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Medscape
16-06-2025
- Health
- Medscape
Missed Target Treatment Times May Increase MI Mortality
When it comes to delivering timely treatment for patients experiencing myocardial infarction (MI), many hospitals are continuing to fall short of national guidelines, new research showed. Benchmarks for percutaneous coronary intervention, the standard of care for acute ST-elevation MI (STEMI), aren't being met in some cases. Delays in care in the key metric of the time from first contact with medical care to angioplasty with stenting resulted in worse patient outcomes and were associated with increased in-hospital mortality risk in some cases, according to the findings, published on June 11 in JAMA Cardiology . 'There are two categories of patient delays: Those that are patient-centered and those that are system-centered,' said Neal S. Kleiman, MD, Houston Methodist DeBakey Heart and Vascular Center, Houston, the senior author of the new study. 'We don't have control over patient-related factors, but there is a lot we can do in terms of hospital systems.' For the retrospective cross-sectional study, Kleiman and his colleagues analyzed data on 73,826 patients with STEMI or STEMI equivalent from 503 sites across the United States. The goal was to determine site-level variability in patterns of treatment times and clinical outcomes from 2020 to 2022 based on an analysis of data from the American Heart Association's Get With the Guidelines — Coronary Artery Disease registry — a quality improvement program for patients with coronary artery disease, acute MI and chest pain. The authors said the study is the first large-scale analysis of treatment goals and outcomes in STEMI based on hospital performance. The researchers found an association between failure to reach the target time from first medical contact with care to angioplasty with stenting — 90 minutes or less — and increased risk for in-hospital mortality for primary presentations and transfers (adjusted odds ratio, 2.21; 95% CI, 2.02-2.42, and 2.44; 95% CI, 1.90-3.12, respectively). Low-performing hospitals were associated with increased risk for mortality and longer stays in the hospital than were high-performing hospitals. However, hospital location and case volume were not associated with worse outcomes. The guidelines recommend a target time from first contact with care to angioplasty with stenting of 90 minutes or less for patients presenting directly to hospitals offering angioplasty with stenting and 120 minutes or less for patients requiring transfer to a facility offering the procedure. The study findings revealed significant variability between hospital sites in meeting the key metric of the recommendations — adherence in at least 75% of patients with STEMI. At hospitals with the capability to perform angioplasty with stenting, the target was met in 72.2% of patients at high-performing sites, 60.8% at intermediate-performing sites, and 46.0% at low-performing sites. When patients required transfers to other facilities with the capability to perform angioplasty, a target first medical contact-to-device treatment time of 120 minutes or less was achieved in 72.3% of patients at high-performing sites, 48.8% at intermediate performing sites, and 21.9% at low-performing sites, according to the researchers. In these hospitals, treatment delays were caused primarily by longer stays in the emergency department and time from arrival in the catheterization laboratory to stenting. Limitations of the study included the fact registry responses were provided on a voluntary basis and may not reflect the totality of STEMI care in all geographical areas, according to the researchers. The analysis also lacked data on follow-up after discharge, making it difficult to extrapolate the findings over the long term, they said. Yasser M. Sammour, MD, MSc, cardiology fellow at Houston Methodist DeBakey Heart and Vascular Center, who led the work, said several decades of research have highlighted the importance of treating patients with STEMI efficiently. A previous registry study found fewer treatment delays were linked to reduced mortality. 'The current study tried to take that research one step further, assessing how factors such as hospital performance and location affect patient outcomes,' Sammour said. The result, he said: 'We're still underperforming. We need to have coordinated strategies with local intervention at the hospital level to examine where significant delays in percutaneous coronary intervention time are occurring.' The absence of uniformity in established performance measures such as time to initiate treatment in STEMI has led to calls for greater adherence to current recommendations. In an editorial accompanying the journal article, Roxana Mehran, MD, Mount Sinai Fuster Heart Hospital in New York City, wrote: 'After two decades of data collection, national initiatives, and public accountability, the next step must involve tailored solutions addressing barriers within each institution. Bridging the gap now requires renewed efforts and commitments to prioritize timely, coordinated STEMI care. Until then, the clock will continue to tick — against our patients.'
