GRID VIEW
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One of the most important tasks for researchers is to make sure the experiment we are running is accurately assessing the intended variable. Because of this, each study has specific inclusion and exclusion criteria, which determine who can qualify to participate. An example would be needing a diagnosis of severe asthma for a study testing a new asthma medication. Usually, criteria include age, relevant medical diagnoses or histories, and exclude major health events such as cancer, heart attack, or stroke. Recently (as of the writing of this article), however, we have seen a notable uptick in the number of cardiovascular studies that allow or even require a previous heart attack or stroke as an inclusion criterion. This is because there are several medications or devices being studied that hope to lower the recurrence of these events.
Heart attack and stroke are often two sides of the same coin. In both cases, blood flow to part of the organ is lowered or stopped, and the affected tissue is damaged or dies. You might be familiar with the term Major Adverse Cardiovascular Event (MACE), which encompasses various cardiovascular issues, including heart attack and stroke. Most people survive their first incident, but 20-25% of people have more than one. According to the American Heart Association, about 1 in 5 people who have had a heart attack will suffer from (or experience) a second one within five years. Each heart attack or stroke comes with a chance of lowered quality of life, disability, or death, so preventing further events is critical.
One of the biggest problems with preventing a second heart attack or stroke is the myriad of causes of these conditions. Any prolonged insult to the cardiovascular system can lead to a heart attack or stroke. The risks, then, include a sedentary lifestyle, poor diet, obesity or excess weight (especially around the midsection), high blood pressure, high cholesterol, uncontrolled diabetes, smoking, stress, alcohol, and drugs. The solutions to these disparate causes can also spread far and wide. For this reason, the two most important ways to reduce the risk of a second heart attack or stroke are to talk to a medical professional and take prescribed medications.
A medical professional can look at the underlying condition of individuals and determine which factors likely had the biggest impact. They may recommend cardiac rehabilitation and specific medications to address underlying conditions and prevent recurrence. Targeting specific, relevant causes with medications, such as anticoagulants like warfarin, antiplatelets like aspirin, and cholesterol-lowering medications like statins, can reduce the risk of resurgence by up to 70%! Doctors may also recommend medications to help with diabetes or blood pressure and/or surgical procedures to fix structural problems with the cardiovascular system. Managing the risk factors that caused the first heart attack or stroke can reduce the likelihood of a second (or third). On top of this, changes to lifestyle and diet can have a significant impact, lowering the chance of a second event by almost a third. Add a reduction in smoking, alcohol, and drugs for an even greater effect.
Beyond standard medical advice, two additional interventions may help. The first is support. Family, friends, and others who have experienced heart attacks and strokes can help make the recovery process more bearable and lower anxiety and stress (which are risk factors in themselves!). Finally, clinical trials may help. Indeed, the inclusion of previous heart attacks or strokes in clinical research inclusion criteria indicates an increased recognition that indirect influence can induce repeated injury to the heart and brain. In short, research studies are looking at new ways to lower the incidence of a second heart attack or stroke by targeting underlying conditions with new medications and new methods of treatment. This is invariably a great idea. Only YOU (and your doctor (and maybe a clinical research coordinator)) can prevent secondary strokes and heart attacks.
At the time of this writing, ENCORE Research Sites have several studies for people who have had a previous heart attack or stroke. Call your local office to explore research options for you.
Staff Writer / Editor Benton Lowey-Ball, BS, BFA
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References:
Yoo, S. G. K., Chung, G. S., Bahendeka, S. K., Sibai, A. M., Damasceno, A., Farzadfar, F., … & Flood, D. (2023). Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries. JAMA, 330(8), 715-724. https://doi.org/10.1001/jama.2023.12905
Esenwa, C., & Gutierrez, J. (2015). Secondary stroke prevention: challenges and solutions. Vascular health and risk management, 437-450. http://dx.doi.org/10.2147/VHRM.S63791
American Heart Association News. (April 4, 2019). Proactive steps can reduce chances of second heart attack. American Heart Association. https://www.heart.org/en/news/2019/04/04/proactive-steps-can-reduce-chances-of-second-heart-attack
American Heart Association. (2022). 5 ways to lower your risk of a second heart attack. American Heart Association. https://www.heart.org/-/media/files/health-topics/heart-attack/5-ways-to-lower-your-risk-of-second-heart-attack-infographic.pdf
Karlin, R., Wojcik, S., Kang, S. (2024). Preventing a second heart attack. University of Rochester Medical Center Rochester. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=56&contentid=2446
de Jong, M., van der Worp, H. B., van der Graaf, Y., Visseren, F. L., & Westerink, J. (2017). Pioglitazone and the secondary prevention of cardiovascular disease. A meta-analysis of randomized-controlled trials. Cardiovascular diabetology, 16(1), 1-11 .https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644073/
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I recently went to a dessert party. That’s a party where everyone brings a dessert. I, naturally, arrived with cookies while others brought cakes and pies. Surprisingly, there was one attendee who presented a bowl of berries, another who showcased a sweet potato casserole, and a third who simply brought avocado with a dash of salt. Do these all count as desserts? What is a dessert? A word that was clear at the outset was quickly confusing in how broad it was. Unfortunately, that confusion can also happen with medical terms. Take cardiovascular disease. It’s got something to do with the heart, but sometimes it includes strokes in the brain. So what is cardiovascular disease?
