What student-athletes need to know about Hypertrophic Cardiomyopathy

Illustration: Sanjay K J/Pixabay

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Family Features - You may find it difficult to wrap your mind around the idea of an energetic student-athlete with a cardiac diagnosis. Heart conditions may be more often associated with older individuals, but you might be surprised to learn hypertrophic cardiomyopathy is the most common condition responsible for sudden cardiac death in young athletes. In fact, it's the cause of 40% of sudden cardiac death cases.

It's estimated 1 in every 500 adults living in the United States has hypertrophic cardiomyopathy, according to the American Heart Association, but a significant percentage are undiagnosed. More than 80% of individuals who experience this condition show no signs or symptoms before sudden cardiac death. While sudden cardiac death is rare, it can occur during exercise or in its aftermath. That's why it's important for student-athletes and their loved ones to learn more about this condition and talk to a doctor about their risk.

With proper knowledge and the support of a skilled care team, it's possible to manage hypertrophic cardiomyopathy with heart-healthy actions to prevent complications or worsening cardiovascular conditions like atrial fibrillation (a quivering or irregular heartbeat), stroke or heart failure. Hypertrophic cardiomyopathy awareness and education for athletes by the American Heart Association is made possible in part by a grant from the Bristol Myers Squibb Foundation.

What is hypertrophic cardiomyopathy?

Hypertrophic cardiomyopathy is the most common form of inherited heart disease and can affect people of any age. It's defined by thickening and stiffening of the walls of the heart. The heart's chambers cannot fill up or pump blood out adequately, so the heart is unable to function normally.

There are different types of this condition. Most people have a form of the disease in which the wall that separates the two bottom chambers of the heart (the septum) becomes enlarged and restricts blood flow out of the heart (obstructive hypertrophic cardiomyopathy).

However, sometimes hypertrophic cardiomyopathy occurs without significant blocking of blood flow (nonobstructive hypertrophic cardiomyopathy). The heart's main pumping chamber is still thickened and may become increasingly stiff, reducing the amount of blood taken in then pumped out to the body with each heartbeat.

What are possible symptoms?

Symptoms can include:

• shortness of breath
• chest pain
• heart palpitations
• fatigue

The severity of symptoms can vary, but if you experience them or if you have a family history of hypertrophic cardiomyopathy or sudden cardiac death, it may be a good idea to speak to your doctor about whether you have this condition.

For some people, symptoms can get worse and new symptoms can appear over time, resulting in people dealing with harsher effects and a diminished ability to do the activities they love. This decrease in functions can be one of the most challenging aspects of the disease. Keeping your health care team aware of any new or changing symptoms allows them to work with you to develop a plan to manage these symptoms and reduce their impact.

How is hypertrophic cardiomyopathy diagnosed?

Medical history, family history, a physical exam and diagnostic test results all factor into a diagnosis. A common diagnostic test is an echocardiogram that assesses the thickness of the heart muscle and observes blood flow from the heart.

If anyone in your family has been diagnosed with hypertrophic cardiomyopathy, other heart diseases or has been told they had thick heart walls, you should share that information with your doctor and discuss the need for genetic testing. Because this condition is hereditary, first-degree relatives, which include siblings and parents, should be checked.

Learn more at heart.org/HCMStudentAthlete.

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Good to know; Learn CPR as a life-saving skill

Family Features - While many Americans agree Conventional CPR (cardiopulmonary resuscitation) or Hands-Only CPR (HOCPR) significantly improve a person's chance of survival from cardiac arrest, less than half are confident they can perform either Conventional CPR or HOCPR in an emergency.

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Photo by Raven Domingo/PEXELS

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Black or Hispanic adults who experience cardiac arrest outside a hospital setting are substantially less likely to receive lifesaving care from a bystander. In spite of these survey results, the American Heart Association is working to change this by empowering members of these communities to learn lifesaving CPR, and a growing segment of respondents are willing to act in an emergency.

The American Heart Association's 2023 survey also revealed that as a result of the organization's efforts to change attitudes about performing CPR, which can lead to lifesaving results, more than half of African Americans said they would be willing to perform CPR in an emergency compared to 37% two years ago. Additionally, Hispanic and Latino respondents are more confident in their abilities to perform CPR.

Committed to turning a nation of bystanders into lifesavers, the American Heart Association's multiyear initiative, Nation of Lifesavers, helps teens and adults learn how to perform CPR and use an automated external defibrillator (AED); share that knowledge with friends and family; and engage employers, policymakers, philanthropists and others to create support for a nation of lifesavers.

"Each of us has the power in our own hands to respond to a sudden cardiac arrest," said Anezi Uzendu, M.D., American Heart Association expert volunteer. "We simply need to know what to do and have the confidence to act."

The long-term goal: to ensure that in the face of a cardiac emergency, anyone, anywhere is prepared and empowered to perform CPR and become a vital link in the chain of survival, aiming to double the survival rate of cardiac arrest victims by 2030. It takes just 90 seconds to learn how to save a life using HOCPR, which can be equally as effective as traditional CPR in the first few minutes of cardiac arrest.

Nationally supported by the Elevance Health Foundation, the American Heart Association's HOCPR campaign is focused on chest compression-only CPR. If a teen or adult suddenly collapses due to a cardiac event, you can take two steps to save a life: immediately call emergency services and use these tips to begin performing HOCPR.

1. Position yourself directly over the victim.
2. Put the heel of one hand in the center of the chest and put your other hand on top of the first.
3. Push hard and fast in the center of the chest at a rate of 100-120 beats per minute, which is about the same tempo as the song "Stayin' Alive" by the Bee Gees, and at a depth of approximately 2 inches.
4. Continue compressions and use an AED, if available, until emergency help arrives.

To learn more about how you could be the difference between life and death for someone experiencing a cardiac event, visit Heart.org/nation.

