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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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.

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.

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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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.

Ducking winter's toughest punch, avoiding potential health issues

by Paul Arco
OSF Healthcare

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Every year, thousands of people end up in an emergency department due to things happening when they’re shoveling snow

ROCKFORD - It’s that time of the year when winter can really show its teeth. For adults, snow – especially the heavy stuff – also means lots of shoveling, which can lead to an assortment of health-related problems if you’re not careful and properly prepared for the winter season.

Photo: Serkan Gönültaş/PEXELS

“Every year, thousands of people end up in an emergency department due to things happening when they’re shoveling snow," says Amy Henderson, a family practice physician assistant for OSF HealthCare. "These include falls, sometimes people experience heart attacks from extraneous activities, back injuries amongst other things. So it’s really important to take some caution when you are going to be shoveling snow, and the snow is coming.”

Among the people at the greatest risk of experiencing potential issues while shoveling are the elderly, people with a history of back problems as well as people who have suffered a heart attack or other serious illness. Henderson says to check with your doctor first if you have any concerns about your health.

“If a person develops any chest pain, sharp, radiating arm pain, jaw pain, those are all signs and symptoms of a possible heart attack," says Henderson. "If those symptoms do not improve with rest after a short amount of time, it’s concerning. My advice would be to seek immediate medical attention if you’re concerned at all about a cardiac event or a heart attack; in this case it’s always good to play it safe than sorry.”

Safety is key when it comes to snow and ice. Henderson offers a few basic tips before getting started with shoveling your sidewalk or driveway.

“One of the most important things to do is wear the appropriate clothing to stay warm and avoid frostbite," says Henderson. "Also, stretching prior to going out and doing this activity is important so I recommend stretching 5 to 10 minutes before you go out in the cold. I also recommend staying hydrated because you’re doing physical activity.”

Other important tips include:

Lift with your legs, not your back

Push (don’t) lift the snow

Stay low to the ground

Shovel more frequently

Take breaks if you feel winded

Be aware of ice

Go inside to warm up in order to avoid frostbite

The same suggestions apply when using a snow blower. Many people are injured every year by pushing their snow blower, twisting their body or reaching into the snow blower.

The bottom line when it comes to snow shoveling, Henderson says, is play it safe, take your time and be sure to let your loved ones and friends know what you’re up to in the event something does happen. And don’t be afraid to ask for help.

Key Takeaways: 

• Every year, thousands of people visit the emergency department due to snow-related injuries or events. 
• People at the greatest risk are the elderly, those with back issues or a history of heart problems. 
• Wear appropriate clothing to stay warm and avoid frostbite. 
• Other tips include lifting with your legs, push (don't) lift the snow, take breaks, and be aware of ice. 
• If you experience a medical emergency, call 911. 

“If you really should not be shoveling snow, or you’re at higher risk, I recommend trying to find someone else who can do it for you, whether that’s a neighbor or a family member. I highly recommend that," adds Henderson. "It’s not worth the broken hip or the hospital follow up. Another thing for people who are at higher risk is to bring a cellphone. If you do fall, you’re able to call somebody.”

Before you bundle up and head outside to shovel your driveway, make sure you follow proper safety measures to avoid injury. If you or a loved one experiences severe injury, heart attack, or other medical emergencies while shoveling snow, call 911.

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Hypertension is a key risk factor for cardiovascular disease

Courtesy The American Heart Association

DALLAS - High levels of lipoprotein(a), a type of “bad” cholesterol, may be associated with a 24% higher risk of cardiovascular disease among people who have hypertension, however, CVD risk was not higher among those without hypertension, according to new research published today in Hypertension, an American Heart Association journal.

“High blood pressure is a known cardiovascular disease risk factor, and lipoprotein(a) is a type of inherited ‘bad’ cholesterol that may also lead to cardiovascular disease,” said lead study author Rishi Rikhi, M.D., M.S., a cardiovascular medicine fellow at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “We found that among people with hypertension who have never experienced a stroke or heart attack before, lipoprotein(a) seems to increase the risk of cardiovascular disease and risk of a major cardiovascular event like heart attack or stroke.”

