coronary syndrome, an Italian study has shown. Hospitalisation and death rates were also reduced by the intervention. A total of 235 patients, median age 76 years, range 73-81 years, were recruited to the trial conducted at three sites in Italy. They were randomised one month after their ACS event to the exercise or control group. All had reduced physical performance defined by the short physical performance battery with scores of 4-9.

Are psychological techniques effective in patients at high risk of CVD?

24 Mar 2020Paid-up subscribers

Enhanced motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in patients at high risk of cardiovascular disease, a primary care study has shown.

How accurate are wearable electronic devices for monitoring atrial fibrillation?

24 Feb 2020Paid-up subscribers

A smartwatch-based patient device demonstrated only moderate diagnostic accuracy in detecting atrial fibrillation (AF) when compared with a 12-lead ECG, in a study from Australia. Accuracy was improved if the automated device diagnosis was combined with specialist interpretation of unclassified tracings.

Antihypertensive drugs most effective when taken at bedtime

20 Dec 2019Paid-up subscribers

Patients who took their blood pressure medication at bedtime had improved blood pressure control and lower risk of major cardiovascular disease events compared with those who took their drugs in the morning, a primary care study has shown.

Flu vaccination reduces all-cause mortality in heart failure patients

24 Oct 2019Paid-up subscribers

Influenza vaccination was associated with a significantly lower risk of all-cause mortality in patients with heart failure, a meta-analysis has found. However, the effect on cardiovascular deaths and hospitalisations was not significant.

Bundle branch block an indicator of heart failure risk

25 Sep 2019Paid-up subscribers

Opportunistic finding of bundle branch block (BBB) in primary care patients without major cardiovascular disease should be considered a warning of future heart failure, a retrospective cohort study from Denmark concludes.

How does weight change affect risk of atrial fibrillation?

07 Aug 2019Paid-up subscribers

Putting on weight appears to raise the risk of developing atrial fibrillation (AF), a meta-analysis  by investigators in Oxford, UK, has concluded. However, no clear evidence emerged as to whether weight loss reduces the risk.

Sitting time linked to raised mortality risk in inactive adults

22 May 2019Paid-up subscribers

Sitting for long periods is associated with an increased risk of all cause and cardiovascular disease (CVD) mortality among the least physically active adults. However, moderate to vigorous physical activity equivalent to public health recommendations can attenuate or effectively eliminate such associations, a study from Australia has found.

Continuous ECG vs loop recording for AF detection post stroke

24 Apr 2019Registered users

Automatic external loop recording (ELR) is not suitable as a single monitoring device for AF screening following stroke, a prospective cohort study from Denmark has concluded.

Cuffless vs standard devices for ambulatory blood pressure monitoring

25 Mar 2019Registered users

A novel cuffless device recorded significantly higher values for both systolic and diastolic blood pressure (BP) compared with standard equipment for 24-hour ambulatory BP monitoring, in a small study from Switzerland.

Reminder app improves compliance with CHD therapy

22 Feb 2019Registered users

The use of a widely available basic medication reminder app significantly improved adherence to treatment for coronary heart disease (CHD), in a study from Australia.

High BP, smoking and diabetes are stronger predictors of MI in women than men

20 Dec 2018Registered users

Hypertension, smoking, especially heavy smoking, and both type 1 and type 2 diabetes are associated with a higher risk of myocardial infarction (MI) in women than men, a prospective population-based study has shown.

AF recurrence following catheter ablation more likely in obese patients

22 Nov 2018Registered users

Atrial fibrillation (AF) patients with a baseline BMI ≥ 30 kg/m2 have a higher recurrence rate following catheter ablation, a  study of  an AF Ablation Long-Term Registry that included 104 centres across 27 European countries.

Pre-eclampsia raises risk of vascular dementia later in life

22 Nov 2018Registered users

Women with a history of pre-eclampsia are three times more likely to develop vascular dementia later on, a Danish cohort study has found.