Yahoo
05-06-2025
- Health
- Yahoo
Are you among adults who don't know you have diabetes, hypertension?
A significant number of adults in the U.S. don't know that they have high blood pressure, diabetes or bad total cholesterol numbers, which all contribute to the risk of death from cardiovascular disease. And awareness may be even worse now because COVID-19 disrupted preventive screenings. That's according to a new study in the journal JAMA Cardiology from researchers at Beth Israel Deaconess Medical Center, the Pritzker School of Medicine at the University of Chicago and the Harvard T.H. Chan School of Public Health. The research involved 15,269 nonpregnant adults 20 or older (average age 56.8 years) who had cardiovascular risk factors between 2013 and 2023, using the National Health and Nutrition Examination Survey. The researchers looked specifically at how many didn't know their own health status for those conditions, which was learned through a household interview and then a medical examination. 'The proportion of U.S. adults who were unaware of having hypertension increased significantly over the study period, particularly in young adults and women, while diabetes and high cholesterol level unawareness remained stable. By the 2021 to 2023 cycle, approximately 1 in 6 adults with hypertension and 3 in 10 with diabetes were unaware of their condition,' per the study. The adults who had been identified as having a cardiovascular risk factor but who reported not being told by a health professional that they had the factor were classified as unaware. 'Given declining cardiometabolic health in young adults,' the authors expressed concern that about one-third of those with hypertension, 2 in 5 with diabetes and 1 in 4 with high cholesterol are not aware of their own situation. They added that 'policy efforts to address these gaps in awareness are needed to prevent future cardiovascular events.' The researchers found that across the entire age range studied, 17.8% who had hypertension didn't know it in 2021-2023, compared to 14.6% in 2013-2014. The proportion of adults who didn't know they had diabetes did not change significantly, going from 27.5% to 28.9%. The share with high cholesterol who didn't know was also stable, at 11.5% and 11.9% respectively. But age made a difference. The proportion of young adults ages 20-44 who didn't know they had hypertension rose from 21.9% to 37.1%. Awareness of that didn't change for those 45 and older, or among different age groups who had undiagnosed diabetes or high cholesterol. Lack of awareness of having high blood pressure rose significantly over the study period in women, to 16.5%. All three of those conditions are treatable. Left untreated, however, they can cause severe problems or kill. They are considered 'modifiable risk factors' for cardiovascular disease. The Centers for Disease Control and Prevention reports that heart disease is the leading cause of death in the United States. It includes stroke, heart failure and atrial fibrillation. High cholesterol can lead to a buildup of plaque on artery walls, narrowing those blood vessels and limiting or blocking blood flow to and from the heart and other organs, per CDC. That can cause chest pain or a heart attack. It also raises the risk for heart disease and stroke, which are leading causes of death. High blood pressure or hypertension doesn't usually have symptoms, but can damage the heart, brain, kidneys and eyes. Making lifestyle changes or taking blood pressure medicines can reduce the risk, per CDC. People who have diabetes have twice the risk of heart disease and the risk climbs over time. High blood sugar damages blood vessels and the nerves that control the heart, per CDC. But medication and lifestyle changes can help there, too. Those with diabetes are also more apt to have high blood pressure and so-called 'bad' cholesterol — along with the increased risk those conditions bring. They are also more likely to experience heart failure, where the heart pumps less efficiently, which can also lead to a buildup of fluid in the lungs, making breathing both miserable and difficult. Cleveland Clinic reports that about half of U.S. adults have some form of cardiovascular disease and that 1 in 3 women die from it. Among the risk factors — besides hypertension, high cholesterol and type 2 diabetes — are tobacco use including vaping, genetics, lack of exercise, an unhealthy diet, overuse of alcohol, misuse of prescription and recreational drugs, some chronic autoimmune or inflammatory conditions, chronic kidney disease, and certain pregnancy-related complications. As reported by Medical News Today, researchers at the University of Copenhagen in Denmark found that those who don't know they have forms of heart disease and who have undetected obstructive coronary atherosclerosis have an eight-fold risk of heart attack. That same study suggested that nearly half of adults over 40 'may have such 'hidden' heart conditions.' The American Heart Association noted that there are other conditions that often go undiagnosed, including a 'potentially fatal buildup of abnormal proteins in the heart and other organs.' That condition, called transthyretin amyloidosis, is considered rare, but studies now suggest that it's a fairly common cause of heart failure in older adults, with the proteins found in the hearts of one-fourth of older adults at autopsy. That condition, like hypertension, diabetes and high cholesterol, is also treatable. But it has to be diagnosed and addressed. Undiagnosed heart disease is also responsible for a very large share of heart attacks that aren't caused directly by a blood clot, the association separately reported.
