Congenital Heart Disease: Symptoms & Treatment

Lung Disease Patients More Likely To Develop Heart Disease Independent Of Any Risk Factors

Patients with lung disease are more likely to develop heart disease independent of any risk factors, according to new research.

A new study published in Orphanet Journal of Rare Diseases looked at patients who have a rare genetic condition called Alpha-1 antitrypsin deficiency (AATD) which causes lung disease similar to COPD independently of any risk factors such as smoking or age. More than 220 patients with AATD were recruited to the study alongside patients with COPD, and a control non lung disease population; and all were assessed for present cardiovascular disease (CVD) and recognized risk factors, including assessment of vascular stiffness known to increase risk for future events. Patients were then tracked for four years to see whether they developed CVD.

The patients with the rare genetic condition AATD had the highest adjusted scores among all participants for vascular stiffness, but had lowest scores for standard associated risk factors of CVD and nearly half (45%) of patients had discordant scores where one was high and other low.

Meanwhile, COPD and control participants had similar scores across the direct and indirect measures of CVD risk.

Furthermore, despite the AATD participants having lower risk factors associated with developing cardiovascular disease including being younger and a higher proportion who had never smoked, 12.7% of participants developed CVD after four years of follow-up.

This long-term study has enabled us to see the relationship between lung disease and heart disease in a unique way by following a group of patients with this rare genetic disease.

Our study has shown that there is an increased risk for people with lung conditions of going on to develop cardiovascular conditions, and that only looking at conventional factors such as age and smoking doesn't give the full picture of the relationship between these two essential systems in the body."

Robert Stockley, Professor and Consultant in Acute and Respiratory Medicine at University of Birmingham and senior author of the paper

Participants also gave blood which was tested for an enzyme linked with lung damage in AATD patients.

There was a significantly higher levels of the enzyme Proteinase 3 in the AATD patients, but the study found that there was a link between elevated levels of the enzyme and vascular stiffness and hence CVD risk. The team believe that the Proteinase 3 enzyme may have a more direct impact on the development of heart and lung disease through the breakdown of fibers that support the large arteries and lungs, and that Proteinase 3 inhibitors could be a novel therapeutic to prevent cardiovascular disease especially in AATD patients.

Louise Crowley, Clinical Research Fellow and PhD researcher at the University of Birmingham and corresponding author of the paper said:

"The role of Proteinase 3 acts as a powerful link between lung and heart disease. The action that the enzyme has in attacking elastin fibers found in the lungs and major arteries suggests that inhibiting its action could have a dual effect to slow both lung and cardiovascular diseases."

Source:

Journal reference:

Sapey, E., et al. (2024) Cardiovascular disease in Alpha 1 antitrypsin deficiency: an observational study assessing the role of neutrophil proteinase activity and the suitability of validated screening tools. Orphanet Journal of Rare Diseases. Doi.Org/10.1186/s13023-024-03124-x.

Protecting Our Health Starts With Our Planet: A Heart Surgeon's View

As a heart surgeon, I made major decisions daily guided by what medical science told me. And, right now, scientific evidence increasingly shows that nature – the land, water, plants, and animals around us – is fundamental to our personal health.

But we should be concerned. Because scientific evidence also indicates that with society's progressive economic growth (a positive thing), our planet's biodiversity is declining. We are losing green spaces, freshwater sources, and plant and animal species at an alarming rate. And climate change further accelerates this. Indeed, if we don't act now to better prioritize conservation, soon there might not be much nature as we know it left. This is not to be alarmist; it is just where we are heading. Our personal health — that of you and me and generations to follow— and the health of our communities, will irreversibly suffer. And our overall quality of life will diminish alongside it.

Right now, scientific evidence increasingly shows that nature – the land, water, plants, and animals ... [+] around us – is fundamental to our personal health.

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To more clearly and more rationally discuss climate change and biodiversity loss, and to bring significantly more people to the table to engage in the conversation of solutions and actions, I strongly believe we should more aggressively frame the discussion in terms of its impact on our physical and mental health. People care about their health, and the health of their children and grandchildren, and if they understand how climate change, land degradation, and species loss is detrimental to their health, they will engage, they will respond, and they will act.

So let's view climate change and the environment through the lens of individual and public health. We are already starting to see the negative impact of a continually warming planet on our health. This isn't surprising. Think about the growing number of extreme heat waves, catastrophic weather events, and days with poor air quality that we have witnessed every year over the past decade. Each of these directly and indirectly influences our ability to live a healthy and fulfilling life and for our communities to thrive.

