Tag: Heart

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Gout flares associated with subsequent cardiovascular events

Gout flares associated with subsequent cardiovascular events

Experts at the University of Nottingham, in collaboration with experts at Keele University, have found that the risk of heart attacks and strokes temporarily increases in the four months after a gout flare.

The research showed that gout patients who suffered from a heart attack or stroke were twice as likely to have had a gout flare in the 60 days prior to the event, and one and a half times more likely to have a gout flare in the 61-120 days prior.

The results of the study, led by Professor Abhishek in the School of Medicine at the University of Nottingham, are published in the journal JAMA.

Gout is a common form of arthritis that affects one in 40 adults in the UK. It is caused by high levels of uric acid, a chemical produced by breakdown of tissues in the body and present in certain foods and drinks.

At high levels, uric acid is deposited in and around joints as needle shaped urate crystals. Once released from their deposits, these crystals cause severe inflammation manifesting as joint pain, swelling, redness, and tenderness that often lasts for 1-2 weeks. These episodes, called gout flares, often recur. Inflammation is also a risk factor for heart attack and stroke.

People with gout tend to have more cardiovascular risk factors, although there have been no previous studies about whether gout flares are linked with an increased risk of heart attack and stroke. In this study, the experts examined whether there was a temporary increase in risk of heart attack or stroke after a gout flare.

The team used anonymized data from 62,574 patients with gout treated in the National Health Service in the UK. Of these, 10,475 experienced heart attack or stroke after the diagnosis of gout, while others of similar age, sex, and duration of gout, did not experience such events. They evaluated the association between heart attacks or strokes and recent gout flares and adjusted these results for comorbidities, socioeconomic deprivation, lifestyle factors and prescribed medications among other things. They found that gout patients who suffered a heart attack or stroke were twice as likely to have had a gout flare in the 60 days prior to the event, and one and a half times more likely to have a gout flare in the preceding 61-120 days.

They found a similar high rate of heart attack or stroke in the 0-60 and 61-120 days after gout flares compared with other time periods, when they used information from only patients who consulted for a gout flare and also experienced either heart attack or stroke. This further strengthened the finding that gout flares are associated with a transient increase in cardiovascular events following flares. The increased odds and rates persisted when people with pre-existing heart disease or stroke before their gout diagnosis were excluded, and when shorter exposure periods such as 0-15 and 16-30 days prior to heart attack or stroke, were considered.

Gout patients who died from a heart attack or stroke had over four times the odds of experiencing a gout flare in the preceding 0-60 days and over twice the odds of gout flare in the preceding 61-120 days.

This is the first study of its kind to examine whether there is an association between recent gout flares and heart attacks and strokes.


The results show that among patients with gout, patients who experienced a heart attack or stroke had significantly increased odds of a gout flare during the preceding 120-days compared with patients who did not experience such events. These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares.


People with recurrent gout flares should be considered for long-term treatment with urate lowering treatments such as allopurinol. This is a reliable way of removing urate crystal deposits and providing freedom from gout flares. Patients should also be considered for concurrent treatment with anti-inflammatory medicines such as colchicine for the first few months because urate lowering treatments may trigger gout flares in the short term.


People with gout should be encouraged to adopt a healthy lifestyle with appropriate treatment of conditions such as high blood pressure, high cholesterol, obesity and diabetes to minimise their background risk of heart attack and stroke”


Professor Abhishek, lead author on the study

Source:

Journal reference:

Cipolletta, E., et al. (2022) Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout. JAMA. doi.org/10.1001/jama.2022.11390.

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Art from the heart event Thursday supports local mental health

Art from the heart event Thursday supports local mental health

Organizers created the July 14 event to provide a safe space where people can participate in movement therapy and art workshops

From 6 to 9 p.m. on Thursday, July 14, the community can come out to the Kinbridge Community Association, at 200 Christopher Dr., for Art from the Heart.

The event was created by Rhythm and Blues Cambridge to support people’s mental health by coming together to process what happened over the last few years.

The ‘Processing Night’ will provide movement therapy and art workshops.