Hypertension is a key risk factor for cardiovascular disease. In this study, hypertension was defined as a top number of 140 mmHg or higher, a bottom number of 90 or mmHg or the use of blood pressure medication. In 2017, the Association updated its definition of hypertension to be a top number of 130 mmHg or higher or a bottom number of 80 mmHg or higher.  Previous studies have indicated that when a person has hypertension and lipid imbalance, or dyslipidemia, their cardiovascular disease risk substantially increases. According to the study’s authors, there is less information on how much of an affect lipoprotein(a) may have on cardiovascular disease risk among people with hypertension.

Lipoproteins, which are made up of protein and fat, carry cholesterol through the blood. The subtypes of lipoproteins include low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipoprotein(a), or Lp(a). Much like LDL cholesterol, lipoprotein(a) cholesterol may deposit and build up in the walls of blood vessels, thus increasing a person’s risk of a heart attack or stroke.

The research used health data from the Multi-Ethnic Study of Atherosclerosis (MESA) study, an ongoing community-based study in the U.S. of subclinical cardiovascular disease—meaning the disease is discovered before there are clinical signs and symptoms. MESA is a research study including nearly 7,000 adults that began in 2000 and is still following participants in six locations across the U.S.: Baltimore; Chicago; New York; Los Angeles County, California; Forsyth County, North Carolina; and St. Paul, Minnesota. At the time of enrollment in the study, all participants were free from cardiovascular disease.

The current study included 6,674 MESA participants who had lipoprotein(a) levels and blood pressure assessed and for whom there was documented cardiovascular disease event data throughout MESA’s follow-up exams in approximately 2001, 2003, 2004, 2006, 2010, 2017 and in telephone interviews every 9 to 12 months to gather interim data on new diagnoses, procedures, hospitalization and deaths. The study’s participants were from diverse racial and ethnic groups: 38.6% self-identified as white adults; 27.5% self-identified as African American adults; 22.1% self-identified as Hispanic adults; and 11.9% self-identified as Chinese American (n=791) adults.  Additionally, more than half of the group was female (52.8%).

To evaluate the potential correlation between hypertension and lipoprotein(a) on the development of cardiovascular disease, the researchers first categorized the participants into groups based on their lipoprotein(a) levels and blood pressure measures obtained once at baseline:

• Group 1 (2,837 people): lipoprotein(a) levels less than 50 mg/dL and no hypertension.
• Group 2 (615 people): lipoprotein(a) levels greater than or equal to 50mg/dL and no hypertension
• Group 3 (2,502 people): lipoprotein(a) levels less than 50mg/dL and hypertension
• Group 4 (720 people): lipoprotein(a) levels ≥ 50mg/dL and hypertension

Participants were followed for an average of approximately 14 years and cardiovascular events, including heart attack, cardiac arrest, stroke or death from coronary artery disease, were tracked.

The study’s results include:

• A total of 809 of the participants experienced a cardiovascular disease event.
• Lipoprotein(a) levels had an effect on hypertension status that was statistically significant (meaning it was not due to chance).
• When compared to Group 1 (low lipoprotein(a) levels and no hypertension), Group 2 (higher lipoprotein(a) levels and no hypertension) did not have an increased risk for cardiovascular disease events.
• Less than 10% of Group 1 (7.7%) and Group 2 (participants 8%) had cardiovascular disease events.
• Participants in Groups 3 and 4, all of whom had hypertension, demonstrated a statistically significant increase in risk for cardiovascular disease events when compared to those in Group 1.
• Approximately 16.2% of the people in Group 3 (lower lipoprotein(a) levels and hypertension) had cardiovascular disease events, and 18.8% of the participants in Group 4 (higher lipoprotein(a) levels and hypertension) experienced cardiovascular disease events.

“We found that the overwhelming amount of cardiovascular risk in this diverse population appears to be due to hypertension,” Rikhi said. “Additionally, individuals with hypertension had even higher cardiovascular risk when lipoprotein(a) was elevated. The fact that lipoprotein(a) appears to modify the relationship between hypertension and cardiovascular disease is interesting, and suggests important interactions or relationships for hypertension, lipoprotein(a) and cardiovascular disease, and more research is needed.”

