Patient Care Editorial Staff 

A new analysis of results from the SPRINT trial finds that across age groups, intensive blood pressure control may lengthen a person’s lifespan by 4-9 percent.

"High blood pressure has been implicated as one of the reasons for stalled progress in reducing heart disease-related deaths in the United States," said Muthiah Vaduganathan, M.D., MPH, Brigham and Women's Hospital, Boston in a 

 issued by the American Heart Association (AHA). Dr. Vaduganathan is the study’s lead author. "These data reinforce that tighter blood pressure control, especially when started earlier in life, may meaningfully prolong life span."

The findings were presented during the AHA's Scientific Sessions annual meeting that took place November 16-18 in Philadelphia.

The Systolic Blood Pressure Intervention Trial (

), which was published in 2015, showed that intensive blood pressure (BP) control (systolic BP target less than 120 mm Hg) was superior to standard BP control (SBP  less than 140 mmHg), reducing participants’ risk of cardiovascular events (ie., heart attack, stroke, heart failure) by 25 percent and mortality by 27 percent.

SRPINT enrolled middle-aged and older adults at high cardiovascular risk, but without diabetes and with baseline standard blood pressure readings of 130 to 180 mm Hg. The study was stopped early for benefit after median follow-up of 3 years (up to 6 years) limiting the ability to assess more long-term effects of the intensive vs standard blood pressure control strategies on life expectancy.

For the current analysis, study authors calculated the actuarial estimates of residual survival (at a given age) by using baseline age rather than time from randomization as the time axis. Residual life span at all ages (up to 95 years) was estimated using area under the survival curve. Differences in areas under the survival curves reflect estimated treatment effects on residual survival.

Mean survival benefits with intensive vs standard BP ranged from 0.5 years to 3 years (see Figure [click to enlarge]). Absolute survival gains decreased with age, but the relative benefits were relatively consistent (4-9 percent).

Results of the analysis demonstrate clear clinical benefits of more aggressive BP control. The findings also create a patient counseling opportunity as well, as summed up in an AHA press release by Mitchell SV Elkind, M.D., AHA  president-elect, chair of the advisory committee of the American Stroke Association, and professor of neurology and epidemiology at Columbia University.

"When you tell people that lowering their blood pressure is going to reduce their chance of having a stroke or a heart attack by 25%...what does that number mean, in real terms? This analysis suggests that for a man who is 50-years-old, lowering blood pressure to [<120 mm Hg]…could extend your lifespan by 3 years, on average."

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Controlling Blood Pressure Lengthens Lifespan

The impact of electronic cigarettes on cardiovascular disease risk factors is similar to effects seen in people who smoke traditional combustible cigarettes with harmful effects on cholesterol, triglycerides and blood glucose, as well as on blood flow to the heart.

These findings were reported in two studies presented at the American Heart Association’s (AHA) Scientific Sessions held this month in Philadelphia.

Smokers who use electronic cigarettes under the impression these devices can aid in quitting cigarettes altogether, should probably stop, said Rose Marie Robertson, M.D., AHA's deputy chief science and medical officer, in an 

. She points to the paucity of long-term safety data and the expanding body of information describing a range of negative physiologic effects of the devices themselves as well as the chemical compounds used in them.

In the first study, which links e-cigarettes to alterations in lipid profiles, Sana Majid, M.D., a postdoctoral research fellow at Boston University School of Medicine, and colleagues compared cholesterol, triglycerides, and glucose levels in healthy adult nonsmokers, electronic cigarette smokers, and dual electronic cigarettes and traditional cigarette smokers (dual smokers).

The 476 participants from the "Cardiovascular Injury due to Tobacco Use" (CITU) study were aged 21-45 years, free of cardiovascular disease and taking no daily medications. They included 285 traditional cigarette smokers, 94 nonsmokers 45 electronic cigarettes smokers and 52 dual smokers.

Electronic cigarette users were predominantly dual or former smokers and were overall younger, with more men and fewer blacks in the group.

Traditional cigarette users had lower high-density lipoproteins (HDL) levels and higher levels of glucose, total cholesterol, low-density lipoproteins (LDL), and very-low-density lipoprotein vs nonsmokers. Exclusive electronic cigarette use remained associated with elevated total cholesterol, triglycerides, and LDL vs nonsmokers (all P<.05) in multivariate regression models adjusted for age, race, and sex. Dual cigarette use was associated with lower HDL-C (P<.01).

