Heart Beat December 2016 Issue

Emotional Stress Triggers Heart Attacks, High Blood Pressure, Dabigatran

Emotionally Upsetting Episodes, Heavy Exertion May Trigger Heart Attacks

It may not be a surprise, but recent research suggests that episodes of extreme anger or emotion may indeed lead to a heart attack. In a study published in the American Heart Association journal Circulation, researchers found that individuals experiencing extreme anger or emotional upset may face double the risk of a heart attack. The study also suggests that an extremely emotional episode experienced while also engaging in heavy physical exertion may triple the likelihood of having a heart attack. These findings were gleaned from a large, ongoing study of heart patients called INTERHEART, which includes more than 12,000 first-time heart attack survivors in 52 countries. The data for this study are somewhat limited, because the patients had to recall their circumstances and possible triggers just prior to having their heart attack. The researchers acknowledged that some patients may be more inclined to remember the events surrounding a heart attack as more intense than they were. However, because the patient responses were so consistent across nationalities and demographics, researchers believe people with heart attack risk factors should be mindful of their emotional state, especially when also involved in strenuous physical activity. This study underscores the strong connection between the heart and the brain, and should be a reminder that emotional stress can have a profound effect on your cardiovascular health. Stress can affect your heart rate, blood pressure, and the way blood flows through your arteries and away from your heart. If arteries are already narrowed due to cholesterol plaque or smoking, additional stress-induced burden can be dangerous.

AHA: High Blood Pressure Associated with Cognitive Decline Later in Life

Individuals who have high blood pressure in middle age may be at a higher risk of cognitive impairment in old age. In the journal Hypertension, the American Heart Association (AHA) issued a statement calling for more clinical trials to better understand the role high blood pressure plays in the vascular health of the brain. There have been many observational studies suggesting a strong link between chronic hypertension and cognitive decline, but the AHA said more tangible evidence is needed. The new SPRINT-MIND trial may provide some answers. The study is looking to see whether treating high blood pressure can help reduce the risk of dementia later in life. The two main causes of dementia are Alzheimer’s disease and vascular cognitive dementia, which is usually triggered by a stroke or multiple strokes that reduce blood flow to the brain. While the relationship between hypertension and brain health is still being understood, the AHA says that blood pressure control should be a priority for everyone to help preserve the health of the heart, brain, and entire body.

Dabigatran May Be Safer Than Rivaroxaban for Older Atrial Fibrillation Patients

For older patients with atrial fibrillation (AF) unrelated to valve disease, the anticoagulant drugs rivaroxaban and dabigatran appear to be equally effective in helping to prevent a stroke. AF causes the heart’s upper chambers to beat chaotically and raises the risk of blood clot formation, which can lead to stroke. Anticoagulants interfere with the blood clotting. But in a study published in JAMA: Internal Medicine, researchers found that while dabigatran and rivaroxaban provide comparable protection against stroke, the risk of bleeding episodes in the brain was higher among patients on rivaroxaban. These two drugs are among several recently approved alternatives to warfarin (Coumadin®), a widely prescribed blood thinner taken by many AF patients. Warfarin, however, requires frequent monitoring and adjustments in dosage. That’s because an individual’s response to warfarin can change over time, meaning the same dose that limits blood clotting in a healthy way may allow for too much bleeding just a few months later. Patients on warfarin are therefore advised to go in for tests on a regular basis to make sure their current warfarin dose is doing the job. Rivaroxaban and dabigatran don’t require the same level of monitoring. While they are still more expensive than warfarin, they are more convenient. New information comparing these newer warfarin alternatives continues to be uncovered. In this study, the researchers suggest that dabigatran be prescribed ahead of rivaroxaban, though they add that in younger patients, the risks may be less pronounced.

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