Cancer Survivors Face Higher Heart Risks Later

Steven Reinberg wrote . . . . . . . . .

If you survive cancer, you’re more apt to have heart trouble later on, a new study shows.

Researchers found that compared to others, cancer survivors had a 42% greater risk of heart disease, most likely due to damage resulting from cancer treatment.

“There are chemotherapies that can damage the heart, and radiation to the chest can also affect the heart,” said lead researcher Dr. Roberta Florido, director of cardio-oncology at Johns Hopkins Medicine in Baltimore. “So it’s possible that these therapies, in the long run, increase the risk of cardiovascular disease.”

The risk for heart failure after cancer was particularly high: 52%. Stroke risk also rose 22%. There wasn’t, however, a significantly higher risk for heart attack or coronary artery disease.

For the study, Florido and her colleagues collected data on more than 12,400 men and women who were part of a study investigating risk of cardiovascular disease from 1987 to 2020. Of the participants, more than 3,200 developed cancer during that time.

Those at the highest risk for heart disease were survivors of breast, lung and colon cancer, the study found. Blood and lymphatic cancers also boosted heart disease risk.

Prostate cancer, on the other hand, did not. It is rarely treated with aggressive therapies that can affect the heart, Florido said.

Heart problems can develop during cancer therapy or months or years after, she said.

“Even if you don’t develop any problems during therapy, that increased risk will persist for your lifetime,” Florido said. “The fact that you didn’t develop heart failure during chemotherapy doesn’t mean that 10 to 15 years later you’re not going to. You’re always at a higher risk of developing heart failure than patients who did not receive those therapies.”

Florido said many doctors aren’t aware of the increased risk, but they and their patients need to be aware of it.

“I’m hoping that data like this will raise an awareness for oncologists and primary care providers, who are often the physicians who follow cancer survivors,” she said.

Cancer survivors, meanwhile, need to take appropriate steps to lower their heart disease risk, Florido said.

“If you’ve had cancer, you should be very aggressive and manage all your other cardiovascular risk factors, your blood pressure, your cholesterol, if you have diabetes, maintaining a healthy weight, engaging in physical activity, eating a healthy diet, because just having had prior cancer makes you a high-risk person for developing cardiovascular disease,” she said.

Dr. Gregg Fonarow, interim chief of UCLA’s Division of Cardiology, said the growing population of cancer survivors has focused more attention on how cancer and its treatment affect other aspects of health. He was not involved in the new study but reviewed the findings.

Fonarow noted that many studies have suggested that heart disease and heart risk factors are common in cancer survivors. The current study noted that heart disease is the No. 1 cause of death among some cancer survivors.

“These findings suggest that adult survivors of cancer may need enhanced detection and surveillance for cardiovascular disease and heart failure along with better implementation of cardiovascular disease and heart failure prevention strategies,” Fonarow said.

The findings were published online in the Journal of the American College of Cardiology.

Source: HealthDay

9 Ways to Protect Your Heart and Brain from the Summer Heat

Michael Merschel wrote . . . . . . . . .

Your favorite summertime playlist probably has more songs about surfing than about potential health risks. But with much of the nation having already sweated out a historic heat wave in June, health experts would like to add a note of caution to the mix.

Hot weather is like a stress test for your heart, said Dr. Lance Becker, chair of emergency medicine at Northwell Health, a health care provider in New York. And some people respond poorly to such stress. “They could have a heart attack. Their congestive heart failure symptoms could get much worse. Or they could have an arrhythmia,” the medical term for an irregular heartbeat.

The risk to your heart and brain can be serious.

A 2020 report by the Centers for Disease Control and Prevention cited research showing that hospital admissions for cardiovascular problems jumped in the days after temperatures spiked. And a 2017 review of research in the American Heart Association journal Stroke concluded that hot temperatures seem to increase the immediate risk of having a clot-caused ischemic stroke, the most common type of stroke.

Heat regulation in humans is all about blood flow. A healthy body sheds heat by pushing blood to the skin. We also sweat, and as sweat evaporates, it carries more heat away.

It’s usually a “pretty darn good mechanism,” Becker said. But excessive heat can overwhelm it. And then things can become “very, very dangerous.”