Gizmodo
04-06-2025
- General
- Gizmodo
Smoking Weed and Eating Edibles Share This Surprising Health Risk
A new study has found a startling link between chronic cannabis use and increased risk of cardiovascular disease—regardless of whether you smoke it or consume edibles. The finding challenges commonly held beliefs about the health impacts of tetrahydrocannabinol (THC), which many see as a relatively harmless drug—especially when ingested. The study, published Wednesday, May 28 in the journal JAMA Cardiology, found that THC smokers suffer from significantly worse artery function than non-users. They observed the same effect in edible consumers, though their arteries were not as severely affected. In either case, vascular function was reduced by roughly half compared to those who do not use cannabis, according to a statement from the University of California, San Francisco. 'Scientifically, this THC result is really interesting but boy does it screw up the public health messaging,'' co-author Matt Springer, a cardiovascular researcher at UCSF, reportedly said to lead author and UCSF physician-scientist Leila Mohammadi when he saw the data. These results add to a growing body of evidence that suggests long-term weed use can lead to cardiovascular damage and life-threatening events such as heart attacks and strokes, though experts still lack consensus on its precise impacts. A 2024 study published in the Journal of the American Heart Association found that people who consume cannabis daily had a 25% increased risk of heart attack and a 42% increased risk of stroke compared to non-users. For this new study, researchers investigated how cannabis impacts vascular function. To isolate the effects of chronic cannabis use, they recruited 55 otherwise healthy adults aged 18 to 50 who did not use any form of nicotine and were not frequently exposed to secondhand smoke. These participants were sorted into three groups: marijuana smokers, edible users, and non-users. Those in the two cannabis user groups reported taking the drug at least three times per week, either exclusively through smoking or edibles. To assess the participants' vascular function, the researchers measured dilation of the brachial artery—located in the upper arm—to determine whether it could properly expand in response to increased blood flow. To that end, they used an inflatable forearm cuff to briefly block blood flow to the artery, then used ultrasound to measure its diameter before and after inflating the cuff. Matt Springer, a cardiovascular researcher at UCSF whose lab led the study, told Live Science that his test offers a 'window into the future.' When blood vessels cannot fully dilate, he said, the risk of heart attack and other poor cardiovascular outcomes increases. Participants who did not consume cannabis showed an average vessel dilation—represented as the percent change from the baseline measurement of artery diameter—of 10.4%. This value was significantly reduced among weed smokers and edible users, who showed an average vessel dilation of 6.0% and 4.6%, respectively. For reference, average values for brachial artery dilation in healthy individuals typically range from 8.0% to 15%. In a previous study, Springer's lab found similarly reduced levels of vessel dilation among e-cigarette and cigarette smokers. To better understand how THC causes this change, the researchers ran lab tests to determine how endothelial cells—which form the linings of blood vessels and release nitric oxide to trigger dilation—responded to the participants' blood samples. These tests revealed that the blood of chronic cannabis smokers inhibited nitric oxide production in the cells, which may explain why these participants showed reduced vessel dilation. This effect was not observed in edible consumers, however, suggesting that ingestible THC may impact arterial function via an entirely separate mechanism. Figuring out what that mechanism may be will require further research. What's more, subsequent studies will need to reproduce these findings in a larger population to validate the results. Within the last several years, cannabis use among U.S. adults has reached new heights, according to the NIH's National Institute on Drug Abuse. As such, investigating the health effects of THC is more important than ever before—especially as mounting evidence challenges perceptions of weed as a harmless high.