The organizers hope to provide a safe space where people can talk about their emotions, mental health and chat while having fun through, art, music and movement.

“In Jamaican culture when you’re grieving, we do something where you play a lot of music and let your feelings out,” said Krysanne Mclean, the organizer of the event and one of the founders of Rhythm and Blues. 

She mentioned how they wanted to show the community that there are different ways to grieve and let feelings out. Dancing is encouraged, she added.

Rhythm and Blues aims to provide safe spaces to empower, inform and inspire the Black community in the city.

“This year I wanted to focus on mental health and continue that in different forms.”

Mclean knows the pandemic has impacted people’s mental health locally and they want to provide events this year where people can feel connected again.

In addition to the unique non-traditional therapies and workshops at the event this evening, there will be face painting, food trucks and door prizes.

The three women who organized the event met during Rythm and Blues’ Black Girl Excellence program and wanted to create events where people can come let their feelings out, similar to how they do in their culture, which is generally more celebratory.

One of the organizers, Alannah Decker, is a local visual artist who will be conducting a Paint and Flow Music Healing Workshop.

“Alannah wanted to do art therapy in a different way,” said Mclean about the workshop.

The third organizer of Art from the Heart, Nicole Brown Faulknor, is a registered psychotherapist, child and youth worker, yoga instructor and embodied coach of ‘Mama Soul-House Rides.’

Faulknor will be hosting ‘yoga soul’ a movement therapy and stretch class, combining her passion for mental health with her knowledge of yoga.

“We can always be working on our mental health in different settings,” Mclean said.

The event is free and open to everyone.

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You’re invited to these amazing pop-up patio events in the heart of downtown Vancouver

You’re invited to these amazing pop-up patio events in the heart of downtown Vancouver





You’re invited to these amazing pop-up patio events in the heart of downtown Vancouver – Vancouver Is Awesome
































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Juneteenth organizers ‘carry a broken heart’ planning events after mass shooting in Buffalo

Juneteenth organizers 'carry a broken heart' planning events after mass shooting in Buffalo

The upcoming federal Juneteenth holiday commemorates the day in 1865 when enslaved people in Texas found out they were free — 2 1/2 years after Abraham Lincoln issued the Emancipation Proclamation granting freedom to people who had been enslaved.

Celebrations will be mixed with sadness during this year’s festivities, though. The holiday comes only about two months after the slaughter of 10 Black people in a Buffalo, N.Y., grocery store. It was just about two years ago that a white Minneapolis police officer murdered George Floyd. And the COVID-19 pandemic persists into its third summer.

The theme for Austin’s citywide Juneteenth celebration for the past few years has been “Stay Black and Live.” Festival organizers are staying with the theme this year.

Regine Malibiran is a co-project manager for Stay Black and Live, a joint effort between the George Washington Carver Museum, Cultural and Genealogy Center in Austin and Six Square, Austin’s Black cultural district. She says the phrase is a call to action for everyone.

“Not only for Black people specifically to find joy, find things to celebrate, find things to work for,” Malibiran says, “but also a call to action for people outside of the Black community to recognize what it means for Black people to assert control over their lives.”

Are we really free.jpg

Malibiran says events like the mass shooting in Buffalo can make that control feel elusive, and it permeates the work of planning Juneteenth festivities and social justice work year-round.

“We recognize that in order to do this work, you have to carry a broken heart,” she says. “That’s kind of both the reason why you do it, but also one of the most challenging obstacles in the work itself.”

Malibiran says the declaration of Juneteenth as a federal holiday last year might be seen as removing one of the obstacles to doing that work. And while she acknowledges that declaration as a “win,” she says it could actually erode the importance of the holiday.

“What does it mean when holidays become so large and nationwide like this?” she says. She says she believes these holidays can “become commercialized and almost sanitized at times.”

Malibiran says many Black people may not be able to enjoy the holiday because “they might be the ones who are serving you or cooking for you at brunch when you take the day off on Monday.”

Listen to the interview above or read the transcript below to hear more about one of the central questions Malibiran wants everyone to contemplate: “What does it mean for marginalized communities to create space for themselves and carve out space to be alive?”

