20 VOLUME 19 NUMBER 1 • July 2022 DIABETES NEWS SA JOURNAL OF DIABETES & VASCULAR DISEASE One study conducted in Houston and six other US urban centres examined mobile stroke units, ambulances with specially trained staff, a CT scanner and laboratory testing equipment that allows for stroke diagnosis and treatment in the vehicle. Staff in the mobile unit can give patients tPA, a clot-dissolving medicine that can save lives and reduce disability when administered promptly. Mobile stroke units can also help determine, before reaching the hospital, which patients are candidates for endovascular thrombectomy (EVT), which removes the blockage in the brain that caused the stroke. The study focused on 1 047 patients eligible for tPA. Compared with usual emergency medical services, additional dispatch of a mobile stroke unit was linked to more patients receiving tPA, plus substantially shortened times from stroke onset to the start of treatment, and led to more patients returning to normal activities within 90 days, researchers reported in the New England Journal of Medicine. Meanwhile, in stroke patients believed to have a blockage in one of their major brain arteries, expediting their transfer for angiography to quickly image those arteries and remove any clots was linked to less-severe disability later, a study from Spain found. Among 174 patients in the study who were within six hours of stroke onset, roughly half were transferred directly to a Barcelona hospital’s angiography suite, bypassing the emergency department and conventional imaging. Upon arrival at the hospital, the directtransfer patients underwent EVT and had blood flow in the brain restored more quickly, the study in Journal of the American Medical Association Neurology showed. In another study, STROKE-AF, researchers sought a better understanding of the risk of atrial fibrillation (Afib), a type of irregular heartbeat that increases stroke risk, in patients who had already had a stroke due to a blockage in large or small blood vessels. More than 400 participants at 33 US sites were assigned to usual care, including external heart monitoring, or to long-term monitoring with an inserted cardiac device within 10 days of their stroke. After a year, Afib had been detected in 12% of those with the inserted monitor, compared with fewer than 2% of those receiving usual care, the investigators reported in the Journal of the American Medical Association. Heart health issues in pregnancy put mothers, infants and adolescents at risk Cardiovascular disease is the number one cause of maternal death in America. Risk factors that arise before pregnancy can threaten pregnancy outcomes and raise cardiovascular dangers later. And a recent study finds that pre-pregnancy heart health is getting worse. Researchers analysed more than 31.6 million US birth certificates from 2011 to 2019, focusing on four cardiovascular-related data points collected about mothers (prepregnancy smoking, body mass index and presence of high blood pressure or diabetes) assigning one point for each optimal metric. In 2011, 42.1% of women had ideal scores of 4 but in 2019, only 37.7% did, the research team reported in the American Journal of Preventive Cardiology. Black women, women on Medicaid and those receiving support from WIC (the Special Supplemental Nutrition Program for Women Infants and Children) were least likely to have ideal scores for cardiovascular health in 2019, the study found. Hispanic women, meanwhile, had the greatest decline in pre-pregnancy heart-health scores over the study period. Rates of obesity and diabetes are on the rise among young adults, the study notes, and are disproportionately high among Hispanic people. Future studies, the authors say, should include more factors associated with heart health and aim to capture how social factors that influence health, including structural racism, are related to women’s health before pregnancy. Other research indicates that poor maternal heart health can echo far beyond pregnancy and the postpartum months, and into children’s adolescence. In a study of more than 2 300 mothers and their children in the US, Canada and four other nations, poor maternal heart health at an average of 28 weeks into pregnancy was linked to poorer heart health in the children later, at ages 10 to 14 years. The research was described in the Journal of the American Medical Association. Maternal health was scored based on five measures of cardiovascular health: body mass index, blood pressure, total cholesterol, glucose level and smoking status. Children were scored on those factors minus smoking status. Only about one-third of mothers had top scores reflecting all ideal metrics; about 42% of children did. As gestational health scores for themothers worsened, the prevalence of ideal scores among the children declined. This suggests a general profile of cardiovascular health during pregnancy (rather than just focusing on individual risk factors) may shed light on foetal health and help identify newborns at risk for poor heart health later, the authors wrote. Studies scrutinise the risk of extra anti-clotting treatments Two studies in 2021 took new looks at old habits related to the use of antiplatelet medicines. An international trial called MASTER DAPT examined outcomes for more than 4 500 patients after coronary angioplasty and implantation of a particular type of biodegradable, drug-eluting stent. Among patients who were at high risk of bleeding, shortening the time they received dual antiplatelet therapy to one month appeared to lower that risk without worsening cardiovascular outcomes, including heart attack, stroke and death, scientists reported in the New England Journal of Medicine. Research from Michigan, meanwhile, suggests a need to review aspirin use in patients taking a direct oral anticoagulant (DOAC), any of several anti-clotting drugs that are an alternative to a vitamin K antagonist such as warfarin. The study first looked at records of 3 280 people who were being treated for atrial fibrillation or venous thromboembolism but had no recent heart attack or history of heart valve replacement. Nearly one-third were taking aspirin on top of a DOAC although they had no clear reason to, investigators reported in the Journal of the American Medical Association Internal Medicine. Records of two matched groups of patients, more than 2 000 in total, who were using a DOAC, revealed that over an average of almost 21 months, those also taking aspirin had a higher risk of bleeding problems and related hospitalisations without an improvement in clotting rates. A pill packed with drugs for cholesterol and blood pressure may help prevent heart disease In the challenge of preventing cardiovascular disease, a one-pill-fits-all approach could have a broad public-health impact. A large international study published in the New England Journal of Medicine found that such a polypill, taken with aspirin, was associated with a 31% lower risk of cardiovascular death or events, including heart attack, stroke, cardiac arrest and heart failure, compared with placebo. The polypill contained four drugs: simvastatin, which is used to treat high cholesterol and triglyceride levels, and the blood pressure medicines hydrochlorothiazide, atenolol and ramipril. Research subjects, men 50 years or older and women 55 years or older, did not have established cardiovascular disease, but scoring suggested they had at least an intermediate risk level. Source: MedicalBrief 2022
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