Medscape
02-06-2025
- General
- Medscape
Genetic Tests in AF Patients May Flag Heart Failure Risk
Genetic testing in patients with atrial fibrillation (AF) may identify those at higher risk of developing incident cardiomyopathy or heart failure, new research from the Netherlands suggested. In a study that included two longitudinal cohorts (the All of Us Research program and the UK Biobank), the prevalence of inherited rare gene variants associated with cardiomyopathy was twice as high in patients with AF and up to five times as high in patients with early-onset AF, defined as that occurring in people younger than 45 years. The analysis, of 44,182 patients with AF, also found those with gene variants associated with cardiomyopathy were at a higher risk for incident cardiomyopathy or heart failure after a diagnosis of AF — about 50%-70% higher compared with noncarriers — independent of clinical and polygenic risk. The findings appeared in JAMA Cardiology . 'If you see a young person in the clinic with AF, first of all, it's not a good sign,' Sean J. Jurgens, MD, MSc, PhD, assistant professor in the Department of Experimental Cardiology at Amsterdam UMC, and a co-author of the study, told JAMA in an interview about the research. 'The risk of heart failure and cardiomyopathies are relatively high and substantially elevated in any person with AF at a younger age. It's not a benign disease where you only have to treat the ischemic stroke risk.' People carrying rare pathogenic variants 'are the patients you really need to look after because these will be the ones who will go on to develop heart failure more likely,' he said. Jurgens acknowledged barriers remain with widespread genetic testing, citing cost, insurance coverage, a lack of cardiovascular genetic expertise, and the lack of genetic counselors. Genetic testing is also more widely available in a smaller country like the Netherlands. In the United States, especially outside of urban centers, accessibility is particularly limited. 'This is a very difficult problem, is why it is so important to do the right stratification,' Jurgens said. 'We can't offer it to everyone. One thing that's good to see is that the prices, at least on the technological side are dropping.' Jurgens said the new research may help reduce the cost of genetic testing, as it narrowed the panel of pathogenic variants from more than 100 to 26, with a high degree of confidence. Notable Strengths In an editorial accompanying the journal article, Olivia G. Anderson, MS, CGC, with the Division of Cardiovascular Medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia, and her colleagues called the new study 'methodologically rigorous.' The work 'affirms the observation that AF can be an early phenotypic manifestation' of genetic cardiomyopathy, they wrote. Anderson and her co-authors praised the study for generating concordant results from a sensitivity analysis using a 12-month blanking period, which reduced the likelihood patients were diagnosed with AF and cardiomyopathy at the same time. They also said the Dutch team's study makes a strong case for genetic testing in patients with AF, particularly for those younger than 45 years. 'Their findings also highlight the increasing need for genetic counselors embedded in cardiology practices and an expanded availability of specialized cardiovascular genetics clinics,' they wrote. This work was supported in part by the Amsterdam UMC YTF, Dutch Heart Foundation, and the AFIP Foundation; the Deutsche Forschungsgemeinschaft; the CIRCULAR NOW Consortium and the Dutch Heart Foundation, focused on genomic risk prediction in cardiomyopathies; the American Heart Association, the European Union, and the Fondation Leducq. Jurgens and the authors of the editorial reported no relevant financial relationships.