And this is exactly why I, a former heart and lung surgeon, am serving as the chair of the global board of The Nature Conservancy, the world's largest nonprofit dedicated to protecting nature and tackling climate change with solutions that are good for our planet and good for people. It's not just conservation for conservation's sake; it's for people, to make their lives better. I spent 20 years studying health science and personally delivering health services, so I understand peoples' health. I see how nature and climate are inextricably linked to personal health.

Why is conservation important to your health?

On average our mental, physical, and emotional health in the U.S. Ranks behind other developed countries. Take life expectancy, for example. The U.S. Is not in the top 10 or even the top 20 when it comes to the average number of years we can expect to live. In fact, we rank 26th with a life expectancy of 77.5 years. The most advanced and wealthiest nation in the world ranks 26th in the health of its people! And compared to similarly sized, wealthy countries, we have the absolute lowest life expectancy despite outspending every one of them on healthcare.

In terms of our mental health specifically, we are also far behind. The United Nations 2024 annual World Happiness Report placed the U.S. 23rd in the world in happiness, falling from 15th place in last year's rankings. Indeed, our country has the highest suicide rate of any wealthy nation (double that of the United Kingdom).

For a country that spends nearly 20% of our GDP on healthcare, these numbers are especially shocking. And it's not just because of a lack of doctors in the U.S., or uneven access to healthcare, or inadequate health insurance that our health outcomes rank so poorly. It's an issue that runs much deeper than that and stems from how we interact with and behave in the world around us. And our environment plays a fundamental role.

Prioritizing conservation – better understanding and more actively protecting nature and the natural ... [+] world we live in – is a great way for each of us to start changing this narrative and improving our health and wellbeing.

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That is why prioritizing conservation – better understanding and more actively protecting nature and the natural world we live in – is a great way for each of us to start changing this narrative and improving our health and wellbeing. It's not just better for the planet, it's better for us as individuals, and our families and communities.

A Case Study: Heart Health and Nature

Here is where it is personal for me. One clinical area where the intersection of our environment and our health can be clearly seen is my own medical specialty of heart and lung disease. Cardiovascular disease is consistently one of the leading causes of death worldwide, accounting for 17.9 million deaths each year. It is the leading cause of death for women and men here at home. This acute and chronic condition is greatly impacted by the health of our environment, especially when it comes to heat events and air pollution.

Heat: Heat events are the top annual weather-related killer in the U.S. And rising temperatures are making extreme heat waves more frequent and more intense. As our average temperatures continue to trend upward - this past winter was the warmest on record - so does the already high risk of heat-related adverse health effects for those with cardiovascular disease. The human body simply was not made to thrive in extremely high and rapidly elevating temperatures. And our bodies' evolution can't keep up with the rapid pace of temperature escalation. Because of this, heat waves result in a range of devastating physical consequences like heat stroke, heart attacks, cardiovascular and respiratory stress, dehydration, and stroke.

And research also shows that rising temperatures greatly affect our mental and emotional health as well. Hotter days result in an uptick in reported anxiety, anger, suicide attempts, and overdose deaths. A 2019 study by the National Bureau of Economic Research found a 5.7% increase in violent crime on days above 85 degrees Fahrenheit than on cooler days in Los Angeles.

Air Pollution: Air pollution is the fourth leading cause of disease and death worldwide. Research shows that exposure to poor air quality due to particle pollution increases the risk of heart-related events. In fact, a recent Global Burden of Disease (GBD) study estimates that air pollution resulted in 9 million deaths globally, 61.9% of which was due to cardiovascular disease. Similarly in 2022, researchers published findings suggesting a connection between air pollution and lung cancer, and air pollution has also recently been associated with dementia.

Events such as wildfires directly affect air quality. Climate change has doubled the number the number of large fires over the last three decades. As fire seasons grow longer and more severe due to drier conditions, chronic illness and the significant costs related to smoke exposure are surging (premature deaths and hospital admissions accounted for more than half of the total cost of the fires).

Lung Health: Our lung function is also greatly impacted by our environment. Hotter and drier conditions lead to a greater risk of wildfires which release microscopic particles in smoke and make it difficult to breathe (especially for those with preexisting conditions like asthma, or heart and lung disease). And in areas where climate change has increased rainfall and floods, moisture is leading to heightened risk of mold which is also bad for our lungs. Further, higher temperatures cause plants to produce more pollen and allergens and to do so over a greater range. As a result, allergy seasons, and their related morbidity to individuals, are lasting even longer and geographically expanding to new areas.

The science is clear: the natural world around is inextricably linked to our health – the health of our bodies, the health of our communities, and the health of our planet. And when nature suffers, so, too, does our personal health. But the good news is that, by this same token when nature thrives, so do we. That's right. Mother Nature is medicinal. I saw it in my medical practice and the scientific literature supports it. And protecting and conserving nature can be a great way to not only protect our health but improve it. Economic growth and progress can and will continue to flourish, but as responsible citizens we should insist that they do so with careful attention to the balanced, long-term sustainability of nature and biodiversity. And I should add, with my former political hat on, this is not a Democrat or Republican issue, it is a public health and wellbeing issue for us all.

