Inactivity, Excess Weight Linked to Hard-to-Treat Heart Failures

 Prevention is imperative for heart failure with preserved ejection fraction.

Newswise, April 20, 2017– Lack of exercise and excessive weight are strongly associated with a type of heart failure that has a particularly poor prognosis, UT Southwestern Medical Center researchers determined in an analysis of data from three large studies.

Heart failure is a chronic condition in which the heart is unable to supply enough oxygenated blood to meet the demands of the body.

Heart failure is approximately equally divided between two subtypes: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Ejection fraction refers to the percentage of the blood that exits the heart with each contraction.

“Previous studies have consistently found an association between low levels of physical activity, high BMI, and overall risk of heart failure, but this study shows that the association is more pronounced for heart failure with preserved ejection fraction, the type of heart failure that is the most challenging to treat,” said preventive cardiologist Dr. Jarett Berry, Associate Professor of Internal Medicine at UT Southwestern, and the study’s senior author.

The study appears in the Journal of the American College of Cardiology. 

In heart failure with preserved ejection fraction, the heart stiffens. Instead of being soft, it’s rigid and it resists expansion.

Cardiologists often explain the difference between the two types of heart failure by saying that in heart failure with preserved ejection fraction, the heart doesn’t relax enough, while in heart failure with reduced ejection fraction the heart doesn’t squeeze enough. Many treatments have been developed for treating the latter but there are no evidence-based treatments for the former. 

“The five-year survival rate among heart failure with preserved ejection fraction patients is around 30 to 40 percent. While heart failure with reduced ejection fraction survival has improved significantly over the years, heart failure with preserved ejection fraction prognosis is little changed,” said Dr. Ambarish Pandey, a cardiology fellow in Internal Medicine at UT Southwestern Medical Center and first author of the study.

The pooled analysis looked at data from 51,000 participants in three cohort studies, the Women’s Health Initiative, the Multiethnic Study of Atherosclerosis (MESA), and the Cardiovascular Health Study. Among the 51,000 participants, there were 3,180 individuals who developed heart failure.

Of these, 39 percent were heart failure with preserved ejection fraction, 29 percent were heart failure with reduced ejection fraction, and 32 percent had not been classified when the data was gathered.

The incidence of heart failure with preserved ejection fraction was 19 percent lower for individuals who exercised at recommended levels.

Similarly, body mass index (BMI) had an inverse relationship with heart failure with preserved ejection fraction. Higher BMI levels were more strongly associated with heart failure with preserved ejection fraction than with heart failure with reduced ejection fraction.

Heart failure with preserved ejection fraction is a growing problem as the population ages, and is particularly a problem among elderly women.

Medications such as ACE inhibitors, beta blockers, and aldosterone antagonists have been shown in large-scale randomized trials to reduce mortality in patients with heart failure with reduced ejection fraction. Clinical trials have not identified medications that reduce mortality in patients with heart failure with preserved ejection fraction.

Heart transplant is the ultimate option for some patients with heart failure with reduced ejection fraction but is not an option for patients with heart failure with preserved ejection fraction, all of which means that prevention is crucial for heart failure with preserved ejection fraction.

“These findings highlight the importance of lifestyle interventions such as increasing physical activity levels and reducing weight to combat the growing burden of this disease,” said Dr. Berry, Dedman Family Scholar in Clinical Care.

Other UT Southwestern researchers who contributed to this study are Colby Ayers, faculty associate, and Dr. James de Lemos, Professor of Internal Medicine and holder of the Sweetheart Ball‐Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology. 

Funding for this study was provided by the American Heart Association.

Preventing heart failure:

•The American Heart Association recommends 150 minutes per week of moderate exercise, 75 minutes per week of vigorous exercise, or a mix of the two.

•A patient’s cardiorespiratory fitness in middle age is particularly important in predicting the long-term risk of heart failure.

About UT Southwestern Medical Center

UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. The faculty of almost 2,800 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in about 80 specialties to more than 100,000 hospitalized patients and oversee approximately 2.2 million outpatient visits a year.

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Cedars-Sinai Neurologist Warns of Increased Risk of Strokes During and after the Holidays

Stroke Expert Explains How to Recognize Symptoms and Prevent Life-Threatening Complications by Acting Quickly

Newswise, January 3, 2017 — Along with increased cheer and festivities during the holidays comes an increased risk of stroke, one of the leading causes of death and disability in the U.S.

Patrick D. Lyden, MD, chair of the Cedars-Sinai Department of Neurology, said he sees a significant increase in stroke incidents during December and January, particularly on Christmas Day and New Year’s Day.

Lyden attributes the surge to holiday stress, sleep deprivation, dehydration, smoking, overindulging, and seasonal colds and influenza. He also says that changes in barometric pressure and lower temperatures can play a role.