The findings suggest that traditional cigarette smokers who concurrently use or switch to electronic cigarettes may not experience appreciable metabolic benefits. "Although primary care providers and patients may think that use of e-cigarettes by smokers makes heart health sense," Dr. Majid stated. "...the best option is to use FDA-approved methods...along with behavioral counseling."

In the second study, "Coronary endothelial dysfunction more persistent with e-cigarette use," coronary vascular dysfunction associated with electronic cigarette was found to be worse than from smoking traditional cigarettes 

E-cigarettes purportedly deliver a lower dose of nicotine per inhalation vs combustible cigarettes and thus have been marketed as a safer alternative. However, authors write in their abstract: "Each e-cigarette inhalation delivers an aerosolized bolus of poorly-characterized ultrafine particles with potential cardiovascular effects that remain unclear."

To assess coronary vascular function, authors analyzed change in myocardial blood flow after acute exposure among self-reported chronic electronic cigarette (n=10) and chronic tobacco cigarette (n=9) users, aged 24-32 years. After overnight abstinence, acute increase in myocardial blood flow was measured via myocardial contrast echocardiography after exposure to one use (15 puffs in 7 minutes) of a popular electronic cigarette or one cigarette (Camel Filtered) while participants were at rest and again during post-handgrip cuff ischemia.

For traditional cigarette users, myocardial blood flow increased modestly after inhalation then decreased with subsequent stress. And, for electronic cigarette users, myocardial blood flow decreased both at rest and after handgrip stress suggesting chronically abnormal coronary vascular function.

“We were surprised by our observation of the heart’s blood flow being reduced at rest, even in the absence of stress, following inhalation from the e-cigarette,” said study co-author Susan Cheng, M.D., MMSc, MPH, director of Public Health Research at Cedars-Sinai Medical Center, Los Angeles.

“Providers counseling patients on the use of nicotine products will want to consider the possibility that e-cigs may confer as much and potentially even more harm to users and especially patients at risk for vascular disease,” she said.

For more news from the American Heart Association’s (AHA) 2019 Scientific Sessions, visit our sister site 

The impact of electronic cigarettes on cardiovascular disease risk factors is similar to effects seen in people who smoke traditional combustible cigarettes with harmful effects on cholesterol, triglycerides and blood glucose, as well as on blood flow to the heart, researchers reported at AHA's Scientific Sessions this month.

Electronic Cigarettes Pose CVD Risks Similar to Traditional Cigarettes 

Patients who suffer from depression are at increased risk for cardiovascular disease (CVD), but what about the risk of non-fatal cardiovascular disease events?

The risk of having a heart attack or stroke increases significantly with the severity of depression, according to preliminary research presented at the American Heart Association's (AHA) Scientific Sessions this month in Philadelphia.

“We found that the level of depression was strongly tied to living with heart disease and stroke, even after accounting for other factors that could impact risk,” according to an 

 citing study author, Yosef M. Khan, M.D., Ph.D., MPH, director of Health Informatics and Analytics for the AHA.

Usinig data from the National Health and Nutrition Examination Survey, Dr. Khan and colleagues examined the relationship between depression and non-fatal CVD such as heart failure, stroke, heart attack, coronary heart disease, or angina in adults 20 years 

More than 11,000 adults diagnosed with depression were identified, of which approximately 1,200 had self-reported CVD.

The highest percentage of study participants reported experiencing recent episodes of mild depression (13.9%), followed by moderate (4.6%), moderate-to-severe (1.8%), and severe (0.7%).

Researchers found that each level increase in depression increased the odds of non-fatal CVD outcomes by 24 percent after adjusting for risk factors.

With an understanding of the impact of this association, researchers said that physicians can help improve patients overall health by talking about mental health and heart disease together.

“The implications of such an increase are vast,” Dr. Khan said. “By understanding the relationship and degree of impact we can properly identify, prevent, treat and create policies and strategies to help decrease cardiovascular diseases and improve lives by tackling mental health and heart disease together.”

Authors noted that more detailed studies are needed to determine whether depression causes CVD or if CVD causes depression.

Patients who suffer from depression are at increased risk for cardiovascular disease, but what about the risk of non-fatal cardiovascular disease events?