Everyone can improve their cardiovascular health by following the American Heart Association’s Life’s Essential 8: eating healthy food, being physically active, not smoking, getting enough sleep, maintaining a healthy weight, and controlling cholesterol, blood sugar and blood pressure levels. Cardiovascular disease claims more lives each year in the U.S. than all forms of cancer and chronic lower respiratory disease combined, according to the American Heart Association.

Sudden cardiac arrest and women, it can happen to women in their 30s

by Paul Arco
OSF Healthcare

ROCKFORD - Every year, about 350,000 people suffer sudden cardiac arrest (SCA) outside of a hospital setting with almost 90% of all cases being fatal.

Photo provided

Nancy Dagefoerde
OSF Cardiovascular Institute

While there is an underlying belief that heart problems such as SCA tend to be more of a concern for men, that’s not the case. In fact, women make up almost 40% of SCA episodes. Just as women may experience different symptoms of heart disease than men, their risk of SCA is somewhat different too.

According to Nancy Dagefoerde, an advanced practice registered nurse with OSF Cardiovascular Institute, SCA can happen to any adult 30 and older, depending on risk factors, family history and other issues such as a heart birth defect.

Dagefoerde says SCA is different than a heart attack, which occurs when there is a blockage in a coronary artery on the outside of the heart. Many times, a heart attack is the cause for the sudden cardiac arrest.

“Sudden cardiac arrest occurs when there's an irregular heartbeat," she says. "We call it an arrhythmia that causes the heart not to beat or have electrical activity anymore. So in general, there'll be no breathing and no pulse when you come upon a person that's having a sudden cardiac arrest.”

“The thing that may be different with women is oftentimes their symptoms are portrayed differently and they often can get missed," says Dagefoerde. "A woman may come to an emergency room or a health care provider and say ‘I'm more tired’ or ‘I'm more short of breath.’ It's not the typical elephant on my chest type of chest pain that a man may have. And so working them up for their symptoms, although they're more vague, is important to be preventive to catch these things early before there's damage.”

Another reason why women are at a higher risk for SCA is because they are more likely to delay seeking care for their symptoms since women tend to prioritize the health of other family members first.

“As all of us get older, the risk is higher for any of these conditions as far as heart disease, diabetes, blood pressure, so we need to be aware that maybe our numbers were okay, or we were doing pretty good when we were in our 20s and 30s," says Dagefoerde. "But as we age, we need those regular checkups and do that good preventive care, because things do change. And women are caring for husbands and parents, even children and grandchildren and they don't often take the time to care for themselves.”

Symptoms of SCA include:

• Fainting
• Dizziness
• Racing or irregular heartbeat
• Chest pain
• Shortness of breath
• Nausea

Risk factors for SCA include a previous heart attack, coronary artery disease, a prior episode of SCA, family history and personal or family history of abnormal heart rhythms, among others.

Dagefoerde has a simple message for any patient who is experiencing any potential cardiac symptom.

“This is another area that your health prevention will benefit you. So seeing your physician on a regular basis, having regular checkups, checking your labs, knowing your family history, knowing your own history, and doing all those things on a regular basis and don't ignore any symptoms that you may be having.”

If you see someone drop to the ground and think it could be SCA, call 911 immediately. The faster CPR is started and defibrillation is administered, the better the chances of survival.

Expert says certain risk factors increase your chance of blood clots

by Shelli Dankoff
OSF Healthcare

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Peoria -- In November, Today Show weatherman Al Roker was hospitalized after a blood clot that formed in his leg sent clots to his lungs. After being discharged on Thanksgiving he was readmitted almost immediately because he started showing more symptoms.

According to the Centers for Disease Control and Prevention (CDC), blood clots are a serious and growing health issue affecting an estimated 900,000 Americans each year resulting in nearly 100,000 deaths.