Dr. Rachel M. Bond, director of women’s heart health at Dignity Health in Arizona, said anyone with a history of heart disease, high blood pressure, stroke or obesity is at higher risk for heat-related problems. Similarly, the CDC warns that people with diabetes may have damage to blood vessels and nerves that can affect their ability to cool off.

What can you do to stay safe?

Know these symptoms. Signs of heat exhaustion include headache, dizziness, weakness, nausea and cool, moist skin. It can be treated by moving out of the heat or using a damp cloth to cool off. If symptoms don’t improve within an hour, seek medical attention.

Heat stroke is more severe. Symptoms include a rapid, strong pulse; body temperature above 103 F; and red, hot, dry skin. “That is actually a medical emergency,” Bond said, and people should call 911.

Drink lots of water. Hydration helps the heart pump more easily and helps the muscles work more efficiently, Bond said. The exact amount of fluids you need can vary. Bond typically encourages her patients to drink at least 64 ounces a day, unless they have cardiovascular conditions that would limit them.

But not alcohol. Avoid it, Bond said. It can dehydrate you.

Keep cool. If you don’t have air conditioning, or can’t get to a place that does, Becker suggests getting a fan and a spray bottle or damp cloth.

“The combination of sitting directly in front of a fan and then either spraying a little water on your body or taking a cold wash rag and putting water on your body and evaporating that water off of your skin will help cool you down,” he said. “That is actually one of the things we do to people in the emergency department.”

Monitor medications. Because of the extra strain on their systems, heart patients need to be diligent about keeping up with prescriptions.

Some situations might require a doctor’s help. People with high blood pressure or heart failure might use diuretics to help rid the body of excess fluid. But they also might need to increase their fluid intake to cope with the heat. It’s a confusing situation, Becker said. “Because of that, we generally recommend that those people simply avoid heat stress, because it is very difficult to manage that properly.”

Watch what you eat. If you grew up enjoying summertime staples such as watermelon or cucumbers, go right ahead, Bond said; they’re full of water.

But you may want to avoid heavy meals, Becker said. When your body is straining to push blood to the skin, that’s not the best time to eat a big meal that’s going to demand more blood go to your digestive system.

Watch the clock – and your clothes. In the triple-digit desert heat of Phoenix, Bond and other physicians routinely remind people to avoid going outdoors in the early afternoon and encourage people to wear loose, lightweight, light-colored clothing.

Exercise, but be smart about it. Even in the heat, exercise is important for long-term health. But if you have the option, move your workout indoors – or take up swimming.

Parents and coaches can encourage youth sports but need to be aware of the risks. “Unfortunately, we do lose young people this time of year,” Bond said. The CDC provides heat-related guidance for athletes.

Take care of one another. “This is really the time for community spirit,” Becker said. Social isolation is a root cause in many of the heat deaths he sees.

He suggests checking on at-risk neighbors, friends and relatives. Say, “It’s going to be really hot. Can I help you out?” Invite them to share time in an air-conditioned space. “Because this is truly a time where that kind of spirit can save people’s lives.”

Source: American Heart Association


Heart Complications Treatable in Children with COVID-19

Heart complications in children and young adults infected with COVID-19 are treatable, according to a new science report summarizing what’s known about how to treat, manage and prevent cardiovascular complications from the coronavirus in youth.

The scientific statement from the American Heart Association, published Monday in its journal Circulation, also calls for more research on the short- and long-term cardiovascular effects from COVID-19 in people under 30.

“Although much has been learned about how the virus impacts children’s and young adult’s hearts, how to best treat cardiovascular complications and prevent severe illness and continued clinical research trials are needed to better understand the long-term cardiovascular impacts,” Dr. Pei-Ni Jone said in a news release. Jone is chair of the statement writing group and director of 3D Echocardiography, the Kawasaki Disease Clinic and Quality in Echocardiography at Children’s Hospital Colorado in Aurora.

Children infected with the coronavirus usually experience mild symptoms, the report said. As of Feb. 24, children accounted for about 17.6% of total COVID-19 cases in the U.S. and about 0.1% of deaths, according to Centers for Disease Control and Prevention data cited in the report. Young adults ages 18 to 29 accounted for 21.3% of COVID-19 cases and 0.8% of deaths. The research suggests children may be less susceptible to severe COVID-19 because their cells have fewer receptors for the virus to attach to and they may have a lower immune response than adults.

