Angina - Causes, symptoms & treatments
Blood Platelet Score Detects Previously Unmeasured Risk Of Heart Attack And Stroke, Finds Study
Platelets are circulating cell fragments known to clump up and form blood clots that stop bleeding in injured vessels. Cardiologists have long known that platelets can become "hyperreactive" to cause abnormal clotting that blocks arteries and contributes to heart attack, stroke, and peripheral artery disease.
Despite this major contribution to cardiovascular risk, routine measurement of whether each patient's platelets clump (aggregate) too much has been infeasible to date. This is because results delivered by the method typically used to determine platelet activity, called platelet aggregometry, vary too much from lab to lab.
To address this challenge, a new studyled by researchers at NYU Grossman School of Medicine, precisely identified a group of patients with platelet hyperreactivity, and then surveyed them to reveal 451 genes the activity of which differed significantly in those with hyperreactive platelets versus those without. Publishing online August 20 in Nature Communications, the research team then used bioinformatics to assign a weight to each genetic difference and generate each patient's Platelet Reactivity ExpresSion Score (PRESS).
"Our results demonstrate that our new platelet-centric scoring system can, for the first time and across populations, circumvent aggregometry to reliably predict platelet hyperreactivity and the related risk of cardiovascular events," said corresponding study author Jeffrey Berger, MD, director of the Center for the Prevention of Cardiovascular Disease at NYU Grossman School of Medicine.
The researchers found that their new score can detect platelet hyperreactivity, both in patients at imminent risk of heart attack, and in healthy patients whose future risk may otherwise remain unknown.
"Physicians currently prescribe aspirin, a medication that counters platelet activity, to patients based on available risk factors, including high cholesterol or high blood pressure, which are not directly related to platelet function," added Berger. "PRESS promises to help physicians confine anti-platelet treatment to the people most likely to benefit: those with platelet hyperreactivity."
By acting on platelets, aspirin is known to protect against abnormal clotting, but in doing so, increases risk of bleeding, said the study authors. The field needs a reliable way to identify patients for whom protection against heart attack outweighs bleeding risk.
Platelet ScoreProgress toward the design of the PRESS began with a shift in the field away from aggregometry methods that expose each patient's platelets to high doses of proteins known to strongly encourage aggregation. Platelets that do not aggregate under these extreme conditions are labelled dysfunctional, but these tests were not designed to directly assess hyperreactivity.
Experience on Berger's team and in other labs working with platelets led to a switch to an aggregometry method that instead exposes platelets to a very small dose (4 μM or microMolar) of epinephrine known to weakly encourage aggregation. The field settled on 60 percent aggregation in platelet sample at 0.4 μM of epinephrine as the threshold over which platelets would be designated as hyperreactive. While this method is not new, the current study provided new evidence that patients meeting this hyperreactivity definition are at much greater risk for cardiovascular events.
Specifically, the team used the newer, but still labor-intensive, aggregometry method to track the impact of platelet activity status on MACLE (major adverse cardiovascular and limb events), a composite measure of death, heart attack, stroke, and lower extremity amputations in patients enrolled in the Platelet Activity and Cardiovascular Events in PAD (PACE-PAD) clinical study. MACLE was measured in this group of high-risk patients after they underwent lower extremity revascularization (LER), a group of procedures that open blocked arteries.
In 254 PACE-PAD patients whose platelet aggregation was measured with 0.4 μM of epinephrine, 17.5% showed hyperreactive platelets, and those patients with hyperreactivity had more than double the incidence of heart attack, stroke, or acute limb ischemia or major amputation within the 30 days after LER than those without hyperreactivity.
While the team has an uncommon expertise in aggregometry, and despite these learnings, their goal was to create a generalizable measure of risk that could one day be easily performed in physicians' offices. To make global implementation feasible, the researchers designed PRESS based on a genetic signature and independent of blood collection techniques and other variables that affect aggregometry.
To create PRESS, the researchers collected platelet genetic material from 129 PACE-PAD patients before their LER procedure and designed the score based on the genetic differences seen with hyperreactivity. The researchers confirmed the score's accuracy by checking it against platelet aggregation tests.
To further validate PRESS, the team explored the link between the score and cardiovascular risk in several other patient groups. Among these was the Heart Attack Research Program, which enrolled women undergoing coronary angiography. In this group PRESS was found to be higher in those who had a heart attack than in those with stable coronary artery disease. Among patients with lower extremity atherosclerosis followed for an average of 18 months, patients with PRESS above the middle (average) score were 90% percent more likely to have a major cardiovascular event than those below it.