This transcript has been edited lightly for clarity:

KUT: The theme for Austin’s Juneteenth commemoration for the past few years has been “Stay Black and Live.” Is that the theme for this year’s celebration? Why?

Regine Malibiran: We wanted it to be a call to action to “stay Black and live” — not only for Black people specifically to find joy, find things to celebrate, find things to work for, but also a call to action for people outside of the Black community to recognize what it means for Black people to assert control over their lives, agency over [their] lives.

It’s still relevant in 2022. I think it will stay relevant for a while, especially as we reflect on what happened in Buffalo, N.Y., a very heavy thing to reflect on. What does it mean for marginalized communities to create space for themselves and carve out space to be alive?

There was a mass shooting in Buffalo. Ten Black people were killed. How has that impacted thinking about this year’s gathering and impacted everybody who’s involved?

I am very fortunate and lucky and honored to work with a largely Black staff in my capacity at Six Square and also at the Carver Museum. It’s hard to say this, Jennifer, but it comes to a point where I feel like day to day, people have to learn to compartmentalize it. And that’s sad. We as teams, we recognize that in order to do this work you have to carry a broken heart. That’s kind of both the reason why you do it, but also one of the most challenging obstacles in the work itself.

And so for us as a team, what’s important for us is that we use these events as motivation. We fuel this grief, this anger, this fear into action for our community.

And so with the Juneteenth festival specifically, I think because it is a celebration of freedom — that’s what it’s always been — it’s important to create that space where Black people can be around their own community. And we are able to experience all of these feelings, whether it be celebration, because that’s what the holiday is about, whether it be reflection on what has changed and what has not since 1865, and what fighting for Black lives looks like as we march forward.

Part of the monthlong commemoration of Juneteenth are videos streaming [at Austin-Bergstrom International Airport]. And you had indicated those were kind of a welcome to Black Austin. What is Black Austin these days? How do you describe Black Austin in 2022?

I really feel like it is within the connections that Black people make between themselves here and even outside of Austin. Black people in the United States have centuries-long history of displacement and disconnection. You would have enslaved people who would be separated from their children. And then if they had the opportunity with their freedom afterwards, they would go on these lifelong searches to find their family. That sort of deeply rooted interpersonal intercommunity connection is really still what ties Black people today.

It was right before Juneteenth last year that Juneteenth was declared a federal holiday. Does that matter or mean anything?

You know, it’s funny because my partner is Black and he was like, “It’s kind of weird that white people get Juneteenth off. It was like — why do white people get the day off from Juneteenth? That’s kind of strange to me.” And I think that’s an important conversation, because like I said, in order to do this work, you have to carry a broken heart and you have to celebrate the wins when you can get them.

And so some people, they consider this federal recognition of Juneteenth as a holiday, as a win. And I don’t want to take away from that.

But I think that we can also look at that with a critical lens because what does it mean when holidays become so large and nationwide like this? These sorts of holidays — they become commercialized and almost sanitized at times. And we’ve seen that in this past year with Juneteenth. People were joking about getting 19% off sales at certain companies or whatever.

And so while I do recognize that it’s a step forward for us to say Juneteenth is important, is significant enough to be a holiday, that standard of importance and significance is still weighed with a white supremacist lens. Because before it was a national holiday, it was important for Black Texans, and they had a specific and very meaningful perspective on why they celebrated it.

Most of the time when you get these federal holidays, who gets those days off? It’s people who work in offices. A lot of people of color, Black people, they might not be working in the office. They might be the ones who are serving you or cooking for you at brunch when you take the day off on Monday. We have to think about who benefits when nationally we have changes like this.

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Analysis finds little proof that testosterone treatment increases the risk of cardiovascular events

Analysis finds little proof that testosterone treatment increases the risk of cardiovascular events

Testosterone replacement therapy appears safe in the short-to-medium term to treat a condition caused by deficiency of the male sex hormone, according to the most comprehensive analysis of the treatment to date, published in The Lancet Healthy Longevity journal.

