Shoveling heavy snow may increase risk of a heart attack or sudden cardiac episode

by The American Heart Association

Photo: Todd Trapani/Unsplash

DALLAS — Clearing sidewalks and driveways of snow may be essential to keep from being shut in, however, the American Heart Association urges caution when picking up that shovel or even starting the snowblower. Research shows that many people may face an increased risk of a heart attack or sudden cardiac arrest after shoveling heavy snow.

The American Heart Association’s 2020 scientific statement, Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective–An Update, notes snow shoveling among the physical activities that may place extra stress on the heart, especially among people who aren’t used to regular exercise. Numerous scientific research studies over the years have identified the dangers of shoveling snow for people with and without previously known heart disease.

The lead author of that scientific statement and long-time American Heart Association volunteer Barry Franklin, Ph.D., FAHA, is one of the leading experts on the science behind the cardiovascular risks of snow shoveling. He has authored a number of studies on the topic, estimating that hundreds of people die during or just after snow removal in the U.S. each year.

"Shoveling a little snow off your sidewalk may not seem like hard work. However, the strain of heavy snow shoveling may be as or even more demanding on the heart than taking a treadmill stress test, according to research we’ve conducted." said Franklin, a professor of internal medicine at Oakland University William Beaumont School of Medicine in Royal Oak, Michigan. "For example, after only two minutes of snow shoveling, study participants’ heart rates exceeded 85% of maximal heart rate, which is a level more commonly expected during intense aerobic exercise testing. The impact is hardest on those people who are least fit."

A study conducted in Canada a few years ago found that the chance of heart attack after a snowfall increased among men but not among women. The study found that, compared to no snowfall, a heavy snow – about 7-8 inches – was associated with 16% higher odds of men being admitted to the hospital with a heart attack, and a 34% increase in the chance of men dying from a heart attack.

Photo provided by AHA

Franklin said winter weather in general can contribute to the increased risk. Cold temperatures may increase blood pressure while simultaneously constricting the coronary arteries. Those factors, combined with the higher heart rate from the extra physical effort, may increase the risk for acute cardiac events. There are even studies that show an increased risk for heart attacks among people using automatic snow blowers. Similar to the extra exertion of pushing shovel, pushing a snow blower can raise heart rate and blood pressure quickly.

"The impact of snow removal is especially concerning for people who already have cardiovascular risks like a sedentary lifestyle or obesity, being a current or former smoker, having diabetes, high cholesterol or high blood pressure, as well as people who have had a heart attack or stroke," he said. "People with these characteristics and those who have had bypass surgery or coronary angioplasty simply should not be shoveling snow."

Franklin said the most important thing is to be aware of the dangers, be prepared and take it easy, including taking short breaks. Even people who are relatively healthy should note that pushing the snow with a shovel is better physically than lifting and throwing it.

The American Heart Association urges everyone to learn the common signs of heart trouble and if you experience chest pain or pressure, lightheadedness or heart palpitations or irregular heart rhythms, stop the activity immediately. Call 9-1-1 if symptoms don’t subside shortly after you stop shoveling or snow blowing. If you see someone collapse while shoveling snow, call for help and start Hands-Only CPR if they are unresponsive with no pulse.

Learn more about cold weather and cardiovascular disease here.

Viewpoint |Heart rate zones aren’t a perfect measure of exercise intensity

Runners make their way along the 2023 Illinois Marathon course through Urbana. Jogging and running are rudimentary forms of exercise important in maintaining excellent heart and cardiovascular health. The human body is remarkable in its abilty to adapt quickly to moderate- and high-intensity exercise.

Photo: Sentinel/Clark Brooks

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by Jason Sawyer, Bryant University

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Aerobic exercise like jogging, biking, swimming or hiking is a fundamental way to maintain cardiovascular and overall health. The intensity of aerobic exercise is important to determine how much time you should spend training in order to reap its benefits.

As an exercise science researcher, I support the American College of Sports Medicine’s recommendation of a minimum of 150 minutes per week of moderate aerobic exercise, or 75 minutes per week of high-intensity exercise. But what does exercise intensity mean?

There is a linear relationship between heart rate and exercise intensity, meaning as the exercise intensity increases, so does heart rate. Heart rate zone training, which uses heart rate as a measure of exercise intensity, has increased in popularity in recent years, partially due to the ubiquity of wearable heart rate technology.

The way exercise intensity is usually described is problematic because one person’s “vigorous” may be another’s “moderate.” Heart rate zone training tries to provide an objective measure of intensity by breaking it down into various zones. But heart rate can also be influenced by temperature, medications and stress levels, which may affect readings during exercise.

Heart rate and exercise intensity

The gold standard for determining aerobic exercise intensity is to measure the amount of oxygen consumed and carbon dioxide exhaled. However, this method is cumbersome because it requires people to wear a breathing mask to capture respiratory gases.

An easier way is to predict the person’s maximum heart rate. This can be done with an equation that subtracts the person’s age from 220. Although there is controversy surrounding the best way to calculate maximum heart rate, researchers suggest this method is still valid.

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What happens when you reach your maximum heart rate?

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The American College of Sports Medicine outlines five heart rate zones based on a person’s predicted heart rate maximum. Zone 1, or very light intensity, equals less than 57% of maximum heart rate; zone 2, or light intensity, is 57% to 63%; zone 3, or moderate intensity, is 64% to 76%; zone 4, or vigorous intensity, is 77% to 95%; and zone 5, or near-maximal intensity, is 96% to 100%.

However, other organizations have their own measures of exercise intensity, with varying ranges and descriptions. For example, Orange Theory describes their zone 2 training as 61% to 70% of maximum heart rate. Complicating matters even further, companies that produce heart rate monitors also have higher thresholds for each zone. For example, Polar’s zone 2 is up to 70% of maximum heart rate, while the American College of Sports Medicine recommends a zone 2 of up to 63%.

