Alcohol May Have Immediate Effect on Atrial Fibrillation Risk, Events

Alcohol appears to have an immediate—or near-immediate—effect on heart rhythm, significantly increasing the chance that an episode of atrial fibrillation (AFib) will occur, according to new data presented at the American College of Cardiology’s 70th Annual Scientific Session.

The data revealed that just one glass of wine, beer or other alcoholic beverage was associated with twofold greater odds of an episode of AFib occurring within the next four hours. Among people having two or more drinks in one sitting, there was a more than threefold higher chance of experiencing AFib. Using an alcohol sensor placed on participants’ ankles, which passively monitored alcohol intake, the investigators found that every 0.1% increase in inferred blood alcohol concentration over the previous 12 hours was associated with an approximate 40% higher odds of an AFib episode. Evidence from those sensors also demonstrated that the total alcohol concentration over time also predicted the chance AFib would occur.

“Alcohol is the most commonly consumed drug in the world, and there is still a lot we don’t understand about what it does to our bodies and, in particular, our hearts,” said Gregory M. Marcus, MD, cardiologist and professor of medicine at the University of California, San Francisco, and the study’s lead author. “Based on our data, we found that alcohol can acutely influence the likelihood that an episode of AFib will occur within a few hours, and the more alcohol consumed, the higher the risk of having an event.”

AFib is the most common heart rhythm disorder. It is often characterized by a rapid, chaotic and fluttery heartbeat. Marcus said that people can experience a range of symptoms. Some may not feel anything, while others are overcome with severe shortness of breath, fatigue, fainting or near fainting spells and a disconcerting sensation that the heart is beating out of control. AFib also results in costly use of health care services, including visits to the emergency department, hospitalizations and procedures each year. Over time, AFib can lead to heart failure, stroke and dementia if untreated.

Researchers enrolled 100 patients with paroxysmal or intermittent AFib, which tends to go away within a short period of time (unlike chronic AFib). Patients in the study were 64 years old on average; the majority were white (85%) or male (80%). Past medical history, medications and lifestyle habits were assessed through chart reviews and patient interviews. Each participant was fitted with a wearable heart monitor that continuously tracked their heart rhythm and an ankle sensor to objectively detect when more than two to three drinks were consumed on a given occasion. Participants were asked to press a button on the heart monitor each time they had an alcoholic drink. Finger stick blood tests measuring alcohol consumption in the previous few weeks were also used to corroborate self-reported drinking events. Because researchers used repeated measurements from the same individual, they served as their own control over time. Overall, more than half (56) had an episode of AFib during the four-week study.

“Patients have been telling us that alcohol is a trigger for AFib for a long time, but it’s been hard, if not impossible, to study because there is a critical temporal relationship that requires a real-time assessment of alcohol intake and heart rhythm,” Marcus said. “This is the first study to objectively demonstrate and quantify the real-time relationship between alcohol consumption and AFib episodes. While this study was limited to people with intermittent AFib, it’s reasonable to extrapolate the fact that in many people alcohol may be the main trigger for an initial episode.”

Marcus said there may be other factors—such as race/ethnicity, sex, genetics or other environmental exposures—that influence alcohol’s effect on the heart in various ways and need to be studied. In addition, people often pair alcohol with foods that are high in sodium, while some pour a drink because they feel stressed, so there may be other things that play a role. The findings also run counter to previous reports about the potentially protective role of alcohol on heart health when used in moderation.

“There is conventional wisdom that alcohol is ‘good’ or ‘healthy’ for the heart, based on observational studies, but that relates to coronary heart disease and heart attack. These new data present an interesting conundrum regarding the overall risks versus benefits of alcohol in moderation,” Marcus said. “But the data is very clear that more is not better when it comes to alcohol; those who drink more have a higher risk of heart attack and death.”

Marcus added that this situation is a perfect example where precision medicine may play a clinically relevant role to help identify which patients are at high risk for alcohol-related AFib. Those who are not at high-risk of the harmful effects of alcohol might yet benefit from moderate alcohol consumption as another way to potentially protect them from coronary blockages and disease.

The general recommendation for daily alcohol consumption is no more than one standard alcoholic beverage a day for women and two for men.

“Still, when patients ask me what they can do to avoid an AFib episode, I tell them the evidence suggests that they should minimize, if not completely eliminate, alcohol. But we have to consider quality of life as well, which is both relevant to arrhythmia symptoms and the opportunity to enjoy a glass of wine once in a while for some. So, it’s not as simple as instructing everyone to avoid alcohol,” Marcus said.

As far as next steps, Marcus and his team will look at how these results, which are limited to those with intermittent AFib, may apply to the general population. They also hope to identify other factors that may influence the relationship between alcohol and AFib, including genetics.