The findings suggest that men given testosterone to treat hypogonadism are at no greater risk of heart attack, stroke, and other cardiovascular events in the short-to-medium term than men who do not receive testosterone treatment.

Testosterone replacement therapy is the standard treatment for hypogonadism, which can cause sexual dysfunction, weakening of bones and muscles, and reduced quality of life. Risk factors for the condition include aging (as testosterone levels decline with age), obesity (BMI of 30 kg/m2 or above), and diabetes.

Despite being widely used, the cardiovascular safety of testosterone treatment has until now remained unclear due to inconsistent findings. This is because most previous clinical studies have relied on aggregate data, rather than individual participant data and have not published details of individual adverse events.

Prescribing of testosterone for hypogonadism is increasing globally, but conflicting messages about its safety may have led to many patients not receiving the treatment. Ongoing studies should help to determine the longer-term safety of testosterone but, in the meantime, our results provide much-needed reassurance about its short-to-medium term safety. Our findings could have important implications for the treatment of men with hypogonadism worldwide.”


Jemma Hudson, Study Lead Author, University of Aberdeen

The authors conducted a systematic review identifying 35 eligible clinical trials published since 1992, of which 17 provided individual participant data. A blinded analysis by two independent clinicians enabled the classification of every cardiovascular event, allowing for a more robust analysis of the cardiovascular safety of testosterone treatment.

A meta-analysis using individual participant data from 17 studies and a further meta-analysis integrating these data with the aggregate data provided by the 18 trials that did not provide individual participant data were performed.

Among the 17 trials with individual patient data, 1,750 participants received testosterone and 1,681 were given a placebo. The average length of testosterone treatment was 9.5 months. The average age of participants was 65 years, and most were white and did not smoke. Participants’ average BMI was 30 kg/m2, which is considered obese.

A meta-analysis showed there were 120/1,601 (7.5%) cardiovascular events in the testosterone group and 110/1,519 (7.2%) in the placebo group across 13 trials that provided this information. Patient age, smoking or diabetes status did not affect cardiovascular risk. Similarly, there was no significant difference in mortality rate between the testosterone group (6/1,621 deaths, 0.4%) and the placebo group (12/1,537 deaths, 0.8%) across the 14 trials that provided individual patient data on mortality, but only limited data were available.

The researchers also found that testosterone significantly reduced serum total cholesterol, high-density lipoprotein (HDL), and triglycerides compared with placebo. However, there were no significant differences in serum low-density lipoprotein (LDL), blood pressure, glycaemic parameters, diabetes incidence, and prostate adverse outcomes between the testosterone and placebo groups.

The meta-analysis that integrated individual participant data with aggregate data showed similar results.

The authors acknowledge some limitations to their study. There was little available data evaluating the cardiovascular safety of testosterone treatment beyond 12 months, and the very small number of deaths recorded during testosterone trials hampered the authors’ ability to analyze why they occurred.

However, the longer-term safety of testosterone treatment is currently being investigated in another clinical trial. While the meta-analysis of aggregate data showed similar results to the one involving individual patient data only, it cannot be ruled out with certainty that a high number of unreported cardiovascular events in the trials that did not provide individual participant data could alter the current conclusions.

Source:

Journal reference:

Hudson, J., et al. (2022) Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis. The Lancet Healthy Longevity. doi.org/10.1016/S2666-7568(22)00096-4

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Clopidogrel monotherapy linked with reduced risk of net adverse clinical events, study finds

Clopidogrel monotherapy linked with reduced risk of net adverse clinical events, study finds

Results from a real-world study investigating safety and effectiveness of clopidogrel versus aspirin monotherapy beyond 12 months after PCI in high-risk patients during the chronic maintenance period. This study found that clopidogrel monotherapy was associated with reduced risk of net adverse clinical events (NACE; all-cause death, MI, stent thrombosis, stroke, or BARC type 2, 3, or 5 bleeding) and MACCE (death, MI, stent thrombosis, stroke), and a numerical decrease in major or clinically relevant nonmajor bleeding (BARC type 2, 3, or 5 bleeding), compared with aspirin monotherapy. The findings were presented today as late-breaking clinical research at the Society for Cardiovascular Angiography & Interventions (SCAI) 2022 Scientific Sessions.