Heart complications are uncommon in children with COVID-19 infections. However, some may experience abnormal heartbeats, inflammation in and around the heart muscle or cardiogenic shock, which occurs when a suddenly weakened heart can’t pump enough blood to meet the body’s needs. Children with severe illness from COVID-19 that affected the heart have suffered sudden cardiac death or have died following intensive medical or life support treatment.

Children with mild or no symptoms can safely return to sports after they recover from an infection, the report said. Those experiencing more severe illness should have heart exams that include an echocardiogram, blood tests of heart enzyme levels and other screenings for proper heart function before resuming sports or strenuous physical exercise.

Rarely, children with COVID-19 develop a condition called multisystem inflammatory syndrome in children, or MIS-C, that can cause inflammation of the heart muscle or arteries. This can be treated with intravenous immunoglobulin alone or as dual therapy with infliximab or other immunomodulatory agents. Most children recover within four weeks.

The statement pointed out that research shows COVID-19 vaccines reduce the risk of MIS-C by up to 91% and help protect children from infection. An analysis of the data indicates the benefits of vaccination outweigh any risk of developing rare vaccine-associated heart inflammation called myocarditis. Research estimated that 1 million doses of the mRNA COVID-19 vaccine to boys and men ages 12 to 29 – the highest-risk group for developing myocarditis – would prevent an estimated 11,000 infections, 560 hospitalizations and six deaths, while causing 39 to 47 cases of myocarditis.

The statement outlines available treatments for children with COVID-19, including antiviral drugs remdesivir and dexamethasone for children in certain age groups.

The statement also looked at COVID-19’s impact on special populations. It said children with congenital heart defects appear to have low infection rates and deaths from the virus, while those with underlying genetic syndromes, such as Down syndrome, have a higher risk of severe disease if infected.

“It is also important to address health disparities that have become more apparent during the pandemic,” Jone said. “We must work to ensure all children receive equal access to vaccination and high-quality care.”

The statement calls for further research into treatment of COVID-19, vaccine-associated myocarditis; the long-term outcomes of both COVID-19 and MIS-C; and the impact of these conditions on heart health for children and young adults. It also calls for clinical trials of new antiviral therapies for children.

Source: American Heart Association

First Direct Evidence to Show Cost-effectiveness of Salt Substitutes on Cardiovascular Outcomes

Replacing table salt with a reduced-sodium, added-potassium ‘salt substitute’ is cost-saving and prevents death and disease in people at high risk of having a stroke, according to new research. Salt substitution has been shown to reduce stroke risk by 14 percent and the number of strokes and heart attacks combined by 13 percent, but this new analysis revealed that the costs saved as a result outweighed the cost of the intervention.

The results were presented at the American College of Cardiology Annual Scientific Session in Washington DC by Professor Bruce Neal, Executive Director of The George Institute Australia, and published in Circulation.

Senior author Thomas Lung, Senior Research Fellow at The George Institute for Global Health said salt substitutes should now be considered as a key element of any salt reduction campaigns.

“Our research has already shown that salt substitutes reduce the risks of stroke, heart attack and premature death, but now we can say for the first time that they also reduce healthcare costs,” he said.

“Salt substitution is a particularly low cost and effective intervention in countries where most of sodium in the diet comes from the salt added during home cooking, which can be easily substituted.”

Globally, excess salt consumption (more than five grams per day) is responsible for three million deaths each year. Four out of five of these deaths occur in low- and middle-income countries, and nearly half are among people younger than 70.

First published in August 2021, the Salt Substitute and Stroke Study demonstrated a reduced risk of stroke, heart attack and premature death among people living in rural China.

Researchers enrolled 21,000 adults with either a history of stroke or poorly controlled blood pressure from 600 villages in rural areas of five provinces – Hebei, Liaoning, Ningxia, Shanxi and Shaanxi between April 2014 and January 2015.

Participants in intervention villages were provided enough salt substitute to cover all household cooking and food preservation requirements – about 20g per person per day – free-of-charge. Those in the other villages continued using regular salt.

During an average follow up of almost five years, more than 3,000 people had a stroke. For those using the salt substitute, researchers found that stroke risk was reduced by 14 percent. In this new analysis they weighed up the costs associated with the salt substitute intervention and compared them with the cost savings resulting from the reduced number of hospitalisations due to strokes prevented and associated quality of life benefits gained.