Risk of dementia is nearly three times higher the first year after a stroke

DALLAS — Having a stroke may significantly increase the risk of developing dementia. The risk of dementia was the highest in the first year after a stroke and remained elevated over a period of twenty years, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“Our findings show that stroke survivors are uniquely susceptible to dementia, and the risk can be up to 3 times higher in the first year after a stroke. While the risk decreases over time, it remains elevated over the long-term,” said lead study author Raed Joundi, M.D., D.Phil., an assistant professor at McMaster University in Hamilton, Ontario, Canada, and an investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences.

To evaluate dementia risk after stroke, the researchers used databases at the Institute for Clinical Evaluative Sciences (University of Toronto, Canada), which includes more than 15 million people in the Canadian province of Ontario. They identified 180,940 people who had suffered a recent stroke — either an ischemic stroke (clot-caused) or intracerebral hemorrhage (bleeding within the brain) — and matched those stroke survivors to two control groups — people in the general population (who had not had a heart attack or stroke) and those who had had a heart attack and not a stroke. Researchers evaluated the rate of new cases of dementia starting at 90 days after stroke over an average follow-up of 5.5 years. In addition, they analyzed the risk of developing dementia in the first year after the stroke and over time, up to 20 years.

The study found:

• The risk of dementia was highest in the first year after stroke, with a nearly 3-fold increased risk, then decreasing to a 1.5-fold increased risk by the 5-year mark and remaining elevated 20 years later.
• Dementia occurred in nearly 19% of stroke survivors over an average follow-up of 5.5 years.
• The risk of dementia was 80% higher in stroke survivors than in the matched group from the general population. The risk of dementia was also nearly 80% higher in stroke survivors than in the matched control group who had experienced a heart attack.
• The risk of dementia in people who had an intracerebral hemorrhage (bleeding in the brain) was nearly 150% higher than those in the general population.

“We found that the rate of post-stroke dementia was higher than the rate of recurrent stroke over the same time period,” Joundi said. “Stroke injures the brain including areas critical for cognitive function, which can impact day-to-day functioning. Some people go on to have a recurrent stroke, which increases the risk of dementia even further, and others may experience a progressive cognitive decline similar to a neurodegenerative condition.”

Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. According to the CDC, of those at least 65 years of age, there is an estimated 7 million adults with dementia in 2014 and projected to be nearly 14 million by 2060.

“Our study shows there is a large burden of dementia after acute stroke in Canada and identifies it is a common problem that needs to be addressed. Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said. “More research is needed to clarify why some people who have a stroke develop dementia and others do not.”

A 2023 American Heart Association scientific statement, Cognitive Impairment After Ischemic and Hemorrhagic Stroke suggests post-stroke screenings and comprehensive interdisciplinary care to support stroke survivors with cognitive impairment.

A limitation of the study is that administrative data, hospital records and medication dispensary data were used for the analysis. Researchers were not able to perform cognitive assessments or neuroimaging (noninvasive images of the brain) on stroke survivors, therefore, there is no way to confirm the dementia diagnosis or type of dementia. However, the dementia definition was previously validated and shown to be accurate when compared to medical charts.

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Study finds two common types of antidepressants were safe for most stroke survivors

by American Heart Association

Researchers looked at the frequency of serious bleeding among hundreds of thousands of stroke survivors who took different types of SSRI and/or SNRI antidepressants.

DALLAS — Most stroke survivors were able to safely take two types of common antidepressants, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Among people with ischemic (clot-caused) stroke, those who began taking an antidepressant known as an SSRI (selective serotonin reuptake inhibitor) and/or an SNRI (serotonin and norepinephrine reuptake inhibitor) for the common conditions of post-stroke depression and anxiety, did not have an increased risk of hemorrhagic (bleeds) stroke or other serious bleeding. This included people taking anticoagulation medications. There was, however, an increased risk of hemorrhagic stroke among stroke patients taking two anti-platelet medications, also called dual anti-platelet therapy or DAPT.

“Mental health conditions, such as depression and anxiety, are very common yet treatable conditions that may develop after a stroke. Our results should reassure clinicians that for most stroke survivors, it is safe to prescribe SSRI and/or SNRI antidepressants early after stroke to treat post-stroke depression and anxiety, which may help optimize their patients’ recovery,” said study lead author Kent P. Simmonds, D.O., Ph.D., a third-year physical medicine and rehabilitation resident at the University of Texas Southwestern Medical Center in Dallas. “However, caution is needed when considering the risk-benefit profile for stroke patients receiving dual anti-platelet therapy because we did find an increased risk of bleeding among this group.”

According to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update, when considered separately from other cardiovascular diseases, stroke ranks fifth among all causes of death, behind diseases of the heart, cancer, COVID-19 and unintentional injuries/accidents. Approximately one-third of stroke survivors develop poststroke depression. If left untreated, depression may affect quality of life and reduce the chances for optimal poststroke recovery such as returning to their usual daily living activities without assistance.

The most common classes of antidepressants are SSRIs or SNRIs, and they are widely used and effective for treating anxiety and depression. However, they may not be prescribed at all or early enough after a stroke, when the risk of depression or anxiety is particularly high, due to concerns that they may increase the risk of a hemorrhagic stroke or other serious types of bleeding.

Researchers looked at the frequency of serious bleeding among hundreds of thousands of stroke survivors who took different types of SSRI and/or SNRI antidepressants (such as sertraline, fluoxetine, citalopram, venlalfaxine). Serious bleeding was defined as bleeding in the brain, digestive tract; and shock, which occurs when bleeding prevents blood from reaching the body’s tissues.

Researchers also investigated serious bleeding among stroke survivors who took antidepressants combined with different types of blood-thinning medications that are used to prevent future blood clots. These blood-thinning medications may include either anticoagulants or antiplatelet medications. Anticoagulants are prescribed as a single medication and include medications such as warfarin, apixaban and rivaroxaban. Antiplatelet medications may be prescribed as either a single medication (commonly aspirin) or two types of antiplatelet medications can be used in dual antiplatelet therapy. DAPT includes aspirin plus another antiplatelet medication called a P2Y12 inhibitor (such as clopidogrel, prasugrel or ticagrelor).

