Angina - Causes, symptoms & treatments
Phenylacetylglutamine Levels Linked To Coronary Heart Disease In Women
Higher plasma levels of phenylacetylglutamine (PAGln) are associated with an increased risk for coronary heart disease (CHD), particularly among female individuals with diets higher in animal foods and lower in plant foods, according to study results published in the Journal of Clinical Endocrinology & Metabolism.
Although previous study findings suggest a link between PAGln levels and stenosis among patient with coronary artery disease, the association between PAGln levels and CHD among patients at usual risk remains unclear.
To investigate the association between plasma PAGln levels and cardiometabolic risk factors on the basis of dietary patterns among female individuals, researchers sourced data from 2 studies: (1) a prospective nested case-control study of incident CHD in the Nurses' Health Study (NHS; n=1520); and, (2) a cross-sectional study of women participating in the Women's Lifestyle Validation Study (WLVS; n=725).
For the NHS component, the primary outcome was non-fatal myocardial infarction or fatal CHD across 11 to 16 years. Participants were stratified on the basis of plant-based diet index. For the WLVS component, the researchers assessed the relationship between dietary intake and PAGln levels.
Among the WLVS participants, higher intakes of dietary protein and phenylalanine were positively associated with PAGln levels, particularly from red and processed meat (P =.015), but not from poultry or fish/seafood. In contrast, higher vegetable intake was linked to lower PAGln levels (P =.024).
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Adherence to plant-based diets attenuated unfavorable associations between PAGln and CHD risk, highlighting the importance of interplays of diet and the novel microbial metabolite in relation to long-term CHD risk.
Higher PAGln levels were associated with significant differences in various lipid and insulin-related biomarkers. Specifically, a 1-SD increment in log-transformed PAGln was associated with:
Among the NHS participants (mean age, 64.6 years), 760 had incident CHD and 760 were control participants. The CHD vs control group had:
Notably, a 1-SD increment in PAGln was associated with an increased risk for CHD (relative risk [RR], 1.11; 95% CI, 1.003-1.22), with the risk being particularly elevated among participants with low adherence to a plant-based diet (adjusted RR, 1.22; 95% CI, 1.05-1.41; P =.008). Conversely, no significant risk increase was observed among those with high adherence to a plant-based diet.
Study limitations include the assessment of PDI and other covariates based on self-reports, absence of data on creatinine levels, and limited generalizability beyond female individuals who were health professionals.
The study authors concluded, "Adherence to plant-based diets attenuated unfavorable associations between PAGln and CHD risk, highlighting the importance of interplays of diet and the novel microbial metabolite in relation to long-term CHD risk."
Multiple study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.
This article originally appeared on Endocrinology Advisor
How To Survive A Heart Attack In Hot Weather, According To Experts
The US has experienced record high temperatures over the past few weeks. Extreme heat can exacerbate chronic conditions, including heart problems, so knowing what to do when someone is having a heart attack is essential.
There are steps you can take to improve the chances of survival and potentially save a life when the unthinkable happens. Here's how to survive a heart attack or help someone having one.
For more tips about your health, learn how to check your heart metrics at home and CNET's recommendations for the best heart rate monitors. You'll also want to find out about one of the most important elements of your health: your blood type.
Common symptoms of a heart attack magicmine/Getty ImagesWhen you think "heart attack," classic symptoms such as chest discomfort might first come to mind. But heart attacks can present differently in men and women, and in people with certain diseases, like diabetes.
Heart attack symptoms could include:
"Essentially anything from the belly button up," says Dr. Khadijah Breathett, a heart failure transplant cardiologist and tenured associate professor of medicine at Indiana University. "Constant pressure should raise concern that you should see your doctor, and it's OK if it's something else. We'd rather have an individual come see a health care professional and get evaluated rather than toughing it out at home, because that is what contributes to the escalating risk of death."
1. Call 911, no matter whatIf you feel any of the above symptoms, even if you aren't sure it's a heart attack, you should call 911 immediately, doctors recommend.
