Commonly Used Antibiotics May Lead to Heart Problems

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Scientists have shown for the first time a link between two types of heart problems and one of the most commonly prescribed classes of antibiotics.

In a study published today in the Journal of the American College of Cardiology, researchers at the University of British Columbia (UBC) in partnership with the Provincial Health Services Authority’s (PHSA) Therapeutic Evaluation Unit found that current users of fluoroquinolone antibiotics, such as Ciprofloxacin or Cipro, face a 2.4 times greater risk of developing aortic and mitral regurgitation, where the blood backflows into the heart, compared to patients who take amoxicillin, a different type of antibiotic. The greatest risk is within 30 days of use.

Recent studies have also linked the same class of antibiotics to other heart problems.

Some physicians favour fluoroquinolones over other antibiotics for their broad spectrum of antibacterial activity and high oral absorption, which is as effective as intravenous, or IV, treatment.

“You can send patients home with a once-a-day pill,” said Mahyar Etminan, lead author and associate professor of ophthalmology and visual sciences in the faculty of medicine at UBC. “This class of antibiotics is very convenient, but for the majority of cases, especially community-related infections, they’re not really needed. The inappropriate prescribing may cause both antibiotic resistance as well as serious heart problems.”

The researchers hope their study helps inform the public and physicians that if patients present with cardiac issues, where no other cause has been discovered, fluoroquinolone antibiotics could potentially be a cause.

“One of the key objectives of the Therapeutic Evaluation Unit is to evaluate different drugs and health technologies to determine whether they enhance the quality of care delivered by our programs or improve patient outcomes,” said Dr. Bruce Carleton, director of the unit and research investigator at BC Children’s Hospital, a program of PHSA. “This study highlights the need to be thoughtful when prescribing antibiotics, which can sometimes cause harm. As a result of this work, we will continue working with the BC Antimicrobial Stewardship Committee to ensure the appropriate prescribing of this class of antibiotics to patients across British Columbia, and reduce inappropriate prescribing.”

For the study, scientists analyzed data from the U.S. Food and Drug Administration’s adverse reporting system. They also analyzed a massive private insurance health claims database in the U.S. that captures demographics, drug identification, dose prescribed and treatment duration. Researchers identified 12,505 cases of valvular regurgitation with 125,020 case-control subjects in a random sample of more than nine million patients. They defined current fluoroquinolone exposure as an active prescription or 30 days prior to the adverse event, recent exposure as within days 31 to 60, and past exposure as within 61 to 365 days prior to an incident. Scientists compared fluoroquinolone use with amoxicillin and azithromycin.

The results showed that the risk of aortic and mitral regurgitation, blood backflow into the heart, is highest with current use, followed by recent use. They saw no increased risk aortic and mitral regurgitation with past use.

Etminan hopes that if other studies confirm these findings, regulatory agencies would add the risk of aortic and mitral regurgitation to their alerts as potential side effects and that the results would prompt physicians to use other classes of antibiotics as the first line of defense for uncomplicated infections.

Source: University of British Columbia


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Going Vegetarian Good for Your Heart, But May Up Stroke Risk

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

Vegetarianism is all the rage these days, but a new study suggests that slicing meat from your diet might raise your risk of stroke slightly.

While vegetarians had a 22% lower risk for heart disease, they had a 20% higher risk for stroke, British researchers found. Meanwhile, people who ate fish but no other meats (pescatarians) had a 13% lower risk of heart disease, with no increased stroke risk.

“The lower risk of heart disease is likely at least partly due to lower weight, lower blood pressure, lower blood cholesterol and lower rates of diabetes linked to pescatarian or vegetarian diets,” said lead researcher Tammy Tong, a nutritional epidemiologist in the Nuffield Department of Population Health at the University of Oxford.

Tong cautioned that this study can’t prove that not eating meat reduces the risk for heart disease or increases the risk for stroke, only that there seems to be a connection.

And the absolute reduction in the risk for heart disease and increased risk for stroke is modest, she said.

“When translated into absolute numbers, this was equivalent to 10 fewer cases of heart disease in the vegetarians than the meat eaters in every 1,000 people eating these diets over 10 years,” Tong said.

As for stroke, three more strokes would be seen among vegetarians compared with meat eaters over the same time, she said.

Why?

Recent evidence suggests that very low cholesterol levels might be linked to a higher risk of hemorrhagic stroke, Tong noted. Vegetarians and vegans might also have low levels of some nutrients, such as vitamin B12, which is only naturally available from animal foods, she added.

“Some research has suggested there may be a link between B12 deficiency and higher stroke risk, but the evidence is not conclusive,” Tong said.

Tong also said that only heart disease and stroke were studied, but other chronic conditions need to be looked at to show the total benefit of a vegetarian diet.

The report was published in the BMJ journal.

Mark Lawrence, a professor of public health nutrition at Deakin University in Melbourne, Australia, said that dietary guidelines have the best advice for vegetarians as well as for fish and meat eaters.