The study found:

SSRI and SNRIs were generally safe to start during the important early stages of recovery as patients taking these medications were not more likely to develop serious bleeding compared to stroke survivors who did not take an antidepressant. This included ischemic stroke patients who are also taking anti-coagulation therapy.

An increased risk of serious bleeding occurred when SSRIs or SNRIs were taken in combination with DAPT treatments (aspirin and blood thinners). However, the overall risk remained low as serious bleeding events were rare.

Among ischemic stroke patients on antidepressant medications, there was a 15% increase in the risk of serious bleeding when taking medications from classes such as mirtazapine, bupropion and tricyclics compared to SSRI/SNRIs.

“Maximizing rehabilitation early after a stroke is essential because recovery is somewhat time-dependent, and most functional gains occur during the first few months after a stroke,” Simmonds said. “Fortunately, dual antiplatelet therapy is often administered for 14, 30 or 90 days, so, when indicated, clinicians may not need to withhold antidepressant medications for prolonged periods of time. Future research should investigate the risk of bleeding associated with the use of anti-depressant and anxiety medications among patients with hemorrhagic or bleeding stroke.”

According to a 2022 American Heart Association scientific statement, social isolation and loneliness are associated with about a 30% increased risk of heart attack or stroke, or death from either. “Depression may lead to social isolation, and social isolation may increase the likelihood of experiencing depression. The current study helps answer safety issues around the use of antidepressants for treatment of mental health issues that may develop after a stroke,” said Crystal Wiley Cené, M.D., M.P.H., FAHA, chair of the writing group for the Association’s scientific statement, and a professor of clinical medicine and chief administrative officer for health equity, diversity and inclusion at the University of California San Diego Health. Dr. Cené was not involved in this study.

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Red Dress Collection Concert kicks off American Heart Month

by The American Heart Association

DALLAS – Powerful players in music, entertainment, fashion and philanthropy joined the American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, to celebrate progress towards health equity, while calling for a renewed commitment to investing in women’s heart health in a fashion-forward, musical kickoff to American Heart Month.

The Red Dress Collection® Concert—hosted this year from the Appel Room at Jazz at Lincoln Center in New York City—serves as the American Heart Association’s Go Red for Women national marquee event. Every year, it builds on the iconic tradition of the Red Dress Collection fashion show founded by the National Heart, Lung, and Blood Institute’s The Heart Truth® program, adding musical performances and personal stories of those affected by heart disease and stroke. This year, the event kicks off both American Heart Month, commemorated every February, as well as the Association’s centennial celebration, marking 100 years of service saving and improving lives, and positioning the Association as a change agent for generations to come.

Host Sherri Shepherd wore Ganni on the red carpet and Harbison on the runway. The Daytime Emmy Award-winning talk show host, comedian, actress, and best-selling author began the event by sharing her own connection with cardiovascular disease and spotlighting survivors and women’s health champions in attendance, before introducing the evening’s opening entertainment, GRAMMY-nominated country music star, Mickey Guyton.

The country trailblazer wore Sergio Hudson on the red carpet and Monetre on the runway. Wearing custom RC Caylan for her performance, she opened with “My Side of Country,” and performed hits “Something About You,” “Make It Me,” and “Flowers.”

This year’s concert was headlined by Award-winning musician, actor, advocate and New York Times best-selling author Demi Lovato. The Grammy-nominated artist was introduced on stage by Damar Hamlin, cardiac arrest survivor, Buffalo Bills safety and American Heart Association national ambassador for the Nation of Lifesavers™. The 25-year-old experienced his sudden cardiac arrest on the NFL football field last year and now uses his platform to raise awareness of the need for CPR and AEDs.

Lovato wore a Nicole + Felicia Couture custom gown on the red carpet, and performed wearing a custom Michael Ngo suit. The set started with Lovato singing chart-topper, “Confident,” and continued with hits “Give Your Heart a Break,” “Tell Me You Love Me,” “Sorry Not Sorry,” “Anyone,” “Neon Lights,” “No Promises,” “Skyscraper,” “Heart Attack,” and closed the evening with “Cool for the Summer” alongside all of the Red Dress Collection Concert participants.

Holding true to the Red Dress Collection’s origin in fashion, red haute couture moments were served throughout the show, reclaiming the power of sisterhood and community against the No. 1 killer of women, cardiovascular disease.

Other stars of stage and screen lending their support to the event included: Ana Navarro-Cárdenas (Co-host of ABC’s The View and CNN political commentator) wearing Alexander by Daymor, Bellamy Young (actor, singer and producer; Scandal) wearing Gustavo Cadile on the red carpet and Sachin & Babi on the runway, Brandi Rhodes (Pro wrestling star and founder of Naked Mind Yoga + Pilates) wearing Do Long, Brianne Howey (actress and mother, Ginny & Georgia) wearing Reem Acra, Dominique Jackson (model, actress, author and star of FX's Pose) wearing Coral Castillo, Francia Raísa (actress & entrepreneur) wearing Goddess Exclusive on the red carpet and Maria Lucia Hohan on the runway, Heather Dubrow (actress, author, podcast host and TV personality on Real Housewives of OC) wearing Gattinolli by Marwan on the red carpet and Pamella Roland on the runway, Katherine McNamara (award winning actor, singer, writer, and producer) wearing Mikael D, Madison Marsh (Active Duty Air Force Officer - Second Lieutenant and Miss America 2024) wearing Jovani, Mira Sorvino (Academy Award-winning actress and human rights advocate, Shining Vale and Romy and Michele’s High School Reunion) wearing Dolce and Gabbana, Richa Moorjani (actress and activist, star of Netflix’s Never Have I Ever) wearing Oscar de la Renta, Samira Wiley (Emmy winner for The Handmaid's Tale and producer) wearing Le Thanh Hoa, and Yvonne Orji (actress, comedienne, author; known for the TV show Insecure) wearing House of Emil on the red carpet and Jovana Louis on the runway.