"In current practice, anti-platelet therapy is not routinely recommended for the prevention of a first heart attack or stroke, but a platelet-based test would help to identify patients at highest risk, and those who would benefit most from anti-platelet therapy to prevent a cardiovascular event," says study author Tessa Barrett, PhD, assistant professor in the departments of Medicine and Pathology at NYU Langone. "Our score has the potential to further personalize cardiovascular disease risk prevention."
Reference:
Berger, J.S., Cornwell, M.G., Xia, Y. Et al. A Platelet Reactivity ExpreSsion Score derived from patients with peripheral artery disease predicts cardiovascular risk. Nat Commun 15, 6902 (2024). Https://doi.Org/10.1038/s41467-024-50994-7
Suffering From Heart Palpitations In The Night Can Be Incredibly Anxiety-inducing
If you've ever experienced heart palpitations, you'll know that they're pretty unpleasant to say the least.
While most of the time, we don't even notice our heartbeat, experiencing a palpitation can be extremely unnerving and induce a variety of different symptoms, including anxiety - which really doesn't help the situation.
Heart palpitations are usually harmless. (Getty Stock Photo) What exactly is a heart palpitation?Well, over on the Guys and St Thomas' Specialist Care website, consultant cardiologist, Dr Mumin Noor explains that palpitations are essentially 'the sensation of being aware of your heart beating'.
"They are a common condition and not usually a serious cause for concern," he explains.
"It may feel like your heart is pounding, fluttering, beating irregularly, or beating faster."
You can feel palpitations in your chest or neck and the feeling can last for just moments or even minutes.
While they are often harmless, they can sometimes indicate a condition like arrhythmia, which is an irregular heartbeat.
You might have noticed palpitations at night time, which can sometimes occur as a result of lying down.
"It is understood that people who sleep on their side – in particular on their left side – could be more likely to have heart palpitations at night. Because the heart is next to the chest wall, the sensation can reverberate more strongly in this position," says Dr Noor.
You may also be more aware of your heartbeat at night, due to the fact it's quiet and there are fewer distractions.
Symptoms include:The NHS explains that there are a number of factors that can increase the risk of palpitations.
These include:
They add: "Sometimes heart palpitations can be a sign you're going through the menopause. Some people get them during pregnancy.
"Less often, they can be caused by a condition such as iron deficiency anaemia, an overactive thyroid (hyperthyroidism) or a heart rhythm problem (arrhythmia)."
When to seek medical helpThey note that if you have chest pain, shortness of breath, or you feel faint, seek urgent medical attention and call 999.
If you are concerned about heart palpitations, it's important to consult your doctor.
You may be able to have an ECG which is a non-invasive test in which small pads are stuck to your skin to assess the electrical signals coming from your heart.
We Found A Must-see Labor Day Deal On Under-desk Treadmills: Save 73% On A Walking Pad
Summer is winding down, which means it's time to make sure your home gym is all set for you to move your favorite workouts indoors. Right now, you have a chance to get the upgrades you need at a major discount thanks to the early Labor Day deals we're finding at Amazon.
One of the biggest deals is on the Sperax walking pad. The under-desk treadmill is normally listed at $700. But ahead of Labor Day, you can get it for just $190. Clip the $40 coupon at checkout to bring the price down even further to $150.
Get the Sperax walking pad at Amazon AmazonThis lightweight walking pad is the perfect way to make meeting your step count goals easy. It's compact enough to fit under a couch or bed when you're not using it, while the transport wheels make it easy to take out when you do want to get some steps in. If you work from home, that means you can easily swap out your office chair for a treadmill to get some walking in while you answer emails or attend virtual meetings. Then, roll it out of the way and switch back to your chair for more focused work.
The 2.0 HP motor is quiet and you'll also get a remote to easily start, stop and change the speed on your treadmill as you go. This handy walking pad has an adjustable speed ranging from 0.6 mph up to 4 mph. While that's not a very fast maximum speed, it's enough for a light jogging session to get your heart pumping.
Right now, the 4.7-star rated under-desk treadmill is 73% off at Amazon. Combine that with the $40 coupon you can clip at checkout, and you'll get this $700 walking pad for just $150.
$150 with coupon at Amazon More early Labor Day deals on treadmills at Amazon
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