Source: The American College of Cardiology

A Healthier Heart Might Make You Smarter

Serena McNiff wrote . . . . . . . . .

In new evidence that illustrates that health issues rarely exist in a vacuum, a new study finds a link between heart health and brain function.

Existing evidence suggests that having heart disease raises one’s risk of dementia, and vice versa, but a team of researchers based in London wanted to find out if this connection could be seen in a healthier population.

For the study, nearly 30,000 mostly healthy adults in the United Kingdom had MRI scans to assess their heart health. The participants also completed thinking (“cognitive”) tests, measuring their ability to solve logic and reason-based problems, and showing how fast the brain processes information. Performing well on these tests is associated with better brain function.

The results revealed that those who excelled on the cognitive tests were more likely to have a healthier heart than those who tested poorly, said study co-author Nicholas Harvey, a professor of rheumatology and clinical epidemiology at the University of Southampton in the United Kingdom.

“We found that better scores for the two cognitive tests that we used, indicating better brain function, were associated with heart measures, from the cardiac [MRI] scans, which indicated a healthier heart,” Harvey said. “Thus, having a healthy brain is associated with having a healthy heart, and vice versa.”

The study was published online in the European Heart Journal — Cardiovascular Imaging.

Risk factors such as age, smoking, high blood pressure, alcohol intake and exercise level can affect one’s risk of developing problems such as heart disease and dementia. Thus, it was important to determine if these factors were responsible for the brain-heart connection or if these organs were independently associated.

However, even after accounting for these risk factors, the relationship between heart health and brain function held steady, suggesting that some other mechanism may be responsible.

“Importantly, the association was not explained by classical risk factors for heart disease or dementia, which suggests that there may be a biological link between the two conditions, separate from the contribution to both conditions from these risk factors,” Harvey said.

While the potential mechanisms linking heart and brain health are not fully mapped out, it is clear that these systems are tightly connected, said Dr. Joseph Diamond, director of nuclear cardiology at Long Island Jewish Medical Center, in New Hyde Park, N.Y.

“There are a lot of nerves from the brain directly to the heart, and we know there’s a strong connection between the two,” Diamond said.

According to Diamond, stress is a prime example of a health problem that has a cascading effect on different systems in the body, including the heart and brain.

“When you are dealing with individuals who have chronic stress or chronic anxiety issues, it affects a lot of parts of the body,” Diamond said. He explained how many of the different hormones released in response to stress can provoke an increase in heart rate and blood pressure.

“We think that a lot of people who have chronic elevations of stress hormones may have more tendency to have atrial fibrillation [an irregular heart rate], and it may be an independent risk factor for heart disease,” he said.

In light of the increasing burden of age-related problems such as heart disease and dementia, learning more about the complex causes of these diseases is essential, Harvey said.

“Our findings are highly relevant in an ever-aging global population,” Harvey said. “Understanding links between these diseases enables us to optimize our assessment of older people and to potentially develop new therapies, which will target common mechanisms of aging.”

Source: HealthDay

Close Monitoring for Heart Risk Needed if Breast, Prostate Cancer Treatment Includes Hormones

The hormonal therapies used to treat many breast and prostate cancers raise the risk of a heart attack and stroke, and patients should be monitored regularly and receive treatment to reduce risk and detect problems as they occur, according to a new American Heart Association scientific statement, published today in the Association’s journal Circulation: Genomic and Precision Medicine.

“The statement provides data on the risks of each type of hormonal therapy so clinicians can use it as a guide to help manage cardiovascular risks during cancer treatment,” said Tochi M. Okwuosa, D.O., FAHA, chair of the scientific statement writing group, an associate professor of medicine and cardiology and director of Cardio-Oncology Services at Rush University Medical Center in Chicago.

Hormone-dependent cancers, such as prostate and breast cancer, are the most common cancers in the United States and worldwide not including skin cancers. As improvements in treatment – including increased use of hormonal therapies – allow people with these cancers to live longer, cardiovascular disease has emerged as a leading cause of illness and death in these patients.

Hormonal treatments for breast cancer include selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). SERMs block estrogen receptors in cancer cells so the hormone can’t spur tumor growth, while letting estrogen act normally in other tissues such as bone and liver tissue; examples of SERMs include tamoxifen and raloxifene. Aromatase inhibitors lower the amount of estrogen produced in post-menopausal women and include exemestane, anastrozole and letrozole. Endocrine treatments for prostate cancer, called androgen deprivation therapy, include some medications that decrease production of testosterone by their action on the brain and others that block testosterone receptors found in prostate cells and some prostate cancer cells.