As part of its commitment to supporting women and women's health, KISS USA is proud to support the American Heart Association’s Go Red for Women movement, and the Red Dress Collection Concert.

The Go Red for Women movement, sponsored nationally by CVS Health, exists to increase women’s heart health awareness, and serves as a catalyst for change in the drive to improve the lives of all women. Find resources to support women’s heart health at every age, through every stage of life at GoRedforWomen.org. 

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Fitness Tracking Competition from NFL PLAY 60 launched, competition starts next week

by The American Heart Association

DALLAS - The American Heart Association and National Football League are asking classrooms, afterschool programs and other student groups to join the NFL PLAY 60 Fitness Tracking Competition from Jan. 22 to Feb. 9. The classroom with the most activity minutes in each of the 32 NFL club markets will receive a $1,000 grant with an additional $1,000 PLAY 60 grant awarded to the top classroom overall. The competition and the goal of NFL PLAY 60 is to increase physical activity in kids which impacts overall mental and physical wellness which is essential to help children reach their full potential.

The NFL PLAY 60 Fitness Tracking Competition takes place in the free NFL PLAY 60 app, (available for iOS and Android devices). The app invites users to select their NFL team and control personalized avatars onscreen with their own physical movement. Users can create custom workouts, earn special PLAY points and unlock cool NFL gear for on-screen PLAY 60 avatars. Using the Group Quickplay feature in the app's Teacher Dashboard, students will get active together adding to their classroom's total activity minutes. Educators can commit to participating now at heart.org/NFLPLAY60 and will officially register their student group via the app on Jan. 22.

"Working together with the National Football League on NFL PLAY 60, we're excited for continued ways to support getting youth across the country moving towards a healthier and more active lifestyle," said American Heart Association Chief Executive Officer Nancy Brown. "It's our 100th birthday and we're committed to making our future all about improving yours. Prevention skills as well as lifesaving skills, such as CPR, are critical to change health outcomes across generations."

The American Heart Association and the NFL offer students, teachers and families different ways to add movement minutes to achieve their daily goal of 60 minutes of play. In addition to the NFL PLAY 60 app, the NFL PLAY 60 Exercise Library features two-to-three minute on-demand exercise videos from each of the 32 NFL teams featuring players, NFL Legends, cheerleaders and mascots.

Lastly, the NFL PLAY 60 Fitness Break broadcasts are a series of three 15-minute synchronous broadcasts that get students moving with sneak peeks into the NFL season, including tentpole events like the Kickoff, Super Bowl and Draft. The last Fitness Break broadcast of this school year, the NFL Draft broadcast, will air on April 25 at 1 p.m. ET/ 12 p.m. CT/ 10 a.m. PT. Advanced registration is required.

Rooted in American Heart Association science, the NFL PLAY 60 initiative helps children develop healthy habits for a better chance of a healthy adulthood. The program encourages kids to get a minimum of 60 minutes of vigorous physical activity each day to meet the U.S. Department of Health and Human Services' 2018 Physical Activity Guidelines for Americans[1]. Reducing sedentary behavior and increasing physical activity are keys to immediate and long-term health for children.

"As proud partners of the American Heart Association, the NFL is excited to once again kick off the NFL PLAY 60 Fitness Tracking Competition to encourage students to achieve the daily goal of 60 minutes of play," said NFL Senior Vice President of Social Responsibility Anna Isaacson. "Through our NFL PLAY 60 app, we are providing youth across the country with an interactive and engaging platform to get moving with their favorite NFL teams."

The NFL and the American Heart Association have been teaming up since 2006 to inspire kids through fun and engaging ways to get physically active for at least 60 minutes a day. Information on NFL PLAY 60 resources and additional grant opportunities can be found online at heart.org/NFLPLAY60.

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Infective endocarditis death rates declined overall in the U.S. over past 21 years.

Our study findings raise a public health concern, especially since the deaths in younger age groups are on the rise ...

by American Heart Association

DALLAS - Death rates related to infective endocarditis declined in most adults across the U.S. within the last two decades, yet accelerated among young adults ages 25 to 44 years old, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Infective endocarditis, also called bacterial endocarditis, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. The disease is rare, however, people with previous valve surgeries, heart valve abnormalities, artificial valves, congenital heart defects or previous infective endocarditis have a greater risk of developing it. It can also be a complication of injecting illicit drugs.

“Our study findings raise a public health concern, especially since the deaths in younger age groups are on the rise,” said study lead author Sudarshan Balla, M.D., an associate professor of medicine at the West Virginia University Heart and Vascular Institute at J.W. Ruby Memorial Hospital in Morgantown, West Virginia. “We speculate that this acceleration was likely, in the most part, due to the opioid crisis that has engulfed several states and involved principally younger adults.”

Researchers examined death certificate data from the Centers for Disease Control and Prevention’s (CDC) Multiple Cause of Death dataset, which contains death rates and population counts for all U.S. counties. They looked for national trends in deaths caused by infective endocarditis, plus differences in deaths related to age, sex, race and geography among states from 1999-2020. Researchers also analyzed the association with substance use disorder, considering the emergence of the opioid epidemic during the study’s time frame.

The analysis found:

• In the 21-year period analyzed, infective endocarditis death rates declined overall in the U.S.
• Death rates increased significantly for young adults, at an average annual change of more than 5% for the 25-34 age group and more than 2% for the 35-44 age group.
• In the 45-54 age category, death rates remained stagnant at 0.5%, and there was a significant decline among those aged 55 and older.
• Substance use disorder associated with multiple causes of death increased drastically – between 2-fold and 7-fold among the 25-44 age group.
• Kentucky, Tennessee and West Virginia showed an acceleration in deaths caused by infective endocarditis in contrast to other states with either a predominant decline or no change.

