In The News; October 2019
Both Types of High Blood Pressure Predict Bad Outcomes
Blood pressure (BP) is measured when the heart is contracting (systolic BP, the first number) and when the heart is resting (diastolic BP, the second number). Ever since the Framingham Heart Study identified that high systolic BP was a stronger predictor of cardiovascular outcomes than high diastolic BP, physicians have focused on lowering high systolic pressures. After the definition of hypertension was lowered from 140/90 millimeters of mercury (mmHg) to 130/80 mmHg in 2017-a controversial move-guidelines continued to emphasize treating the higher number. But a study involving more than 1.3 million outpatients published in the New England Journal of Medicine on July 18, 2019, may change this practice. In this study, researchers showed that having either high systolic or high diastolic high BP, or both, increased the risk of heart attack and stroke. Additionally, the negative influence of blood pressure on cardiovascular outcomes was seen at 130/80 mmHg, validating the lower threshold for hypertension.
Valve Disease: Another Reason to Watch Your Blood Pressure
High blood pressure damages blood vessels, and it may damage heart valves, as well. A study published online July 10, 2019, in JAMA Cardiology revealed that years of high systolic blood pressure triple the risk of developing valve disease. Researchers in the UK examined the records of nearly 330,000 people ages 40 to 96, who were entered into a databank between 2006 and 2010. Only 1.8% had valve disease (aortic stenosis, aortic regurgitation or mitral regurgitation). Over time, the risk of developing these valve diseases tripled with each 20 mmHg increase in systolic blood pressure. This suggests that more aggressive efforts to control blood pressure might help lower the incidence of valve disease.
PAD Tops the List of Reasons to Stop Smoking
Cigarette smoking is a major risk factor for heart attack and stroke, and quitting smoking is one of the best things you can do to prevent these events. Now it appears the impact of smoking is even greater on the legs than on the heart and brain. An analysis of data on 13,355 participants in the long-term Atherosclerosis in Communities (ARIC) study revealed that the risk of developing peripheral arterial disease (PAD) was double that of heart attack or stroke in people who smoked more than 35 pack years. (A pack year is defined as 20 cigarettes smoked every day for one year). Those who smoked more than 40 pack years had quadruple the risk of PAD.
The researchers also found that smoking cessation had the greatest impact on reducing risks from PAD. The benefits were slow in coming, however. As the authors explained in the Journal of the American College of Cardiology on July 30, 2019, the risk of PAD remained elevated for 30 years after quitting smoking, while it took only two decades for heart attack and stroke risk to normalize.
Who Is Most Likely to Develop Heart Failure from Diabetes?
The connection between diabetes and cardiovascular risk is well known. Fewer people know that women with diabetes have a greater risk of coronary artery disease, stroke, dementia and cancer than men with diabetes. Now heart failure can be added to this list. Researchers analyzed 47 published studies that included more than 12 million participants. In their paper, published July 18, 2019, online in Diabetologia, they found that both type 1 and type 2 diabetes were risk factors for heart failure, as well as increased risk of death following the diagnosis. However, women were at significantly greater risk than men. Women with type 1 diabetes had a 47% higher risk of heart failure than men with diabetes. The risk of heart failure in women with type 2 diabetes was 9% higher than in men. The researchers offered theories as to why type 1 had a greater effect than type 2 diabetes, and why women were more at risk than men, but the reasons are still unclear.