Depression Severity May Increase Stroke and Heart Disease Risk

Patients with obesity who undergo bariatric surgery are less likely to experience cerebrovascular events, shows a study presented at the American Heart Association’s (AHA) Scientific Sessions annual meeting that took place this month in Philadelphia.

The metabolic derangements associated with obesity are known to contribute to the development of cerebrovascular disease. However, while bariatric surgery is associated with improvements in weight and metabolic profiles, authors of the new study (oral presentation 335) note that its effectiveness on long-term reduction of stroke risk has not been investigated.

This is the largest and longest study of bariatric surgery to-date. Researchers, co-lead by Maddalena Ardissino, MBBS, BSc, of the Imperial College London, compared health records of more than 4,200 patients who had bariatric surgery to an equal number of control patients who did not have surgery. They were matched by age, gender, and weight-for-height.

Primary composite endpoint: occurrence of any major adverse cerebrovascular event (MACE, ie, intracranial hemorrhage, ischemic stroke, transient ischemic event, and subarachnoid hemorrhage). Secondary endpoints: composite ischemic events, hemorrhagic events, individual components of the primary endpoint and all-cause mortality. Mean follow-up was 11.4 years.

The primary endpoint of MACE occurred in 73 patients.

Patients in the bariatric surgery group had significantly lower adjusted major cerebrovascular event rates (HR 0.352, 95%CI 0.195-0.637).

Authors note the lower rate was driven by reduced risk of ischemic events (HR 0.315, 95%CI 0.156-0.635), but not of hemorrhagic events (HR 0.442, 95%CI 0.147-1.330).

All-cause mortality was lower in the bariatric surgery group (229 patients died during follow-up).

“These findings call for increased awareness and implementation of bariatric surgery as a treatment step for obese patients who are unable to achieve adequate weight loss through lifestyle and medication therapy,” Dr. Ardissino stated in an 

“Currently, only a small fraction of people with obesity receive bariatric surgery.”

Dr. Ardissino is calling for a shift in perception of bariatric surgery, once seen as a cosmetic procedure and not available to the majority of the eligible population. Bariatric surgery, he emphasizes, needs to be viewed as a “potentially death-preventing and standard-of-care procedure that should be discussed with all eligible patients.”

Patients with obesity who undergo bariatric surgery are less likely to experience cerebrovascular events, shows a study presented at AHA's Scientific Sessions earlier this month.

Bariatric Surgery May Lessen Stroke Risk in Obese Patients

Approximately one in three patients with atherosclerotic cardiovascular disease skip the flu shot each year despite its effectiveness in lowering the risk of illness and death, shows research presented at the American Heart Association’s (AHA) Scientific Sessions annual meeting that took place this month in Philadelphia 

Researchers examined vaccination rates in more than 15,000 patients with ASCVD (aged ≥40 years) who participated in the national Medical Expenditure Panel Survey between 2008 and 2015.

Researchers asked participants whether they received a flu vaccination in the last year and found:

1 in 3 patients had not been vaccinated in the past year (32%, 95% CI: 30.2%, 33.0%)

30% of patients with insurance and a regular source of medical care had not been vaccinated

Uninsured, low-income patients had the highest rate of non-vaccination (65%)

“Our study sheds light on key inequalities related to disparities in flu vaccination rates,” said senior author Khurram Nasir, M.D., MPH, MSc, Houston Methodist Hospital, Texas, in an 

 “We hope that flu vaccinations among heart disease patients becomes an integral part of quality of care measures and will facilitate processes to limit these unintended care gaps among the most vulnerable in our society.”

Patients with heart disease are at an increased risk for medical complications or mortality from the flu, so researchers emphasized the need for patient education prior to flu season.

“Cardiologists, primary care doctors and other clinicians need to have a conversation about flu vaccination well in advance of the onset of flu season to encourage patients to have routine follow-up appointments early in the flu season,” said lead study author Gowtham Rama Harsha Grandhi, MBBS, MPH, of MedStar Health, Baltimore, in the AHA press release.

Grandhi added that physicians should offer vaccination as well as walk-in appointments for vaccination at their clinics to further encourage ASCVD patients to get the flu shot.

Due to the fact that patient history was obtained through surveys and not verified with medical records, researchers noted that inaccuracies in patient recall may have influenced study results.

“Future studies should put emphasis on patient and health system factors driving these disparities and practical interventions to overcome these challenges,” Nasir concluded.

For more news from the American Heart Association’s (AHA) 2019 Scientific Sessions, visit our sister site 