ACC.23/WCC Consumer Research Explores Cannabis Use, CV Complications During Pregnancy, Long COVID, and More

The latest research on a wide array of topics – including the link between cannabis use and coronary artery disease (CAD), technology-assisted pregnancy increasing the risk of preeclampsia, and cardiac symptoms developed by patients experiencing long COVID – will be presented at ACC.23/WCC in New Orleans, LA and virtually. Here is a round-up of some of the top consumer research highlights you need to know:

Frequent Marijuana Use and CAD

People who used marijuana daily were found to be 34% more likely to develop CAD vs. people who have never used the drug. In contrast, monthly cannabis use was not associated with a significant increase in the risk of CAD. Researchers then used Mendelian randomization analysis to determine a causal relationship between cannabis use disorder and developing CAD. Previous studies have reported somewhat mixed findings on the relationship between cannabis and cardiovascular disease, with some suggesting that smoking marijuana can raise the risk of myocardial infarction (MI), stroke and other cardiac events, especially in younger people. “In terms of the public health message, it shows that there are probably certain harms of cannabis use that weren’t recognized before, and people should take that into account,” said Ishan Paranjpe, MD, the study’s lead author.

Technology-Assisted Pregnancy and Preeclampsia

A study assessing how reproductive technologies may affect risk of cardiovascular complications during pregnancy found that people who became pregnant using assisted reproductive technologies may be twice as likely to develop preeclampsia than those with traditional pregnancies. Although the study did not examine the mechanisms behind the association between technology-assisted pregnancy and preeclampsia, researchers propose that the placenta may develop differently in some pregnancies involving assisted reproductive technologies, increasing the likelihood of preeclampsia. “Having twice the risk of preeclampsia compared to traditional pregnancy should not discourage people from considering assisted reproductive technologies,” said Ahmad Mustafa, MD, the study’s lead author. “However, it is important to follow up with a cardio-obstetrician or maternal fetal medicine specialist for appropriate care and timely management if cardiovascular issues arise.”

Health Status Impacting Pregnancy Complication Rates

Rising rates of adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDP), preterm birth and low birthweight, over the past decade may be largely attributable to the health status of a person before they get pregnant, rather than age. A study found that while the average age of pregnant individuals rose from 27.9 to 29.1 years from 2011 to 2019, this accounted for only a small portion of the marked increase in adverse pregnancy outcomes. Most striking, the rate of HDP rose by >50%, with the shift in age distribution accounting for <2% of the change. “What’s really driving it is prepregnancy health issues like diabetes and hypertension. That’s important to know because these are factors we could potentially modify,” said Zachary Hughes, MD, the study’s lead author.

Long COVID and New Cardiac Symptoms

Experiencing long COVID was found to more than double a person’s likelihood of developing cardiovascular issues, according to a systematic literature review and meta-analysis of 11 major studies involving a total of 5.8 million people. This comprehensive effort to examine cardiovascular complications from long COVID found that individuals with long COVID were significantly more likely than those who never had COVID-19 to experience symptoms including chest pain, shortness of breath, palpitations and fatigue, and more likely to show markers of cardiovascular disease or elevated cardiovascular risk in medical imaging and diagnostic tests. “COVID-19 is more than a simple respiratory disease – it is a syndrome that can affect the heart,” noted lead author Joanna Lee, BS. “Coordinated efforts among primary care providers, emergency room staff and cariologists could help with early detection and mitigation of cardiac complications among long COVID patients.”

Insomnia May Increase Risk of MI

Insomnia as well as sleeping less than five hours a night may increase the risk of an MI, according to findings from a systematic review and meta-analysis of nine studies. Researchers from Alexandria, Egypt, found a significant association between insomnia and the incidence of MI, the primary outcome, among the 153,881 participants with insomnia in their pooled analysis. Moreover, their risk for an MI was 1.62-times that seen among the 1,030,375 controls without insomnia. The association remained after adjusting for age, gender, comorbidities and smoking and was consistent across all subgroups (age younger or older than 65, sex, common comorbidities and follow-up duration. Sleep duration also increased MI risk: by 1.38-times and 1.56-times when sleeping less than five hours a night compared with six hours and with seven to eight hours, respectively. And a 13% higher risk for an MI was found in participants with disorders of initiating and maintaining sleep. Based on their pooled data, the researchers stated that insomnia should be considered a risk factor for developing MI. “We need to do a better job of educating people about how dangerous [lack of good sleep] can be,” said Yomna E. Dean, the study’s lead author.