The writing group reviewed existing evidence from observational studies and randomized controlled trials and found that:

  • Tamoxifen increases the risk of blood clots, while aromatase inhibitors increase the risk of heart attack and stroke more than tamoxifen. For breast cancer patients who require more than one type of hormonal therapy because of developed resistance to the initial medication, , there is an improvement in cancer outcomes. However, treatment with multiple hormones is associated with higher rates of cardiovascular conditions such as high blood pressure, abnormal heart rhythms and blood clots.
  • Androgen deprivation therapy (to reduce testosterone) for prostate cancer increases cholesterol and triglyceride levels, adds body fat while decreasing muscle and impairs the body’s ability to process glucose (which may result in type 2 diabetes). These metabolic changes are associated with a greater risk of heart attacks, strokes, heart failure and cardiovascular death.
  • The longer people receive hormonal therapy, the greater the increased risk of cardiovascular problems. Further research is required to better define the risks associated with duration of treatment.
  • The hormonal therapy-associated increase in CVD risk was highest in people who already had heart disease or those who had two or more cardiovascular risk factors – such as high blood pressure, obesity, high cholesterol, smoking or a family history of heart disease or stroke – when they began treatment.

“A team-based approach to patient care that includes the oncology team, cardiologist, primary care clinician, dietician, endocrinologist and other health care professionals as appropriate is needed to work with each patient to manage and reduce the increased risk of heart disease and strokes associated with hormonal therapy in breast and prostate cancer treatment,” Okwuosa said.

There are currently no definitive guidelines for monitoring and managing hormonal therapy-related heart risks. The statement calls for clinicians to be alert for worsening heart problems in those with prior heart disease or risk factors, and to recognize that even those without pre-existing heart problems are at higher risk because of their exposure to hormonal therapies.

“For patients who have two or more cardiovascular risk factors, it is likely that referral to a cardiologist would be appropriate prior to beginning hormone treatment. For patients already receiving hormonal therapies, a discussion with the oncology team can help to determine if a cardiology referral is recommended,” Okwuosa said.

The statement also calls for additional research in several areas, including:

  • Further evaluation of racial and ethnic disparities among breast and prostate cancer patients who have received hormone therapy. In the few studies that exist, racial and ethnic differences detected may be related to health inequities and other factors, and these are important areas to address.
  • Heart disease and stroke outcomes and risks should be added as primary endpoints in randomized trials of hormonal therapies.
  • Studies of specific hormonal medications are needed since each one may have different heart risks even if they work in the same way to treat breast or prostate cancer.

Source: American Heart Association

Waist Size May Better Predict AFib Risk in Men

Sarah Amandolare wrote . . . . . . . . .

Body mass index may be more helpful in predicting the risk of a common type of irregular heartbeat in women, while waist size may better predict that risk in men, new research suggests.

The link between obesity and atrial fibrillation, or AFib – when the heart beats irregularly and often too fast – is well established. But researchers wanted to understand the extent to which body fat distribution might predict AFib risk among men and women.

The researchers analyzed BMI, waist circumference and electrocardiogram data gathered between 2008 and 2013 from more than 2 million older adults in the U.S. and United Kingdom who didn’t have cardiovascular conditions, including heart failure and stroke. The study’s lead author, Dr. Michiel Poorthuis of University Medical Center Utrecht in the Netherlands, described it as “probably the largest study of its kind to date.”

About 12,000 participants – 0.6% – had AFib. After adjusting for variables such as a history of high blood pressure, diabetes and smoking, the researchers found both higher BMI and a bigger waist were associated with an increased risk of AFib in men and women.

But there was a stronger connection between BMI and AFib risk among women, while waistline seemed a greater predictor in men. For women, adding BMI to the calculation improved the ability to predict AFib by 23% compared to a 12% improvement using waist size. In men, however, waist size came out on top, with a 30% improvement in predicting AFib versus 23% using BMI.

According to the National Heart, Lung, and Blood Institute, normal BMI is defined as below 25, and women with a waist size greater than 35 inches and men with a waist larger than 40 inches are at higher risk for heart disease and Type 2 diabetes.

Dr. Richard Bulbulia, co-senior author of the analysis published Thursday in the Journal of the American Heart Association, said the results bolster advice to maintain a healthy weight – and point to the next research question.

“What’s really exciting is the question of, can weight loss decrease atrial fibrillation burden in people who have it, or prevent people from developing it?” said Bulbulia, a research fellow in the University of Oxford Nuffield Department of Population Health and a consultant vascular surgeon at Cheltenham General Hospital in the United Kingdom.

The answer to that question could have broad repercussions: AFib, a major risk factor for stroke, is poised to affect an estimated 12.1 million Americans by 2030, according to American Heart Association statistics.

Left untreated, AFib doubles the risk of heart-related death and is associated with a fivefold higher risk of stroke. Some people with AFib have no symptoms, but others experience a rapid heartbeat or skipped beats.