“Holiday strokes can be an unexpected and even fatal problem because they often arrive with little warning,” said Lyden, director of the Cedars-Sinai Stroke Center. “The good news, however, is that with advanced tools and technology available to us, we may prevent life-threatening complications and even reverse the effects of a stroke if we administer treatment within six hours.”

Lyden says the number of stroke cases treated at Cedars-Sinai rises to about 100 from about 80 per month during the winter season. Stroke is the fifth-leading cause of death in the U.S. and a leading cause of disability, according to the American Stroke Association.

To recognize symptoms, leading stroke experts recommend memorizing an easy-to-remember acronym: FAST!

Face (drooping of the face)
Arm (arm weakness)
Speech (slurred speech)
Time (time counts -- call 911 immediately)

To reduce the risk of strokes, Lyden recommends that individuals reduce stress, eat and drink in moderation, be vigilant about taking prescribed medications, exercise, get rest and stop smoking.

“Studies show that 80 percent of strokes can be prevented,” said Lyden. “But if it occurs, the key is calling 911 fast. Every minute a stroke is untreated, the average patient loses about 1.9 million brain cells.”

Cedars-Sinai has been designated a Comprehensive Stroke Center by The Joint Commission, an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States.

This advanced certification for comprehensive stroke centers recognizes the significant resources in staff and training that these centers must have to treat complex stroke cases. Cedars-Sinai was proud to be among the first five hospitals in the nation, and the first in Southern California, to receive this designation.

Exercise May Help You Survive a First Heart Attack

Henry Ford Hospital study links Fitness and Survival

Newswise, February 1, 2016– People who are fit are more likely to survive their first heart attack, according to a study of nearly 70,000 patients of Henry Ford Hospital in Detroit.

The results of the study by Henry Ford and the Johns Hopkins University School of Medicine will be published online February 1 in Mayo Clinic Proceedings.

“Our data suggests that doctors working with patients with cardiovascular risk factors should be saying, ‘Mr. Jones, you need to start an exercise program now to improve your fitness and chance of survival, should you experience a heart attack,’” says Clinton Brawner, PhD., Clinical Exercise Physiologist and Senior Bioscientific Clinical Staff Researcher at Henry Ford Health System.

“These findings suggest that higher aerobic fitness before a heart attack is associated with better short-term survival after the first heart attack.”

While several prior studies have reported a strong relationship between fitness and long-term risk of death in various patient populations, the study is the first to examine the association of early death following a first heart attack.

The analysis is part of the Henry Ford Exercise Testing Project, or FIT Project, a study of nearly 70,000 adults who completed a physician referred exercise stress test at Henry Ford Health System between 1991 and 2009.

In the current analysis of the Henry Ford data, the researchers focused on 2,061 patients who suffered their first heart attack after the stress test, during follow-up. Mean time between the exercise test and the first heart attack was six years.

Patients with a high level of fitness during their initial stress test at a Henry Ford Health System facility were 40% less likely to die within a year following their first heart attack compared to patients with lower fitness, according to the study.

“We knew that fitter people generally live longer, but we now have evidence linking fitness to survival after a first heart attack,” says Michael Blaha, M.D., M.P.H., director of clinical research at the Ciccarone Center for the Prevention of Heart Disease and assistant professor of medicine at the Johns Hopkins University School of Medicine.

“It makes sense, but we believe this is the first time there is documentation of that association.”

Those Henry Ford patients who were more active also reduced their likelihood of dying during the year following their first heart attack by 8 to 10% for each level of increased fitness they had reached during the stress test.

The results suggest that low fitness may represent a risk of death following a heart attack that is similar to traditional risk factors, such as smoking, high blood pressure, or diabetes, says Henry Ford’s Dr. Brawner.

The findings suggest doctors should include exercise when counseling patients about controlling their risk factors.

“While up to 50% of fitness may be based on genetics, physical activity is the only behavior we have that can improve fitness,” Dr. Brawner says.

Follow-up studies are needed to formally establish whether exercise training among individuals with low fitness and increased risk for a heart attack reduces the short-term mortality risk following a first heart attack, Dr. Brawner added.

Investigators also intend to look at whether patients with low fitness suffer more damage to their heart during their heart attack.

The primary investigator of the FIT project is Henry Ford cardiologist Mouaz Al-Mallah, M.D.

The lead author of the present analysis was Gabriel Shaya, M.S., of the University of Miami.

Additional investigators include Jonathan Ehrman, Ph.D., and Steven Keteyian, Ph.D., of Henry Ford Hospital; Blaha, Rupert Hung, B.A., Khurram Nasir, M.D., and Roger Blumenthal, M.D., of Johns Hopkins; and Waqas Qureshi, M.D., of Wake Forest University.