P2Y12 inhibitor monotherapy reduces bleeding risk without increasing the risk of ischemic events compared with dual antiplatelet therapy (DAPT), especially in the first 12 months following percutaneous coronary intervention (PCI). Recent research showed that among patients who were event free for six to 18 months post-PCI and successfully received the intended duration of DAPT, clopidogrel monotherapy was superior compared with aspirin monotherapy in terms of NACE. However, optimal antiplatelet monotherapy during the chronic maintenance period beyond 12 months after PCI with drug-eluting stents in high-risk patients in real-world settings is previously unknown.

In total, 8,377 consecutive patients at high risk for both bleeding and thrombosis were identified from the prospective Fuwai PCI Registry if they satisfied one clinical and one angiographic criterion. Patients who received antiplatelet (aspirin or clopidogrel) monotherapy longer than 12 months and were free from ischemic and bleeding events at 12-month post-PCI without extended duration of DAPT were included. The primary endpoint was net adverse clinical events (NACE) from 12 to 30 months. The key secondary endpoints were major adverse cardiac or cerebral events (MACCE) and major or clinically relevant nonmajor bleeding (BARC type 2, 3 or 5).

“These findings show for the first time clopidogrel monotherapy is associated with reduced risk of long-term NACE and MACCE,” said Hao-Yu Wang, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. “Our results may have important practical implications for determining the optimal treatment for patients requiring a single antiplatelet drug, either aspirin or clopidogrel, for secondary prevention of ischemic events in high-risk PCI population.”

Of 7,392 high-risk patients that were event-free after the first year and adherent to DAPT, 5,664 patients who received antiplatelet monotherapy (clopidogrel monotherapy: n=1,974 and aspirin monotherapy: n=3690) were included in the present analysis. Researchers found that between 12 and 30 months, the net adverse clinical events were lower with clopidogrel monotherapy compared to aspirin monotherapy (Kaplan-Meier estimate: 2.5% vs. 5.0%; adjusted HR:0.566, 95% CI: 0.403-0.795). Clopidogrel monotherapy was associated with lower risk for MACCE (Kaplan-Meier estimate: 1.0% vs. 3.1%, log-rank p = 0.001 ), as well as lower incidence rates of all-cause death, MI, and stroke. The difference in risk between the groups was statistically similar for major or clinically relevant nonmajor bleeding (Kaplan-Meier estimate: 1.5% vs. 2.1%, log-rank p = 0.199).

Researchers recommended that their findings should be further investigated through a randomized clinical trial.

Source:

Society for Cardiovascular Angiography and Interventions

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Takotsubo Syndrome Also Linked to Happy Life Events

Takotsubo Syndrome Also Linked to Happy Life Events

Takotsubo syndrome, a condition that’s also been called “broken heart syndrome,” can be triggered by both positive and negative life stressors, especially in men, a new study suggests.

The findings show that although Takotsubo syndrome, a type of acute heart failure related to atypical patterns of transient left ventricular contraction abnormalities, is often triggered by negative emotional stressors, it can also stem from positive life events, something the researchers are calling “happy heart syndrome.”

In this registry study, males were more likely to experience Takotsubo syndrome from a positive life event, as were those with atypical, nonapical ballooning, report Thomas Stiermaier, MD, of the University Hospital Schleswig-Holstein in Lübeck, Germany, and colleagues.

Patients with negative and positive emotional triggers experienced similar short- and long-term outcomes, they found.

The results were published online May 4 in the JACC: Heart Failure.

Previous studies have shown that Takotsubo syndrome can be related to negative emotional triggers, physical triggers such as heavy physical activity or medical procedures (or, in some cases, neither of these), or even a combination of emotional and physical triggers, the authors say. Research shows that physical triggers are most often linked to poor outcomes.

A vast number of clinical scenarios may lead up to Takotsubo syndrome, noted Jason H. Rogers, MD, a professor of cardiovascular medicine at the University of California, Davis, Medical Center, commenting on these findings.