Big swollen leg with discomfort, the discoloration is not normal

Blood clots are a normal response to an injury where a blood vessel gets broken. If it doesn’t clot, you will continuously bleed causing a hemorrhage. The problem is when blood clots occur for the wrong reasons such as a piece of plaque breaking off in the artery to the heart which can cause a heart attack.

According to Mark Meeker, D.O., an internal medicine physician and vice president of community medicine at OSF HealthCare, another example is in the legs. He says blood usually flows relatively rapidly through our body but if something changes that flow, that’s when you could have a problem.

"If you think about if you mix cocoa and milk, and you stir it, it all dissolves. If you just dump it in there, it clumps up. So if our blood isn't flowing, it can tend to clump or clot. So if I have surgery, for example, and I'm laid up in bed, and I'm not moving, and the blood flow in the veins of my legs really slows down and starts to pool I can get a blood clot that shouldn't be there. It's blood that stays there. I might be okay, but if a blood clot breaks off and goes to my heart or lungs that's called a pulmonary embolus. That's very serious and can be life threatening."

Dr. Meeker says the signs to watch out for that you might have a problem depends on where the clot is located and what it’s affecting. In an artery, that is the high pressure system that delivers oxygen from the lungs, through the heart and out to your body. Dr. Meeker recalls a patient of his who developed pain in her leg but no swelling, the leg became pale looking and cold to the touch. The arterial clot prevented the leg from getting oxygen and the leg ended up having to be amputated because the arteries clotted off.

The other side is the low pressure venous system bringing the blood back to the heart and lungs to be re-oxygenated and recirculated. On the venous side, a clot can cause a backup not unlike clogging the drain to a sink. This will cause blood to build up in your leg and the leg to swell, maybe change color, and potentially cause a pain in the calf if the swelling starts to increase pressure inside the muscle. If the clot then breaks off and goes to your heart and lungs, as in Al Roker’s case, you could have chest pain, shortness of breath, and heart palpitations.

"Big swollen leg with discomfort, the discoloration is not normal. If you have one leg swollen and not the other and you've either had recent surgery or a recent illness, or you are sitting for a long period of time, usually. Either you really got into a movie marathon or you're on a plane to Hawaii or something like that, or a long car ride. Some people get in the car and they drive for hours. They don't take a break to go for a small walk. All those are risk factors for those venous clots."

Dr. Meeker says there are risk factors that increase your chances of developing blood clots like smoking or taking birth control bills. But he adds blood clots don’t care, under the right circumstances they will happen to anybody

"If you have a family history of stroke or heart attack, you want to be checked out by your primary care team to see if you have genetic risk factors for heart attack or stroke because you have them in your family. And if you do there are specific things that can be done depending on what that risk profile looks like. From a general standpoint from the venous clots side, maintain a healthy weight, stay hydrated, and don't get dehydrated. Don't sit for unusually prolonged periods of time. You want to be up and moving around because movement is what gets the circulation that veins in the legs need to stay active and not clot."

Learn more about the signs and symptoms of blood clots and remember to reach out to your primary care provider if you are experiencing any of them, or visit your nearest emergency department if necessary.

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.

You've heard it before, as you age, exercise and eat healthy

by Tim Ditman
OSF Healthcare

RANTOUL - The National Institute on Aging says people age 65 and older are at a higher risk for heart attack, stroke, coronary artery disease and heart failure. February – American Heart Month - is the perfect time for people 65+ and their caregivers to arm themselves with the information and supplies needed to keep their heart healthy.

Karen Whitehorn, MD, is an internal medicine physician at OSF HealthCare. Of the many risk factors for heart issues in older people, she points to blood pressure as a big one to watch. Dr. Whitehorn says a healthy blood pressure reading is 130/80 and below.

"If you're on medication, take your medicine every day," to keep your blood pressure normal, Dr. Whitehorn says. "Exercise and eat healthy. You want a diet that's low in sodium and processed food. You want fruits, vegetables, fresh whole grains and lean proteins like turkey, chicken and lean pork."

An annual physical exam is critical, too.

