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Key Takeaways From Three Landmark Heart Studies

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Today, at the American Heart Association Scientific Sessions, the research group led by Sumeet Chugh, MD, professor of Medicine and associate director of the Smidt Heart Institute, presented three critical research studies aimed at better understanding sudden cardiac arrest.

“These research studies provide clues into some of the toughest questions in cardiac care,” said Chugh, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research.

“These findings help us move closer to understanding who is at highest risk of sudden cardiac arrest.”

The three studies presented today all establish connections between sudden cardiac arrest and specific health conditions:

  • An Association Between Multiple Sclerosis and Sudden Cardiac DeathInvestigators found patients with multiple sclerosis have a five-fold higher incidence of sudden cardiac arrest over the general U.S. population. This observational study evaluated clinical characteristics of individuals who suffered cardiac arrest in the community. While the reasons for this finding need to be investigated, the brain has established links with heart function and could be influencing electrical function of the heart.
  • Enhancement of Sudden Death Risk Prediction in Patients With Left Ventricular HypertrophyPatients with left ventricular hypertrophy (LVH) also have a higher risk of sudden cardiac arrest, but until now, researchers have been unable to identify which patients are at highest risk. Using a novel electrocardiography risk score, Chugh and his research team can better identify patients with intermediate or high-risk LVH. They plan to test their findings in a larger group of patients.
  • Does Left Ventricular Hypertrophy Explain the Increased Sudden Death Risk in Obesity? Obesity is a known risk factor of sudden cardiac arrest, as is LVH. This research study aimed to find if a correlation exists between obesity and LVH, or if they are independent of one another. Chugh’s research suggests that both are independent predictors of sudden cardiac arrest and each have their own deadly properties. Next steps are to understand if being both obese and having LVH doubles the risk of sudden cardiac arrest.

All of the above data comes from the Oregon Sudden Unexpected Death Study, a comprehensive, 16-hospital, multiyear assessment of cardiac deaths in the 1 million population of the Portland, Oregon, metropolitan area. Led by Chugh, the projectnow ongoing for more than 15 yearsprovides researchers with unique, community-based information to help determine the causes of sudden cardiac arrest.

Although “sudden cardiac arrest” and “heart attack” often are used interchangeably, the terms are not synonymous. Unlike heart attacks (myocardial infarctions), which are typically caused by clogged coronary arteries reducing blood flow to the heart muscle, sudden cardiac arrest is the result of defective electrical activity of the heart. Patients may have little or no warning, and the disorder usually causes instantaneous death. Sudden cardiac arrest accounts for approximately 300,000 deaths each year in the U.S.

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Report Reveals Link Between Air Pollution And Increased Risk For Miscarriage

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Air quality has been associated with numerous adverse health outcomes from asthma to pre-term birth. Researchers at University of Utah Health found women living along the Wasatch Front — the most populous region in the state of Utah — had a higher risk (16 percent) of miscarriage following short-term exposure to elevated air pollution. The results are available online on December 5 in the journal Fertility and Sterility.

“Not being from Salt Lake originally, I noticed a pattern in the relation to air quality and pregnancy loss,” said Matthew Fuller, M.D., assistant professor of Surgery at U of U Health and senior author on the paper.

“I knew this was an understudied question so we decided to dig deeper.”

Fuller joined University of Utah research analyst Claire Leiser on a retrospective study consisting of more than 1,300 women (54 percent Caucasian, 38 percent Hispanic, and other/missing 8 percent; average age 28 years). The women in the study sought help at the U of U emergency department following a miscarriage (up to 20-weeks gestation) between 2007 to 2015.

The team examined the risk of miscarriage during a three- or seven-day window following a spike in the concentration of three common air pollutants: small particulate matter (PM 2.5), nitrogen dioxide and ozone. The study excluded women who lived outside Utah.

“We are really only seeing the most severe cases during a small window of time,” said Leiser, first author on the paper.

“These results are not the whole picture.”

Leiser notes the results suggest there could be an increased risk for an individual. Their research only captured women who sought help at an emergency department at one hospital in the region. It does not account for women who may have sought outpatient care through their obstetric or primary care providers.

The team found a slight increased risk in miscarriage for women exposed to elevated levels of nitrogen dioxide (16 percent for 10 ppb increase during the seven-day window). Although small particulate matter does track with nitrogen dioxide, these results did not significantly associate with an increased risk of miscarriage.

“While we live in a pretty unique geographic area, the problems we face when it comes to air pollution are not unique,” said Fuller.

“As the planet warms and population booms, air pollution is going to become a bigger problem not only in the developing world but across the United States.”

The Wasatch Front experiences short-periods of poor air quality, primarily during the winter months, when inversions trap pollutants close to the ground (for the 7-day window: PM2.5 min = 0.3 μg/m3; PM2.5 max = 73.0 μg/m3; O3 min = 4 ppb; O3 max= 80 ppb; NO2min = 0.5 ppb; NO2 max = 65 ppb). The researchers tracked air quality by zip code, establishing six designated air basins within the Wasatch Front. They compared air quality in each basin to their patients’ outcomes.