"If you feel unwell, or you're starting to have chest discomfort, seek medical attention quickly, because the sooner you get treated, the better," says Dr. Grant Reed, an interventional cardiologist and director of Cleveland Clinic's STEMI program. "A lot of patients ignore their symptoms, and by the time they come in, their heart muscle has already died."
Richard T. Nowitz/Getty ImagesThe No. 1 indicator of how well you're going to do after a heart attack is how fast you recognize your symptoms, Reed adds. There's a strong relationship between when you start to have your heart attack (which is generally when symptoms start) and how fast doctors can open up the blocked coronary artery that's causing it -- the shorter the time, the better the outcomes, not just regarding survival but also the likelihood of heart failure or needing to be readmitted to the hospital.
When you get to the hospital, medical professionals will likely perform an electrocardiogram (EKG or ECG), which will determine the diagnosis of a heart attack. If it is a heart attack, you'll be taken to the cardiac catheterization laboratory, where a coronary angiography will be performed. If you have a blockage in your coronary artery, the doctors will offer treatment with a balloon and a stent to keep the artery open.
Many people are hesitant to seek emergency medical care due to a lack of insurance or immigration status. But in the US, hospitals are required to treat all people who come in with life-threatening emergencies.
"It's a lot better to be treated and deal with the financial ramifications after the fact," Reed says. In most cases, costs can be sorted out with the hospital, he adds.
jayk7/Getty Images 2. Have an ambulance take you to the hospitalIf you suspect you're having a heart attack, don't drive yourself to the hospital: Call an ambulance. You could lose consciousness and hurt yourself or others on the road, says Dr. Joel Beachey, a cardiologist at Mayo Clinic Health System in Eau Claire, Wisconsin. The same goes for having a loved one drive you -- if your symptoms worsen, they won't be able to help you while they're driving, and may be distracted.
Paramedics can provide the best and fastest care while you're on the way to the hospital, including giving you an assessment and providing some treatment, Beachey says.
If you're with someone who is having heart attack symptoms and becomes unconscious, you should first call 911 and then engage in CPR, Breathett says. (You can find free CPR training at your local American Heart Association branch and many other places.)
3. Take aspirin, if you have itIf you're having heart attack symptoms and have access to aspirin, take a full dose of 325 mg after calling the ambulance, Beachey says. (If you have baby aspirin, which comes in an 81 mg dose, take four of those.) He recommends chewing it instead of swallowing, so it gets into your system faster.
The reason? When you're having a heart attack, a plaque inside your arteries becomes unstable and ruptures, which forms a blood clot that can close off supply to that artery. Taking aspirin can help break down some of that blood clot.
ER Productions Limited/Getty Images 4. Advocate for yourselfThough in an ideal world, health care providers would take all patient concerns seriously when it comes to heart attack symptoms, studies show women and people of color are less likely to receive adequate treatment for heart attacks and heart disease. For example, older Black women were 50% less likely to be treated when they arrived at a hospital with heart attack or coronary artery disease symptoms than white women, including after accounting for education, income, insurance status and other heart health complications like diabetes and high blood pressure, a 2019 study found.
"It's been very clear over most of our history in the US that women and people of color are not heard," Breathett says. "Their symptoms get dismissed, and they have worse outcomes. As a health care system, we have a lot more work to do to change that system so that each person can get equitable care irrespective of their demographic."
Until that time comes, patients need to be their own advocate and speak up for themselves, she adds. And if they aren't being heard, they have the right to seek care elsewhere.
One tip recommended by a resident on TikTok: If you feel a provider isn't taking your symptoms seriously, for heart health or otherwise, you can ask the provider, "What is your differential diagnosis?"
A differential diagnosis is a term to describe what the different diseases are that could be contributing to your symptoms, basically asking the provider to explain why they've ruled out a heart attack and what else it could be. "That might help a person realize, oh, I haven't effectively tested to make sure this is not cardiac disease," Breathett says.