Adapting heart rate zones

Zone training is based on the idea that how the body responds to exercise is at least in part determined by exercise intensity. These adaptations include increased oxygen consumption, important cellular adaptations and improved exercise performance.

Zone 2 has received a lot of attention from the fitness community because of its possible benefits. Performance coaches describe zone 2 as “light cardio,” where the intensity is low and the body relies mainly on fat to meet energy demands. Fats provide more energy compared to carbohydrates, but deliver it to cells more slowly.

Because fat is more abundant than carbohydrates in the body, the body responds to the cellular stress that exercise causes in muscle cells by increasing the number of mitochondria, or the energy-producing component of cells. By increasing the number of mitochondria, the body may become better at burning fat.

While you don't have to be a competitive level cyclist, even at a low level of 30-60 minutes along with a healthy protein-rich diet has been proven to lower many health risks and help in the weight-loss process.

Photo: PhotoNews Media/Clark Brooks

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On the other end of the spectrum of exercise intensity is high-intensity interval training, or HIIT. These workouts involve exercising at a high intensity for short durations, like an all-out sprint or cycle for 30 seconds to a minute, followed by a period of low intensity activity. This is repeated six to 10 times.

During this sort of high-intensity activity, the body primarily uses carbohydrates as a fuel source. During high-intensity exercise, the body preferentially uses carbohydrates because the energy demand is high and carbohydrates provide energy twice as fast as fats.

Some people who turn to exercise to lose fat may eschew high-intensity training for zone 2, as it’s considered the “the fat burning zone.” This may be a misnomer.

Researchers have found that high-intensity interval training produces a similar increase in markers for mitochondria production when compared to longer, moderate aerobic training. Studies have also shown that high-intensity exercisers build muscle and improve insulin resistance and cardiovascular health similar to moderate-intensity exercisers, and they made these gains faster. The main trade-off was discomfort during bouts of high-intensity exercise.

Moderate- or high-intensity exercise?

With varying guidelines around heart rate zones and conflicting evidence on the potential benefits of training in each zone, exercisers may be left wondering what to do.

In order to yield the health benefits of exercise, the most important variable to consider is adhering to an exercise routine, regardless of intensity. Because the body adapts in similar ways to moderate- and high-intensity exercise, people can choose which intensity they like best or dislike the least.

Swimming is a good activity to maintain heart and cardiovascular health.

Photo: PhotoNews Media/Clark Brooks

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Notice that the American College of Sports Medicine’s recommendation for exercise falls under moderate intensity. This is equivalent to zone 3, or 64% to 76% of maximum heart rate, a range you can only meet in the upper levels of most zone 2 workouts. If you’re not seeing desired results with your zone 2 workouts, try increasing your intensity to reach the moderate level.

A commonly reported reason for not exercising is a lack of time. For people short on time, high-intensity training is a good alternative to steady-state cardiovascular exercise. For people who find exercising at such a high intensity uncomfortable, they can get the same benefit by doing moderate-intensity exercise for a longer period.

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About the author:
Jason Sawyer is an Associate Professor of Exercise and Movement Science at Bryant University. This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Health & Wellness |Ask your healthcare provider if a CT calcium screen is right for you

by Tim Ditman
OSF Healthcare

Ash Al-Dadah, MD

URBANA - Here’s something new to bring up the next time you visit your health care provider: Should I undergo a CT calcium score screen to take stock of my heart health? It’s not for everybody, but it could mean the difference between a long, healthy life and finding yourself on an operating table.

“The number one killer in the United States is heart disease,” says Ash Al-Dadah, MD, an interventional cardiologist at OSF HealthCare. “We have to do a better job.

“This calcium scoring is a screening where we may say ‘Hey, you need to exercise more’ or ‘Hey, we just found out you have high blood pressure. Let’s control that.’ or ‘Hey, you’re a smoker. Maybe you need to quit that,’” he adds. “We go after the risk factors that precipitate and lead to heart disease. It’s a wake-up call. Getting ahead of things so you’re not coming in with a heart attack and damage to the heart muscle. At that point, it’s too late.”

The screening

Dr. Al-Dadah says the 15-minute or so, non-invasive procedure is similar to other CT [computed tomography] scans. “A fancy X-ray,” he calls it. You lie down, and a doughnut-looking device surrounds you and takes pictures of your heart.

“The arteries in our heart are supposed to be flesh and appear gray [on the imaging]. As we roll the body through the scan, we want to see all gray,” Dr. Al-Dadah explains. “But if there’s hardening and plaque formation in the arteries, it will light up as white. That’s because plaque as it ages forms calcification. There are calcium deposits.”

You could be told you’re at low, medium or high risk. Or, providers may look at the results based on your age compared to the typical amount of plaque found in a person of that age.

Put simply: “It’s one way to measure risk for heart disease,” Dr. Al-Dadah says. “The most common heart disease is blocked arteries, leading to a risk for heart attacks and other issues.”Cardiologists and radiologists have a scoring system based on how much plaque is found.

Next steps

Dr. Al-Dadah says if your screen comes back with red flags, you’ll want to see a cardiologist to discuss next steps. That could mean more tests, especially if you have daily symptoms like chest pain or shortness of breath:

• A stress test, where you walk and run on a treadmill while providers see how your heart functions.
• A coronary angiogram, which provides more comprehensive images of your arteries.
• Or, a provider could recommend you get another CT calcium screen in a few years.

Plaque in heart

Other treatment options for milder cases: “Even if your cholesterol level is normal, I could still put you on a medication class called statins. Statins reduce plaque thickness. They stabilize the plaque and reduce the risk for heart attack,” Dr. Al-Dadah outlines.

“I could put you on aspirin. Aspirin will dramatically reduce the risk for a heart attack if you have significant plaque,” he adds.

One other outcome of note: Though rare, Dr. Al-Dadah says your CT calcium screen could come back OK, but you could still have a heart issue soon after. No screening is a silver bullet to keep you 100% healthy, in other words. That’s why it’s important to follow your provider’s recommendations and practice healthy habits, like eating a balanced diet, exercising and ditching the cigarettes.

