Posts Tagged "cardiovascular disease"

The U.S. Preventive Services Task Force, in a draft statement, is recommending low-dose aspirin to prevent both cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who have a 10-year CVD risk of 10% or greater (grade B recommendation). Patients aged 60 to 69 should talk to their clinicians about whether the benefits of daily aspirin outweigh the risks (grade C).

Patients using aspirin as a preventive must have a life expectancy of at least 10 years and be willing to take it daily for that length of time. The USPSTF notes that patients at increased risk for bleeding shouldn’t use daily aspirin.

The task force says there is insufficient evidence to make a similar recommendation for adults younger than 50 years or older than 70 years (both grade I statements).  The task force previously published separate recommendations on aspirin use for preventing CVD (2009) and colorectal cancer (2007); this is the first update to address the combined benefit.

Source: Journal Watch

More intensive management of high blood pressure, below a commonly recommended blood pressure target, significantly reduces rates of cardiovascular disease, and lowers risk of death in a group of adults 50 years and older with high blood pressure. This is according to the initial results of a landmark clinical trial sponsored by the National Institutes of Health called the Systolic Blood Pressure Intervention Trial (SPRINT). The intervention in this trial, which carefully adjusts the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg), reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg.

“This study provides potentially lifesaving information that will be useful to health care providers as they consider the best treatment options for some of their patients, particularly those over the age of 50,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), the primary sponsor of SPRINT. “We are delighted to have achieved this important milestone in the study in advance of the expected closure date for the SPRINT trial and look forward to quickly communicating the results to help inform patient care and the future development of evidence-based clinical guidelines.”

High blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems. An estimated 1 in 3 people in the United States has high blood pressure.

The SPRINT study evaluates the benefits of maintaining a new target for systolic blood pressure, the top number in a blood pressure reading, among a group of patients 50 years and older at increased risk for heart disease or who have kidney disease. A systolic pressure of 120 mm Hg, maintained by this more intensive blood pressure intervention, could ultimately help save lives among adults age 50 and older who have a combination of high blood pressure and at least one additional risk factor for heart disease, the investigators say.

The SPRINT study, which began in the fall of 2009, includes more than 9,300 participants age 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States and Puerto Rico. It is the largest study of its kind to date to examine how maintaining systolic blood pressure at a lower than currently recommended level will impact cardiovascular and kidney diseases. NIH stopped the blood pressure intervention earlier than originally planned in order to quickly disseminate the significant preliminary results.

The study population was diverse and included women, racial/ethnic minorities, and the elderly. The investigators point out that the SPRINT study did not include patients with diabetes, prior stroke, or polycystic kidney disease, as other research included those populations.

Source: NIH

Gout’s association with a host of vascular events was confirmed in a new study that explored the links between the inflammatory condition and coronary artery disease, peripheral vascular disease, and cerebrovascular events.

Though both men and women with gout were at increased risk for vascular events overall, the association appeared strongest for women. Dr. Lorna Clarson of Keele (England) University and her associates drew these conclusions from a retrospective cohort study of men and women with an incident diagnosis of gout.

Gout, caused by the deposition of uric acid crystals in joints, is characterized by acute flares of intensely painful and inflamed joints. However, the state of hyperuricemia that predisposes patients to acute attacks of gout may precede the first attack by years, and may persist between flares. The proinflammatory course of the natural history of gout has increasingly been recognized as a potential contributor to vascular disease.

The precise mechanism by which gout may increase vascular risk has not been identified. Dr. Clarson and associates noted that in addition to the acute and chronic inflammation associated with gout and hyperuricemia, serum uric acid may have a more direct effect on vascular health, as urate crystal deposition on vessel walls may promote vascular damage.

Source: Family Practice News

Cardiovascular disease (CVD) is the top killer in women and is largely preventable. The call for women to reduce their risk comes from the European Society of Cardiology (ESC) today on International Women’s Day.

Dr. Susanna Price, ESC spokesperson and consultant cardiologist at the Royal Brompton Hospital in London, UK, said:

“CVD is still largely considered a man’s problem with breast cancer commonly perceived as the greater issue for women. However, CVD is the top killer of women in Europe, resulting in 51% of deaths compared to 3% caused by breast cancer.” (1)

She added: “Women’s risk of heart disease tends to be underestimated by both the public and the medical profession because of the perception that estrogen protects them. In reality this just delays the onset of CVD by 10 years. (2) The result is that women’s risk factors are left untreated, leaving them more vulnerable to heart attack, heart failure and sudden cardiac death when the protection fades after menopause.”

Despite these misconceptions, the facts are that:

-CVD is the main cause of death in women in all countries of Europe (3)

-CVD causes 51% of deaths in women and 42% of deaths in men in Europe (1)

-CVD kills 51% of women in Europe and breast cancer causes 3% of deaths (1)

-The risks of smoking are higher in women because women metabolize nicotine faster, especially those taking oral contraceptives (2)

-Type 2 diabetes doubles CVD risk in men but more than triples the risk in women (4)

-Women are more likely to be severely disabled after a stroke than men (5).

Source: European Society of Cardiology

Isolated systolic hypertension in young and middle-age adults was associated with an increased risk of death from cardiovascular causes later in life, according to a study done over 3 decades.

Men in the study with systolic blood pressure (BP) levels of 140 mmHg or higher and diastolic BP below 90 had a 28% increased risk for death from coronary heart disease compared with men with normal BP (hazard ratio 1.28, 95% CI 1.04-1.58), reported Donald M. Lloyd-Jones, MD, of Northwestern University Feinberg School of Medicine in Chicago.

In addition, women with isolated systolic hypertension (ISH) had a more than twofold greater death risk (HR 2.12, 95% CI 1.49-3.01) than women with optimal BP, they wrote in the Journal of the American College of Cardiology.

The findings provide strong evidence that ISH is a clinically meaningful condition in young and middle-age adults and not just pseudo or ‘white-coat’ hypertension, Lloyd-Jones told MedPage Today.

“It is not well supported by science, but there has been a belief by many that elevated systolic and not diastolic blood pressure in younger adults is benign,” he said. “Most previous research hasn’t really examined hypertension by subtype. That’s why we did this study.”

ISH is defined as a systolic BP of 140 mmHg or greater with a diastolic BP of less than 90 mmHg. It is common in the elderly, but relatively uncommon in younger and middle-age adults, the researchers wrote.

NHANES data suggest that the overall prevalence of ISH among adults in their 20s and 30s has more than doubled in recent decades, from 0.7% between 1988 and 1994 to 1.6% between 1999 and 2004, but there is still a great deal of uncertainty about the clinical consequences of ISH in younger adults.

Source: MedPage Today