“Examples would include other medical illness, such as infection or recent surgery, having a heated argument with someone, running to catch a flight at the airport, and even being awakened suddenly by a sick pet,” Rogers told theheart.org | Medscape Cardiology.

But not all patients experience unhappy life stressors before these events occur, he added. “It is possible for patients to have happy life stressors that can lead to Takotsubo syndrome also.”

For this analysis, the research team evaluated 2482 patients using data from the multicenter GErman-Italian-Spanish Takotsubo (GEIST) Registry, one of the largest of its kind. Of these patients, 910 experienced an emotional trigger; of these, 873 had negative preceding events, and 37 had pleasant preceding events. The mean age was about 70 years in both groups.

The study team then compared patients with negative emotional triggers to those with positive emotional triggers, which included weddings, the birth of grandchildren, birthday parties, or anticipation of a trip or Christmas.

There was a 1.5% incidence of pleasant emotional triggers among all Takotsubo syndrome patients.

Among patients with positive prior triggers, there was a higher incidence of atypical ballooning (27.0% vs 12.5%; P = .01), and a higher percentage of these patients were male (18.9% vs 5.0%; P < .01) in comparison with those with negative events prior to Takotsubo syndrome.

Long-term death rates (8.8% vs 2.7%; P = .20) and rates of in-hospital complication outcomes, including cardiogenic shock, stroke, death, or pulmonary edema (12.3% vs 8.1%; P = .45), were similar for patients with negative preceding events and for those with positive preceding events.

Study limitations include that it cannot provide insight into the specific mechanisms of Takotsubo syndrome, it was observational, the sample size of patients in the positive events group was small, and the contributing research facilities assessed cardiac biomarker levels differently.

“Additional research efforts are needed to explore whether numerically lower cardiac-related event rates in patients with happy heart syndrome would be statistically significant in a larger sample size,” the researchers conclude.

Stiermaier reports no relevant financial relations.

JACC Heart Fail. Published online May 4, 2022. Full text

Ashley Lyles is an award-winning medical journalist. She is a graduate of New York University’s Science, Health, and Environmental Reporting Program. Previously, she studied professional writing at Michigan State University, where she also took premedical classes. Her work has taken her to Honduras, Cambodia, France, and Ghana and has appeared in outlets such as The New York Times Daily 360, PBS NewsHour, The Huffington Post, Undark, The Root, Psychology Today, Insider, and Tonic (Health by Vice), among other publications.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

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Bariatric Surgery Cuts Cardiovascular Events, Even in Seniors

Bariatric Surgery Cuts Cardiovascular Events, Even in Seniors

Bariatric surgery can reduce the risk of long-term cardiovascular outcomes in older Medicare beneficiaries with obesity, a large new observational study in which a third of the patients were over age 65 years, suggests.

Overall, patients who underwent bariatric surgery had 37% lower all-cause mortality and were significantly less likely to have admissions for new-onset heart failure (64% risk reduction), myocardial infarction (37% risk reduction), and ischemic stroke (29% risk reduction) as compared with similar patients who received more conservative treatment, after a median of 4 years of follow-up, report Amgad Mentias, MD, MS, a clinical cardiologist at the Cleveland Clinic Foundation in Ohio, and colleagues.

The results were published in the Journal of the American College of Cardiology.

Previous studies on bariatric surgery outcomes have primarily focused on individuals from select healthcare networks or medical facilities with restricted coverage in the United States or on patients with diabetes, noted Tiffany M. Powell-Wiley, MD, MPH, of the National Institutes of Health’s National Heart, Lung, and Blood Institute in Bethesda, Maryland, and colleagues in an accompanying editorial.

Moreover, other long-term and observational studies have shown that bariatric surgery can decrease the risk of myocardial infarction, death, and stroke in young and middle-aged patients with obesity, but the evidence is less clear for older patients and those without diabetes, noted Mentias in a phone interview.

“To date, this is one of the first studies to support bariatric surgery for CVD risk reduction in patients older than 65 years, a population at highest risk for developing heart failure,” the editorial points out.

