ACC.24 Consumer Research: Effects of E-Cigarettes, Eggs, Greenspace and More on Heart Health

During ACC.24 in Atlanta, GA, researchers will be presenting the latest studies on a wide variety of topics, including the cardiovascular effects of e-cigarette use, fortified egg consumption, greenspace environments and more. Here’s a brief overview of the consumer research highlights:

E-Cigarette Use Increases Risk of HF

People who used e-cigarettes were 19% more likely to develop heart failure (HF) compared with those who never used them, according to a new prospective observational study. Authors Yakubu Bene-Alhasan, MD, et al., examined data from 175,667 participants (average age 52 years, 60.5% women) in All of Us, a large national study of U.S. adults by the National Institutes of Health, to track the association between e-cigarettes and new diagnoses of HF. Over the median follow-up of 45 months, 3,242 participants developed HF. Of note, the increased risk for HF with preserved ejection fraction (HFpEF) was statistically significant, but it was not for HF with reduced ejection fraction (HFrEF). “I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said. Surveys indicate that about 5% to 10% of U.S. teens and adults use e-cigarettes.

PROSPERITY: What is the Effect of Eggs on CVD?

A prospective, randomized, study with 140 patients found there was no difference at four months in cholesterol levels between those who ate ≥12 fortified eggs per week and those who ate fewer than two eggs. In the single-center PROSPERITY trial, Nina Nouhravesh, MD, et al., studied the effect of an egg-rich diet on HDL-C and LDL-C, as well as other key markers of cardiovascular health, in a high-risk population older than 50 years who had either experienced one cardiovascular event or had two cardiovascular risk factors; their average age was 66 years, half were women and 27% were Black. Results at four months showed a reduction of 0.64 mg/dL and a 3.14 mg/dL in HDL-C and LDL-C, respectively, in the fortified egg group, compared with the non-egg group. The authors stated that while differences weren’t statistically significant, they do suggest that eating 12 fortified eggs a week does not have an adverse effect on cholesterol. A subgroup analysis of patients ≤65 years old and those with diabetes in the fortified egg group had numerical increases in HDL-C and reductions in LDL-C. Researchers also observed a numerical reduction in total cholesterol, LDL particle number, apoB, high-sensitivity troponin and insulin resistance scores, as well as an increase in vitamin B in the fortified egg group. “While this is a neutral study, we did not observe adverse effects on biomarkers of cardiovascular health and there were signals of potential benefits of eating fortified eggs that warrant further investigation in larger studies as they are more hypothesis generating here,” said Nouhravesh.

Vertical Greenspace Associated With Better Heart Health

People living in neighborhoods with sidewalks, trees and clear skies are less likely to experience a major adverse cardiovascular event (MACE) than those who do not. A study of nearly 50,000 people tracked their heart health and used a machine learning algorithmic analysis of Google Street View to classify their neighborhoods by greenspace. The analysis, centered on northeastern Ohio, found that approximately 2,000 participants experienced a MACE over the median 27-month follow-up. The study found that people living in areas with more sidewalks were 9% less likely to suffer a major event, and people living in neighborhoods with vertical greenspace – trees and clear sky – were 5% less likely. “A lot of research has shown that environmental factors strongly affect our health,” said lead author Zhuo Chen, PhD. “If we can find a way to stratify this risk and provide interventions before cardiovascular events happen, then we could save a lot of lives.” The study authors found no significant association with horizontal greenspace (grass).

High Stress and Genetics Can Increase MI Risk

People with a high genetic stress sensitivity have a higher risk of acute coronary syndromes (ACS) in response to stressful cultural or political events, according to data from the Mass General Brigham Biobank. A 2000-2020 retrospective analysis of 18,428 patients that included their neuroticism polygenic risk score (nPRS), a well-established metric that reflects a person’s genetic predisposition to stress, found that those with an above median nPRS were 34% more likely to experience ACS during the days following Christmas, presidential elections and major sporting events involving local teams than the rest of the year. “With this study, we have identified a new factor that could be incorporated into screening to identify people who are at increased risk,” said lead author Shady Abohashem, MD. “This could also help shape prevention strategies and help us see how we might be able to intervene.”

Anxiety and Depression Can Contribute to CV Risk in Younger Women

Younger women with anxiety or depression were nearly twice as likely to develop high blood pressure (BP), high cholesterol or diabetes over a 10-year period compared with women without either – putting them nearly on par with men of the same age group for cardiovascular disease risk. During the study, based on health records of 71,214 people at the Mass General Brigham Biobank, 38% of participants developed high BP, high cholesterol and/or diabetes. Those with a history of anxiety or depression before the study were 55% more likely to develop one or more of these risk factors than those without either. Compared with any other group, women <50 years old with anxiety or depression had nearly double the risk. “We often feel that young women are the ‘safe group’ with regard to cardiovascular disease,” said lead author Giovanni Civieri, MD. “But this study suggests that if a younger woman has depression or anxiety, we should start screening for cardiovascular risk factors.”

ADHD Stimulants and Heart Damage

Young adults who were prescribed stimulant medications for attention-deficit/hyperactivity disorder (ADHD) were significantly more likely to develop cardiomyopathy compared with those who were not prescribed stimulants, according to a new study by Pauline Gerard, et al. Using the TriNetX database, which includes information from 80 U.S. hospitals, the authors analyzed data on 25,518 adults with ADHD aged 20-40 years. The analysis paired each person who was prescribed stimulants with someone of the same demographic and medical background who was not prescribed the medications. Those prescribed stimulants such as Adderall and Ritalin were 17% more likely to have cardiomyopathy at one year and 57% more likely at eight years. After taking stimulants for 10 years, only 0.72% of patients developed cardiomyopathy, compared with 0.53% among those who did not. Gerard, the lead author, stated, “I don’t think this is a reason to stop prescribing the medications. There’s very little increased risk of these medications over the long term; it’s a real risk, but it’s small.”