On exercise, Dr. Whitehorn admits mobility may be an issue for older people. She recommends checking with a health care provider like a physical therapist to see what exercises are right for you. Some workouts can be done sitting down. Low-impact cardio like walking is an option.

"But if any exercises hurt, don't do them," Dr. Whitehorn warns. "If you walk too far and you're having pain, stop walking. You might not want to walk every single day."

Dr. Whitehorn says if you have high blood pressure, check it at least once a day at home. Ask your health care provider what type of home blood pressure kit is best. If you don't have high blood pressure, check it every six months. Your provider should also check your blood pressure when you have an appointment. But Dr. Whitehorn says don't worry if that reading is a little high.

"People get nervous just seeing the doctor. They're already a little upset because they have to come to the doctor," Dr. Whitehorn says of the phenomenon known as white coat syndrome. "So when you take their blood pressure, it goes up. Normally, the nurse takes the blood pressure first. Then, after the person has been resting for a while, the doctor takes it again. It usually comes down."

Other symptoms of heart issues include shortness of breath, chest pain and dizziness. Someone experiencing a heart attack might suffer nausea and neck, arm or shoulder pain. If you experience these symptoms, call 9-1-1 right away.

Your doctor may order a stress test to get a better idea if your symptoms are indeed due to a heart problem. Dr. Whitehorn says one type of stress test puts you on a treadmill while your heart rhythm is monitored.

"If the rhythm is abnormal, it might indicate there's a problem with your heart," Dr. Whitehorn says.

For people who can't tolerate walking or jogging on a treadmill, there is medicine to safely increase their heart rate while a health care provider monitors.

If the results of the stress test warrant further examination, a doctor will perform a cardiac catheterization. They will insert a catheter, usually through the groin, and send it up to your heart to take images using contrast dye. This will show if any of your arteries are narrow and what steps the provider will take next, short term and long term.

Learn more about heart care on the OSF HealthCare website.

Tips for a healthy heart during the holidays

(American Heart Association) -- Scientific research over time has shown an uptick in cardiac events during the winter holiday season, and more people die from heart attacks between December 25^th and January 1^st  than at any other time of the year.

The American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, has tips and resources to help you and yours have a happy, healthy holiday season.

"The holidays are a busy, often stressful, time for most of us. Routines are disrupted; we may tend to eat and drink more and exercise and relax less. We also may not be listening to our bodies or paying attention to warning signs, thinking it can wait until after the new year. All of these can be contributors to increasing the risk for heart attack at this time of the year," said Donald Lloyd-Jones, M.D., Sc.M., FAHA, volunteer president of the American Heart Association and Eileen M. Foell Professor of Heart Research, professor of preventive medicine, medicine and pediatrics, and chair of the department of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago. "This may be even more likely for many people who didn't get to be with family and friends last year due to COVID1-19 restrictions. It's incredibly important to be aware of these risks. Take a few simple steps that can help keep you heart healthy with much to celebrate in the new year."

Here are some things to be mindful of (a list we recommend checking twice):

• Know the symptoms and take action: Heart attack signs may vary in men and women and it’s important to catch them early and call 9-1-1 for help. The sooner medical treatment begins, the better the chances of survival and preventing heart damage.
• Celebrate in moderation ‘Tis the season for unhealthy changes in diet and higher alcohol consumption. Eating healthfully during the holidays doesn’t have to mean depriving yourself, there are still ways to eat smart. Look for small, healthy changes and swaps you can make so you continue to feel your best while eating and drinking in moderation, and don’t forget to watch the sodium.
• Plan for peace on earth and goodwill toward yourself: Make time to take care of yourself during the busy holiday. Reduce stress from family interactions, strained finances, hectic schedules and other stressors that tack on this time of year, including traveling.
• Keep moving: The American Heart Association recommends at least 150 minutes of physical activity per week and this number usually drops during the holiday buzz. Get creative with ways to stay active, even if it’s going for a family walk or another fun activity you can do with your loved ones.   
• Stick to your meds: Busy holidays can make way for skipping medications, forgetting them when away from home, or not getting refills in a timely manner. Here is a medication chart to help stay on top of it, and be sure to keep tabs on your blood pressure numbers.