For me?

Who is this screening intended for? Dr. Al-Dadah says it’s often done on people aged 40 to 65 or people with a family history of heart disease. But, anyone can and should ask their provider about it.

“If you’re 75 and have diabetes,” for example, Dr. Al-Dadah says. “You’re going to have a lot of calcification in the arteries. But it does not signify blockages. It’s just hardening of the arteries that comes with age. But if you’re younger and have that calcification, that’s a marker for risk of heart disease and heart attack.”

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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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Heart attack risks increase as people with HIV and hepatitis C age, according to recent study

by American Heart Association

DALLAS -- As people with HIV age, their risk of heart attack increases far more if they also have untreated hepatitis C virus, even if their HIV is treated, 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.

Since the introduction of antiretroviral therapies to treat HIV in the late 1990s, the lifespan of people with HIV has increased dramatically. However, even with treatment, studies have found the heart disease risk among people with HIV is at least 50% higher than people without HIV. This new study evaluated if people with HIV who also have hepatitis C – a viral liver infection – have a higher risk of heart attack.

"HIV and hepatitis C coinfection occurs because they share a transmission route - both viruses may be transmitted through blood-to-blood contact," said Keri N. Althoff, Ph.D., M.P.H., senior author of the study and an associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "Due in part to the inflammation from the chronic immune activation of two viral infections, we hypothesized that people with HIV and hepatitis C would have a higher risk of heart attack as they aged compared to those with HIV alone."

Researchers analyzed health information for 23,361 people with HIV (17% female, 49% non-Hispanic white) in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) between 2000 and 2017 and who had initiated antiretroviral treatment for HIV. All were between 40 to 79 years of age when they enrolled in the NA-ACCORD study (median age of 45 years). One in 5 study participants (4,677) were also positive for hepatitis C. During a median follow-up of about 4 years, the researchers compared the occurrence of a heart attack between the HIV-only and the HIV-hepatitis C co-infected groups as a whole, and by each decade of age.

The analysis found:

With each decade of increasing age, heart attacks increased 30% in people with HIV alone and 85% in those who were also positive for hepatitis C.

The risk of heart attack increased in participants who also had traditional heart disease risk factors such as high blood pressure (more than 3 times), smoking (90%) and Type 2 diabetes (46%).

The risk of heart attack was also higher (40%) in participants with certain HIV-related factors such as low levels of CD4 immune cells (200cells/mm3, signaling greater immune dysfunction) and 45% in those who took protease inhibitors (one type of antiretroviral therapy linked to metabolic conditions).

"People who are living with HIV or hepatitis C should ask their doctor about treatment options for the viruses and other ways to reduce their cardiovascular disease risk," said lead study author Raynell Lang, M.D., M.Sc., an assistant professor in the department of medicine and community health sciences at the University of Calgary in Alberta, Canada.

"Several mechanisms may be involved in the increased heart attack risk among co-infected patients. One contributing factor may be the inflammation associated with having two chronic viral infections," Lang said. "There also may be differences in risk factors for cardiovascular disease and non-medical factors that influence health among people with HIV and hepatitis C that plays a role in the increased risk."

According to a June 2019 American Heart Association scientific statement, Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV, approximately 75% of people living with HIV are over the age of 45. "Even with effective HIV viral suppression, inflammation and immune dysregulation appear to increase the risk for heart attack, stroke and heart failure." The statement called for more research on cardiovascular disease prevention, causes and treatment in people with HIV.

"Our findings suggest that HIV and hepatitis C co-infections need more research, which may inform future treatment guidelines and standards of care," Althoff said.

The study is limited by not having information on additional factors associated with heart attack risk such as diet, exercise or family history of chronic health conditions. Results from this study of people with HIV receiving care in North America may not be generalizable to people with HIV elsewhere. In addition, the study period included time prior to the availability of more advanced hepatitis C treatments.

"Because effective and well-tolerated hepatitis C therapy was not available during several years of our study period, we were unable to evaluate the association of treated hepatitis C infection on cardiovascular risk among people with HIV. This will be an important question to answer in future studies," Lang said.

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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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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If your blood pressure goes up when you stand, your risk for a heart attack might, too

A nurse records a patient's blood pressure at UTSW Medical Center in Dallas, Texas. Researchers have compared heart disease risk factors, laboratory measures and the occurrence of major cardiovascular events such as heart attacks, heart-related chest pain, stroke, aneurysm of the aortic artery, and clogged peripheral arteries.

Photo: American Heart Association

American Heart Association

DALLAS, TX -— Among young and middle-aged adults with high blood pressure, a substantial rise in blood pressure upon standing may identify those with a higher risk of serious cardiovascular events, such as heart attack and stroke, according to new research published today in the American Heart Association’s peer-reviewed journal Hypertension.

“This finding may warrant starting blood-pressure-lowering treatment including medicines earlier in patients with exaggerated blood pressure response to standing,” said Paolo Palatini, M.D., lead author of the study and a professor of internal medicine at the University of Padova in Padova, Italy.

Nearly half of Americans and about 40% of people worldwide have high blood pressure, considered to be the world’s leading preventable cause of death. According to the American Heart Association’s 2022 heart disease statistics, people with hypertension in mid-life are five times more likely to have impaired cognitive function and twice as likely to experience reduced executive function, dementia and Alzheimer’s disease.

Typically, systolic (top number) blood pressure falls slightly upon standing up. In this study, researchers assessed whether the opposite response – a significant rise in systolic blood pressure upon standing – is a risk factor for heart attack and other serious cardiovascular events.