Dr. Matthew Kalscheur, a clinical cardiologist and cardiac electrophysiologist at UW Health in Madison, Wisconsin, said the possible connection between waist circumference and AFib in men was important to consider.

Kalscheur, who was not involved in the new research, said although BMI – a standard measure of overweight and obesity – is routinely recorded and considered by clinicians in the context of AFib risk, waist circumference typically is not.

“The next step is, how do we present that to our patients, and how do we use this data to try to change behaviors that could impact that risk development,” Kalscheur said.

Like Bulbulia, Kalscheur wonders if, for instance, a person without AFib who is older, overweight and has high blood pressure can make behavioral changes to help prevent AFib – and, ideally, prevent stroke.

“We need to incorporate the results of studies like this one into the shared decision-making process that we have with our patients,” Kalscheur said. “In this case, it would be the shared decision about the importance of losing weight to reduce AFib risk.”

Source: American Heart Association

Good Dental Health May Help Prevent Heart Infection from Mouth Bacteria

Maintenance of good oral health is more important than use of antibiotics in dental procedures for some heart patients to prevent a heart infection caused by bacteria around the teeth, according to a new American Heart Association (AHA) scientific statement published today in the association’s flagship journal, Circulation.

Infective endocarditis (IE), also called bacterial endocarditis, is a heart infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. It is uncommon, but people with heart valve disease or previous valve surgery, congenital heart disease or recurrent infective endocarditis have a greater risk of complications if they develop IE. Intravenous drug use also increases risk for IE. Viridans group streptococcal infective endocarditis (VGS IE) is caused by bacteria that collect in plaque on the tooth surface and cause inflammation and swelling of the gums. There’s been concern that certain dental procedures may increase the risk of developing VGS IE in vulnerable patients.

The new guidance affirms previous recommendations that only four categories of heart patients should be prescribed antibiotics prior to certain dental procedures to prevent VGS IE due to their higher risk for complications from the infection:

  • those with prosthetic heart valves or prosthetic material used for valve repair;
  • those who have had a previous case of infective endocarditis;
  • adults and children with congenital heart disease; or
  • people who have undergone a heart transplant.

“Scientific data since the 2007 AHA guidelines support the view that limited use of preventive antibiotics for dental procedures hasn’t increased cases of endocarditis and is an important step at combating antibiotic overuse in the population,” said Walter R. Wilson, M.D., chair of the statement writing group and a consultant for the Division of Infectious Diseases, Department of Internal Medicine at Mayo Clinic in Rochester, Minn.

It has been over a decade since recommendations for preventing infective endocarditis were updated amid concerns of antibiotic resistance due to overprescribing. The American Heart Association’s 2007 guidelines, which presented the biggest shift in recommendations from the Association on the prevention of infective endocarditis in more than 50 years, more tightly defined which patients should receive preventive antibiotics before certain dental procedures to the four high-risk categories. This change resulted in about 90% fewer patients requiring antibiotics.

The scientific statement writing group reviewed data on VGS IE since the 2007 guidelines to determine if the guidelines had been accepted and followed, whether cases of and mortality due to VGS IE have increased or decreased, and if the guidance might need to be adjusted.

The writing committee reports their extensive review of related research found:

  • There was good general awareness of the changes in the 2007 guidelines, however, adherence to the guidelines was variable. There was about a 20% overall reduction in prescribing preventive antibiotics among high-risk patients, a 64% decrease among moderate-risk patients, and a 52% decrease in those patients at low- or unknown-risk.
  • In a survey of 5,500 dentists in the U.S., 70% reported prescribing preventive antibiotics to patients even though the guidelines no longer recommend it, and this was most often for patients with mitral valve prolapse and five other cardiac conditions. The dentists reported that about 60% of the time the antibiotic regimen was recommended by the patient’s physician, and 1/3 of the time was according to patient preference.
  • Since the stricter 2007 antibiotic guidelines, there is no convincing evidence of an increase in cases of VGS IE or increased mortality due to VGS IE.
  • The writing group supports the 2007 recommendation that only the highest risk groups of patients receive antibiotics prior to certain dental procedures to help prevent VGS IE.
  • In the presence of poor oral hygiene and gingival disease, VGS IE is far more likely to develop from bacteria attributable to routine daily activities such as toothbrushing than from a dental procedure.
  • Maintenance of good oral hygiene and regular access to dental care are considered as important in preventing VGS IE as taking antibiotics before certain dental procedures.
  • It is important to connect patients with services to facilitate access to dental care and assistance with insurance for dental coverage, especially in those patients at high risk for VGS IE.
  • It is still appropriate to follow the recommendation to use preventive antibiotics with high-risk patients undergoing dental procedures that involve manipulation of the gum tissue or infected areas of the teeth, or perforation of the membrane lining the mouth.

Source: American Heart Association