You can also bring a family member or friend to help ask questions on your behalf. Write down questions in advance if you can, so you can have them addressed during your short visit. And call back with any questions that weren't answered. If you're not satisfied or feel that you're not being heard, seek out another care team.
5. Work on preventionYou've heard it a million times, but that's because it's true: The best way to prevent a heart attack is maintaining a healthy diet, doing moderate exercise for 120 to 150 minutes per week, keeping your cholesterol and blood pressure under control and not smoking.
Petar Chernaev/Getty ImagesHeart attacks can happen to people of any age, race or gender. You should get regular physical exams with your primary care provider to assess your risk, and make lifestyle changes that can help with prevention. Some people might also benefit from taking a baby aspirin every day as a preventative measure, but you'll need to talk to your care provider about that.
Exercise is important even if you have a history of heart trouble, Beachey says.
Knowing what to do to prevent and respond to a heart attack is just one of the many important elements of your health you should know about. Read on to discover the best workouts to strengthen your heart, the difference between the types of cholesterol and how your diet affects your health. Plus, if you're looking for new ways to monitor your metrics, check out CNET's list of recommended fitness trackers and blood pressure monitors.
Radial Artery Access Safe For Peripheral Vascular Intervention
Radial artery access is safe and feasible for peripheral vascular intervention (PVI) in patients with peripheral artery disease (PAD), according to a study in the American Journal of Cardiology.
Researchers retrospectively reviewed consecutive endovascular interventions for lower extremity and subclavian artery disease with documented radial artery access at a single center from February 2020 to September 2022. All patients were assessed at 30 days, 6 months, and 1 year after the procedure.
The primary endpoint was procedure success rate, which was successful completion without conversion to femoral access. Secondary endpoints included the composite of access site complication and postoperative stroke.
A total of 447 patients had 491 endovascular interventions for lower extremity and subclavian disease, of whom 143 patients (32%) had 156 (31.8%) endovascular interventions with radial artery access (97.4%) and ulnar artery access (2.6%). The participants had a mean age of 70.9±8.1 years and 100 (69.9%) were men.
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…the growing body of evidence supporting its [radial artery access in PVI] use suggests that it may become more commonplace in the future.
Access occurred in the right radial artery in 92.9% of cases, left radial artery in 4.5% of cases, and right ulnar artery in 2.6% of cases. Among the 261 lesions, 37.5% were located in the superficial femoral artery and 19.2% in the common iliac artery.
The primary endpoint of procedure success rate occurred in 98.1% of cases. Conversion to femoral access was observed in 3 cases (1.9%) from arterial spasm, arm pain, and noncrossable lesions, and 2 patients (1.3%) needed concomitant pedal access for lesions below the knee. The secondary outcome was observed in 3.84% of participants, with 5 patients (3.2%) having an access-site hematoma that did not require blood transfusion or surgical intervention. No pseudoaneurysms occurred, and 1 patient (0.64%) had an in-hospital stroke.
Mortality rates at 30 days, 6 months, and 1 year were 1.4%, 2.8%, and 4.2%, respectively. Acute kidney injury occurred in 2 patients (1.3%), and 19 (13.3%) follow-up interventions via radial artery access were performed at 1-year. Follow-up intervention through other access was needed for 16 cases (11.2%).
Patients' symptoms were reduced at 30 days, 6 months, and 1 year. At baseline, 97.4% of participants were Rutherford class III, IV, or V, which decreased to 2.0% at 30 days (P <.0001), 2.7% at 6 months, and 4.8% at 1 year.
Limitations of the study include the retrospective design and follow-up duration, and the rate of radial artery occlusion was not reported. In addition, younger patients were selected to proceed with femoral access or pedal access to allow use of currently available drug-coated balloons.
"While the technique [radial artery access for PVI] is not yet widely adopted in clinical practice at this time due to availability of wide variety of interventional equipment, the growing body of evidence supporting its use suggests that it may become more commonplace in the future," the investigators wrote.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.
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