The investigators evaluated 1,207 people who were part of the HARVEST study, a prospective study that began in Italy in 1990 and included adults ages 18-45 years old with untreated stage 1 hypertension. Stage 1 hypertension was defined as systolic blood pressure of 140-159 mm Hg and/or diastolic BP 90-100 mm Hg. None had taken blood pressure-lowering medication prior to the study, and all were initially estimated at low risk for major cardiovascular events based on their lifestyle and medical history (no diabetes, renal impairment or other cardiovascular diseases). At enrollment, participants were an average age of 33 years, 72% were men, and all were white.

At enrollment, six blood pressure measurements for each participant were taken in various physical positions, including when lying down and after standing up. The 120 participants with the highest rise (top 10%) in blood pressure upon standing averaged an 11.4 mm Hg increase; all increases in this group were greater than 6.5 mm Hg. The remaining participants averaged a 3.8 mm Hg fall in systolic blood pressure upon standing.

The researchers compared heart disease risk factors, laboratory measures and the occurrence of major cardiovascular events (heart attack, heart-related chest pain, stroke, aneurysm of the aortic artery, clogged peripheral arteries) and chronic kidney disease among participants in the two groups. In some analyses, the development of atrial fibrillation, an arrhythmia that is a major risk factor for stroke, was also noted. Results were adjusted for age, gender, parental history of heart disease, and several lifestyle factors and measurements taken during study enrollment.

During an average 17-year follow-up 105 major cardiovascular events occurred. The most common were heart attack, heart-related chest pain and stroke.

People in the group with top 10% rise in blood pressure:

• were almost twice as likely as other participants to experience a major cardiovascular event;
• did not generally have a higher risk profile for cardiovascular events during their initial evaluation (outside of the exaggerated blood pressure response to standing);
• were more likely to be smokers (32.1% vs. 19.9% in the non-rising group), yet physical activity levels were comparable, and they were not more likely to be overweight or obese, and no more likely to have a family history of cardiovascular events;
• had more favorable cholesterol levels (lower total cholesterol and higher high-density-lipoprotein cholesterol);
• had lower systolic blood pressure when lying down than the other group (140.5 mm Hg vs. 146.0 mm Hg, respectively), yet blood pressure measures were higher when taken over 24 hours.

After adjusting for average blood pressure taken over 24 hours, an exaggerated blood pressure response to standing remained an independent predictor of adverse heart events or stroke.

“The results of the study confirmed our initial hypothesis - a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure. We were rather surprised that even a relatively small increase in standing blood pressure (6-7 mm Hg) was predictive of major cardiac events in the long run,” said Palatini.

In a subset of 630 participants who had stress hormones measured from 24-hour urine samples, the epinephrine/creatinine ratio was higher in the people with a rise in standing blood pressure compared to those whose standing blood pressure did not rise (118.4 nmol/mol vs. 77.0 nmol/mol, respectively).

“Epinephrine levels are an estimate of the global effect of stressful stimuli over the 24 hours. This suggests that those with the highest blood pressure when standing may have an increased sympathetic response [the fight-or-flight response] to stressors,” said Palatini. “Overall, this causes an increase in average blood pressure.”

“The findings suggest that blood pressure upon standing should be measured in order to tailor treatment for patients with high blood pressure, and potentially, a more aggressive approach to lifestyle changes and blood-pressure-lowering therapy may be considered for people with an elevated [hyperreactor] blood pressure response to standing,” he said.

Results from this study may not be generalizable to people from other ethnic or racial groups since all study participants reported white race/ethnicity. In addition, there were not enough women in the sample to analyze whether the association between rising standing blood pressure and adverse heart events was different among men and women. Because of the relatively small number of major adverse cardiac events in this sample of young people, the results need to be confirmed in larger studies.

Children with COVID-19-related MIS-C condition usually recover in months

This study details the cardiovascular complications or damage found during a three-month follow-up period to assess the short-term impact of MIS-C.

by American Heart Association

DALLAS -- Heart function recovery returned within three months in children who developed COVID-19-related multisystem inflammatory syndrome (MIS-C), 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.

MIS-C is a new illness identified during the COVID-19 pandemic that affects children about four to six weeks after exposure to COVID-19. The new condition has some overlapping symptoms with Kawasaki disease, however, MIS-C is associated with more profound inflammation. MIS-C can cause inflammation in different parts of the body, including the heart, lungs, kidneys and gastrointestinal organs. About 80%-85% of MIS-C cases across the U.S. and Europe have involved the heart’s left ventricle.

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Photo: American Heart Assoc.

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This study details the cardiovascular complications or damage found during a three-month follow-up period to assess the short-term impact of MIS-C. It also employs newer cardiac measurements, known as "strains," to assess heart function related to MIS-C. Strain testing is a more sensitive tool that can detect whether an area of the heart is deformed or if there are any subtle changes in heart function during cardiac contraction and relaxation.

"There is limited data at this time about how frequently and how long we should monitor heart function during the recovery state of MIS-C after the child leaves the hospital," said the study’s senior author Anirban Banerjee, M.D., a professor of clinical pediatrics at the University of Pennsylvania Perelman School of Medicine and an attending cardiologist with the Cardiac Center at the Children’s Hospital of Philadelphia, both in Philadelphia.

"Given that MIS-C was identified as a result of the COVID-19 pandemic, treatment protocols have not yet been standardized and follow-up care varies greatly, which may lead to confusion and anxiety among families of patients and their care team. Our research team hoped to provide some guidance and reduce the ambiguity on optimal care approaches, especially as it relates to sports participation," Banerjee added.

Researchers retroactively reviewed data on 60 children hospitalized with MIS-C due to COVID-19 exposure who were treated at two Philadelphia hospitals between April 2020 and January 2021. None of the children were initially diagnosed with COVID-19 before the onset of MIS-C symptoms. This group of children were 60% male, with an average age of 10 years. About 48% were Black children, 27% were white children, 15% were Hispanic children, 4% were Asian children and the race/ethnicity of 23% of the children was unknown. The participants were treated with intravenous immunoglobulin and/or systemic steroids. Researchers reviewed echocardiographic and clinical data from medical records, including demographic factors, testing, treatment and hospital outcomes.