“We found that substance use was listed as a contributing cause that could explain the higher death rates in the younger age groups and also in the states in those who died due to endocarditis,” Balla said.

The study researchers call the rise of infective endocarditis as the underlying cause of death in adults 25-44 years old “alarming” and recommend more investigation to identify the reasons for these trends among young adults and in the three states noted. Researchers speculate the increase is connected to the opioid crisis that has engulfed several states and involves primarily younger adults.

“Comprehensive care plans for those treated for infective endocarditis should also include screening and treatment for substance use disorder,” Balla said.

To address intravenous drug use, some states have started harm reduction programs, which are public health efforts to reduce the harm from substance use and drug abuse, such as increased risk of infectious diseases like HIV, viral hepatitis, and bacterial and fungal infections. “Whether these programs make an impact is yet to be determined,” Balla said.

Researchers were limited in the medical details they could collect because of the use of death certificate data, which may contain inaccuracies, such as errors in diagnosis, data entry and cause of death. For similar reasons, researchers could not determine a direct cause-and-effect relationship between the rise in deaths caused by infective endocarditis in younger adults and substance use disorder.   

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Innovation is the key to improving health in rural areas

by The American Heart Association

Dallas, TX - Cardiovascular mortality is on the rise in rural areas of the United States, where more than 60 million Americans live, according to an American Heart Association presidential advisory. Understanding and addressing the unique health needs of people in rural America is critical to the Association’s pursuit of a world of longer, healthier lives.

Today — on National Rural Health Day — the Association, the world’s leading nonprofit organization focused on heart and brain health for all, announces two new collaborative efforts to help close the gap between rural and urban hospital care and bring equitable care to all, regardless of where you live.

“Addressing the unique health needs of people in rural America is critical to achieving the American Heart Association’s 2024 impact goal for equitably increasing healthy life expectancy nationwide,” said Karen Joynt-Maddox, M.D., MPH, American Heart Association volunteer, associate professor at the Washington University School of Medicine and co-director of the Washington University in St. Louis Center for

Advancing Health Services, Policy & Economics Research. “Innovative collaborations like these are key to improving rural health across the nation.”

Sharing clinical educational resources

The American Heart Association is collaborating with the National Rural Health Association (NRHA) to highlight and share cardiovascular and stroke clinical educational resources such as model practices, collaborative learnings and rural quality research findings with NRHA membership.

Through this collaboration, the American Heart Association will submit content for NRHA’s magazine Rural Horizons, weekly e-newsletter NRHA Today and Journal of Rural Health, as well as participate in NRHA’s 2024 Annual Rural Health Conference and 2024 Rural Health Clinic and Critical Access Hospital Conference.

“NRHA is excited to partner with the American Heart Association to share resources and education to help reduce rural cardiovascular health disparities,” said NRHA CEO Alan Morgan.

Harmonizing quality data for analysis and validation

The American Heart Association and the American College of Emergency Physicians (ACEP) are collaborating on efforts to resolve outcomes gaps and identify model practices for hospitals and health systems in the rural setting. This effort will identify sites participating in both organizations’ respective quality programs and cross-promote their data registries, as well as explore data harmonization and opportunities for shared data analysis and validation.

The Association and ACEP share common priorities in addressing outcomes gaps in rural areas and building the knowledge base needed for evidence-based clinical practice. Reaching clinicians and providers and other key constituents with important messages is foundational to these efforts.

ACEP’s E-QUAL stroke initiative strives to make stroke quality improvement strategies accessible for emergency departments of all shapes and sizes. The E-QUAL data submission activities have been designed to allow hospitals who are already participating in the American Heart Association’s Get With The Guidelines® programs to seamlessly meet all E-QUAL reporting requirements.

“Through ACEP’s E-QUAL stroke initiative, we strive to make stroke quality improvement strategies accessible for emergency departments of all shapes and sizes,” said Kori Zachrison, M.D., MSc, E-QUAL Stroke Initiative co-lead. “While many rural EDs may be working with fewer resources at their disposal, they remain the anchor of the community’s stroke chain of survival. We’re thrilled to work side-by-side with the AHA in investing in these communities.”

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Lack of representation significant barrier for optimal health in Hispanic Latino community

by The American Heart Association

Dallas, TX - Disparities in health care persist, with Hispanic and Black adults reporting less satisfaction with their interactions with physicians, leading to poorer quality of care and health outcomes.^[1],[2],[3] While 19% of people in the U.S. identify as Hispanic, fewer than 7% of physicians do.^[4]

This lack of representation in the delivery of health care has been shown to exacerbate health disparities among underrepresented groups and is a significant barrier to the Hispanic Latino community achieving optimal health.^[5] In response to this challenge, the American Heart Association, a global force for healthier lives for all, has established the National Hispanic Latino Cardiovascular Collaborative (NHLCC). This initiative specifically unites Hispanic Latino volunteers, professional staff and allied supporters committed to bridging the gap in health care disparities and ensuring that equitable health is a reality for everyone everywhere.

The group launched its second cohort of the National Hispanic Latino Cardiovascular Collaborative Scholars Program during the American Heart Association’s annual Scientific Sessions the world’s preeminent scientific meeting focused on cardiovascular disease. This NHLCC mentorship and professional development program aims to leverage the global gathering of scientific thought leadership to cultivate the next generation of Hispanic Latino researchers and health care leaders, in turn actively addressing longstanding systemic inequities in health care.

“The important of representation within health care and research cannot be overstated. As the American Heart Association strives for equity in cardiovascular health outcomes, we are excited to support the National Hispanic Latino Cardiovascular Collaborative to uplift the voices and experiences of the Hispanic Latino community, in an effort to eliminate health disparities and improve health and well-being,” said Eduardo Sanchez, M.D., M.P.H., FAHA, the American Heart Association’s chief medical officer for prevention, and the executive staff sponsor of the National Hispanic Latino Cardiovascular Collaborative.