That’s because they consider dietary associations with multiple health outcomes — not just heart disease and stroke, said Lawrence, who co-authored an accompanying journal editorial.

“Shifting towards a plant-based diet can have personal and planetary health benefits, though it does not necessarily mean becoming a vegetarian,” he said.

For the study, Tong and her colleagues collected data on more than 48,000 men and women, average age 45, with no history of stroke or heart disease.

Among the participants were more than 24,000 meat eaters, about 7,500 pescatarians and more than 16,000 vegetarians and vegans.

During the 18 years of the study, nearly 3,000 people developed heart disease and more than 1,000 suffered a stroke. About 500 of the strokes were caused by blood clots in the brain (ischemic stroke) and 300 resulted from bleeding in the brain (hemorrhagic stroke).

The researchers accounted for factors such as medical history, smoking, use of dietary supplements, and physical activity, which can affect the risk for heart disease and stroke.

One U.S. dietitian noted that there are benefits to vegetarian diets — as long as you include vitamins that may be lacking.

“Vegans and strict vegetarians need to be mindful of obtaining certain nutrients, such as vitamin B12, vitamin D and omega-3 fatty acids from their diet and supplements,” said Samantha Heller, a senior clinical nutritionist at NYU Langone Medical Center in New York City.

Not getting enough of these nutrients may increase the risk of certain health problems, she said.

“That said, a more plant-based approach to eating helps reduce the risk of diseases such as cardiovascular disease, certain cancers and type 2 diabetes,” Heller said.

“You can’t go wrong cutting back on red and processed meats such as beef, pork and ham and adding lentils, chickpeas, tofu, broccoli, spinach or cauliflower to your meals,” Heller advised.

Source: HealthDay


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Greater Left Ventricular Mass Increases Risk of Heart Failure

Elevated left ventricular (LV) mass is a stronger predictor of coronary artery disease-related death and heart failure than coronary artery calcium score, according to a new study in the journal Radiology.

In the study led by Nadine Kawel-Boehm, MD, a senior staff radiologist at Hospital Graubünden in Chur, Switzerland, a team of researchers analyzed data collected in the Multi-Ethnic Study of Atherosclerosis (MESA) sponsored by the National Heart, Lung, and Blood Institute. MESA is an ongoing, multi-center study of a diverse, population-based sample of 6,814 men and women age 45-84 with no known heart disease.

According to Dr. Kawel-Boehm, there is little research on predicting the long-term risk of cardiovascular events in ethnically diverse patients who have MRI-identified LV hypertrophy.

“Previous studies have used ECG or echocardiography, which have lower sensitivity in the diagnosis of LV hypertrophy, and typically follow patients for only several years,” she said. “The MESA study used MRI, which is the gold standard for quantifying LV mass, and had a long follow-up of 15 years.”

The researchers studied otherwise healthy individuals from the community in the MESA study. The 4,988 MESA participants underwent a baseline cardiac MRI between 2000 and 2002 and participated in follow-up over a 15-year period. MRI showed that 247 participants in the study group had LV hypertrophy.

The mean age of all participants at baseline was 62 years, and 52 percent were women. Thirty-nine percent were white, 13 percent were Asian, 26 percent were African American and 22 percent were Hispanic.

At the 15-year follow-up, the research team found that 290 patients had a significant coronary heart disease (CHD) event, including 207 myocardial infarctions and 95 CHD deaths. Cardiovascular disease-related deaths occurred in 57 patients, and 215 patients had heart failure.

A statistical analysis of the data demonstrated that LV hypertrophy was an independent predictor of significant CHD events, including myocardial infarction, coronary artery disease-related death and heart failure.

According to the analysis, 22 percent of the study participants with LV hypertrophy had a significant CHD event, compared to 6 percent of participants without LV hypertrophy.

Patients with LV hypertrophy had 4.3 times the risk of coronary artery disease-related death compared to participants without LV hypertrophy. Deaths from coronary and non-coronary related cardiovascular causes were more strongly related to LV hypertrophy than to coronary artery calcium scoring done with a CT scan.

“In contrast to the widely used coronary artery calcium by CT, which measures a condition not known to regress under medical therapy, an elevated LV mass is potentially reversible under treatment,” Dr. Kawel-Boehm said.

As a result of the long length of the study follow-up, Dr. Kawel-Boehm said the researchers were able to determine that the risk of cardiovascular events began to increase in participants with LV hypertrophy particularly after five years.

“Our results provide further evidence and motivation for regular follow up and management of individuals with LV hypertrophy,” she said. “A higher LV mass quantified by imaging may matter more in some instances than a high calcium score.”

Source: Radiological Society of North America

Even Small Improvements in Cholesterol, Blood Pressure Help Prevent Heart Attack

Serena Gordon wrote . . . . . . . . .

Small, lasting changes in cholesterol and blood pressure levels can dramatically reduce the risk of heart disease and strokes over a lifetime, new research suggests.

The large study found that a combination of a drop in LDL cholesterol (the bad type) of 14 mg/dL and a 5 mm Hg drop in systolic blood pressure (the top number in a blood pressure reading) cut the lifetime risk of heart disease and stroke in half.