Data on another 60 children who had structurally normal hearts and did not have MIS-C or COVID-19 exposure served as control subjects. Their average age was 11.5 years, and 55% were male; 62% white children, 27% Black children, 7% Hispanic children, 3% Asian and 8% unknown. The control participants were divided into two groups: 60% had echocardiograms on file that were done prior to the COVID-19 pandemic, and 40% had echocardiograms under rigid COVID-19 protocols after October 2020.

For the children with MIS-C, researchers analyzed images of the heart taken at the initial hospitalization (acute phase) and examined additional imaging for a portion of the children who also had scans up to three additional times – one week after the first scan (subacute phase); at the one-month follow-up; and at a three or four-month follow-up. The children were screened using conventional echocardiography, speckle tracking echocardiography – an imaging technique that analyzes the motion of the heart tissue - and cardiac magnetic resonance imaging (MRI) for images of the heart.

The study found:

Based on echocardiogram imaging, systolic and diastolic function in the left ventricle and systolic function in the right ventricle improved quickly within the first week, followed by continued improvement and complete normalization by three months.

81% of patients lost some contractile function in the left ventricle during the acute phase of illness, yet, by months three and four, contraction function had returned to normal.

MIS-C did not cause lasting coronary artery abnormalities. During the initial hospitalization, 70% of patients had evidence of some heart malfunction, however, all scans were normal by the three-month follow-up.

Using strain parameters to measure cardiac function, the results suggest that there is no subclinical cardiac dysfunction after three months.

"Recovery among these children was excellent," Banerjee said. "These results have important implications for our health care teams managing care for children with MIS-C. Our findings may also provide guidance for a gradual return to playing sports after cardiac clearance three to four months later. Tests needed for clearance include electrocardiogram and echocardiogram. We also recommend cardiac MRI for children who have highly abnormal baseline cardiac MRI during the acute stage or show evidence of continued severe left ventricle dysfunction."

The study researchers note there are still important gaps in existing knowledge about MIS-C, since COVID-19 and MIS-C are both new illnesses. The most important question yet to answer is how these children are faring one to two years after their initial hospitalization.

There are important limitations to note: the study was retrospective for clinical purposes and was not standardized for research. In addition, follow-up data was missing for some patients who dropped out of the study during follow-up stages. Banerjee explained that because both COVID-19 and MIS-C were newly discovered diseases, the timing of follow-up echocardiograms was somewhat arbitrary and driven by preference of different clinicians, rather than standard research protocol.

"The strength of the study is that researchers performed a detailed, serial assessment of cardiac function over the initial three to four months of illness," according to AHA volunteer expert Kevin G. Friedman, M.D., a member of the American Heart Association’s Young Hearts Council and the AHA’s Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, an attending physician in pediatric cardiology at Boston Children’s Hospital and associate professor of pediatrics at Harvard Medical School, both in Boston.

"This study provides additional evidence that myocardial involvement is transient and may not lead to long-term abnormalities in left ventricular diastolic or systolic function," Friedman said. "Although cardiac involvement in the acute stage of illness is common, it is reassuring that all patients recovered normal cardiac function within about one week. This data tells us that, fortunately, lasting heart injury is very uncommon in MIS-C. Even in those patients with significant cardiac abnormalities in the acute phase of illness, these changes resolved by 3-4 months."

Co-authors of the study are Daisuke Matsubara, M.D., Ph.D.; Joyce Chang, M.D., M.S.C.E.; Hunter L. Kauffman, B.S.; Yan Wang, R.D.C.S.; Sumekala Nadaraj, M.D.; Chandni Patel, M.D.; Stephen M. Paridon, M.D.; Mark A. Fogel, M.D.; and Michael D. Quartermain, M.D..

** Editor's note: This story was updated on Jan. 20 due to new information from the American Heart Association. The story initally said "During the initial hospitalization, 7% of patients had evidence of some heart malfunction". That number was suppose to be "70%".

Study finds firefighters’ risk of irregular heartbeat linked to the number of fires they fought

Photo: Matt C/Unsplash

American Heart Association

DALLAS —- Among firefighters, the risk of having an irregular heart rhythm, known as atrial fibrillation (AFib), increases with the number of fires they respond to, 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.

Compared with people in other occupations, firefighters are known to have a disproportionately high risk of heart disease, and almost half of fatalities in on-duty firefighters result from sudden cardiac death – when the heart suddenly stops beating and pumping blood to vital organs. An increased risk of an irregular heart rhythm or arrhythmias from the ventricles, the bottom chambers of the heart, has been documented in firefighters, however, prior to this study, little was known about AFib, which is an arrhythmia involving the top chambers of the heart. According to the American Heart Association, AFib is the most common type of irregular heartbeat with at least 2.7 million people living with it in the United States. People with AFib have an increased risk of blood clots, heart failure, stroke and other heart complications.

"A few years ago, I treated a local firefighter for atrial fibrillation, and he felt dramatically better with the treatment, so he referred other firefighters to me for care, all with AFib. I decided to methodically examine AFib in the firefighter population, as it may shed light into the cause of atrial fibrillation in non-firefighters as well," said Paari Dominic, M.D., senior author of the study, the director of clinical cardiac electrophysiology and associate professor of medicine and molecular and cellular physiology at LSU Health Shreveport in Louisiana.

Participants were recruited through five professional firefighter organizations. The study was conducted from 2018-19 among active firefighters throughout the U.S. They completed a survey about their occupational exposure (number of fires fought per year) and about their history of heart disease. Of the 10,860 firefighters who completed the survey (93.5% male, and 95.5% were age 60 or younger), 2.9% of the men and 0.9% of the women reported a diagnosis of AFib.

"Among adults in the general population younger than age 60, there is a 0.1-1.0% prevalence of having AFib. However, among our study population, 2.5% of firefighters ages 60 or younger had AFib," Dominic said. "Of the few respondents who were 61 or older, 8.2% reported a diagnosis of AFib."

