Patrick Campbell

Patrick Campbell is the senior editor of Practical Cardiology, as well as its sister publication Endocrinology Network. Prior to joining these brands, he led coverage of cardiology and diabetes with HCPLive. Before joining parent company MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a freelance multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. In his free time, he enjoys traveling, sports, and exploring the great outdoors. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

New research is underlying the potential impact of mobile technology in helping patients achieve 

The study, which was led by investigators at the University of California, San Francisco (UCSF), provides evidence suggesting use of mobile technology resulted in 84% of users with stage 2 hypertension reducing blood pressure at 3 years and also indicate increased engagement with technology was associated with lower risk of experiencing very high blood pressure.

“This is the first peer-reviewed, published study reporting the long-term experience of a digital health application for blood pressure management, with a magnitude of association that is clinically meaningful,” said lead investigator Alexis Beatty, MD, MAS, a cardiologist and associate professor at UCSF, 

. “The level of engagement is something I have not seen in other digital hypertension management programs. Sustained engagement and decreases in systolic blood pressure of more than 20 mmHg could reduce a person’s chances of heart attack, stroke, kidney disease, and death.”

As the integration of technology into cardiology continues, Beatty and a team of colleagues sought to further understand how use of mobile self-management programs might influence long-term blood pressure control among patients with elevated blood pressure. Using a cohort of individuals enrolled in an employer-sponsored health insurance program, investigators designed their study to assess whether use of the Hello Heart hypertension self-management program, which includes a blood pressure monitor and connected smartphone application, over a long-term period.

Individuals enrolled in the health plan with either a diagnosis of elevated blood pressure or hypertension or a pharmacy claim for medication for treatment or management of hypertension were invited to participate in the study. With a study period ranging from January 1, 2015, through July 1, 2020, investigators identified 28,189 adults meeting inclusion criteria for the study, which required an individual to record at least 2 blood pressure measurements in the app during the study period.

For the purpose of analysis, median systolic and diastolic blood pressures were recorded during the first week, after 2 weeks, and again 4 (weeks 3-4), 6 (weeks 5-6), 12 (weeks 11-12), 26 (weeks 24-27), 52 (weeks 48-55), 104 (weeks 96-111), and 155 (weeks 148-163) weeks after the first reading. The primary outcome of interest for the study was changes in systolic and diastolic blood pressure over time. The exposure of interest for the study was program engagement, which investigators defined as the average number of application sessions. Based on engagement levels relative to the rest of the cohort, patients were placed into groups defined by low, medium, and high engagement.

The study cohort had a median age of 51 (IQR, 43-58) years, 40.4% were women, and the median systolic and diastolic blood pressure measurements at baseline were 129.5 (IQR, 120.5-139.6) mmHg and 81.7 (IQR, 75.7-88.4) mmHg, respectively. The mean number of blood pressure measurements per week ranged from a median of 1.3 (IQR, 0.6-2.8) in the low-engagement group to 2.8 (IQR, 1.5-5.3) in the high-engagement group.

Upon analysis, results indicated median systolic blood pressure improved at least 1 category for 495 of 934 participants (53.0%) with baseline elevated BP, 673 of 966 (69.7%) with baseline stage 1 hypertension, and 920 of 1075 (85.7%) with baseline stage 2 hypertension at 1 year. Among individuals enrolled in the program for 3 years, the mean reduction in systolic blood pressure was 7.2 (SEM, 0.4) mmHg among those with elevated blood pressure, 12.2 (SEM, 0.7) mmHg among those with stage 1 hypertension, and 20.9 (SEM, 1.7) mmHg, among those with stage 2 hypertension when compared to baseline measurements.

Further analysis indicated greater engagement was associated with lower systolic blood pressure over time, even after adjustment for age, gender, depression, anxiety, diabetes, high cholesterol, smoking, area deprivation index rank, and US region. Investigators also pointed out greater engagement was associated with a lower risk of very high blood pressure, with increased incidence seen among the low-engagement group (1.42%, [95% CI, 1.26%-1.59%]) compared with the medium-engagement group (0.79%, [95% CI, 0.71%-0.87%]; 

 <.001) and the high-engagement group (0.53%, [95% CI, 0.45%-0.60%]; 

Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-Management Program

Articles

New research suggests use of mobile technology could help improve blood pressure over a long-term period, with greater engagement with the technology associated with greater improvements in blood pressure. 

