Medical Bulletin 26/ July/ 2024

High blood pressure is known to increase a person's chances of having a stroke. A study led by Michigan Medicine focuses on the cumulative effects of years of high systolic blood pressure, the top number on a blood pressure reading, which indicates how hard the heart pumps blood to the arteries. The study, published in the journal JAMA Network Open, found that higher average systolic blood pressure during adulthood is linked to a greater risk for the two most common types of stroke.

Elevated blood pressure, or hypertension, affects the body by exerting excessive force on the walls of blood vessels. Over time, this constant pressure can damage arteries, leading to the formation of clots or causing them to rupture. This damage increases the risk of stroke, heart attack, and other cardiovascular diseases. Specifically, hypertension can cause the narrowing and hardening of arteries, reducing blood flow to critical areas such as the brain and heart.

The study analyzed the average systolic blood pressure years ahead of the first stroke for more than 40,000 adults with no history of stroke. Researchers examined three types of stroke: ischemic, caused by a clot that cuts off blood supply to the brain and accounts for over 85% of all strokes; intracerebral hemorrhage, a bleed within the brain; and subarachnoid hemorrhage, bleeding between the brain and the tissues that cover it.

Findings revealed that a mean systolic blood pressure 10-mm Hg higher than average was associated with a 20% higher risk of overall stroke and ischemic stroke, and a 31% greater risk of intracerebral hemorrhage. The study underscored the importance of managing systolic blood pressure to prevent strokes and other cardiovascular diseases.

Self-monitoring of blood pressure can improve diagnosis and control, proving to be an accurate and cost-effective method. However, it remains an underused tool despite its potential benefits. Regular monitoring and management of blood pressure are crucial steps in reducing the risk of stroke and maintaining overall cardiovascular health.

Reference: Johnson, K. E., et al. (2024). Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2024.8502.

Daily use of statins, or cholesterol-lowering drugs, may help reduce the risk of cardiovascular events such as heart attacks and strokes in people with HIV by 35%, according to a study published in the New England Journal of Medicine.

Statins are a class of drugs that reduce levels of low-density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol. By lowering LDL cholesterol, statins help prevent the buildup of fatty deposits in arteries, reducing the risk of cardiovascular events. They are commonly prescribed to manage and prevent heart disease in the general population and have now shown promise for those living with HIV.

People living with HIV face a 50-100% increased risk of cardiovascular disease compared to the general population. The research showed that daily statin use could prevent one in five major cardiovascular events or premature deaths in this population.

“This research suggests that statins may provide an accessible, cost-effective measure to improve cardiovascular health and quality of life for people living with HIV,” said Gary H. Gibbons, director of the National Heart, Lung, and Blood Institute, part of the US National Institute of Health.

The study involved 7,769 adults aged 40-75, who were randomized to receive either pitavastatin or a placebo. Participants who took pitavastatin experienced 35% fewer major cardiovascular events and a 21% reduction in deaths compared to the placebo group. Additionally, those taking the statin saw a 30% decrease in LDL cholesterol levels.

Researchers also noted that while lowering LDL cholesterol reduces risks for heart attacks and strokes, the findings suggested additional benefits of statin therapy for people living with HIV.

The study further highlighted the need to address comorbidities like cardiovascular disease in the management of HIV, which affects more than 38 million people worldwide, with 1.5 million new diagnoses in 2021, according to the World Health Organization (WHO). Addressing cardiovascular risks is crucial for improving the overall health and longevity of individuals living with HIV.

Reference: Amena Alhammadi,Rasha Alshawaf,Swati Chavda,Sonya Ramondino,Mindy Schuster,Infectious Diseases: What You May Have Missed in 2023, Annals of Internal Medicine, (2024); https://doi.org/10.7326/M24-0679

Using wearable devices like smartwatches to track health data and symptoms is intended to help individuals monitor their health and promptly address symptoms, aiming for positive health outcomes. However, for people with atrial fibrillation (Afib), using such devices to monitor heart rate and alert wearers of irregular heartbeats might not be as beneficial as expected.

A new study published in the Journal of the American Heart Association found that wearable devices can significantly amplify anxiety and increase healthcare usage among Afib patients.

The study involved 172 patients from UNC Health with a prior diagnosis of Afib who completed a survey and had their information linked to electronic health records. About half of the participants used wearable devices, and their data was compared to those without such devices.

The researchers discovered that Afib patients using wearables were more likely to be preoccupied with their heart symptoms, express concerns about their Afib treatment, and utilize healthcare resources more frequently than those without wearables. Additionally, healthcare providers and clinics were affected, as wearable users were more likely to contact the clinic and send messages to their healthcare providers.

The result showed that 1 in 5 Afib patients using wearables experienced intense fear and anxiety in response to irregular rhythm notifications from their devices. A similar proportion routinely contacted their doctors when ECG results were abnormal or indicative of possible Afib.

“Given the significant increase in use of wearable devices in this patient group and the population in general. We believe prospective studies and randomized trials are needed to understand the net effects of wearables – including their alerts – on patients’ healthcare use and psychological well‐being, as well as the downstream effects on providers, hospitals, and health systems” said Lindsay Rosman, assistant professor of medicine in the division of cardiology at the University of North Carolina School of Medicine.

Reference: Christopher C. Cheung,Mussa Saad,Wearable Devices and Psychological Wellbeing—Are We Overthinking It?, Journal of the American Heart Association, 0, 0, (undefined). /doi/10.1161/JAHA.124.035962