And, the more those levels fell, the greater the reduction in heart disease and stroke risk.

“Small changes in blood pressure and cholesterol over decades can lead to huge benefits. Changes that are doable with a healthy diet and exercise can cut cardiovascular risk by 50%,” said Dr. John Osborne, a spokesman for the American Heart Association and director of cardiology at State of the Heart Cardiology, in Dallas.

Osborne wasn’t involved in the new study, but is familiar with the findings.

A number of past studies have shown that lowering blood pressure or cholesterol for five years or so can have an impact on cardiovascular disease. But it’s been difficult to know how a lifetime of these changes could affect the risk of heart disease and stroke.

The new research included almost 440,000 people, average age 65, enrolled in a long-term study in the United Kingdom. Fifty-four percent were women.

The study participants were recruited between 2006 and 2010. The follow-up lasted through 2018. During that time, almost 25,000 people had a non-fatal heart attack, a stroke caused by a blood vessel blockage (ischemic) or a heart disease death.

The researchers looked for study participants who had genetic variants that led to them having lower LDL cholesterol and systolic blood pressure throughout the study. Using a statistical technique called Mendelian randomization, the investigators were able to estimate lifetime effects of lower cholesterol and systolic blood pressure compared to people without these gene variations.

The study found the combination of an LDL reduction of 39 mg/dL and a 10 mm Hg lower systolic blood pressure could decrease the lifetime risk of cardiovascular disease by 80%. The same combination also lowered the lifetime risk of death due to heart disease by more than two-thirds.

Osborne said that much of a reduction might be tough to achieve with just diet and exercise, but it’s “doable” with medications.

“In clinical trials, we’re often just looking at five or six years. Now, we can appreciate the effect of those changes over decades of life,” he said.

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City, also reviewed the findings.

“We know that elevated bad cholesterol and elevated blood pressure are two independent, modifiable risk factors for heart disease. The combination of the two elevate this risk further,” he explained.

But, Bhusri said, this study revealed that “even a modest decline had a major impact on the diagnosis of heart disease.” He added that this study also shows what happens if someone adheres to a healthy lifestyle or medications to lower these risk factors over a lifetime.

“Adherence to lifestyle changes and to medications is a major predictor of heart disease,” Bhusri said.

The study was presented at the European Society of Cardiology meeting in Paris. It was simultaneously published online in the Journal of the American Medical Association.

Source: HealthDay


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Lower Risk for Heart Failure with New Type 2 Diabetes Drug

The new type of drugs for type 2 diabetes, the so-called SGLT2 inhibitors, are associated with a reduced risk of heart failure and death as well as of major cardiovascular events, a major Scandinavian registry study led from Karolinska Institutet reports in The BMJ.

Cardiovascular disease is a serious complication of type 2 diabetes. The new SGLT2 inhibitors, which are now a commonly used drug group, reduce blood glucose. Clinical studies have also shown that SGLT2 inhibitors can reduce the risk of cardiovascular events in patients with type 2 diabetes and established cardiovascular disease or high cardiovascular risk.

However, it is unclear whether these findings also mean that there are positive cardiovascular effects from SGLT2 inhibitors in a broader patient group. This has now been investigated in a study published in The BMJ.

Over 40,000 patients

The study was a collaboration between researchers at Karolinska Institutet in Sweden, Statens Serum Institut in Denmark, the NTNU in Norway and the Swedish National Diabetes Register. The researchers used several national registries containing data on drug use, diseases, cause of death and other data from close to 21,000 patients with type 2 diabetes who began treatment with SGLT2 inhibitors between April 2013 and December 2016.

This information was then compared with an equally sized matched population who began treatment with a different diabetes drug, a DPP4 inhibitor. The primary outcomes in the study were major cardiovascular events (defined as myocardial infarction, stroke or cardiovascular death) and hospital admission for heart failure. An important secondary outcome was any-cause death.

Reduced risk of heart failure

In the primary analysis, the patients were monitored throughout the follow-up period, regardless of whether they had completed their treatment. The researchers found that the use of SGLT2 inhibitors was associated with a reduced risk of heart failure but not with major cardiovascular events. The risk of heart failure was 34 per cent lower in the SGLT2-inhibitor group than in the DPP4-inhibitor group. The use of SGLT2 inhibitors was also linked to a 20 per cent lower risk of death.

In an additional analysis the researchers studied the risks only when the patients took the drug and found a reduced risk of both heart failure and major cardiovascular events.

“Our study suggests that there is cardiovascular benefit from SGLT2 inhibitors for a broader patient group in routine clinical care,” says principal investigator Björn Pasternak, associate professor at Karolinska Institutet’s Department of Medicine in Solna. “This is an important result that we believe may be of interest to patients as well as drug authorities and doctors.”

The results are applicable primarily to dapaglifozin, which was the predominant SGLT2 inhibitor used in Scandinavia during the study period.

The study is an observational study, which means that causality cannot be established.

Source: Karolinska Institutet


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