New ACC.21 Research Explores Flu Vaccines, Sleep, HTN, Secondhand Smoke, Alcohol and Stress Reduction, More

Research addressing a wide array of topics ranging from the prevalence (or lack thereof) of flu vaccines among cardiovascular disease patients, to the impacts of prediabetes on cardiovascular disease risk, will be presented as part of the poster and oral abstract presentations during ACC.21. The following is a round-up of some of the consumer research highlights making news headlines around the world:

Flu Shots and Cardiovascular Disease: While patients with cardiovascular disease are more likely to become seriously ill from the flu and other respiratory illnesses, including COVID-19, a study using data from the 2018-2019 Behavioral Risk Factor Surveillance System survey conducted by the Centers for Disease Control and Prevention, found only half of Americans with a history of cardiovascular disease or stroke report getting an annual flu shot. Rates of vaccination were even lower among Blacks and Hispanics. "We need more research to better understand vaccine reluctance, inequities in access to vaccines as well as the value of seeking out community partnerships to improve vaccinations across the board," said Varayini Pankayatselvan, MD, the study's lead author. Access ACC clinician and patient tools related to the flu vaccine, here.

Prediabetes and Risk of Cardiac Events: People with prediabetes may be more likely to suffer a myocardial infarction (MI), stroke or other major cardiovascular event when compared with those who had normal blood sugar levels. The study looked at 25,829 patients who were split into either the prediabetes (n=12,691) or control group (n=13,138) based on at least two A1C levels five years apart; the control group included patients who maintained a normal hemoglobin A1C during the study. Serious cardiovascular events occurred in 18% of people with prediabetes compared with 11% of people in the control group over a median of five years follow-up. The relationship between higher blood sugar levels and cardiovascular events remained significant even after taking into account other factors that could play a role, such as age, gender, body mass index, blood pressure, cholesterol, sleep apnea, smoking and peripheral artery disease, researcher said. "Based on our data, having prediabetes nearly doubled the chance of a major adverse cardiovascular event," said Adrian Michel, MD, the study's lead author. CardioSmart patient tools addressing diabetes and heart health can be accessed here. Learn more about reducing cardiovascular risk in diabetes with clinician education tools.

CV Risk and Sleep: People who clocked six to seven hours of sleep a night had the lowest chance of dying from a MI or stroke when compared with those who got less or more sleep, according to a study of 14,079 participants in the 2005-2010 National Health and Nutrition Examination Survey. In addition to grouping patients by their amount of sleep per night, researchers assessed participants' atherosclerotic cardiovascular disease (ASCVD) risk scores and levels of C-reactive protein (CRP). "Participants who sleep less or more than six to seven hours have higher ASCVD risk scores, which is likely driven by heightened inflammation as measured by CRP, which was found to be higher among those who had less or more sleep," said Kartik Gupta, MD, the study's lead author. "Sleep is often overlooked as something that may play a role in cardiovascular disease, and it may be among the most cost-effective ways to lower cardiovascular risk."

Secondhand Smoke and HF: Breathing in secondhand cigarette smoke may leave individuals more vulnerable to heart failure (HF), according to an analysis of 11,219 participants from the U.S. Third National Health and Nutrition Examination survey who reported being nonsmokers. Data showed that nonsmokers with recent exposure to secondhand smoke had a 35% increased odds of developing HF vs. those who hadn't been around tobacco. The association of secondhand smoke and HF was stronger in men (compared with women) and among those who had reported a prior MI or stroke. The findings were similar across other subgroups, including different ethnic/racial groups and individuals with obesity and diabetes. According to Travis Skipina, MD, the study's lead author, the findings are a reminder for people who have HF or are at high risk of developing it that "they should be aware that secondhand smoke exposure may play a role." Find tobacco-related patient education resources on CardioSmart.

Reducing Time to PCI Using an App: Patients suffering a MI received PCI an average of 10 minutes faster after clinicians and paramedics began using an app to facilitate efficient hospital intakes for these patients, according to a study conducted at Baystate Medical Center in Springfield, MA. Before adopting the app, clinicians typically only had about five minutes of advance notice when a MI patient was en route, even if the patient had traveled a long distance. The app allowed clinicians to begin coordinating with paramedics much earlier, helping teams prepare for rapid response upon arrival. "Now everybody who is taking care of a patient is able to communicate on one platform much earlier, even when the paramedic is still in the patient's home," said Alina Capatina, MSN, the study's lead author. "This lets us mobilize the cardiology team a lot quicker, which means we can be with the patient much faster."