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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With heart attacks, timing is everything and it can save your life

by Tim Ditman
OSF Healthcare

URBANA -- To say time was of the essence for Tammi Fanson on July 18, 2022, would be an understatement.

The Gibson City, Illinois, woman had been dealing with high blood pressure, stress, fatigue and shortness of breath, but she chalked it up to life just being difficult. But on that day, she found herself at her local Gibson Area Hospital in the midst of a heart attack.

Fanson was then taken by ambulance to OSF HealthCare Heart of Mary Medical Center in Urbana, Illinois – around 40 minutes on a regular drive but half that with the blaring red lights. That, combined with the cooperation between the two hospitals, and Fanson was fast-tracked straight to the cardiac catheterization laboratory at OSF Heart of Mary, something Tammi and her husband Doug say saved her life.

"They knew me," Tammi Fanson says. "They knew exactly what was going on. There must have been a lot of communication even before I got there. So it was very comforting."

"The comfort that she had knowing this crew was waiting for her, it’s pretty remarkable," Doug Fanson adds.

Fanson’s case is an example of the importance of what’s known as door to balloon time. That measures the time between when a patient has first contact with a medical professional to when a balloon is placed in their heart’s arteries to get rid of blockages and resume blood flow. For Fanson, she had a balloon within 27 minutes of arriving at OSF Heart of Mary.

"Time is muscle here in the cath lab," says Jo Lehigh, a registered nurse at OSF Heart of Mary who was on Fanson’s care team. "Every minute that goes by could be tissue death."

That means Lehigh and other OSF caregivers in the cath lab have to be agile. For starters, they have a limited response time to get to the hospital once they get the page that a patient is inbound.

On the balloon process itself, Lehigh says physicians start by accessing an artery through a patient’s wrist or groin.

"We send in a catheter. We go up into the heart and we shoot in contrast dye. The contrast dye helps us to visualize the artery to see where the blockage is located and how severe it is," Lehigh says. "And from there, the doctor goes in with a small balloon on the catheter and inflates the balloon. Then we'll go in with a stent and another balloon to open it up. So we have blood flow after it's all said and done."

The Fansons praise Lehigh for the care Tammi received.

"She was our angel," Doug Fanson says, the emotion in his voice strong.

Tammi Fanson recalls Lehigh at her side in the heat of the battle to save her life.

"I said, ‘Am I going to be OK?’" Fanson says. "And she was right there assuring me that everything was going to be OK."

Lehigh followed up with Fanson, too, during her stay at OSF Heart of Mary.

"I do go down and check on the patients. I make sure they're doing OK and just kind of show my face because a lot of times they can remember my name and remember my voice, but they don't really remember me or what I looked like." Lehigh says. "So I have to go down there and just kind of keep up on them and make sure they're doing OK. I think that builds a good relationship."

Four heart stents later, Fanson is now recovering at home and is doing well. She’s enrolled in cardiac rehabilitation, a typical but vital part of the path back to normal. But most importantly of all, Fanson has a new lease on life. She appreciates the importance of diet, exercise, healthy blood pressure and knowing your family history of heart troubles. And she’s found ways to reduce stress, at least temporarily, like watching the sunrise with no distracting devices in sight.

"I could have easily went back to sleep that night," Tammi Fanson says, recalling the evening that changed her life. "Don’t do that. Go in [to the hospital]. Get your regular checkups. And listen to your body."

"Listen to [your health care providers]. Rely on them. Lean on them. They’re experts," Doug Fanson says. "It helps you get through the traumatic times."

Lehigh concurs with all those sentiments. She adds that if you find yourself in Fanson’s shoes – having sudden, significant symptoms of a heart attack – don’t drive yourself to the hospital. Call 9-1-1.

"The ambulance is going to have everything there that you need," Lehigh says. "They’re going to have the electrocardiogram, the aspirin. They’re going to have all the equipment and supplies they’d need to help make this a smooth and quicker process."