Heart Failure Risk

E-cigarette use could raise heart failure risk up to 19%

Posted by

0


  • E-cigarette use was associated with elevated risk for incident heart failure compared with never use.
  • The association was significant even after adjustment for concomitant substance use and other risk factors.

ATLANTA — Individuals with a history of e-cigarette use may have increased risk for incident heart failure, regardless of concomitant cigarette, cigar, hookah or smokeless cigarette use, a speaker reported.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” Yakubu Bene-Alhasan, MD, resident physician at MedStar Health in Baltimore, said in a press release. “The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

E-cigarette
E-cigarette use was associated with elevated risk for incident heart failure compared with never use. 

Bene-Alhasan and colleagues used electronic health record data from the NIH-sponsored All of Us Research Program and responses to the Population Assessment of Tobacco and Health-styled questions to conduct a prospective analysis to better understand the association between e-cigarette use and incident HF. The overall cohort included 175,667 participants.

During a median follow-up of 45 months, 3,242 HF events occurred.

The findings were presented at the American College of Cardiology Scientific Session.

After adjusting for demographic factors, socioeconomic factors, diabetes, hypertension, hyperlipidemia, BMI and concomitant substance use — including cigarette, cigar, hookah, smokeless cigarette and alcohol use — users of e-cigarettes had an 19% greater risk for incident HF compared with never users (adjusted HR = 1.19; 95% CI, 1.06-1.35).

The researchers noted an increased risk for HF with preserved ejection fraction (aHR = 1.21; 95% CI, 1.01-1.47) and not HF with reduced EF (aHR = 1.11; 95% CI, 0.9-1.37).

The association between e-cigarette use and risk for incident HF was attenuated slightly after researchers excluded participants who reported having a history of cigarette, cigar, hookah and smokeless cigarette use (aHR = 1.04; 95% CI, 0.57-1.89).

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said in the release. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”

Just 2000 Steps a Day Linked to Reduced Heart Failure Risk

Posted by

0


TOPLINE: 

Accelerometer-measured physical activity (PA), whether light, moderate, or vigorous, is associated with lower risk for heart failure (HF) in older women while more sedentary time is associated with higher HF risk in these women, results of a new study suggest. 

METHODOLOGY:

  • The analysis included 5951 women aged 63-99 years (mean age, 78.6 years), including 33.7% Black, 17.2% Hispanic, and 49.2% White individuals without HF from the Objective Physical Activity and Cardiovascular Health (OPACH) study, an ancillary to the Women’s Health Initiative Long-Life Study.
  • Participants wore an accelerometer on their hip 24 hours a day for up to 7 consecutive days except when in water, kept nightly sleep logs, completed questionnaires to provide information on medical history and sociodemographic and lifestyle factors, and self-rated their general health status.
  • Researchers recorded their use of assistive walking devices; determined body mass index as well as blood pressure; obtained fasting serum glucose, total and high-density lipoprotein cholesterol, triglyceride, and high-sensitivity C-reactive protein concentrations; and scored participants’ multimorbidity.
  • They determined intensity-specific PA using vector magnitude acceleration cut points (light PA, 19-518 counts/15 s; moderate to vigorous PA [MVPA], > 518) and steps per day using dedicated software, and they quantified sedentary time (total and mean bout duration).
  • The primary outcome was overall self-reported HF later adjudicated by physicians using medical record reviews; secondary endpoints were heart failure with reduced ejection fraction (HFrEF) and preserved EF (HFpEF), classified by an EF of < 45% or 45% or > 45%, respectively, after cardiac imaging.

TAKEAWAY:

  • A total of 407 HF cases (including 257 HFpEF and 110 HFrEF) were identified during a mean of 7.5 years of follow-up.
  • HFrEF was not associated with PA measures in the fully adjusted model (which controlled extensively for health and physical functioning status), but overall HF and HFpEF were inversely associated with total PA (per 1-standard deviation [SD] increment: hazard ratio [HR] 0.85; 95% CI, 0.75-0.95 and HR, 0.78; 95% CI, 0.67-0.91, respectively), light PA (HR, 0.88; 95% CI, 0.78-0.98 and HR, 0.80; 95% CI, 0.70-0.93, respectively) and MVPA (HR, 0.84; 95% CI, 0.73-0.97 and HR, 0.85; 95% CI, 0.72-1.01, respectively).
  • With regard to daily steps, each 1-SD increment was associated with a significant 26% lower risk for overall HF (HR 0.74; 95% CI, 0.63-0.88) and 29% lower risk for HFpEF (HR, 0.71; 95% CI, 0.57-0.88), with these inverse risks becoming significant at about 2000 steps/d, “far less than the often touted 10,000 steps/d for promoting health benefits,” noted the authors.
  • Total sedentary time was positively associated (per 1 SD in the fully adjusted model) with risks of overall HF (HR, 1.17; 95% CI, 1.04-1.33) and HFpEF (HR, 1.29; 95% CI, 1.10-1.51) but not HFrEF; mean sedentary bout duration was significantly inversely associated with HFrEF (per 1 SD: HR, 0.76; 95% CI, 0.61-0.97), although the relatively small number of cases at the extremes of bout duration may contribute to this unexpected inverse association, said the authors.

IN PRACTICE:

The implications of promoting PA, regardless of intensity, for primary HFpEF prevention in later life, “has profound public health and clinical relevance,” the authors concluded. They noted that HFpEF is a “burgeoning epidemic” that disproportionately affects women and minorities with limited available therapies.

STUDY DETAILS:

The study, led by Michael J. LaMonte, PhD, MPH, University at Buffalo-SUNY, Buffalo, New York, was published online on February 21, 2024, in JAMA Cardiology.

LIMITATIONS:

There was only a single accelerometer assessment of PA and sedentary exposures and relatively small numbers of HFrEF cases, which restricted analytic precision. Although researchers controlled for several established vascular biomarkers, they did not have HF-specific measures such as cardiac troponin or N-terminal pro–brain natriuretic peptide. It’s unknown if the findings can be generalized to men and populations dissimilar to women in OPACH.