“We should consider referring patients who qualify for bariatric surgery based on BMI; it really should be considered as a treatment option for patients with class 3 obesity, especially with a body mass index (BMI) over 40 kg/m2,” Powell-Wiley told Medscape.

“We know that patients are generally under referred for bariatric surgery, and this highlights the need to refer patients for bariatric surgery,” she added.

“There should be discussion about expanding insurance coverage to include bariatric surgery for eligible patients,” Mentias added.

Contemporary Cohort of Patients

“A lot of the studies showed long-term outcomes outside of the US, specifically in Europe,” Mentias added.

The aim of this study was to evaluate the long-term association between bariatric surgery and risk of adverse cardiovascular outcomes in a contemporary large cohort from the United States.

Older patients (> 65 years) and those without diabetes were looked at as specific subgroups.

The researchers assessed 189,770 patients. There were 94,885 matched patients in each cohort. Mean age was 62.33 years. Females comprised 70% of the cohort. The study group had an average BMI of 44.7 kg/m2.

The study cohort was matched 1:1. Participants were either part of a control group with obesity or a group of Medicare beneficiaries who had bariatric surgery between 2013 and 2019. Sex, propensity score matching on 87 clinical variables, age, and BMI were used to match patients.

Myocardial infarction, new-onset heart failure, ischemic stroke, and all-cause mortality were all study outcomes. As a sensitivity analysis, the study team conducted an instrumental variable assessment.

More specifically, the findings showed that bariatric surgery was linked with the following after a median follow-up of 4.0 years:

  • Myocardial infarction (hazard ratio [HR], 0.63; 95% CI, 0.59 – 0.68)

  • Stroke (HR, 0.71; 95% CI, 0.65 – 0.79)

  • New-onset heart failure (HR, 0.46; 95% CI, 0.44 – 0.49)

  • Reduced risk of death (9.2 vs 14.7 per 1000 person-years; HR, 0.63; 95% CI, 0.60 – 0.66)

Findings for those over the age of 65 were similar — lower risks of all-cause mortality (HR, 0.64), new-onset heart failure (HR, 0.52), myocardial infarction (HR, 0.70), and stroke (HR, 0.76; all P < .001). Similar findings were shown in subgroup analyses in men and women and in patients with and without diabetes.

The study cohort primarily consisted of Medicare patients, which limits the generalizability of the data. Lack of data on medications taken for cardiovascular and weight loss purposes and potential coding errors because the information was gathered from an administrative database were all limitations of the study, the researchers note.

An additional limitation was that residual unmeasured confounders, particularly patient-focused physical, social, and mental support factors, could play a role in whether a patient opted to have bariatric surgery, the study authors note.

“Additional studies are needed to compare cardiovascular outcomes after bariatric surgery with weight loss medications like glucagon-like peptide-1 (GLP-1) analogues,” the researchers add.

This study was partially funded by philanthropic contributions by the Khouri family, Bailey family, and Haslam family to the Cleveland Clinic for co-author Dr Milind Y. Desai’s research. Mentias has disclosed no relevant financial relationships. Powell-Wiley disclosed relationships with the National Institute on Minority Health and Health Disparities and the Division of Intramural Research of the National, Heart, Lung, and Blood Institute of the National Institutes of Health.

J Am Coll Cardiol. 2022;79:1429-1437, 1438-1440. Abstract, Editorial

Ashley Lyles is an award-winning medical journalist. She is a graduate of New York University’s Science, Health, and Environmental Reporting Program. Previously, she studied professional writing at Michigan State University, where she also took premedical classes. Her work has taken her to Honduras, Cambodia, France, and Ghana and has appeared in outlets like The New York Times Daily 360, PBS NewsHour, The Huffington Post, Undark, The Root, Psychology Today, TCTMD, Insider, and Tonic (Health by Vice), among other publications.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

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Leakage after left atrial appendage occlusion associated with higher risk of adverse events

Leakage after left atrial appendage occlusion associated with higher risk of adverse events

Patients who had leakage to the left atrial appendage due to incomplete device sealing after left atrial appendage occlusion (LAAO) experienced more clotting and bleeding events within a year following their procedure compared with patients who had no leaking, according to a study presented at the American College of Cardiology’s 71st Annual Scientific Session.