New antiplatelet agents are more effective in preventing recurrent MI

22 Oct 2018Registered users

Compared with clopidogrel, prasugrel and, in particular ticagrelor, led to a significant reduction in risk of recurrent fatal and non-fatal myocardial infarction (MI) in patients with acute coronary syndrome (ACS), in a study from France.

Length and quality of sleep may affect cardiovascular risk

24 Sep 2018Registered users

Sleeping for more than 8 hours a night was associated with an increased risk of mortality and poor quality sleep with an increased risk of coronary heart disease (CHD), a large meta-analysis has found.

Raised resting heart rate associated with increased mortality risk

25 Jul 2018Registered users

A high resting heart rate and an increase in resting heart rate over a decade are associated with a greater risk of death from cancer and other causes as well as cardiovascular disease (CVD), a study from Australia has found.

Patients with heart failure not being diagnosed in primary care

22 May 2018Paid-up subscribers

Only a quarter of patients with symptoms suggestive of heart failure are investigated and referred by GPs in accordance with NICE guidelines, a UK study has shown. Nearly 80% of heart failure patients were diagnosed in hospital. The investigators, from Imperial College, London, extracted data on patients diagnosed with heart failure between 1 January 2010 and 31 March 2013, using the Clinical Practice Research Datalink. This database contains electronic records from 7% of general practices in England.

Exercise in middle age may reduce risk of heart failure

23 Apr 2018Registered users

Two years of high intensity exercise training, in previously sedentary healthy middle-aged adults, improved maximal oxygen uptake (VO2max) and reduced left ventricular (LV) stiffness, in a study from the United States. The investigators conclude that regular exercise training may protect against the future risk of heart failure with a preserved ejection fraction (HFpEF) by preventing the increase in cardiac stiffness caused by sedentary aging.

Anticoagulants underused in older heart failure patients with AF

27 Feb 2018Registered users

Overestimation of risk of bleeding leads to underuse of oral anticoagulants in frail elderly heart failure patients with atrial fibrillation (AF) despite their increased risk of stroke, a study in Heart has concluded.

Triple antiplatelet therapy no better than standard regimens after ischaemic stroke

23 Jan 2018Registered users

Intensive antiplatelet therapy with three agents did not reduce the incidence and severity of recurrent stroke or transient ischaemic attack (TIA) but did significantly increase the risk of major bleeding in the TARDIS study.

Heavy drinking and smoking associated with visible signs of ageing

20 Dec 2017Paid-up subscribers

The risk of developing age-related visible signs, such as arcus cornea and earlobe crease, was higher in smokers and heavy drinkers in a prospective study from Denmark.

Chocolate may lower risk of atrial fibrillation

22 Sep 2017Registered users

Eating chocolate regularly may reduce the risk of atrial fibrillation (AF), the results of a large population-based prospective cohort study suggest.  

Drinking tea every day may lower risk of ischaemic heart disease

22 Jun 2017Registered users

Daily tea consumption was associated with an 8% relative risk reduction in ischaemic heart disease and a 10% relative risk reduction in major cardiac events, in a large prospective study from China.

Heavy drinkers and teetotallers at increased risk of wide range of cardiovascular diseases

23 May 2017Registered users

Both high levels of alcohol consumption and abstinence raise the risk of a broad spectrum of cardiovascular disorders, a UK study has shown.

Non-major bleeds less frequent in AF patients on apixaban

23 May 2017Paid-up subscribers

Non-major bleeding was substantially less in patients on apixaban compared with those on warfarin in the Apixaban for Reduction in Stroke and other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. 

Stress echo has good diagnostic accuracy in elderly patients

24 Apr 2017Paid-up subscribers

Stress echocardiography is a safe and effective first-line test for suspected coronary artery disease in patients over 80, a UK study, published in Heart, has found.

Early catheter ablation improves outcomes in paroxysmal AF

22 Mar 2017Registered users

Patients with paroxysmal atrial fibrillation (AF) treated with catheter ablation first line showed significantly better improvement than those treated initially with drug therapy in a multicentre, randomised, unblinded trial. The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial compared radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment for paroxysmal AF.