When occupational exposure was factored in, the researchers found a direct and significant relationship between the number of fires fought and the risk of developing AFib. The analysis found:

2% of those who fought 0-5 fires per year developed AFib;

2.3% of those who fought 6-10 fires per year developed AFib;

2.7% of those who fought 11-20 fires per year developed AFib;

3% of those who fought 21-30 fires per year developed AFib; and

4.5% of those who fought 31 or more fires per year developed AFib.

After adjusting for multiple risk factors for AFib, such as high blood pressure and smoking, researchers found a 14% increased risk of atrial fibrillation for every additional 5 fires fought annually.

"Clinicians who care for firefighters need to be aware of the increased cardiovascular risk, especially the increased risk of AFib, among this unique group of individuals. The conditions that elevate their risk further, such as high blood pressure, Type 2 diabetes, lung disease and sleep apnea, should be treated aggressively. In addition, any symptoms of AFib, such as palpitations, trouble breathing, dizziness and fatigue, should be investigated promptly," Dominic said.

According to the researchers, multiple mechanisms may be involved in the association between firefighting and AFib. "First, and foremost, are the inhalation and absorption through the skin of harmful compounds and substances produced by the combustion of materials during a fire, including particulate matter, polyaromatic hydrocarbons and benzene. Exposure to these substances, especially particulate matter in air pollution, even for a short time has been previously linked to an increased risk of AFib. In addition, firefighters are exposed to high physical and psychological stress together with long work hours, all of which can increase their adrenaline levels and cause an imbalance in the mechanisms that maintain heart rate. Finally, heat stress (exposure to high temperatures) can cause an increase in core body temperature and severe dehydration, both of which increase the demand for a higher heart rate, and may subsequently trigger AFib," Dominic said.

"Studying firefighters, who personally make sacrifices for the safety of us all, is essential to prevent disease and death in this population that makes a big impact on the well-being of our communities," Dominic said.

The study is limited by basing the presence of atrial fibrillation and all other medical conditions on the firefighters’ survey responses. However, the researchers were able to corroborate the self-reported responses by linking them to well-established associations between atrial fibrillation and the presence of risk factors such as high blood pressure and sleep apnea, suggesting that the self-reports were accurate.

The researchers are currently analyzing the survey data to investigate the association between the annual number of fires fought and the risk of atherosclerotic cardiovascular disease. Atherosclerosis is a buildup of fatty deposits in the arteries that can thicken blood vessel walls and reduce blood flow to the heart muscle, brain, kidneys or extremities.

Based on the results of this study, researchers suggest future studies systematically screen firefighters for AFib to detect asymptomatic or new cases to evaluate the relationship between fire exposure and stroke risk in firefighters with AFib to allow a better understanding about which of the components of occupational exposure to fires plays a key role in causing fibrillation. They should also examine the reluctance of firefighters with AFib to use blood thinners. Blood thinners are a standard treatment for AFib; however, the medication carries an added risk of bleeding and firefighters are concerned about their increased risk of bleeding injuries due to low-visibility firefighting situations.

Young people recover quickly from rare effect caused by COVID-19 vaccine

by American Heart Association

Researchers say future studies should follow patients who have suffered vaccine-associated myocarditis over a longer term, since this study examined only the immediate course of patients and lacks follow-up data.

Most young people under the age of 21 who developed suspected COVID-19 vaccine-related heart muscle inflammation known as myocarditis had mild symptoms that improved quickly, according to new research published today in the American Heart Association’s flagship journal Circulation.

Myocarditis is a rare but serious condition that causes inflammation of the heart muscle. It can weaken the heart and affect the heart’s electrical system, which keeps the heart pumping regularly. It is most often the result of an infection and/or inflammation caused by a virus.

"In June of this year, the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices reported a likely link between mRNA COVID-19 vaccination and myocarditis, particularly in people younger than 39. However, research continues to find COVID-19 vaccine-related cases of myocarditis uncommon and mostly mild," said Donald. M. Lloyd-Jones, M.D., Sc.M., FAHA, president of the American Heart Association, who was not involved in the study. "Overwhelmingly, data continue to indicate that the benefits of COVID-19 vaccination – 91% effective at preventing complications of severe COVID-19 infection including hospitalization and death – far exceed the very rare risks of adverse events, including myocarditis."

"The highest rates of myocarditis following COVID-19 vaccination have been reported among adolescent and young adult males. Past research shows this rare side effect to be associated with some other vaccines, most notably the smallpox vaccine," said the new study’s senior author Jane W. Newburger, M.D., M.P.H., FAHA, associate chair of Academic Affairs in the Department of Cardiology at Boston Children’s Hospital, the Commonwealth Professor of Pediatrics at Harvard Medical School and a member of the American Heart Association’s Council on Lifelong Congenital Heart Disease and Heart Health in the Young. "While current data on symptoms, case severity and short-term outcomes is limited, we set out to examine a large group of suspected cases of this heart condition as it relates to the COVID-19 vaccine in teens and adults younger than 21 in North America."

Using data from 26 pediatric medical centers across the United States and Canada, researchers reviewed the medical records of patients younger than 21 who showed symptoms, lab results or imaging findings indicating myocarditis within one month of receiving a COVID-19 vaccination, prior to July 4, 2021. Cases of suspected vaccine-associated myocarditis were categorized as "probable" or "confirmed" using CDC definitions.

Of the 139 teens and young adults, ranging from 12 to 20 years of age, researchers identified and evaluated:

Most patients were white (66.2%), nine out of 10 (90.6%) were male and median age was 15.8 years.

Nearly every case (97.8%) followed an mRNA vaccine, and 91.4% occurred after the second vaccine dose.

Onset of symptoms occurred at a median of 2 days following vaccine administration.

Chest pain was the most common symptom (99,3%); fever and shortness of breath each occurred in 30.9% and 27.3% of patients, respectively.