Mobile Blood Pressure App Shows Promise in First-of-Its-Kind, Long-Term Study

An analysis of data from more than 2.1 million mothers suggests preterm delivery was associated with a 1.6-fold increase in risk of new-onset chronic 

An analysis of women with a singleton delivery in Sweden from 1973 through 2015, results of the study provide insight into the apparent increase of hypertension associated with preterm delivery in this patient population and also stratified according to weeks of gestation at delivery.

“Preterm delivery should now be recognized as a risk factor for hypertension across the life course. Women with a history of preterm delivery need early preventive evaluation and long-term risk reduction and monitoring for hypertension,” wrote investigators.

With an interest in further investigating associations of preterm delivery with long-term cardiometabolic disorders, a trio of clinicians from Icahn School of Medicine at Mount Sinai led by Casey Crump designed the current study as a national cohort study leveraging data from the Swedish Medical Birth Register. Using the register, which contains prenatal and birth information for deliveries in Sweden dating back to 1973, investigators sought to identify all singleton deliveries occurring from 1973-2015 for inclusion in their analysis.

Investigators noted singleton deliveries were selected to improve internal comparability and women with preexisting hypertension were excluded from the analysis. In total, 2,195,989 women with 4,308,286 deliveries were identified for inclusion. Of these, 351,189 (16.0%) went on to be diagnosed with hypertension during the follow-up period, which included 46.1 million person-years of follow-up.

The primary outcome of interest for the study was new-onset chronic hypertension, which was identified from primary care, specialty outpatient, and inpatient diagnoses using administrative data. Investigators noted plans to use Cox proportional hazards regression adjusted for preeclampsia, other hypertensive disorders of pregnancy, and other maternal factors to determine hazard ratios. Additionally, cosibling analyses were used to assess for potential confounding by shared familial factors.

Upon analysis, preterm delivery was associated with an increased risk for diagnosis of hypertension was observed within 10 years of delivery. Further analysis indicated this risk was greatest among those giving birth at 22-27 weeks (aHR, 2.23 [95% CI, 1.98-2.52]) of gestation followed by those giving birth at 28-33 weeks (aHR, 1.85 [95% CI, 1.74-1.97]), 34-36 weeks (aHR, 1.55 [95% CI, 1.48-1.63]), and 37-38 weeks (aHR, 1.26 [95% CI, 1.22-1.30]) compared with full-term delivery, which was defined as 39-41 weeks of gestation.

When examining risk beyond 10 years, results indicated the apparent risks decreased but remained significant at 10-19 years (aHR, 1.40 [95% CI, 1.36-1.44]), 20-29 years (aHR, 1.20 [95% CI, 1.18-1.23]), and 30-43 years (aHR, 1.12 [95% CI, 1.10-1.14]) after delivery. Additionally, cosibling analyses determined the findings were not explained by shared determinants of preterm delivery and hypertension within families.

“To our knowledge, this is the largest study to date of preterm delivery in relation to future risks of hypertension and the first to assess for potential confounding by shared familial factors using a cosibling design,” added investigators.

Preterm Delivery and Long-term Risk of Hypertension in Women

An analysis of more than 4 million singleton deliveries from more than 2.1 million women provides insight into the apparent increase in risk associated with preterm delivery.

Preterm Delivery Associated with 1.6-Fold Increase in Risk of Hypertension Later in Life

An analysis of data from more than 400 women included in a major study is detailing the insight provided by changes in patterns of menstrual cycle length over the menopause transition on risk of atherosclerosis in aging women.

The study, which leveraged data from women within the Study of Women’s Health Across the Nation (SWAN) Daily Hormone Study (DHS), identified 3 distinct trajectories of cycle length and described their associations with postmenopausal carotid intima-media thickness and brachial-ankle pulse wave velocity.

“Menopause is not just a click of a button. It’s a multistage transition where women experience many changes that could put them at higher risk for cardiovascular disease. Change in cycle length, which is linked to hormone levels, is a simple metric that might tell us who is more at risk,” Samar El Khoudary, PhD, associate professor of epidemiology at Pitt’s Graduate School of Public Health, in a 

statement from the North American Menopause Society (NAMS

As organizations and institutions push to improve the cardiovascular care of women, identifying potential risk factors for cardiovascular disease stand to have a major potential impact on a societal level. With this in mind, El Khoudary and colleagues sought to assess whether trajectories of menstrual cycle length were associated with markers of subclinical atherosclerosis.