Cardiovascular risk factors in middle age linked to heart failure later on

22 Feb 2017Paid-up subscribers

Preventing hypertension, obesity and diabetes in middle age improves morbidity and mortality related to heart failure, a pooled analysis of data from the United States has shown.

Low BP in elderly patients treated for hypertension associated with increased mortality

23 Jan 2017Registered users

Systolic blood pressure (BP) below 135 mmHg was associated with greater mortality in patients, aged 80 and over treated for hypertension, in an observational primary care study.

Will a cup of tea a day keep the cardiologist away?

15 Dec 2016Paid-up subscribers

Moderate tea consumption was associated with a slower progression of coronary artery calcium and lower incidence of major cardiovascular events, a study published in the American Journal of Medicine has found. Regular coffee consumption had neither protective nor adverse effects.

AF linked to raised risk of a wide range of conditions

24 Oct 2016Registered users

Atrial fibrillation (AF) is associated with an increased risk of death, heart failure, chronic kidney disease and major cardiovascular events as well as stroke, a large meta-analysis has found.

High levels of physical activity can negate the detrimental effects of sitting

23 Sep 2016Registered users

Moderate intensity physical activity for 60-75 min per day appears to eliminate the increased risk of death associated with lengthy time spent sitting down, a meta-analysis has shown.

Sexual activity reduced in patients with CHD

01 Aug 2016Paid-up subscribers

Patients with coronary heart disease (CHD), particularly men, are less likely to be sexually active than those without CHD, a large English national study has shown. The effect of atherosclerotic changes on erectile function and the psychological impact of a coronary event on both sexes can have a profound effect on sexual activity. Quite often there is fear that another event could be provoked and this can adversely affect the desire to engage in sexual activity.

New electronic screening tool aids detection of FH

23 Jun 2016Paid-up subscribers

TARB-Ex, a new electronic screening tool, appears to be an efficient and cost-effective method for detecting patients at risk of familial hypercholesterolaemia, a study from Western Australia has found.

Prolonged PR interval may raise risk of cardiovascular events and death

23 May 2016Registered users

A meta-analysis of data from observational studies suggests a possible association between prolonged PR interval and increased risk of atrial fibrillation, heart failure and mortality. Fourteen eligible studies, covering 400,750 participants, undertaken between 1972 and 2011, were included in the analysis. Of these, 11 were prospective and three retrospective cohort studies.

AF is a stronger predictor of stroke and death in women

21 Mar 2016Paid-up subscribers

Women with atrial fibrillation (AF) have double the risk of stroke and death from cardiovascular disease compared with men, a systematic review and meta-analysis has shown.The authors analysed cohort studies published between January 1966 and March 2015 that reported sex-specific associations between the arrhythmia and all cause mortality, cardiovascular mortality, stroke, cardiac events (cardiac death and non-fatal myocardial infarction), and heart failure. A total of 30 studies with 4,371,714 patients were identified and analysed.

Clopidogrel vs aspirin in patients with drug-eluting stents

22 Feb 2016Registered users

Monotherapy with clopidogrel was associated with a reduced risk of recurrent ischaemic events compared with aspirin in patients with drug eluting stents (DES), in an observational study. All patients had previously undergone 12 months of dual antiplatelet therapy following stent insertion.

Sweetened drinks may increase risk of heart failure

22 Dec 2015Registered users

Men who consumed two or more servings of sweetened drinks per day had a significantly higher risk of developing heart failure than those who did not drink these beverages, in a large population-based cohort study. A cohort of 42,400 Swedish men aged between 45 and 79 were followed from 1998 through 2010. Sweetened beverage consumption was assessed by means of a food frequency questionnaire. The authors concluded that sweetened beverage consumption is associated with a higher risk of heart failure and that this could have implications for heart failure prevention strategies.