Scientific Sessions 2023 also featured the inaugural NHLCC Symposium. The symposium, Scientific Sessions’ first ever session dedicated solely to Hispanic Latino health, focused on leading community figures in medicine, clinical research and the social sciences. The session enabled meaningful dialogue about the state of Hispanic Latino health and health care in the United States, while examining emerging trends and identifying strategies for cultivating the next generation of Hispanic Latino health care leaders.

Scientific studies confirm that diversity among nurses, physicians and health care teams enhances overall patient outcomes and dismantles cultural barriers.^[6]  Specific research conducted by Penn State University emphasizes the significance of addressing implicit biases within health systems and diversifying the physician workforce to better meet patients' preferences.^{[7] ,[8]}

Heart disease is a risk for women transitioning through menopause

by The American Heart Association

DALLAS — Medical experts note that hormone and body composition changes during the transition to menopause can increase the risk of developing heart disease after menopause.^[1] The American Heart Association, a global force for healthier lives for all, offers tips to support women’s heart health during this transition.

“More women in the U.S. are living longer, and a significant portion of them will spend up to 40% of their lives postmenopausal,” said Brooke Aggarwal, Ed.D., M.S., F.A.H.A., assistant professor of medical sciences in Cardiology at Columbia University Medical Center and a volunteer for the American Heart Association’s Go Red for Women™ movement.

As women grow and change so does their risk for cardiovascular disease. Go Red for Women, the Association’s premier women’s movement, addresses awareness and clinical care gaps of women’s greatest health threat, and is a trusted source for health and well-being at every age, stage and season.

“Navigating through menopause isn’t one-size-fits-all, and neither is the journey to good heart health,” she added. “This makes it even more important to focus on heart and brain health at all stages of life.”

The best defense against menopause-related changes is working with your doctor to make sure your key health numbers are in a healthy range, and understanding which healthy habits you can fine tune to boost your heart health. These tips can help:

1. Health by the numbers: Blood pressure, blood sugar and body mass index should be monitored yearly. More often if your numbers are out of range. Cholesterol level is also important, and healthy numbers are more individualized based on your other risk factors. Your doctor can help you figure this one out.
2. The best way to eat: No single food is a miracle-worker for health. Instead, look at your overall pattern of eating. Experts at the American Heart Association rated 10 popular eating patterns and the DASH-style and Mediterranean-style way of eating rose to the top as having the most heart-healthy elements: high in vegetables, fruit, whole grains, healthy fat and lean protein; and low in salt, sugar, alcohol and processed foods.
3. Exercise that does double-duty: Strength and resistance training is one of the four types of exercise in a general workout routine along with endurance, balance and flexibility. Strength and resistance have the added benefit of increasing bone strength and muscle mass. As women enter menopause, bone density may take a hit and body composition tends to shift to lower muscle mass. Strength training at least twice a week can help your bones and muscles maintain strength and density.
4. Protect your sleep time: Healthy sleep is part of the 8 essential elements of heart health called Life’s Essential 8, but the transition to menopause comes with myriad interruptions to a good night’s rest – nightly restroom trips, night sweats, insomnia. Do whatever it takes to get your Z’s because better sleep has great health benefits: stronger immune system, better mood, more energy, clearer thinking and lower risk of chronic diseases. A few habit changes can improve sleep, like setting a notification or alarm to remind you it’s time to wind down, then shutting down electronic devices at that time. For stubborn sleep problems your doctor may be able to help.

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Air quaity becoming a growing risk for premature CVD death and disability worldwide

by The American Heart Association

DALLAS — The impact of particulate matter air pollution on death and disability is on the rise worldwide, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Previous research established the association of particulate matter (PM) pollution to CVD death and disability. However, questions remain about the worldwide impact from this type of pollution and how it has been changing over time, the study authors noted.

“We focused on examining the burden globally because particulate matter pollution is a widespread environmental risk factor that affects all populations worldwide, and understanding its impact on cardiovascular health can help guide public health interventions and policy decisions,” said Farshad Farzadfar, M.D., M.P.H., D.Sc., senior author of the study and a professor of medicine in the non-communicable diseases research center of the Endocrinology and Metabolism Research Institute at Tehran University of Medical Sciences in Iran.

The researchers analyzed PM pollution as a risk factor for death and disability using freely available data from 204 countries collected between 1990 and 2019 and detailed in the Global Burden of Disease (GBD) study. Exposure to PM pollution was estimated using a tool from the 2019 update to the GBD study that incorporated information from satellite and ground-level monitoring, computer models of chemicals in the atmosphere and land-use data.

Among the many types of heart disease, the current analysis of cardiovascular disease is restricted to stroke and ischemic heart disease (a lack of blood and oxygen supply to portions of the heart, usually due to plaque build-up in the arteries) because the 2019 GBD study on the global burden of disease attributed to PM pollution only examined these two diagnoses. The Institute for Health Metrics and Evaluation (IHME), which provides the GBD estimates, only reports data for a certain risk factor if there is a large body of evidence about its association with a disease, Farzadfar noted.

“Until now, only the association of PM pollution with ischemic heart disease and stroke has been demonstrated in a large number of studies,” Farzadfar said. “The IHME may include other CVDs in the future. Moreover, ischemic heart disease and stroke contribute to a significant majority of CVDs, and our estimates, despite having limitations, may be used as a good estimate of PM pollution burden on CVDs.”

The investigators analyzed changes over time in years of life lost due to premature death (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs is a measure that considers both the loss of life and the impact on quality of life to assess the full impact of a health condition on a population. The cardiovascular disease burden was assessed both overall and with age standardization, which compares health outcomes across a population with a wide range of ages.