Briefly, the SWAN study, which was co-sponsored by the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the National Institutes of Health (NIH), designed with the intent of collecting data related to potential physical, biological, psychological, and social changes during their transition to menopause. The SWAN DHS study is a subsidy of the SWAN study and recorded additional data, such as vasomotor menopausal symptoms in daily diaries for 12-50 days.

From SWAN DHS, investigators identified 428 women with 1,808 cycles over the menopause transition for inclusion in the current study. To be included in the study, women needed to have an observed date of final menstrual period, have recorded cycle lengths from 2 or more annual menstrual cycles, and have measurements of postmenopausal carotid intimal-media thickness and/or brachial-ankle pulse wave velocity.

The study population had a mean age of 45.1±2.3 years at baseline visit and the mean number of menstrual cycles recorded was 4.22±1.91 cycles. Of the 428 included, 263 had carotid intimal-media thickness and 213 had brachial-ankle pulse wave velocity measured after the transition to menopause. Investigators pointed out carotid intimal-media thickness was measured a mean of 13.88±0.42 years after the baseline visit and brachial-ankle pulse wave velocity was measured a mean of 15.25±0.7 years after the baseline visit.

When assessing patterns of cycle length, investigates identified 3 distinct trajectories. In total, 62.1% were considered to have stable cycle length, 21.8% experienced a late increase in cycle length, and 16.2% experienced an early increase in cycle length. Investigators defined stable as no chances in length over the menopause transition, late increase was defined as a late increase 2 years before the final menstrual period, and early increase was defined as an increase 5 years before final menstrual period.

Results of the investigators’ analysis, which were adjusted for race, concurrent age, socioeconomic status, physical activity level, and premenopausal cardiovascular risk profile, suggested women with a late-increase pattern had significantly lower postmenopausal carotid intima-media thickness (0.72 mm) and brachial-ankle pulse wave velocity (1392 cm/s) than those in the stable group (0.77 mm and 1508 cm/s, respectively).

“These findings are important because they show that we cannot treat women as one group: Women have different menstrual cycle trajectories over the menopause transition, and this trajectory seems to be a marker of vascular health,” said El Khoudary. “This information adds to the toolkit that we are developing for clinicians who care for women in midlife to assess cardiovascular disease risk and brings us closer to personalizing prevention strategies.”

Patterns of menstrual cycle length over the menopause transition are associated with subclinical atherosclerosis after menopause

In an analysis of SWAN data, investigators found changes in menstrual cycle length within the 5 years preceding a woman's final menstrual period was associated with changes in carotid intima-media thickness and brachial-ankle pulse wave velocity.

Changes in Menstrual Cycle Length Prior to Menopause Could Help Predict Risk of Atherosclerosis

Results from an observational analysis of 3 European-based cohorts provide evidence suggesting iron deficiency in middle age was linked to increased risk of poor cardiovascular health later in life.

Designed with the intent of assessing the risks posed by iron deficiency in the general population, results of the study indicate patients with functional iron deficiency (FID) had a 24% greater risk of coronary heart disease, a 26% greater risk of cardiovascular mortality, and a 12% greater risk of all-cause mortality.

“This was an observational study and we cannot conclude that iron deficiency causes heart disease,” said lead investigator Benedikt Schrage, MD, of the University Heart and Vasculature Centre Hamburg, Germany, 

. “However, evidence is growing that there is a link and these findings provide the basis for further research to confirm the results.”

As data related to the effects of iron deficiency continue to grow, Schrage and a team of colleagues form multiple institutions in Europe sought to examine associations between absolute iron deficiency (AID)/FID with incident cardiovascular disease and mortality among the general population. To do so, the current study was designed as an observational analysis of data from within the KORA, Northern Sweden, and Tromsø cohort studies.

From this trio of study cohorts, investigators identified 12,164 individuals for inclusion in the current study. This cohort had a median age of 59 (IQR, 45-68) years, a median follow-up time of 13.3 years, and 45.2% were male. Of the 12,164 identified for inclusion 7296 (60%) had AID, 1989 (16.4%) had severe AID, 7825 had FID, and 4868 had no absolute iron deficiency. Of note, AID was defined as ferritin below 100 μg/L and severe AID as ferritin below 30 μg/L. FID was defined as ferritin above 100 μg/L or ferritin 100–299 μg/L and TSAT below 20%. Investigators planned to assess associations between iron deficiency and incident coronary heart disease, incident stroke, cardiovascular mortality, and all-cause mortality using Cox regression models.