Incidence of atrial fibrillation on the increase

25 Nov 2015Registered users

Non-valvular atrial fibrillation (AF) is increasing in the UK with around 200,000 new cases a year. Over the past 13 years the actual standardised AF incidence rose by 17%, a study published in Heart has found. Early diagnosis of AF remains key to instigating effective thromboprophylaxis and reducing the potential morbidity and mortality associated with the thromboembolic complications of this common arrhythmia. The study authors conclude: ‘Greater awareness of the increasing incidence of AF in the elderly may lead to increased monitoring for new onset AF in elderly patients in primary care settings and when hospitalised for reasons other than AF. This in turn may facilitate earlier institution of therapy to prevent secondary thromboembolism.’

Moderate exercise lowers risk of atrial fibrillation in older women

21 Oct 2015Registered users

A moderate amount of physical activity appears to reduce the risk of atrial fibrillation significantly in middle-aged and elderly women, according to a study published in Heart. Information about physical activity was obtained from 36,513 women, aged 49-83 (median 60) years in the Swedish Mammography Cohort who had completed a questionnaire at study entry.

Standing more and sitting less may benefit cardiometabolic health

24 Sep 2015

Spending less time sitting and more time standing, stepping, or both, improves markers of cardiometabolic health, a study from Australia has shown.The researchers studied participants from the 2011/12 Australian Diabetes, Obesity, and Lifestyle Study who wore the posture-based activPAL3 monitor.

Digoxin therapy associated with increased mortality in atrial fibrillation

05 Aug 2015Registered users

The use of digoxin is independently associated with a raised risk of hospitalisation and death in adults with incident atrial fibrillation and no heart failure, a retrospective cohort study from the USA has found. A total of 14,787 age, sex and high-dimensional propensity score-matched patients with incident atrial fibrillation and no previous heart failure or digoxin use were studied in the ATRIA-CVRN study. The authors of this study conclude that in adults with atrial fibrillation, digoxin use was independently associated with higher risk of death and hospitalisation. They recommend that other rate control options should be tried before resorting to digoxin and that this should generally be used with caution in the management of atrial fibrillation.

Heart rate and age predict progression of atrial fibrillation

22 Jun 2015Paid-up subscribers

Heart rate is associated with progression of atrial fibrillation (AF) independent of rhythm, a large nationwide cohort study from the United States has found. Data from the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) were analysed to determine incidence and predictors of AF progression.

Optimal fitness levels for cardiovascular health in adolescents

21 May 2015Paid-up subscribers

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study has identified a cardiorespiratory fitness threshold associated with a more favourable cardiovascular health profile in adolescents.

Does renal denervation improve BP control in resistant hypertension?

23 Apr 2015Paid-up subscribers

Renal denervation plus a standardised stepped care antihypertensive treatment (SSAHT) regimen reduced ambulatory blood pressure more than the drug regimen alone in the DENERHTN triat. The study was a prospective, open-label randomised controlled trial with blinded endpoint evaluation in patients, aged 18-75 years, with resistant hypertension. It was carried out in 15 French tertiary care centres specialising in the management of hypertension.

Sex differences in cardiovascular outcomes in aortic stenosis

23 Mar 2015Paid-up subscribers

Women with aortic stenosis had a lower rate of all cause mortality and fewer ischaemic cardiovascular events then men, in a randomised controlled trial. However, rate of disease progression was similar for both genders. Data were used from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study, a randomised, double-blind, placebo-controlled trial which assessed the effect of combined treatment with simvastatin and ezetimibe on the progression of mild to moderate aortic stenosis and cardiovascular morbidity and mortality.

Obesity is a risk factor for sudden cardiac death

23 Feb 2015Paid-up subscribers

Both general and central obesity are associated with an increased risk of sudden cardiac death in middle-aged men and women, a prospective cohort study has found. Data from 14,941 men and women aged 45-64 (mean 54) years, taking part in the Atherosclerosis Risk in Communities (ARIC) study were analysed. The participants who were African American or white were recruited from four centres in the US. Body mass index, waist circumference and waist:hip ratio were measured at baseline. Mean follow-up was 12.6 years.