Poor Sleep and Increased Risk of Death

Young people who have more beneficial sleep habits may be incrementally less likely to die early, according to data collected from 172,321 people between 2013 and 2018. The data suggests that about 8% of deaths from any cause could be attributed to poor sleep patterns. Researchers used data from participants in the National Health Interview Survey, which includes questions about sleep and sleep habits. By linking survey participants with the National Death Index records, they examined the association between individual and combined sleep factors and all-cause and cause-specific mortality. Researchers assessed five different factors of quality sleep and found that compared to individuals who had zero to one favorable sleep factors, those who had all five were 30% less likely to die for any reason, 21% less likely to die from cardiovascular disease, 19% less likely to die from cancer, and 40% less likely to die of causes other than cardiovascular disease or cancer. “Even from a young age, if people can develop these good sleep habit of getting enough sleep, making sure they are sleeping without too many distractions and have good sleep hygiene overall, it can greatly benefit their overall long-term health,” said lead author Frank Qian, MD, MPH.

Bachelors Face Poor HF Prognosis

Men who never married may be more than twice as likely to die within five years after a heart failure (HF) diagnosis vs. women of any marital status or men who were previously married. Based on data from the Multi-Ethnic Study of Atherosclerosis, a prospective study of 6,800 American adults between 45-84 years old, researchers compared survival rates from the time of HF diagnosis by gender and marital status over an average follow-up period of 4.7 years. While the reasons behind the relationship between a man’s marital status and survival after HF diagnosis warrants future study, researchers suggest potential drivers could include social interaction or isolation, access to caregiver support for help with home health monitoring, medication adherence and transportation to medical appointments, or differences in health behaviors such as diet, exercise and alcohol intake. “As clinicians, we need to think about our patients not just in terms of their medical risk factors, but also the context of their life," said Katarina Leyba, MD, the study’s lead author.

Too Little Sodium May Harm HF Patients

For people with HF, restricting dietary sodium intake to levels below the standard recommended maximum of about 2.3 grams per day may not bring additional benefits and may increase risk of death, according to a meta-analysis of nine randomized controlled trials. The trials assessed 3,500 HF patients with different levels of sodium restriction and included data on rates of death and hospitalization. Researchers found that patients following a diet with a sodium intake below 2.5 grams per day were 80% more likely to die than those following a diet with a target of 2.5 grams per day or more. The sodium limits varied from about 1.2-1.8 grams per day in the more restrictive study arms, and the analysis did not show a trend toward increased hospitalization among patients following more restrictive diets. “Limiting sodium is still the way to go to help manage [HF],” said lead author Anirudh Palicherla, MD. “This study shows that the focus should be on establishing a safe level of sodium consumption instead of overly restricting sodium.”

Decline in MI Deaths; Narrowing Racial Disparities

The U.S. not only saw a significant decline in the overall rate of MI-related deaths in the past two decades, but also a reduction in racial disparities for MI deaths, according to an analysis of data from the Centers for Disease Control and Prevention. The gap in the rate of MI deaths between White people and African American/Black people narrowed by nearly half over the 22-year period. The findings indicate that the age-adjusted rate of death attributed to acute MI fell by an average of over 4% per year across all racial groups. Researchers note it is difficult to definitively determine whether the decline is the result of fewer instances of MI or better rates of survival when they do occur because of new diagnostic strategies and treatment options. “We’re making progress in the right direction,” said lead author Muchi Ditah Chobufo, MD, “I think the reasons are multifactorial, spanning all the way from health-promoting and prevention activities through treatment during and after a [MI].”

People With Disabilities in Clinical Trials

Disabilities may be underreported in clinical trial data and commonly used as a basis for exclusion from trial participation, according to an analysis of 80 recent trials involving cardiovascular outcomes. While over half of people with cardiovascular disease have one or more disabilities related to cognition, mobility, vision independent living, self-care or hearing, the study found that 38% of clinical trials listed a disability among their exclusion criteria and only 8% of trials reported disability status as part of their baseline data. Researchers analyzed the 20 most recently published clinical trials in each of four major areas: atrial fibrillation, coronary artery disease, hypertension and diabetes. Their findings suggest that there are gaps in both inclusion and reporting, indicating that clinical trial designers are missing an opportunity to ensure studies adequately represent the patient populations they intend to benefit. “There is an abundance of literature within cardiovascular trials on race, ethnicity and gender, but people with disabilities are another population that can be vulnerable,” said lead author Roy Lan, MD. “As we become more advanced in targeting therapies to different population groups, this is one that we really can’t forget and need to serve well.”