Too Little Sleep Linked to High BP

Sleeping fewer than seven hours a night is associated with a higher risk of developing high BP over time, according to a study of 1,044,035 people from six countries who did not have hypertension at baseline. The analysis pooled data from 16 different studies conducted between 2000-2023. Participants ranged from 35 to 60 years old and 61% were women. The median follow-up was five years. Researchers found that sleeping less than seven hours was associated with a 7% increased risk of developing high BP, which spiked to 11% when reported sleep duration was less than five hours. “Getting seven to eight hours of sleep, as is recommended by sleep experts, may be the best for your heart too,” said principal investigator Kaveh Hosseini, MD. There was no significant difference between age groups, but women who reported getting less than seven hours of sleep had a 7% greater risk of developing high BP compared with men.

Women Post Menopause Have Higher CV Risk

A study of post-menopausal statin users found that women’s cardiovascular risk rises sharply after menopause, becoming comparable with men of a similar age and health profile. During the study, the 579 participants underwent two scans for coronary artery calcium (CAC) at least one year apart. Between the two scans, women with baseline CAC of 1-99 saw their CAC rise by a median of eight points, twice the median seen in men. Women with a baseline CAC of 100-399 saw their CAC rise by a median of 31 points, almost double the median of 16 points seen in men. There was no significant difference seen between men and women with baseline CAC of 400 or higher. “After menopause, women have much less estrogen and shift to a more testosterone-heavy profile,” said lead author Ella Ishaaya, MD. “This affects the way your body stores fat, where it stores fat and the way it processes fat; it even affects the way your blood clots. And all of those [changes] increase your risk for developing heart disease.”

Defibrillators Rarely Used by Bystanders

A vast majority of out-of-hospital cardiac arrests (OHCAs) occurred within just a four-minute walk of a public AED but it was not used by bystanders in a study by Mirza S. Khan, MD, et al. They analyzed 1,799 incidents in Kansas City, MO, between 2019-2022 using data from a national registry. Of these, most (85%) occurred at home; a bystander administered CPR in 42% of these cases, while an AED was not used in any case, despite 25% of the at-home OHCAs occurring within a four-minute walk of a public AED. Looking at the 15% of in-public OHCAs, a bystander administered CPR in 42% but an AED was used in only 13 cases (7%), although nearly half of these events occurred within a four-minute walk of an AED. Khan, et al., noted that even in an “optimal scenario,” where a bystander administered CPR and the event happened within a four-minute walk of an AED, it was used in only one of four cases. “Public AED availability is critical for people to be able to use them in the appropriate time and fashion,” Khan emphasized. “However, people need to know it’s there to be able to use it. It’s not sufficient just to have them in the right places.” By drawing attention to this gap, the findings could help inform ongoing efforts to improve signage around AEDs, provide apps or mapping tools to help people locate them and increase education and awareness through community volunteer training programs.

People With CVD Consume Too Much Sodium

A new study of more than 3,100 people with cardiovascular disease found that 89% consumed more than the recommended daily maximum of 1,500 mg of sodium. Authors Elsie Kodjoe, MD, MPH, et al., analyzed data from questionnaires submitted by patients with cardiovascular disease who participated in the National Health and Nutrition Examination Survey 2009-2018. Results showed that participants consumed an average of 3,096 mg per day, slightly lower than the national average of 3,400 mg per day, but more than twice the recommended maximum for people with cardiovascular disease. “To make it easier for patients to adhere to dietary guidelines, we need to find ways for the general public to estimate dietary sodium levels or perhaps consider a reduction in the sodium content of the food we consume right from the source,” said Kodjoe.

Binge-Drinking Can Raise CVD Risk

A new study found that young to middle-aged women who reported drinking eight or more alcoholic beverages per week were significantly more likely to develop coronary heart disease compared with those who drank less. Authors Jamal Rana, MD, FACC, et al., analyzed data collected during primary care visits of >430,000 adults aged 18-65 who received care in the Kaiser Permanente Northern California integrated health organization. Participants were on average 44 years old (44% women) and did not have cardiovascular disease at baseline. During the four-year follow-up, 3,108 study participants were diagnosed with coronary heart disease. Among women, those who reported high alcohol intake had a 45% higher risk of cardiovascular disease vs. those with a low intake and a 29% risk vs. those with a moderate intake. Participants who reported binge drinking (more than three drinks a day in the past three months for women) were 68% more likely to develop cardiovascular disease vs. those with moderate intake. Men with high overall intake were 33% more likely to develop cardiovascular disease vs. men who had moderate intake. “Women feel they’re protected against heart disease until they’re older,” Rana noted. “But this study shows that even when you’re young or middle aged, if you are a heavy alcohol user or binge drink, you are at risk for coronary heart disease.”

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Lipid Metabolism, Nonstatins, Acute Heart Failure, Hypertension

Keywords: ACC Annual Scientific Session, ACC24, ACC International, Heart Failure, Acute Coronary Syndrome, Diabetes Mellitus, Hypertension, Cholesterol, Out-of-Hospital Cardiac Arrest

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