TAVI effective in elderly patients with severe aortic stenosis

22 Jan 2015Paid-up subscribers

Transcatheter aortic valve implantation (TAVI) had similar outcomes to surgical aortic valve replacement (SAVR) in high-risk patients with severe aortic stenosis, in a study from Switzerland. Both procedures were much more effective than medical therapy. Patients with severe aortic stenosis were consecutively enrolled into a prospective single centre registry. There were 442 patients, median age 83 years. A total of 78 patients were allocated to medical treatment, 107 to SAVR, and 257 to TAVI.

Running significantly reduces cardiovascular and all cause mortality risk

15 Dec 2014Paid-up subscribers

Even modest amounts of running, 5-10 minutes a day, at a relatively gentle pace, < 6 miles an hour, can significantly lower the risk of death from cardiovascular disease and all causes, according to a sizeable observational study in the Journal of the American College of Cardiology.

Smartphone programme boosts participation in cardiac rehabilitation

24 Nov 2014Paid-up subscribers

A smartphone-based home service improved uptake, compliance and completion of cardiac rehabilitation compared with a traditional centre-based programme, a study from Australia has shown. Health outcomes were similar with both approaches. A total of 120 patients who had had a myocardial infarction (MI) took part in the unblinded, randomised controlled trial. Half the patients, mean age 55.7 ± 10.4 years, were randomised to a centre-based programme and the other half, mean age 55.5 ± 9.6 years, to a smartphone-based programme. The vast majority of patients, 82% and 85% respectively, were male.

Do beta-blockers benefit patients with early CHD?

23 Oct 2014Paid-up subscribers

The use of beta-blockers in patients with new-onset coronary heart disease (CHD) is associated with a lower risk of cardiac events only in those who have had a recent myocardial infarction (MI), a study has shown.

Spironolactone in heart failure with preserved ejection fraction

23 Sep 2014Paid-up subscribers

Spironolactone did not significantly reduce deaths in patients with heart failure and preserved ejection fraction, however it did cut hospitalisations for heart failure, the TOPCAT study has shown. This was an international, multicentre, randomised, double-blind trial of patients with symptomatic heart failure and left ventricular ejection fraction ≥ 45%. A total of 3,445 patients were randomised to receive either spironolactone (15 to 45 mg daily) or placebo. The mean age of patients was 68.7 in both groups.

Does exercise affect prognosis in coronary heart disease?

25 Jul 2014Paid-up subscribers

Moderately frequent strenuous activity can reduce cardiovascular risk in patients with stable coronary heart disease (CHD) but daily strenuous activity may increase risk although not as much as no exercise at all, a study suggests. The study analysed data from a prospective cohort of 1,038 subjects with stable CHD. The majority of the participants were male, over 60 (median 61 years), overweight, current or former smokers and had a history of myocardial infarction and hypertension.

Newer drug therapies lower morbidity and mortality in acute coronary syndrome

23 Jun 2014Paid-up subscribers

The new ADP receptor antagonists significantly reduce deaths and cardiovascular morbidity compared with clopidogrel in patients with stable angina or acute coronary syndrome managed invasively, a meta-analysis has shown. These benefits were achieved without a significant increase in bleeding complications. The researchers identified eight randomised clinical trials comparing the new ADP receptor antagonists (prasugrel, ticagrelor and cangrelor) with clopidogrel in a total of 67,851 patients with stable angina or acute coronary syndrome.

Investigating the side effects of statins

22 May 2014Paid-up subscribers

Statin therapy increases the risk of diabetes, a systematic review of randomised, placebo controlled trials has confirmed but many of the other side-effects reported were similar with placebo.

Omega-3 PUFAs of little benefit in secondary prevention

20 Mar 2014Paid-up subscribers

The use of omega-3 polyunsaturated fatty acid (PUFA) supplements in patients with coronary heart disease (CHD) does not reduce major cardiovascular events, a large meta-analysis has found. Fourteen randomised controlled trials were analysed. Overall, 16,338 CHD patients received omega-3 PUFAs and 16,318 patients acted as controls.