Yahoo
30-05-2025
- General
- Yahoo
Smoking marijuana and eating cannabis gummies both linked to dangerous health risk, study finds
Long-term cannabis use in any form has been linked to a greater risk of heart disease. In a new study, researchers at UC San Francisco determined that eating edible cannabis, such as gummies, has the same impact on cardiovascular risk as smoking marijuana. The risk stems from reduced blood vessel function, according to the study, which was published in JAMA Cardiology on May 28. Heavy Cannabis Use Could Pose This Threat To The Brain The study included 55 people between 18 and 50 years of age who were "outwardly healthy." The participants were divided into three groups: those who regularly smoked marijuana, those who ate edibles containing THC (tetrahydrocannabinol), and those who didn't use cannabis, according to a UCSF press release. Read On The Fox News App The cannabis users had been consuming the substance at least three times weekly for at least one year. On average, the smokers had the habit for 10 years, while those consuming edibles had been doing so for five years, the release noted. In September 2024, the participants underwent testing to determine how well their blood vessels functioned and whether the cells lining the blood vessels were affected. Dementia Risk Connected To Cannabis-related Hospital Visits, Says Study All cannabis users were found to have "decreased vascular function," comparable to those who smoke tobacco. Their blood vessel function was roughly half compared to those who did not use cannabis. This side effect has been linked to a higher risk of heart attack, high blood pressure and other cardiovascular conditions, the researchers noted. The participants who smoked marijuana were also found to have changes in their blood serum that harmed cells lining their blood vessels and lymphatic vessels, an effect that was not seen in those who ate edible cannabis. The researchers noted that while smoking marijuana and consuming edibles both affect vascular function, they likely do so for different reasons. Shingles Vaccine Has Unexpected Effect On Heart Health "Chronic cannabis smoking and THC ingestion were associated with endothelial dysfunction [impaired functioning of the endothelial cells lining the inside of blood vessels] similar to that observed in tobacco smokers, although apparently occurring via distinct mechanisms," the researchers wrote. "This study enhances the understanding of the potential risks to vascular health linked to cannabis use and provides more evidence that cannabis use is not benign." Dr. Bradley Serwer, a Maryland-based cardiologist and chief medical officer at VitalSolution, an Ingenovis Health company that offers cardiovascular and anesthesiology services to hospitals nationwide, said he was not surprised by the study's findings. "We have known that the chronic use of THC-containing compounds can have negative health consequences — this study just reaffirms those prior studies," Serwer, who was not involved in the UCSF research, told Fox News Digital. The study did have some limitations. "Variability in cannabis strains complicates standardization," the researchers wrote. "Self-reported cannabis use may introduce recall bias; thus, participants were queried at multiple points: in the online survey, at the eligibility interview and before each visit." It was also challenging to determine whether blood vessel function could have also been affected by lifestyle factors like stress, caffeine and secondhand smoke exposure, they noted. Serwer pointed out that this was a "very small" study of only 55 people, all living in the San Francisco Bay area. "The study did not allow for variability in the different strains of cannabis, and they used a self-reporting survey, which can be under- or over-reported," he told Fox News Digital. "They looked for physiologic endpoints and not hard endpoints, such as heart attacks, strokes or death. We have to infer that the physiologic endpoints would result in cardiovascular events." Click Here To Sign Up For Our Health Newsletter The cardiologist said he agreed, however, with the conclusion that cannabis use is "not benign." "Chronic use does have potential cardiovascular risks," he warned. "There are therapeutic uses of cannabis, and the decision to use or avoid it should be made with all benefits and risks in mind." In general, Serwer said he cautions all of his patients to avoid any unnecessary cardiac risks. "As clinicians, we must weigh the benefits and the risks of a medicine/drug or intervention," he said. "If the risks outweigh the benefits, it should be avoided." For more Health articles, visit The study was funded mainly by the National Institute on Drug Abuse; the California Department of Cannabis Control; the California Tobacco-Related Disease Program; the National Heart, Lung, and Blood Institute; and the FDA Center for Tobacco Products. Fox News Digital reached out to cannabis industry organizations requesting article source: Smoking marijuana and eating cannabis gummies both linked to dangerous health risk, study finds