The team conducted a case cross-over study that estimated a woman’s risk of miscarriage multiple times in a month where air pollution exposure varied. This approach removed other risk factors, like maternal age, from the study. The scientists were unable to ascertain the age of the fetus at the time of the miscarriage and were unable pinpoint a critical period when the fetus may be most vulnerable to pollutants.

“The results of this study are upsetting, and we need to work together as a society to find constructive solutions,” Fuller said.

Fuller recommends women speak with their doctor about any health concerns. Women can manage the risk by using a N95 particulate respirator face mask to filter out pollutants or avoid outdoor physical activity on poor air quality days. Women can also use filters to lower indoor pollution and, if possible, time conception to avoid seasonal episodes of poor air quality.

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Alcohol Intake May Be Key to Long-term Weight Loss for People with Diabetes

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Research shows that losing weight can help prevent or delay the onset of diabetes. While best practice for weight loss often includes decreasing or eliminating calories from alcohol, few studies examine whether people who undergo weight loss treatment report changes in alcohol intake and whether alcohol influences their weight loss.

A new study from the University of Pennsylvania School of Nursing (Penn Nursing) suggests that alcohol consumption may attenuate long-term weight loss in adults with Type 2 diabetes.

In the study, close to 5,000 people who were overweight and had diabetes were followed for four years. One group participated in Intensive Lifestyle Intervention (ILI) and the other in a control group consisting of diabetes support and education. Data showed that participants in the ILI group who abstained from alcohol consumption over the four-year period lost more weight than those who drank any amount during the intervention. Results from the study also showed that heavy drinkers in the ILI group were less likely to have clinically significant weight loss over the four years.

“This study indicates that while alcohol consumption is not associated with short‐term weight loss during a lifestyle intervention, it is associated with worse long‐term weight loss in participants with overweight or obesity and Type 2 diabetes,” says lead investigator Ariana M. Chao, PhD, CRNP, Assistant Professor of Nursing in the Department of Biobehavioral Health Sciences.

“Patients with Type 2 diabetes who are trying to lose weight should be encouraged to limit alcohol consumption.”

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Hang In There. As Couples Age, Humor Replaces Bickering

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Honeymoon long over? Hang in there. A new UC Berkeley study shows those prickly disagreements that can mark the early and middle years of marriage mellow with age as conflicts give way to humor and acceptance.

Researchers analyzed videotaped conversations between 87 middle-aged and older husbands and wives who had been married for 15 to 35 years, and tracked their emotional interactions over the course of 13 years. They found that as couples aged, they showed more humor and tenderness towards one another.

Overall, the findings, just published in the journal Emotion, showed an increase in such positive behaviors as humor and affection and a decrease in negative behaviors such as defensiveness and criticism. The results challenge long-held theories that emotions flatten or deteriorate in old age and point instead to an emotionally positive trajectory for long-term married couples.

“Our findings shed light on one of the great paradoxes of late life,” said study senior author Robert Levenson, a UC Berkeley psychology professor.

“Despite experiencing the loss of friends and family, older people in stable marriages are relatively happy and experience low rates of depression and anxiety. Marriage has been good for their mental health.”

Consistent with previous findings from Levenson’s Berkeley Psychophysiology Laboratory, the longitudinal study found that wives were more emotionally expressive than their husbands, and as they grew older they tended toward more domineering behavior and less affection. But generally, across all the study’s age and gender cohorts, negative behaviors decreased with age.

“Given the links between positive emotion and health, these findings underscore the importance of intimate relationships as people age, and the potential health benefits associated with marriage,” said co-lead author Alice Verstaen, who conducted the study as a Ph.D. student at UC Berkeley and is currently a postdoctoral fellow at the VA Puget Sound Health Care System.

The results are the latest to emerge from a 25-year UC Berkeley study headed by Levenson of more than 150 long-term marriages. The participants, now mostly in their 70s, 80s and 90s, are heterosexual couples from the San Francisco Bay Area whose relationships Levenson and fellow researchers began tracking in 1989.

In their investigation of marital relationships, researchers viewed 15-minute interactions between spouses in a laboratory setting as they discussed shared experiences and areas of conflict. They tracked the emotional changes every few years.

The spouses’ listening and speaking behaviors were coded and rated according to their facial expressions, body language, verbal content and tone of voice. Emotions were coded into the categories of anger, contempt, disgust, domineering behavior, defensiveness, fear, tension, sadness, whining, interest, affection, humor, enthusiasm and validation.

Researchers found that both middle-aged and older couples, regardless of their satisfaction with their relationship, experienced increases in overall positive emotional behaviors with age, while experiencing a decrease in overall negative emotional behaviors.

“These results provide behavioral evidence that is consistent with research suggesting that, as we age, we become more focused on the positives in our lives,” Verstaen said.

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