New oral anticoagulants have a good risk-benefit profile in atrial fibrillation

24 Feb 2014Paid-up subscribers

The new oral anticoagulants are at least as good as, if not better than, warfarin at preventing strokes in patients with atrial fibrillation and have a lower rate of major bleeding, a large meta-analysis has found. The analysis, published in The Lancet, covered trials of atrial fibrillation patients who were randomised to new oral anticoagulants or warfarin, and in which both efficacy and safety outcomes were reported. A total of 71,683 patients in the RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE AF-TIMI 48 trials were included.

Adding PCI to medical therapy does not affect outcomes in stable CAD

22 Jan 2014Paid-up subscribers

Patients with stable coronary artery disease (CAD) and myocardial ischaemia who undergo percutaneous coronary intervention (PCI) have similar morbidity and mortality rates to those who receive medical therapy alone, a large meta-analysis has found. The authors performed a meta-analysis of randomised clinical trials of PCI and medical therapy for stable CAD conducted over the past 40 years, covering five trials with a total of 5,286 patients. The trials included COURAGE, MASS II, BARI 2D and FAME 2. There were 4,064 patients with myocardial ischaemia documented by exercise stress testing, nuclear or echo stress imaging modalities or by the measurement of fractional flow reserve. Median follow-up was five years.

Missing out on breakfast associated with raised CHD risk

05 Dec 2013Paid-up subscribers

Men who eat breakfast have a significantly lower risk of coronary heart disease (CHD) than those who do not, a large prospective study based on data from the Health Professionals Follow-up Study has found. The study analysed the eating habits of 26,902 American men aged 45 to 82 who were free of cardiovascular disease and cancer at entry into the study in 1992. During 16 years of follow-up there were 1,527 cases of incident CHD, defined as fatal myocardial infarction (MI) or nonfatal CHD. The results were adjusted for multiple factors such as demographics, diet quality, calories, alcohol intake, eating frequency, sleep characteristics, physical activity, smoking, having a parent who had an MI at a young age and work status (part or full time). Men who reported not eating breakfast were younger and more likely to work full time, drink more alcohol, smoke, be single and less active compared with the other men. Men who skipped breakfast had a 27% higher risk of CHD compared with men who did not, relative risk (RR) 1.27 (95% CI:1.06-1.53). Furthermore, those who ate late at night had a 55% higher CHD risk RR 1.55 (95% CI:1.05-2.29). There was no association seen between eating frequency and risk of CHD. The authors observed that these associations were at least partly the result of adverse changes in body mass index, hypertension, hypercholesterolaemia, and diabetes mellitus as after adjusting for these factors the increased risk from missing breakfast fell to 18%, RR 1.18 (95% CI:0.98-1.43).

High-dose NSAIDs may double risk of MI and heart failure

23 Oct 2013Paid-up subscribers

High doses of commonly used non-steroidal anti-inflammatory drugs (NSAIDs) could significantly increase the risk of major vascular and coronary events, a study in the Lancet has found. This meta-analysis covered 280 trials of NSAIDs versus placebo, involving 124,513 patients, and 474 trials of one NSAID versus another, involving 229,296 patients. Daily treatment with cyclo-oxygenase 2 (COX 2) inhibitors, such as celecoxib and etoricoxib, or high-dose daily regimens of ibuprofen (2,400 mg), diclofenac (150 mg), and naproxen (1,000 mg) were analysed for cardiovascular and gastrointestinal side effects.

Adequate sleep may help lower CVD risk

23 Oct 2013Paid-up subscribers

Sleeping for seven or more hours a night may reduce the risk of morbidity and mortality from cardiovascular disease (CVD), a Dutch study has found. Getting sufficient sleep and adherence to four traditional healthy lifestyle factors were all associated with a fall in risk. When sufficient sleep was added to these factors, the risk of CVD was further reduced.

Maternal obesity linked to premature death in adult offspring

23 Sep 2013Paid-up subscribers

Risk of early death and hospitalisation for a cardiovascular event was significantly higher in the grown-up children of obese mothers compared with those whose mothers had a normal BMI, a study from Scotland has shown.