About one in five patients (18.7%) was admitted to intensive care, but there were no deaths. Most patients were hospitalized for two or three days.

More than three-fourths (77.3%) of patients who received a cardiac MRI showed evidence of inflammation of or injury to the heart muscle.

Nearly 18.7% had at least mildly decreased left ventricular function (squeeze of the heart) at presentation, but heart function had returned to normal in all who returned for follow-up.

"These data suggest that most cases of suspected COVID-19 vaccine-related myocarditis in people younger than 21 are mild and resolve quickly," said the study’s first author, Dongngan T. Truong, M.D., an associate professor of pediatrics in the division of cardiology at the University of Utah and a pediatric cardiologist at Intermountain Primary Children’s Hospital in Salt Lake City. "We were very happy to see that type of recovery. However, we are awaiting further studies to better understand the long-term outcomes of patients who have had COVID-19 vaccination-related myocarditis. We also need to study the risk factors and mechanisms for this rare complication."

Researchers say future studies should follow patients who have suffered vaccine-associated myocarditis over a longer term, since this study examined only the immediate course of patients and lacks follow-up data. Additionally, there are several important limitations to consider. The study design did not allow scientists to estimate the percentage of those who received the vaccine and who developed this rare complication, nor did it allow for a risk/benefit ratio examination. The patients included in this study were also evaluated at academic medical centers and may have been more seriously ill than other cases found in a community.

"It is important for health care professionals and the public to have information about early signs, symptoms and the time course of recovery of myocarditis, particularly as these vaccines become more widely available to children," Truong said. "Studies to determine long-term outcomes in those who have had myocarditis after COVID-19 vaccination are also planned."

Researchers recommend that health care professionals consider myocarditis in individuals presenting with chest pain after receiving a COVID-19 vaccine, especially in boys and young men in the first week after the second vaccination.

"This study supports what we have been seeing – people identified and treated early and appropriately for COVID-19 vaccine-related myocarditis typically experience mild cases and short recovery times," Lloyd-Jones said. "These findings also support the American Heart Association’s position that COVID-19 vaccines are safe, highly effective and fundamental to saving lives, protecting our families and communities against COVID-19, and ending the pandemic. Please get your child vaccinated as soon as possible."

Get in shape before hunting season, strokes and heart attacks can happen

by American Heart Association

DALLAS -- The crisp fall air is a welcome signal for the beginning of hunting seasons across the country, and while gun safety is an important part of any hunting season, the American Heart Association says heart attacks may be one of the biggest dangers many hunters face.

“Many people look to hunting as a way to relax and commune with nature and if you’re healthy and in good physical shape, it can be a great way to get some outdoor exercise. However, for many hunters, the extra exertion, colder temperatures and even the excitement of the hunt can add up to a deadly combination,” said Gustavo E. Flores, M.D., a member of the American Heart Association’s Emergency Cardiovascular Care committee and chairman and chief instructor for Emergency & Critical Care Trainings, LLC, in San Juan, Puerto Rico. “Unfortunately, every year some hunters experience heart attacks or strokes while in the woods, so it’s important to recognize symptoms and to be able to take quick action.”

According to Flores, developing an exercise regimen and getting a good health check-up prior to hunting season would be idea. However, many hunters may not think ahead to prepare physically for the exertion hunting can have on the body – especially the heart. The colder temperatures of hunting season can cause blood vessels to constrict. Tracking prey may mean lots of walking or running, often in hilly terrain. The excitement of seeing and connecting with a target can release hormones that can increase blood pressure to cause the heart rate to spike. Then the labor of dragging an animal through the woods can leave even the most fit hunter breathless.

“Heart attacks and strokes can happen even to people who seem in good physical shape,” Flores said. “Listen to your body, take breaks if needed and have a plan in case of emergencies. Never hunt alone if possible and if cell phone service isn’t available, use walkie-talkies to stay in touch with your hunting party. Recognizing the warnings signs and seeking immediate help are key.”

Some heart attacks are sudden and intense. But most start slowly, with mild pain or discomfort. Pay attention to your body and call 911 if you experience:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes – or it may go away and then return. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath. This can occur with or without chest discomfort.
• Other signs. Other possible signs include breaking out in a cold sweat, nausea or lightheadedness.

Use the letters in F.A.S.T to spot a stroke

• F = Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
• A = Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S = Speech Difficulty – Is speech slurred?
• T = Time to call 911
• Other signs can include: numbness or weakness of face, arm, or leg, especially on one side of the body; confusion, trouble speaking or understanding speech; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; or a severe headache with no known cause

Getting a person to the hospital quickly during a heart attack or stroke is critical to ensure they get medication and treatment to save their life. If calling 9-1-1 isn’t an option in the woods, it can also help to know in advance where the closest hospital is to the hunting area.

Cardiac arrest differs from a heart attack because the heart suddenly stops beating, often without any warning. Signs of a cardiac arrest are:

• Sudden loss of responsiveness – The person doesn’t respond, even if you tap them hard on the shoulders or ask loudly if they're OK. The person doesn’t move, speak, blink or otherwise react.
• No normal breathing – The person isn’t breathing or is only gasping for air.

In the event of a cardiac arrest, seconds count. Call 9-1-1, begin CPR immediately and continue until professional emergency medical services arrive.

“Learning hands-only CPR is one of the best skills any hunter can have. The American Heart Association offers many local CPR classes, and even if you haven’t taken a formal class, you can still save a life. It’s two simple steps – call 9-1-1 and push hard and fast in the center of the chest,” Flores said. “While hunting can be a very strenuous activity, taking a few precautions and being prepared can make a difference in the safety of the experience.”