The study, which included data from more than 50,000 patients, is by far the largest to date to assess how leaking after LAAO affects the likelihood of adverse health outcomes. The results suggest that even small leaks are associated with a 10%-15% higher risk of adverse events.

Our study shows that any leak matters, and we should find ways to optimize the procedure to minimize the proportion of patients who end up with leaks. Because this is a preventative procedure, it is important to find ways to master this and prevent leaks from happening. Fortunately, there are indications that leaking might be less common with newer devices and improved techniques.”


Mohamad Alkhouli, MD, professor of medicine at Mayo Clinic and study’s lead author

Stroke is a major concern in patients with atrial fibrillation (AFib), the most common heart rhythm disorder. Blood thinners are the primary medical option for reducing the risk of strokes, which are caused when a blood clot blocks an artery in the brain; however, blood thinners are not suitable for many patients due to drug interactions, bleeding complications, cost, frequent blood checks with warfarin or other reasons. The WATCHMAN device, approved by the U.S. Food and Drug Administration in 2015, is designed to help prevent strokes by sealing off the heart’s left atrial appendage where blood can pool and clot. It is now widely used to reduce the risk of stroke in patients with AFib who cannot tolerate long-term use of blood thinners.

For the study, researchers analyzed data from 51,333 patients who underwent LAAO procedures with the WATCHMAN device between 2016-2019 as recorded in the ACC’s LAAO Registry, a database that includes nearly all LAAO procedures conducted in the U.S. and is part of the College’s NCDR registries. Echocardiograms were used to classify the size of any leaks around the device an average of 45 days after a LAAO procedure, a standard part of the clinical follow-up for this procedure. Registry data also included information about subsequent adverse health events occurring in the years after the procedure.

Overall, researchers found that 73.4% of patients had no leaks, 25.8% had small leaks (greater than zero but less than 5 millimeters across) and 0.7% had large leaks (greater than 5 millimeters)—proportions similar to those reported in previous registry studies and clinical trials.

While relatively few patients—roughly 2%-3%—experienced adverse events in the year following their LAAO procedure, the researchers found that the relative risk of these events varied significantly between patients with and without leaks. Compared to patients who had no leaking, those with small leaks had a 10% higher relative risk of suffering any major adverse events, an 11% higher relative risk of major bleeding complications, and a 15% higher relative risk of clotting-related events, including stroke, systemic embolization and transient ischemic attacks.

The study revealed no significant differences in the rate of adverse events between patients with large leaks and those with small or no leaks, which Alkhouli said is likely due to the use of anticoagulants in these patients. Instructions for the WATCHMAN device indicate that patients who have residual leaks greater than 5 millimeters across should be considered to have a failed procedure, and they are generally treated with anticoagulants.

Alkhouli said leaking is relatively common with LAAO procedures because the size and shape of the left atrial appendage varies widely from person to person, which can make it difficult for operators to position the device in a way that completely seals off the appendage. He noted that the shape of the appendage portion where the leaked blood flows into could affect the associated risks. More recent technologies, such as the use of CT scans to image the appendage and software that allows users to practice the procedure virtually before operating on a patient, could help operators place the WATCHMAN device in a more optimal position. Alkhouli said newer generation WATCHMAN device designs, which were introduced in 2021, could also help to reduce the risk in some patients.

The study was based on registry data reflecting real-world practices, meaning variations in the measurement of leaks could exist and may impact the results of the study, Alkhouli said. He added that future studies could help clarify whether using blood thinners in some patients with leaks smaller than 5 millimeters would be helpful in reducing stroke risk.

This study was simultaneously published online in the JACC: Clinical Electrophysiology at the time of presentation. The study was funded by Boston Scientific, maker of the WATCHMAN device.

Alkhouli will present the study, “Residual Leaks Post Left Atrial Appendage Occlusion,” on Sunday, April 3, at 12:15 p.m. ET / 16:15 UTC in the Main Tent, Hall D.

Source:

American College of Cardiology