“Cardiovascular” is a word made of two component parts: cardio- means “heart” and vascular indicates blood vessels. Together, cardiovascular disease is that which affects the heart and/or blood vessels. The heart and blood vessels carry oxygen to the cells and keep them alive. Since we’re made of cells, keeping them alive is pretty important. Therefore, the heart and blood vessels are also quite important, and cardiovascular disease can be dangerous if not managed.
Cardiovascular disease is more common than apple pie in the United States. Data from the CDC show that nearly HALF of adults over 20 have some form of cardiovascular disease. With a prevalence that high, it’s no surprise that cardiovascular disease is the leading cause of death in America and around the world. Unfortunately, as noted above, the exact definition of “cardiovascular disease” is very broad. In researching this article you are currently reading, I consulted the World Health Organization, the American Heart Association, and the National Institute of Health (part of the CDC). These organizations listed the various diseases included in cardiovascular disease, and only agreed on two conditions:
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- Coronary artery disease – when the blood vessels to the heart are narrowed by plaques
- Cerebrovascular disease including stroke – where the vessels to be brain are blocked
Other diseases that at least two agreed on include:
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- Arrhythmia – an irregular heartbeat
- Congenital heart defects – heart defects occurring from birth
- Heart attack – also called a myocardial infarction, where the blood flow to the heart is blocked
- Hypertension – high blood pressure
Though all these diseases may seem different, they are all part of the same system. Narrow blood vessels to the heart or brain cause oxygen loss. This narrowing can be caused by plaque formed when cholesterol lodges in the vessel wall. If some of this plaque dislodges, it can lead to heart attacks and strokes. Irregular heartbeats and heart attacks can lower the amount of blood (and oxygen!) delivered around the body. Hypertension stresses the whole system and can lead to heart attack, stroke, and damage to other organs like the kidneys. Additionally, they may have similar risk factors, outcomes, and treatments.
There is a genetic component to cardiovascular disease. This is evident with congenital heart defects, which occur during development. It is also evident looking at who is at risk of developing cardiovascular disease. African Americans are at the highest risk, while people who identify as Hispanic have the lowest risk. Big modifiable risks include cholesterol, smoking, and hypertension (which is itself a form of cardiovascular disease!). Other risks include diabetes, being overweight, poor diet, low exercise, alcohol consumption, and low sleep. Research is ongoing into the cycle of mental health and cardiovascular disease as well. Mood and anxiety disorders, PTSD, and chronic stress can cause direct damage to the cardiovascular system while simultaneously increasing behaviors that compound the danger, including smoking and failing to take medicines.
Lowering the modifiable risks above is, unsurprisingly, one of the best ways to fight cardiovascular disease. Managing cholesterol, blood pressure, and diabetes can help. Cutting smoking and lowering alcohol intake can make a big difference. Getting help with mental health (and getting a good night’s sleep) may help your heart relax as well. Maintaining a healthy weight through a good diet and dynamic exercise is vital. Unfortunately, without management, cardiovascular disease is more like a desert than a dessert: it can kill you.
Staff Writer / Editor Benton Lowey-Ball, BS, BFA
Listen to the article here:
References:
Centers for Disease Control and Prevention. (July 19, 2021). Coronary artery disease (CAD). U.S. Department of Health and Human Services. https://www.cdc.gov/heartdisease/coronary_ad.htm
National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. (May 15, 2023). About heart disease. U.S. Department of Health and Human Services. https://www.cdc.gov/heartdisease/about.htm
American Heart Association. (May 31, 2017). What is cardiovascular disease? https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., … & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2022). Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation, 145(8), e153-e639. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001123
National Heart, Lung, and Blood Institute. (n.d). Heart and vascular diseases. U.S. Department of Health and Human Services. https://www.nhlbi.nih.gov/science/heart-and-vascular-diseases Accessed on September 12, 2023.
The World Health Organization. (June 11, 2021). Cardiovascular diseases (CVD). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Healthy eating and exercise can help with not only your waistline but also cardiometabolic health. Carrying around extra fat can negatively affect your whole body; some areas of concern include the liver, heart, and joints. Although many people can maintain a healthy diet and exercise routine to keep the weight off, some folks need extra help with medication.
The liver is the largest organ inside your body and is integral in filtering harmful substances from your blood. When too much fat builds up in your liver, this is called fatty liver disease. This can progress to damaging and scarring of the liver. The scaring can ultimately lead to liver failure. Lifestyle changes, like healthy eating and exercise, are currently the only treatments for fatty liver disease, although many clinical trials are currently looking for a safe and effective therapy.
Heart disease remains the world’s leading killer. While extra fat itself does not directly cause heart attacks, it leads to other causes that can. High cholesterol, high blood pressure, and diabetes are among those that build up plaque in the arteries leading to heart attacks. ENCORE Research Group offices have many clinical trials in these areas!
Being overweight can affect your joints by raising your risk of developing osteoarthritis. The extra weight puts additional stress on your weight-bearing joints, such as your knees, which can cause additional wear and tear. Additionally, inflammation associated with weight gain might contribute to problems in other joints such as the hands.
For the folks who need more than just a healthy diet and exercise to help with medical conditions, the good news is that many new cutting-edge treatments are being studied and are available to you. Call your local ENCORE Research Group office today to get involved in our research trials.
Sources:
heathline.com
health.clevelandclinic.org
health.harvard.edu
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