During the course of the follow-up period, 2212 individuals died, including 573 from cardiovascular causes. A total of 1033 individuals were diagnosed with incident coronary heart disease and 766 were diagnosed with incident stroke during the follow-up.

In adjusted analysis, results suggested AID was not associated with all-cause mortality (HR, 1.08 [95% CI, 0.98-1.19]; 

=.12) cardiovascular mortality (HR, 1.22 [95% CI, 1.00-1.48]; 

=.05), or incident stroke (HR, 1.11 [95% CI, 0.94-1.31]; 

=.22), but was associated with increased risk of incident coronary heart disease (HR, 1.20 [95% CI, 1.04=1.39]; 

=.01). Further analysis suggested severe AID was associated with increased risk of all-cause mortality (HR, 1.28 [95% CI, 1.12-1.46]; 

<.01), but not cardiovascular mortality (HR, 1.01 [95% CI, 0.76-1.344]; 

=.95), incident coronary heart disease (HR, 1.22 [95% CI, 1.00-1.50]; 

=.05), or incident stroke (HR, 1.10 [95% CI, 0.87-1.40]; 

When assessing associations with FID, results indicated FID was significantly associated with all-cause mortality (HR, 1.12 [95% CI 1.01–1.24]; 

=.03),cardiovascular mortality (HR, 1.26 [95% CI 1.03–1.54] 

=.03), and incident coronary heart disease (HR, 1.24 [95% CI 1.07–1.43] 

 <.01), but not incident stroke (HR, 1.15 [95% CI, 0.97–1.36]; 

“This analysis suggests that if iron deficiency had been absent at baseline, about 5% of deaths, 12% of cardiovascular deaths, and 11% of new coronary heart disease diagnoses would not have occurred in the following decade,” Schrage added. “The study showed that iron deficiency was highly prevalent in this middle-aged population, with nearly two-thirds having functional iron deficiency. These individuals were more likely to develop heart disease and were also more likely to die during the next 13 years.”

Association of iron deficiency with incident cardiovascular diseases and mortality in the general population

Leveraging data from 3 European cohorts, investigators detail the risk of incident coronary heart disease and mortality associated with iron deficiency in the general population. 

Functional Iron Deficiency Linked to Increased Risk of Coronary Heart Disease, Cardiovascular Mortality

A systematic review and meta-analysis from Cedars-Sinai Medical Center is raising the alarm on the potential increase in risk of 

 among patients consuming omega-3 supplements.

With interest and use of both pharmaceutical- and consumer-grade omega-3 supplements at an all-time high, results of the study, which indicated patients consuming more than 1 gram of omega-3 fatty acids per day had a 49% increase in risk of AF, provide valuable insight for clinicians.

“Our goal was to bring clarity, answers and actionable information to the broader medical field and to patients,” said Christine Albert, MD, MPH, a professor of Cardiology and chair of the Department of Cardiology in the Smidt Heart Institute, in a 

. “In this instance, the results suggest that there may not be a straightforward answer to, ‘Is fish oil good or bad for atrial fibrillation?’ but instead, the answer may depend on the dose.”

With recent clinical trials producing results suggesting use of marine omega-3 fatty acid supplements could increase risk of AF, Albert and a team of colleagues conducted the current study to provide further clarity on the potential for arrhythmias associated with these agents. To do so, investigators designed a systematic review and meta-analysis with the intent of assessing this potential for increased risk using data obtained from the MEDLINE and Embase databases as well as a meta-analysis of randomized clinical trials published in 2019.

For inclusion in the analysis, randomized clinical trials needed to report results for AF, either as pre-specified outcome, adverse event, or a cause for hospitalization, with a minimum sample size of 500 patients and a median follow-up of at least 1 year. For the purpose of analysis, investigators meta-analyzed HRs for reported AF outcomes within each trial using random-effects model with Knapp-Hartung adjustment and potential dose-response relationships were assessed with a meta-regression model.

In total, 4059 records were screening for inclusion. Of these, 7 were considered eligible for inclusion, including 5 that were previously included in the 2019 meta-analysis. A total of 81,210 patients were identified from the 7 trials, including 58,939 enrolled in trials testing low dose marina omega-3 fatty acids and 22,271 examining high doses of omega-3 fatty acids. The overall study cohort had a mean age of 65 years, 39% were female, and the average weighted follow-up was 4.9 years. Of note, low dose marine omega-3 fatty acids was considered 1 gram or less per day and high dose was considered more than 1 gram per day.