Living with HIV: Many face CVD health risks and access to proper care

American Heart Association

Research shows that people living with HIV have a significantly high risk for cardiovascular disease – as much as 2 times higher for heart attack and heart failure and 14% higher for sudden cardiac death than people without HIV. So, while many people living with HIV/AIDS are experiencing full, quality lives as AIDS has transitioned from a progressive, fatal disease to what is now a mostly manageable, chronic condition more than three decades after the first World AIDS Day was recognized on Dec. 1, 1988, challenges persist. Not only from increased other health issues, but also navigating a health care system that can still be discriminatory, as outlined in several scientific statements published by the American Heart Association, the world’s leading voluntary organization dedicated to building longer, healthier lives for all.

Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association – In this scientific statement released in June 2019, the Association reported that living with HIV is associated with higher rates of heart attacks, strokes, heart failure, sudden cardiac deaths and other diseases, compared with people without HIV. The statement writing group’s chair, Matthew J. Feinstein, M.D., M.Sc., said this may be because of interactions between traditional risk factors, such as unhealthy diet, lifestyle and tobacco use, and HIV-specific risk factors, such as a compromised immune system and inflammation characteristic of chronic HIV.

"Lifestyle and clinical factors play major roles in the increased risk for heart disease among people with HIV," said Feinstein, an assistant professor of Medicine-Cardiology at Northwestern University in Chicago who specializes in cardiovascular risk in infectious and inflammatory conditions. "In people with HIV, cigarette smoking is quite common. This dovetails with a number of factors – ranging from chronic inflammatory and metabolic effects of HIV and its therapies to psychosocial stressors related to stigma and substance use disorders – to lead to increased risk for cardiovascular diseases among people with HIV."

The American Heart Association recommends people living with HIV talk to their doctor and assess their cardiovascular disease risk using a tool such as the American Heart Association/American College of Cardiology Atherosclerotic Disease Risk Calculator, which estimates a person’s ten-year risk of having a heart attack, stroke or other cardiovascular condition. The Association cautions that the risk calculator is a starting point as people living with HIV may have a higher risk than indicated by the calculator. Other factors to consider in risk assessment include family history of heart disease and HIV-specific factors, such as whether or not a patient started antiretroviral therapy soon after diagnosis.

To help improve the health of people living with HIV, the Association emphasizes the importance of a healthy lifestyle that includes not smoking, adequate physical activity, eliminating or reducing the amount of alcohol consumed and a healthy diet in keeping with the guidance in Life’s Simple 7 – the seven risk factors that people can improve through lifestyle changes to help achieve ideal cardiovascular health.

Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement of the American Heart Association – This scientific statement published in Oct. 2020, highlights the additional challenges LGBTQ people, a population especially vulnerable to living with HIV/AIDS, face in the form of discrimination in the health care setting.

The writing group noted trust toward health care professionals is still lacking among many members of the LGBTQ community – more than half (56%) of LGBTQ adults and 70% of those who are transgender or gender non-conforming report experiencing some form of discrimination, including the use of harsh or abusive language, from a health care professional.

"LGBTQ individuals often skip primary care and preventative visits because there is a great fear of being treated differently,” said the chair of the writing group for this statement, Billy A. Caceres, Ph.D., R.N., FAHA, an assistant professor at the Columbia University School of Nursing in New York City. “Being treated differently often means receiving inadequate or inferior care because of sexual orientation or gender identity."

Although much progress has been made over the past decade in understanding HIV-associated cardiovascular disease, considerable gaps exist, and more research is needed to address the growing physical and sociological challenges.

The heart will take you places

By Glenn Mollette, Guest Commentator

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Typically, the heart leads us and keeps us in various places throughout life.

Most of the time people marry because at that moment that's where their hearts have led them to be. For better or worse many people stay in marriages most of their lives because they have given their heart to their spouse.

We sometimes pursue careers because we have a heart for the vocation. There is something about the vocation that inspires and motivates us. Because our heart is in the work, we stay with the occupation. Success is more likely to occur where the heart is centered.

We become very competent with our hobbies because we love them so much. We enjoy musical instruments, baking, sewing, wood work, painting, fishing, sports and whatever your hobby might be. People are often ready to retire from their jobs because they have hobbies, they love more.

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We love our freedom in America. Freedom to try. Freedom to fail. Freedom to try again.

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The major emphasis of the greatest commandment is to love God with our hearts. Jesus knew no one would have any commitment to God without the full commitment of the heart.

The heart will take you places and keep you places where the mind would never consider. Too often what the mind will not consider the heart will not give up or waver from.

We often forget about the mind. Jesus told us to love God with our minds. Reason, commonsense, inquiry, thinking and education are all important. Sometimes the heart may cause us to be blind. We may love blindly. Stay with negative relationships that are destructive. Hang on to a job or career pursuit that ends up being negative, a dead end and a waste of time.

We have to involve our minds in our lives. Life cannot be lived merely by the heart. Heart will keep you someplace a long time. However, your mind will help you to decipher whether it's the right thing to do.

Americans are at the polls voting. Love for the country, ideas, political parties and candidates have Americans voting in masses.

While you may love the Democratic party or the Republican party or either candidate hopefully you are considering all the reasons why you are voting.

What do you want for America? Good paying jobs? More Government involvement in your life? The removal of guns from society? The freedom to have guns? Less police security? More police security?

More taxes? Less taxes? More jobs coming back to America? More jobs going back to China? Health care that pays for nothing? A better health care for every American? What about our freedom? Freedom of speech?

We love our freedom in America. Freedom to try. Freedom to fail. Freedom to try again. Freedom to succeed. Freedom to pursue owning a house, car and living an independent life. Maybe, you feel that every American should have the same, be the same and that the Government should take care of all us equally?

This election, think about it. Think about what you want for you and your grandchildren. Let your heart drive you to vote but put your mind into your voting.

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Dr. Glenn Mollette is a syndicated American columnist and author of American Issues, Every American Has An Opinion and ten other books. He is read in all 50 states. The views expressed are those of the author and are not necessarily representative of any other group or organization.

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This article is the sole opinions of the author and does not necessarily reflect the views of PhotoNews Media. We welcome comments and views from our readers.

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