The analysis found:

• The total number of premature deaths and years of cardiovascular disability from cardiovascular diseases attributable to PM air pollution rose from 6.8 million in 1990 to 8.9 million in 2019, a 31% worldwide increase.
• The increase in overall deaths was unevenly distributed, with a 43% increase among men compared to a 28.2% increase among women.
• Between 1990 and 2019, there was a 36.7% decrease in age-standardized premature deaths attributed to PM pollution, meaning that while fewer people had died from cardiovascular disease, people are living longer with disability.
• Regions with higher socioeconomic conditions had the lowest number of lost years of life due to cardiovascular disease attributed to PM pollution, yet also the highest number of years lived with disability. The opposite was true in regions with lower socioeconomic conditions, with more lives lost and fewer years lived with disability.
• Between 1990 and 2019, changes in the cardiovascular impact of PM pollution differed between men and women. In all measures, increases in disability and death from ambient PM air pollution were higher in men than women, while declines in disability and death from household PM air pollution were lower in women than men.

“The declines in deaths may be considered positive news, as they indicate improvements in health care, air pollution control measures and access to treatment. However, the increase in disability-adjusted life years suggests that although fewer people were dying from cardiovascular disease, more people were living with disability,” Farzadfar said.

The researchers also found that between 1990 and 2019, age-standardized CVD death and disability attributed to outdoor PM pollution rose by 8.1%, while age-standardized cardiovascular death and disability attributed to household PM pollution, which is produced by solid cooking fuels such as coal, charcoal, crop residue, dung and wood, fell by 65.4%.

“The reason for the decrease in the burden of household air pollution from solid fuels might be better access and use of cleaner fuels, such as refined biomass, ethanol, liquefied petroleum gas, solar and electricity. Moreover, structural changes, such as improved cookstoves and built-in stoves, chimney hoods and better ventilation, might be effective in reducing pollution exposure to solid fuels. Finally, the effects of educational and behavioral interventions should be considered,” Farzadfar said. “The shifting pattern from household air pollution due to solid fuels to outdoor, ambient PM pollution has important public policy implications.”

In a 2020 scientific statement and a 2020 policy statement, the American Heart Association details the latest science about air pollution exposure and the individual, industrial and policy measures to reduce the negative impact of poor air quality on cardiovascular health. Reducing exposure to air pollution and reversing the negative impact of poor air quality on cardiovascular health, including heart disease and stroke, is essential to reducing health inequities in Black and Hispanic communities, those that have been historically marginalized and under-resourced, and communities that have the highest levels of exposure to air pollution.

The study has several limitations. Because the assessment of exposure to particulate matter pollution in the study is based on regional estimates, it may not accurately reflect individual exposure. In addition, results from this analysis of the association between particulate matter pollution and cardiovascular outcomes may not be generalizable to other health conditions or other pollutants.

Fatal heart attack risks may be higher during days with extreme heat & air pollution

by The American Heart Association

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Our findings provide evidence that reducing exposure to both extreme temperatures and fine particulate pollution may be useful to prevent premature deaths from heart attack, especially for women and older adults

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DALLAS — The combination of soaring heat and smothering fine particulate pollution may double the risk of heart attack death, according to a new study of more than 202,000 heart attack deaths in China. The study published today in the American Heart Association’s flagship journal Circulation.

"Extreme temperature events are becoming more frequent, longer and more intense, and their adverse health effects have drawn growing concern. Another environmental issue worldwide is the presence of fine particulate matter in the air, which may interact synergistically with extreme temperatures to adversely affect cardiovascular health," said senior author Yuewei Liu, M.D., Ph.D., an associate professor of epidemiology in the School of Public Health at Sun Yat-sen University in Guangzhou, China. "However, it remains unknown if and how co-exposure to extreme temperatures and fine particulate pollution might interact to trigger a greater risk of death from heart attack, which is an acute response potentially brought on by an acute scenario and a great public health challenge due to its substantial disease burden worldwide."

To examine the impact of extreme temperatures with and without high levels of fine particulate pollution, the researchers analyzed 202,678 heart attack deaths between 2015-2020 that occurred in Jiangsu province, a region with four distinct seasons and a wide range of temperatures and fine particulate pollution levels. The deaths were among older adults with an average age of 77.6 years; 52% were older than age 80; and 52% were male. Particulate exposure on the day of each death and one day before death were included in the analysis.

Extreme temperatures were gauged according to the daily heat index (also referred to as apparent temperature) for an area, which captures the combined effect of both heat and humidity. Both the length and extremeness of heat waves and cold snaps were evaluated. Heart attack deaths, or case days, during these periods were compared with control days on the same day of the week in the same month — meaning that if a death occurred on a Wednesday, all other Wednesdays in the same month would be considered control days. Particulate levels were considered high on any day with an average level of fine particulate matter above 37.5 micrograms per cubic meter.

"Our findings provide evidence that reducing exposure to both extreme temperatures and fine particulate pollution may be useful to prevent premature deaths from heart attack, especially for women and older adults," Liu said.

Compared with control days, the risk of a fatal heart attack was observed at the following levels:

18% higher during 2-day heat waves with heat indexes at or above the 90th percentile (ranging from 82.6 to 97.9 degrees Fahrenheit), increasing with temperature and duration, and was 74% higher during 4-day heat waves with heat indexes at or above the 97.5th percentile (ranging from 94.8 to 109.4 degrees Fahrenheit). For context, 6,417 (3.2%) of the 202,678 observed deaths from heart attack happened during heat waves with heat indexes at or above the 95th percentile (ranging from 91.2 to 104.7 degrees Fahrenheit) for three or more days.

4% higher during 2-day cold snaps with temperatures at or below the 10th percentile (ranging from 33.3 to 40.5 degrees Fahrenheit), increasing with lower temperatures and duration, and was 12% higher during 3-day cold snaps with temperatures at or below the 2.5th percentile (ranging from 27.0 to 37.2 degrees Fahrenheit). For context, 6,331 (3.1%) of the 202,678 observed deaths from heart attack happened during cold spells with temperatures at or below the 5th percentile (ranging from 30.0 to 38.5 degrees Fahrenheit) for 3 or more days.