Optimising treatment for AF patients following MI and coronary intervention

29 Aug 2013Registered users

Dual therapy with an oral anticoagulant (OAC) and clopidogrel appears to be at least as effective and safe as triple therapy, including aspirin, in patients with atrial fibrillation (AF) after MI or percutaneous coronary intervention (PCI), a study from Denmark has found.

Fish oils show no benefit in patients with multiple CVD risk factors

24 Jun 2013Registered users

Fish oils have no effect on cardiovascular morbidity and mortality in patients with multiple risk factors or atherosclerotic vascular disease, a large general practice-based study from Italy has found. The Risk and Prevention Study was double-blind and placebo-controlled. A total of 12,513 patients were enrolled who had multiple cardiovascular risk factors or atherosclerotic vascular disease but none had had a myocardial infarction (MI). They were followed up by a network of 860 GPs. Around half, 6,244 patients, were assigned to 1 g/day of n-3 fatty acids (polyunsaturated fatty acid ethyl esters with eicosapentaenoic acid and docosahexaenoic acid content not less than 85%) and 6,269 to placebo. The primary end point was initially a composite that included death, nonfatal MI and nonfatal stroke but was later revised at one year after a blinded assessment showed a very low event rate. The revised primary end point was death from cardiovascular causes or hospital admissions for cardiovascular problems. The median follow-up was five years.

Why do patients take aspirin for primary prevention?

23 May 2013Paid-up subscribers

A primary care study has shown that many patients continue to use aspirin for primary prevention, with almost two thirds doing so on the advice of their family doctor, despite studies showing an unfavourable risk/benefit profile. The study was a cross-sectional, self-reported, waiting room questionnaire in two North American primary care clinics. Patients were 50 years of age or older.

High levels of processed meat consumption linked to increased mortality rate

25 Apr 2013Paid-up subscribers

Eating large amounts of processed meat is associated with an increased risk of all cause mortality, a large prospective cohort study has found. Data on 448,568 men and women, from ten countries including the UK, enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were analysed.

Exacerbations of COPD associated with significant rise in troponin

21 Mar 2013Paid-up subscribers

Patients with acute exacerbation of COPD had four-fold higher levels of cardiac troponin T compared with patients with stable disease, in a small Scandinavian study.

Does egg consumption increase cardiovascular risk?

21 Feb 2013Paid-up subscribers

Eating up to one egg a day does not raise the risk of coronary heart disease (CHD) or stroke, a meta-analysis published in the BMJ suggests.

Stress echo predicts outcomes in acute chest pain

21 Feb 2013Paid-up subscribers

Stress echo can accurately predict future cardiac events and survival when incorporated into chest pain assessment, a study from a London unit, UK,  has shown.

Aldosterone antagonists of benefit in mild heart failure

28 Jan 2013Paid-up subscribers

Aldosterone antagonists improve ejection fraction and functional capacity in patients with heart failure irrespective of baseline functional class, a meta-analysis has shown.

Newer oral anticoagulants appear more effective than warfarin

12 Dec 2012Paid-up subscribers

The new oral anticoagulants can significantly reduce total mortality, cardiac deaths, and stroke/systemic embolism when compared with warfarin, a meta-analysis has shown.

High BMI in children raises CVD risk parameters

31 Oct 2012Paid-up subscribers

A large systematic review and meta-analysis, published in the BMJ, has shown an association between body mass index (BMI) and cardiovascular disease risk parameters in school age children.

Statins may cause fatigue with exertion

20 Sep 2012Paid-up subscribers

Statin use may result in a subjective feeling of lack of energy and fatigue with exertion, a randomised controlled trial has found. The effects were more common in women than men.

Does coffee consumption affect heart failure risk?

20 Sep 2012Paid-up subscribers

A recent trial has found a J-shaped relationship between coffee consumption and heart failure suggesting that low levels of coffee consumption may actually be protective and reduce the risk of heart failure.