One of the great benefits of being outside in nature is exercise – which is good for our hearts, lungs, and mental wellbeing. Heart disease is linked to a lack of physical activity. Because of this, spending time out in nature can be a successful prevention strategy for cardiac-related events like heart attacks, high blood pressure, and strokes. When it comes to our mental and emotional health, just being in nature has been shown to have measurable, positive effects. Studies show that cortisol —our stress hormone — levels are significantly reduced with something as simple as a 20-minute walk in a local park.

Paying attention to nature, harnessing the tremendous power of biodiversity, and conserving our lands and waters can greatly improve our health. It's good for our planet. And it's good for people. Each of us has an important role to play in preserving nature and biodiversity. Our health – and that of generations to come – depends on answering this call.

More Than A Fifth Of Older Adults With RSV Have Acute Cardiac Events, Data Reveal

A study yesterday in JAMA Internal Medicine demonstrates that 22% of hospitalized adults aged 50 years or older with respiratory syncytial virus (RSV) infection experienced an acute cardiac event—most frequently acute heart failure (16%). Moreover, 1 in 12 of infected patients (8.5%) had no documented underlying cardiovascular disease.

RSV is associated with annual totals of up to 160,000 US hospitalizations, 10,000 deaths, and $4 billion in direct healthcare costs among adults age 65 years or older.

"Despite evidence of considerable RSV-associated morbidity, mortality, and health care expenditure, the potential severity of RSV infection in adults has historically been underappreciated by public health professionals and clinicians," the authors write. RSV is rarely tested for in the clinical settings, and symptoms usually mirror other respiratory diseases, they add. 

Despite evidence of considerable RSV-associated morbidity, mortality, and health care expenditure, the potential severity of RSV infection in adults has historically been underappreciated.

The study consisted of outcomes among 6,248 adults aged 50 years and older hospitalized for RSV during 2014 to 2018, and then in 2022 and 2023, in 12 US states. Almost 60% of the adults were women, and 65.9% were White. 

Upon hospital admission, 93.1% of those included in the study had a fever, and 80.6% had a cough.

Heart failure most common event 

A total of 56.4% of patients had underlying cardiovascular disease, including 31.9% with heart failure, 30.2% with coronary artery disease, and 25.2% with atrial fibrillation. After cardiovascular disease, diabetes (35%) and chronic obstructive pulmonary disease (34.8%) were the most common underlying conditions. 

According to the authors, the weighted estimated prevalence of experiencing an acute cardiac event among adults aged 50 years or older hospitalized with laboratory-confirmed RSV infection was 22.4% (95% confidence interval [CI], 21.0% to 23.7%.) Among those events, acute heart failure was the most common, with a prevalence of 15.8% (95% CI, 14.6% to 17.0%) in all RSV-infected patients.

Patients with underlying cardiovascular disease had a greater weighted risk of experiencing an acute cardiac event of any category compared to those without underlying cardiovascular disease (33.0% vs 8.5%). A history of heart failure, age 85 years or older, and atrial fibrillation were also associated with a higher risk of having an acute cardiac event. 

Experiencing an acute cardiac event during hospitalization was also associated with more severe RSV outcomes, including intensive care unit admission, invasive mechanical ventilation, and in-hospital death.

"Acute cardiac events occurred frequently among adults with a history of underlying cardiovascular disease, particularly chronic heart failure," the authors concluded. "However, acute cardiac events also occurred in 1 in 12 adults who had no previous documentation of cardiovascular disease, suggesting that severe RSV infection may precipitate or reveal previously undiagnosed cardiovascular disease."

RSV vaccine uptake low

Awareness of RSV's costly impact in the United States is growing, however, and in 2023, the first vaccine for adults ages 65 and older was approved for use in older Americans. 

In an editor's note published on the study, Tracy Wang, MD, MHS, a JAMA Internal Medicine associate editor, warns that RSV vaccine uptake among older Americans has been very low, much lower than flu vaccination. 

"Prior RSV-related efforts have focused on infants and young children, with many clinicians and patients still unaware of RSV burden of disease and prognosis in older adults," Wang writes. Moreover, RSV vaccines are inconsistently covered by insurance carriers.  

"This coverage difference means that many clinic offices need to refer patients to pharmacies for vaccination, and out-of-pocket costs may be necessary for vaccination," she adds. "Vaccine fatigue and access barriers among currently eligible persons need to be addressed to enhance uptake by those who stand to benefit."

 

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