They found salt substitution would be cost-saving at the lowest local market price of salt substitute and cost-effective up to an estimated 1.5 times the current highest market price and 10.3 times the price of a widely available salt substitute in China.

“We’ve shown that the use of salt substitute by patients at high risk of cardiovascular disease is a practical and cost-effective way of reducing cardiovascular risk,” said study author Dr Maoyi Tian, Honorary Senior Fellow at The George Institute China.

“The extent to which a patient will benefit depends on how much of their dietary salt is replaced with salt substitute, and the cost-effectiveness will depend mainly on the price of the salt substitute,” he added.

“Salt substitution is now the only salt reduction intervention with what we would call ‘grade one evidence’ demonstrating cost-saving protection against cardiovascular disease and should now be considered by all countries planning or implementing sodium reduction campaigns.”

Source: The George Institute for Global Health

Hold the Salt: Study Reveals How Reducing Sodium Intake Can Help Heart Failure Patients

Gillian Rutherford wrote . . . . . . . . .

For the past century, people with weak hearts have been told to lower their salt intake, but until now there has been little scientific evidence behind the recommendation.

The largest randomized clinical trial to look at sodium reduction and heart failure reported results simultaneously in The Lancet and at the American College of Cardiology’s 71st annual scientific session over the weekend, and the findings were mixed.

Though reducing salt intake did not lead to fewer emergency visits, hospitalizations or deaths for patients with heart failure, the researchers did find an improvement in symptoms such as swelling, fatigue and coughing, as well as better overall quality of life.

“We can no longer put a blanket recommendation across all patients and say that limiting sodium intake is going to reduce your chances of either dying or being in hospital, but I can say comfortably that it could improve people’s quality of life overall,” said lead author Justin Ezekowitz, professor in the Faculty of Medicine & Dentistry and co-director of the Canadian VIGOUR Centre.

Avoid anything in a bag, box or can

The researchers followed 806 patients at 26 medical centres in Canada, Australia, Colombia, Chile, Mexico and New Zealand. All were suffering from heart failure, a condition in which the heart becomes too weak to pump blood effectively. Half of the study participants were randomly assigned to receive usual care, while the rest received nutritional counselling on how to reduce their dietary salt intake.

Patients in the nutritional counselling arm of the trial were given dietitian-designed menu suggestions using foods from their own region and were encouraged to cook at home without adding salt and to avoid high-salt ingredients. Most dietary sodium is hidden in processed foods or restaurant meals rather than being shaken at the table, Ezekowitz noted.

“The broad rule that I’ve learned from dietitians is that anything in a bag, a box or a can generally has more salt in it than you would think,” said Ezekowitz, who is also a cardiologist at the Mazankowski Alberta Heart Institute and director of the U of A’s Cardiovascular Research Institute.

The target sodium intake was 1,500 milligrams per day — the equivalent of about two-thirds of a teaspoon of salt — which is the Health Canada recommended limit for most Canadians whether they have heart failure or not.

Before the study, patients consumed an average of 2,217 mg per day, or just under one teaspoon. After one year of study, the usual care group consumed an average of 2,072 mg of sodium daily, while those who received nutritional guidance consumed 1,658 mg per day, a reduction of a bit less than a quarter-teaspoon equivalent.

The researchers compared rates of death from any cause, cardiovascular hospitalization and cardiovascular emergency department visits in the two study groups but found no statistically significant difference.

They found consistent improvements for the low-sodium group using three different quality of life assessment tools, as well as the New York Heart Association heart failure classification, a measure of heart failure severity.

An achievable goal

Ezekowitz said that he will continue to advise patients with heart failure to cut back on salt, but now he will be clearer about the expected benefits. He urges clinicians to recognize that dietary changes can be a useful intervention for some of their patients.

The team will do further research to isolate a marker in the blood of patients who benefited most from the low-sodium diet, with the aim of being able to give more targeted individual diet prescriptions in the future. The researchers will also follow up patients in the trial at 24 months and five years to determine whether further benefits are achieved over the longer term.

“There are many challenges to eating a healthy diet, but it is achievable. It’s not some unachievable goal for patients,” Ezekowitz said. And the odd treat from time to time is fine.

“If that bowl of ice cream is really important to you, that’s great, but you shouldn’t have it every day,” he said. “It’s not about the hills and valleys, it’s all about the averages.”

Source: University of Alberta