Taking calcium supplements may increase risk of MI

26 Jul 2012Registered users

Although dietary calcium intake may confer some cardiovascular benefits calcium supplements appear to raise the risk of myocardial infarction (MI), a recent study published in Heart, has found.

Is there a role for statins in patients with low CVD risk?

20 Jun 2012Registered users

 A recent meta-analysis, published in The Lancet, suggests that primary prevention with statins could be an effective intervention even in low-risk groups.

Cardiovascular risk increased in patients with resistant hypertension

23 May 2012Registered users

Patients with resistant hypertension are 50% more likely to suffer cardiovascular events than patients whose hypertension is not resistant to treatment, a recent study published in Circulation has found. The retrospective cohort study from the United States included 205,750 patients started on treatment for hypertension between 2002 and 2006.

Are newer anticoagulants as cost-effective as warfarin?

22 May 2012Registered users

An economic evaluation, based on modelling, has suggested that dabigatran may be a cost-effective first-line treatment for the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) in the UK.

Male gender an independent predictor of mortality in heart failure

25 Apr 2012Registered users

Being male or having diabetes confers a poorer prognosis in patients with heart failure, a large meta-analysis in the European Journal of Heart Failure has shown. The authors used data from 31 studies in the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) of 41,949 patients with heart failure of which 28,052 were men and 13,897 women. Dr Peter Savill GP Watercress Medical, Medstead, GPwSI Cardiology, Southampton, writes: 'The authors note that women with ischaemic heart failure present more like men probably because the effect of an acute event such as a myocardial infarction negates the degree of protection from being female unlike the more gradual process of a non-ischaemic cardiomyopathy. Furthermore, diabetes patients with heart failure are known to have a poorer prognosis and again less of a gender effect is seen.'

Difference in BP readings between arms can predict outcomes in hypertension

25 Apr 2012Registered users

An inter-arm difference in systolic BP can predict cardiovascular morbidity and all-cause mortality after 10 years in patients with hypertension, a UK study in the BMJ has found. This cohort study was carried out in a rural general practice setting in Devon.

Statins are as beneficial in women as men

21 Mar 2012Paid-up subscribers

A large meta-analysis has shown that statins are just as effective in women as in men for reducing cardiovascular events and all-cause mortality. The analysis included 141,235 patients, 40,275 of whom were women, from studies such as JUPITER, ALLHAT-LLT, ASCOT-LLA, the Heart Protection Study, PROVE-IT and TNT.

Aspirin not warranted for primary prevention

21 Mar 2012Registered users

The potential cardiovascular benefits of aspirin are outweighed by the risk of nontrivial bleeding in people without cardiovascular disease (CVD), a meta-analysis has shown. The researchers analysed nine randomised placebo-controlled trials reporting on cardiovascular disease, non-vascular outcomes or death.

Low levels of physical activity reduce MI risk

25 Feb 2012Registered users

Leisure time exercise and low to moderate physical activity at work are associated with a reduced risk of myocardial infarction (MI), a large international study across different economic regions has shown. Earlier research had found a link between physical activity during leisure time and cardiovascular disease but the association with work-related activity was less clear.

Should direct renin inhibitors be used in combination therapy with ACE inhibitors or ARBs?

25 Feb 2012Registered users

Combining a direct renin inhibitor with ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy increases the risk of hyperkalaemia, a meta-analysis published in the BMJ has found.

How quickly should BP treatments be titrated?

24 Jan 2012Registered users

The maximal effect of antihypertensive therapy could be estimated between one and two weeks after starting treatment, a UK study the authors of a systematic review have concluded in Heart.

Supervised exercise more beneficial than stents for PAD

24 Jan 2012Registered users

A recent study from North America suggests that a greater improvement in walking distance can be seen with exercise compared with invasive management strategies in peripheral artery disease (PAD). The CLEVER (Claudication: Exercise versus Endoluminal Revascularization) study examined the relative benefit of supervised exercise, stenting, and optimal medical care in patients with aortoiliac PAD.