Cardiology
Practice-changing research in cardiology
New research, presented at a major cardiology congress, is set to inform best practice in cardiovascular care, with the aim of improving outcomes and reducing mortality. The Clinical Services Journal highlights some key findings.
Novel findings were revealed in more than 3,750 abstracts and clinical cases presented by scientists, from 86 countries, at the Annual Congress of the European Society of Cardiology. Practice-changing research was presented
including new findings from major studies. Among these included the findings from STEP- HFpEF, the first trial of a pharmacologic agent to specifically target obesity as a treatment strategy for heart failure with preserved ejection fraction. The study indicated that obesity is a target for therapeutic intervention in this vulnerable patient group. The results of NOAH-AFNET 6 were also
presented, which showed that anticoagulants cause bleeding without preventing stroke in patients with atrial high-rate episodes (AHRE), but without electrocardiogram (ECG)-diagnosed atrial fibrillation. The results of this major trial suggest that ECG documentation of atrial fibrillation is needed before starting oral anticoagulation in patients with AHRE. Other highlights included the results
of COP-AF, a trial in patients undergoing major non-cardiac thoracic surgery, which found that colchicine does not significantly reduce perioperative atrial fibrillation or myocardial injury after non-cardiac surgery.
Stark warning for childhood risks Researchers also issued a stark warning that hours of inactivity during childhood could be setting the stage for heart attacks and strokes later in life.1
The study found that sedentary
time accumulated from childhood to young adulthood was associated with heart damage – even in those with normal weight and blood pressure. “All those hours of screen time in young people add up to a heavier heart, which we know from studies in adults raises the likelihood of heart attack and stroke,”2
said study author
Dr. Andrew Agbaje of the University of Eastern Finland, Kuopio, Finland. “Children and teenagers need to move more to protect their long-term health,” he asserted.
This was the first study to investigate the cumulative effect of smartwatch-assessed sedentary time in young people and cardiac damage later in life. It was conducted as part of the Children of the 90s study, which began in 1990/1991 and is one of the world’s largest cohorts with lifestyle measurements from birth.3 At 11 years of age, children wore a smartwatch with an activity tracker for seven days. This was repeated at 15 years of age and again at 24 years of age. The weight of the heart’s left ventricle was assessed by echocardiography, a type of ultrasound scan, at 17 and 24 years of age and reported in grams relative to height (g/m2.7
).
The researchers analysed the association between sedentary time between 11 and 24 years of age and heart measurements between 17 and 24 years of age after adjusting for factors that could influence the relationship including age, sex, blood pressure, body fat, smoking, physical activity and socioeconomic status. The study included 766 children, of whom
55% were girls and 45% were boys. At 11 years of age, children were sedentary for an average of 362 minutes a day, rising to 474 minutes a
day in adolescence (15 years of age), and 531 minutes a day in young adulthood (24 years of age). This means that sedentary time increased by an average of 169 minutes (2.8 hours) a day between childhood and young adulthood. Each one-minute increase in sedentary time
from 11 to 24 years of age was associated with a 0.004 g/m2.7
increase in left ventricular mass
between 17 to 24 years of age. When multiplied by 169 minutes of additional inactivity this equates to a 0.7 g/m2.7
of a 3 gram increase in left ventricular mass between echocardiography measurements at the average height gain. A previous study in adults found that a similar increase in left ventricular mass (1 g/m2.7
daily rise – the equivalent
) over a seven-year
period was associated with a two-fold increased risk of heart disease, stroke, and death.4 Dr. Agbaje said: “Children were sedentary for
more than six hours a day and this increased by nearly three hours a day by the time they reached young adulthood. Our study indicates that the accumulation of inactive time is related to heart damage regardless of body weight and blood pressure. Parents should encourage
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