HTN and Other Meds: Nearly one in five adults with hypertension are also taking a medicine that could be elevating their blood pressure, according to new research underscoring the need for patients to routinely review all of the medications they take with their care team. Based on the study findings, the three most common classes of medications were antidepressants; nonsteroidal anti-inflammatory drugs; and oral steroids used to treat conditions such as gout, lupus, rheumatoid arthritis or after an organ transplant. These medications were reported by 9%, 7% and 2% of participants, respectively. Other medications associated with blood pressure elevation included antipsychotics, certain oral contraceptives, and popular decongestants. In some cases, rather than treating high blood pressure with more medications, there may be opportunities to lower blood pressure by deprescribing or substituting safer medications, noted John Vitarello, MD, the study's lead author. Visit ACC's High Blood Pressure Guideline Hub for clinician and patient resources.

Gender Differences in MI Care: Among younger adults visiting the emergency department for chest pain, women were triaged less urgently, waited longer to be seen, and were less likely to undergo basic tests or be hospitalized or admitted for observation to diagnose a MI, according to new research examining emergency room management of chest pain. Researchers found that women reporting chest pain were equally likely to arrive at the hospital by ambulance but significantly less likely than men to be triaged as emergent. On average, women waited about 11 minutes longer to be evaluated by a clinician. Women were also significantly less likely to undergo an electrocardiogram or to receive cardiac monitoring or be seen by a cardiologist. "We need to continue to raise awareness and make sure all patients are diagnosed and treated properly, even if they're not the 'classic' demographic for a [MI]. [This knowledge] will help us improve care for all," said Darcy Banco, MD, the study's lead author.

Mental Health and Recovery After MI: Young and middle-aged adults who reported severe psychological distress – such as depression or anxiety – after suffering a MI were more than twice as likely to suffer a second cardiac event within five years compared with those experiencing only mild distress. Researchers analyzed health outcomes in 283 MI survivors between the ages of 18 and 61, with an average age of 51 years. Within five years after their MI, 80 of the 283 patients suffered a subsequent MI or stroke, were hospitalized for HF or died from cardiovascular causes. These outcomes occurred in nearly half (47%) of patients experiencing high distress compared to 22% of those experiencing mild distress. "Our findings suggest that cardiologists should consider the value of regular psychological assessments, especially among younger patients," said Mariana Garcia, MD, the study's lead author. "Equally importantly, they should explore treatment modalities for ameliorating psychological distress in young patients after a MI, such as meditation, relaxation techniques and holistic approaches, in addition to traditional medical therapy and cardiac rehabilitation." Access CardioSmart resources on managing stress here.

Alcohol and the Heart: Moderate alcohol intake – defined as no more than one alcoholic drink for women and two for men per day – may be associated with a lower risk of dying from cardiovascular disease when compared with individuals who abstain from drinking or partake in excessive drinking, according to a new study. Of the 53,064 participants, 7,905 (15%) experienced a major adverse cardiovascular event: 17% in the low alcohol intake group and 13% in the moderate alcohol intake group. People who reported moderate alcohol intake were found to have a 20% lower chance of having a major event compared to low alcohol intake (in adjusted analysis), and also had lower stress-related brain activity. Kenechukwu Mezue, MD, the study's lead author, cautions that these findings should not encourage alcohol use, but that they could open doors to new therapeutics or prescribing stress-relieving activities like exercise or yoga to help minimize stress signals in the brain.

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Interventions and Vascular Medicine, Hypertension, Smoking, Sleep Apnea

Keywords: ACC Annual Scientific Session, ACC21, Influenza Vaccines, C-Reactive Protein, Tobacco, Cardiac Rehabilitation, Blood Pressure, Peripheral Arterial Disease, Percutaneous Coronary Intervention, COVID-19, Myocardial Infarction, Stroke, Heart Failure, Sleep Apnea Syndromes, Electrocardiography, Hypertension, Chest Pain, Obesity, Smoking, Cholesterol, Alcohol Drinking, Emergency Service, Hospital, Vaccination

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