Smartphone App Delivers Better Glycemic Control, Less Medication Change

People with type 2 diabetes who were given a smartphone app called BT-001 that delivers personalized cognitive behavioral therapy saw significantly greater reductions in their blood sugar and less need for higher doses of diabetes medications at six months vs. those who received a control app. All 668 participants were given unrestricted guideline-directed medical therapy. Their mean age was 58 years, 56% were women, 30% Black and 15% Latinx. The mean body mass index was 35 kg/m2 and median HbA1c was 8.1%. Participants were taking a mean of 2±1 antihyperglycemic medications. While the number and dose of antihyperglycemic medications increased in both groups, there was significantly less drug intensification in the treatment group. At the end of the study, 14.4% and 24.4% of the treatment and control groups had an increase in medical therapy. Notably, HbA1c was 0.4% lower at 90 days with the BT-001 app and this was maintained at 180 days. Positive effects were also seen on patient-reported outcomes including depression and quality of life. “The antihyperglycemic effect increased in direct proportion to the number of lessons participants completed,” said lead author Marc P. Bonaca, MD, MPH, FACC. “The more lessons they did, the greater the reductions in HbA1c they achieved.”

Hormone Therapy For Gender Dysphoria and CV Risk

People with gender dysphoria taking hormone replacements as part of gender affirmation therapy may face a substantially increased risk of serious cardiac events, including stroke, MI and pulmonary embolism. Researchers retrospectively examined rates of cardiovascular events in over 21,000 people with gender dysphoria from a national database of hospital records, of whom 1,675 had used hormone replacement therapy. The study found that people with gender dysphoria who had ever used hormone replacements saw nearly seven times the risk of ischemic stroke, nearly six times the risk of STEMI and nearly five times the risk of pulmonary embolism, compared with people with gender dysphoria who had never used hormone replacements. Hormone replacement therapy was not associated with any increase in death or with increased rates of atrial fibrillation, diabetes, hypertension, hemorrhagic stroke or HF. “It’s all about risks and benefits,” states Ibrahim Ahmed, MD, the study’s lead author. “Starting transitioning is a big part of a person’s life and helping them feel more themselves, but hormone replacement therapy also has a lot of side effects – it’s not a risk-free endeavor.”

Association Between Facebook Friendships and CVD Outcomes

Places with higher rates of economic connectedness – linkages between people of lower or higher socioeconomic status as indicated by Facebook friendships – may have lower rates of premature death related to cardiovascular disease. Researchers estimated economic connectedness at the neighborhood level by adapting a method recently developed to estimate the proportion of Facebook users in a specific area who have a large number of Facebook friendships with people of a higher socioeconomic status than themselves. They then compared neighborhood-level economic connectedness data with rates of premature death from cardiovascular disease at the county level. Their results indicate that places with higher economic connectedness tended to have lower rates of premature cardiovascular death, and after adjusting for race, sex, social vulnerability scores and county-level risk factors, social media-derived economic connectedness was estimated to explain 57% of the inter-county variability in premature cardiovascular death rates. “If we can predict a person’s risk, we can use that information to guide medical treatments,” said Tabitha Lobo, MD, the study’s lead author. “Traditionally, we’ve focused on individual-based interventions, but this gives us the opportunity to work at more of a community level.”

Clinical Topics: Anticoagulation Management, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, COVID-19 Hub, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Diet, Hypertension, Chronic Angina

Keywords: ACC Annual Scientific Session, ACC23, Embolism, Socioeconomic Factors, Risk Assessment, Patient Reported Outcome Measures, Social Media, Depression, ST Elevation Myocardial Infarction, Friends, Retrospective Studies, Body Mass Index, Ischemic Stroke, Quality of Life, Glycated Hemoglobin A, Blood Glucose, Diabetes Mellitus, Type 2, Mobile Applications, Hypoglycemic Agents, Gender Dysphoria, Middle Aged, Randomized Controlled Trials as Topic, Cognition, Sodium, Dietary, Centers for Disease Control and Prevention, U.S., Disabled Persons, Hospitalization, Diet, Hypertension, Myocardial Infarction, Diabetes Mellitus, Sodium, Hygiene, Prognosis, Habits, Emergency Service, Hospital, Atherosclerosis, Dyspnea, Fatigue, Heart Disease Risk Factors, Cause of Death, Caregivers, Factor V, Risk Factors, Survival Rate, Single Person, Prospective Studies, Incidence, Sleep Initiation and Maintenance Disorders, Aged, Adolescent, COVID-19, Infarction, Placenta, Hallucinogens, Follow-Up Studies, Birth Weight, Mendelian Randomization Analysis, Coronary Artery Disease, Premature Birth, Cardiovascular Diseases, Pre-Eclampsia, Marijuana Use, Cannabis, Pregnancy, Infant, Newborn, ACC.23/WCC Meeting Newspaper, ACC Scientific Session Newspaper

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