Twice as high during 4-day heat waves that had fine particulate pollution above 37.5 micrograms per cubic meter. Days with high levels of fine particulate pollution during cold snaps did not have an equivalent increase in the risk of heart attack death.

Generally higher among women than men during heat waves.

Higher among people ages 80 and older than in younger adults during heat waves, cold snaps or days with high levels of fine particulate pollution.

The mean age of all individuals who died from a heart attack in Jiangsu from 2015-2020, including during non-extreme temperature events, was 77.6 years old; 52.1% of these individuals were over 80 years old.

The researchers estimated that up to 2.8% of heart attack deaths may be attributed to the combination of extreme temperatures and high levels of fine particulate pollution (> 37.5 micrograms per cubic meter), according to WHO targets.

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Reducing exposure to air pollution and reversing the negative impact of poor air quality on cardiovascular health, including heart disease and stroke, is essential to reducing health inequities in Black and Hispanic communities.

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"Strategies for individuals to avoid negative health effects from extreme temperatures include following weather forecasts, staying inside when temperatures are extreme, using fans and air conditioners during hot weather, dressing appropriately for the weather, proper hydration and installing window blinds to reduce indoor temperatures," said Liu. "Using an air purifier in the house, wearing a mask outdoors, staying clear of busy highways when walking and choosing less-strenuous outdoor activities may also help to reduce exposure to air pollution on days with high levels of fine particulate pollution. To improve public health, it is important to take fine particulate pollution into consideration when providing extreme temperature warnings to the public."

In a 2020 scientific statement and a 2020 policy statement, the American Heart Association details the latest science about air pollution exposure and the individual, industrial and policy measures to reduce the negative impact of poor air quality on cardiovascular health. Reducing exposure to air pollution and reversing the negative impact of poor air quality on cardiovascular health, including heart disease and stroke, is essential to reducing health inequities in Black and Hispanic communities, those that have been historically marginalized and under-resourced, and communities that have the highest levels of exposure to air pollution.

The investigators recommended additional research about the possible interactive effects of extreme weather events and fine particulate pollution on heart attack deaths in areas with different temperature and pollution ranges to confirm their findings. The study did not include adjustments for any adaptive behaviors taken by individuals, such as using air conditioning and staying indoors, when temperatures are extreme or pollution levels are high, which could cause misclassification of individuals’ exposure to weather and alter their risk patterns. These results also may not be generalizable to other regions in China or other countries due to potential variations of adaption capacity and temperature distribution.

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Recipe | Hawaiian Huli Huli Chicken

Photo provided

Family Features - As you plan your summer fun, think also about adopting healthy habits that can help keep your blood pressure under control. When your blood pressure is consistently high - a condition called hypertension - blood flows through arteries at higher-than-normal pressures. This can cause serious health problems not just for your heart, but also for your blood vessels, kidneys, eyes and brain.

Hypertension affects women and men of all ages but making small lifestyle changes can go a long way toward prevention. Start with updating your summer menu with delicious, heart-healthy recipes, like Hawaiian Huli Huli Chicken.

Following a heart-healthy eating plan, such as the Dietary Approaches to Stop Hypertension (DASH), which emphasizes vegetables, fruits, whole grains, fish, poultry, beans, nuts, low-fat dairy and healthy oils, can help keep your blood pressure in a healthy range. Developed through research by the National Heart, Lung, and Blood Institute (NHLBI), DASH focuses on reducing sodium and limiting foods that are high in saturated fat, including fatty meats, full-fat dairy and tropical oils.

Along with adding healthy recipes to your summer menu, NHLBI's The Heart Truth program encourages these healthy habits that can help you control blood pressure:

Move more: Aim for at least 150 minutes (2 1/2 hours) of physical activity each week. Try keeping yourself on pace each week by shooting for 30 daily minutes of activity over five days.

Aim for a healthy weight: Research shows adults with overweight and obesity can lower their blood pressure by losing just 3-5% of their weight. Ask a friend or family member to join a weight loss program with you; social support can help you both stay motivated.

Manage stress: Reduce stress - which can increase blood pressure - with meditation, relaxing activities or support from a counselor or online group.

Quit smoking: Smoking damages your heart and blood vessels. Call 1-800-QUIT-NOW or find other resources available online.

Get your summer off to a heart-healthy start by talking to your health care provider about your blood pressure numbers and what they mean. To learn more about heart health and blood pressure, visit hearttruth.gov and find DASH-friendly recipes at healthyeating.nhlbi.nih.gov.

Hawaiian Huli Huli Chicken

Recipe courtesy of the National Heart, Lung, and Blood Institute

Prep time: 10 minutes
Cook time: 30 minutes
Servings: 4

Sauce:

2 tablespoons ketchup

2 tablespoons light soy sauce

2 tablespoons honey

2 teaspoons orange juice

1 teaspoon garlic (about 1 clove), minced

1 teaspoon ginger, minced

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12 ounces boneless, skinless chicken breast (about 2 large breasts), cut into 1-inch cubes (about 24 cubes)

1 cup fresh pineapple, diced (about 24 pieces)

8 wooden skewers (6 inches each), soaked in water

To make sauce: Combine ketchup, soy sauce, honey, orange juice, garlic and ginger; mix well. Separate into two bowls and set aside.

Preheat grill to medium-high heat. Preheat oven to 350 F.

Alternately thread three chicken cubes and three pineapple chunks on each skewer.

Grill skewers 3-5 minutes on each side. Brush or spoon sauce from one bowl onto chicken and pineapple every other minute. Discard remaining sauce from first bowl.

To prevent chicken from drying out, finish cooking to minimum internal temperature of 165 F in oven. Using clean brush or spoon, coat with sauce from remaining bowl before serving.