Results of the meta-analysis indicated use of marine omega-3 fatty acid supplements was associated with an increased risk of atrial fibrillation (HR, 1.25 [95% CI, 1.07-1.46]; 

=.013). When stratifying by dose, results indicated those receiving a high dose (HR, 1.49 [9545CI, 1.04-2.15]; 

=.042) appeared to be at a greater risk of AF than those receiving a low dose (HR, 1.12 [95% CI, 1.03-1.22]; 

=.024) when compared to those not receiving marine omega-3 fatty acid supplements (

 for interaction <.001). In meta-regression, results indicated the risk of AF increased 11% for every 1 gram increase of omega-3 fatty acids dosage (HR, 1.11 [95% CI, 1.06-1.15]; 

“For patients, the risk of developing atrial fibrillation appears to be relatively small for those taking one gram or less of fish oil per day,” said Albert. “Taking more than one gram of fish oil per day is something you should only do following your doctors’ advice.”

Effect of Long-Term Marine Omega-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

A meta-analysis and systematic review of 7 RCTs suggests consuming more than 1 gram of marine omega-3 fatty acid supplements per day could increase a patient's risk of atrial fibrillation. 

Meta-Analysis Raises Questions Around Risk of Atrial Fibrillation Associated with Omega-3 Supplements

This article was originally published on 

A new study is highlighting the disparities in cardiovascular care provided to women with 

A post hoc analysis of the REWIND trial, results demonstrate women were less likely to achieve treatment targets for cardiovascular management than their male counterparts and were less likely to receive guideline-directed medical therapies.

“Despite evidence of the benefits for managing cardiovascular risk factors (such as lowering blood pressure and cholesterol levels) in people with type 2 diabetes, an unacceptable proportion of affected women are not reaching recommended treatment targets”, said lead author Giulia Ferrannini, MD, from the Karolinska Institutet, Stockholm, Sweden, 

. “Cardiovascular disease is the leading killer of women, but it has never been more preventable and treatable. The reasons why women are not receiving the same standard of treatment as men are complex and require further investigation so that women with type 2 diabetes can be treated more effectively.”

With improving the cardiovascular care of women, especially those with diabetes, a major research focus in the community, Ferrannini and colleagues from Karolinska Institute, Population Health Research Institute, and Eli Lilly and Company performed the current study with the intent of assessing the topic through analysis of the REWIND trial. To do so, the current study was designed as an assessment of a subset of REWIND participants with baseline and follow-up data related to blood pressure, LDL-C, and HDL-C from within the REWIND trial.

Briefly, the REWIND trial was a multicenter, randomized, placebo-controlled trial conducted in 24 countries and enrolling more nearly 10,000 patients with type 2 diabetes and various levels of cardiovascular risk. The trial had a mean follow-up of 5.4 years and was designed to compare the effects of dulaglutide against placebo therapy with a primary composite outcome of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. The trial ultimately concluded dulaglutide was associated with a 12% lower risk of the primary composite outcome (HR, 0.88 [95% CI, 0.79-0.99]; 

Of the 9901 patients within the REWIND trial, 46.3% were women. Of note, men included in the study were more likely to have a history of cardiovascular disease than their female counterparts (41.4% vs 20.0%; 

 <.001). Upon analysis, results indicate the majority of women met clinically relevant treatment targets for blood pressure and cholesterol at baseline, but a smaller proportion of women were at target for ACE/ARB use (80% vs 83%), lipid control or statin use (73% vs 81%), or aspirin use (

Further analysis suggested women had a lower risk for all cardiovascular outcomes included in the study except for fatal or nonfatal stroke, which investigators pointed out was also observed in a subgroup of patients without a history of cardiovascular disease at baseline. Additionally, investigators pointed out women with a history of cardiovascular disease had a similar risk of stroke, heart failure hospitalization, all-cause mortality, and cardiovascular mortality compared to their male counterparts.

“It is important to consider all gender disparities that exist in the real-world setting that prevent women with diabetes to keep such advantage, including time to diagnosis, use of invasive revascularization procedures, and use of guideline-recommended treatments. Women with type 2 diabetes are at high cardiovascular risk and should not be neglected in its comprehensive management,” Ferrannini added.

This study, “Gender differences in cardiovascular risk, treatment, and outcomes: a post-hoc analysis from the REWIND trial,” was presented at EASD 2021.

A post hoc analysis of the REWIND trial suggests women with diabetes were less likely to achieve treatment targets and receive guideline-directed medical therapies than their male counterparts.