New research was presented at ACC 2022, the annual American College of Cardiology Scientific Session, from April 2-4. The features below highlight some of the studies that emerged from the conference.
Women Undergo Fewer CV Procedures & Have Higher Mortality
Despite an increase in the number of cardiovascular (CV) procedures performed every year, data on sex and race-based differences in clinical outcomes are limited. To learn more, Annabelle Volgman, MD, and colleagues conducted a retrospective cohort study between January 2016 and December 2019 among more than 2 million index hospitalizations for adult cardiac procedures (mean age, 69.1±13.5; 38.2% women; 77.1% White, 9.6% Black, 7.5% Hispanic, 2.4% Asian, 3.4% other. A total of 867,853 (41.8%) index procedure hospitalizations had a Charlson comorbidity index (CCI) of greater than or equal to three. Women were older than men (mean age, 71.5 vs 67.7; P<0.001) and had a CCI greater than or equal to 3 (42.1% vs 41.6%; P<0.001). Multivariate regression demonstrated that women had a significantly higher likelihood of in-hospital mortality (adjusted OR, 1.13; 95% CI, 1.07-1.20) after controlling for age, sex, race, regional hospital location, bed capacity, income, insurance, and CCI. The prevalence of common, primary CV procedures rose from 24.1% in 2016 to 26.8% in 2019. The adjusted mortality rate decreased from 0.86% in 2016 to 0.74% in 2019 (P value for trend, <0.001).
Cardiovascular Benefits of Exercise Enhanced in Those With Anxiety & Depression
Data indicate that anxiety and depression are tied to increased stress-associated neurobiological activity and heightened cardiovascular (CV) risk, which can be decreased with exercise. Thus, Hadil Zureigat, MD, and colleagues hypothesized that individuals with anxiety or depression may experience relatively greater CV benefits from exercise and analyzed self-reported physical activity data from 50,359 patients with either condition (median age, 59). Of them, 4,033 developed major adverse CV events (MACE) during a median 1.8 years. Models adjusted for CV risk factors showed that exercise was associated with reduced MACE risk (OR, 0.838; 95% CI, 0.779-0.901). Exercise was also tied to a greater decrease in coronary MACE risk among individuals with anxiety or depression (p-interaction<0.05). “Our research emphasizes the importance of the stress-related neural mechanisms by which physical activity acts to reduce CV risk,” Dr. Zureigat said in a statement.
Myocardial Infarction Survivors May Experience Cognitive Impairment
Research increasingly shows a link between coronary artery disease and the incidence of cognitive impairment (CI). To study this association, Paweł Burchardt, MD, FESC, and colleagues examined rates of cognitive dysfunction among individuals who had experienced a myocardial infarction (MI). Among 220 patients hospitalized for MI, CI was identified at baseline in 40.5% of participants with the Mini-Mental State Examination (MMSE) and in 34.5% using the Clock Drawing Test (CDT). At 6 months, the investigators observed significantly better outcomes for both tests; CI prevalence decreased to 33.6% with MMSE and 26.8% with CDT. However, they also reported that 26 patients (11%) were diagnosed with CI at 6 months following a normal MMSE outcome at baseline, with similar results seen with the CDT. Patients with permanent disorders based on the CDT were significantly older (aged 58.6 vs 64.1; P=0.002); they also had a lower ejection fraction (49.3 vs 44.8; P=0.009) and a higher level of brain natriuretic peptide and troponin compared with those without CI. The study team is assessing data from a larger follow-up study to examine cognitive trends after MI and the drivers that influence them.
Extreme Heat Increases Cardiovascular Mortality
Previous research demonstrates a link between extreme heat and cardiovascular (CV) mortality, but it is currently uncertain whether this association is present across the United States or in different gender or race/ethnic subgroups. Sameed Ahmed Khatana, MD, and colleagues reviewed daily maximum heat index levels from May through September for all counties in the contiguous US from 1979 to 2017 and monthly CV mortality rates for adults aged 20 and older. In 3,108 counties between 2008 and 2017, every added extreme heat day in the summer months was associated with a 0.13% (95% CI, 0.04%- 0.21%) increase in monthly adult CV mortality rates. This association was significant for males (0.21%; 95% CI, 0.08%-0.33%) but not females. Among racial and ethnic subgroups, this link was significant for non-Hispanic Black individuals (0.27%; 95% CI, 0.10%-0.45%) but not for non-Hispanic White (0.10%; 95% CI, -0.03% to 0.20%) or Hispanic (-0.04%; 95% CI, -0.43% to 0.36%) adults. “Extreme heat has an important effect on CV mortality across the country; however, that effect is being felt disproportionately in different populations,” Dr. Khatana said in a statement.
Regular Coffee Consumption Demonstrates Cardiovascular Benefits
Prior studies indicate beneficial effects of coffee consumption on incident cardiovascular (CV) outcomes but have been limited by small sample sizes. Peter M. Kistler, MD, and colleagues examined associations between coffee consumption and incident arrhythmia, CV disease (CVD), and mortality among 382,535 individuals (aged 57±13; 52% female). Consuming two to three cups of coffee per day was found to confer the lowest risk for CVD (HR, 0.91), coronary heart disease (HR, 0.90), cardiac failure (HR, 0.85) and all-cause mortality (HR, 0.86). Stroke risk was the lowest at less than one cup per day (HR, 0.85). The researchers reported that a U-shaped relationship was seen between greater coffee consumption and incident arrhythmia, with the lowest risk at two to three cups per day (HR, 0.92). CV mortality risk was lowest with one cup per day (HR, 0.83). All findings were significant (P<0.01). “Because coffee can quicken heart rate, some people worry that drinking it could trigger or worsen certain heart issues,” Dr. Kistler said in a statement. “This is where general medical advice to stop drinking coffee may come from. But our data suggest that daily coffee in-take shouldn’t be discouraged, but rather included as a part of a healthy diet for people with and without heart disease.”