Conference report: European Society of Cardiology (ESC) congress

The European Society of Cardiology (ESC) is holding several conferences this month, including the ESC Preventive Cardiology 2023 in Malaga, Spain (13-15 April) and the European Heart Rhythm Association (EHRA) 2023 in Barcelona, Spain (16-18 April).

The conferences bring together scientists, healthcare professionals and other players involved in cardiology from all around the world. This conference report holds some of the key findings from both congresses.

ESC Preventive Cardiology 2023, Malaga, Spain

“Worrying associations” between air pollution and death from cardiovascular disease

Air pollution may increase the risk of dying from cardiovascular disease, according to new research published in the International Journal of Environmental Research and Public Health.
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The research found that deaths from cardiovascular disease are elevated on polluted days and for two days afterwards. The authors of the study say the findings should encourage people to stay at home when the air quality is forecast to be poor, or, if this is not possible, wear a mask during peak pollution hours and avoid areas with heavy traffic.

The five-year study was conducted across five different cities in Eastern Poland. It examined the association between air pollution and death from cardiovascular disease.

Mortality data from the Central Statistical Office was compared with concentrations of particulate matter (PM)2.5, PM10, and nitrogen dioxide (NO2). The main sources of these pollutants are road traffic and household heaters using coal or wood.

The researchers compared levels of each pollutant on the day of the week a death occurred (e.g. Wednesday) with pollutant levels on the same day of the week without any deaths (e.g. all remaining Wednesdays) within the same month. Similar analyses were conducted for pollution levels one day and two days before a death occurred.

Of the 87,990 deaths which occurred within the five-year study, 34,907 were due to cardiovascular disease, 9,688 were due to acute coronary syndromes and 3,776 were due to ischaemic stroke. The study found that:

• Death from cardiovascular disease: a 10 μg/m3 rise in PM2.5, PM10 and NO2 was associated with a 3%, 3% and 8% increased risk, respectively (on the same day)
• Death from acute coronary syndromes: a 10 μg/m3 rise in PM2.5 and PM10 was associated with a 3% and 2% increased risk, respectively (on the same day)
• Death from ischaemic stroke: a 10 μg/m3 rise in PM2.5 was associated with a 3% increased risk of death (the following day).

Study author Dr. Michal Swieczkowski of the Medical University of Bialystok, Poland, said: “The results show worrying associations between air pollution and death from cardiovascular disease. Policymakers should consider measures to promote clean air including subsidies for upgrading household heating systems and vehicle-free zones.”

 

Daytime napping could increase the risk of developing atrial fibrillation

Napping for longer than 30 minutes during the daytime could increase the likelihood of developing atrial fibrillation (AF) – the most common heart rhythm disorder, which affects more than 40 million people worldwide.

Despite previous studies suggesting that sleep patterns may play a role in the development of AF, the authors of the study say this is the first to analyse the relationship between daytime napping and the risk of arrhythmia.

Dr Jesus Diaz-Gutierrez of Juan Ramon Jimenez University Hospital, Huelva, Spain, said: “Our study indicates that snoozes during the day should be limited to less than 30 minutes. People with disturbed night-time sleep should avoid relying on napping to make up the shortfall.”

The study used data from 20,348 Spanish university graduates (median age 38, 61% women) who took part in the University of Navarra Follow-up (SUN) Project. Each participant did not have AF at baseline, and all completed a questionnaire every two years.

Information was obtained on sociodemographics (age, sex, working hours), medical conditions (high cholesterol, high blood pressure, diabetes, sleep apnoea, cardiovascular diseases including atrial fibrillation), lifestyle (napping, smoking, exercise, coffee intake, binge drinking, adherence to a Mediterranean diet, TV watching), height and weight.

During a median follow up of 13.8 years, 131 participants developed AF. Those who napped for 30 minutes or more per day had a nearly doubled risk of developing AF compared to those who slept for less than 30 minutes.

The researchers then conducted a second analysis to identify the nap duration associated with the lowest risk of AF (excluding those who did not nap). They found that those who napped for less than 15 minutes had a 42% lower risk of developing AF than those who napped for more than 30 minutes, while those who napped for 15-30 minutes had a 56% reduced risk.

Dr. Diaz-Gutierrez said the results therefore suggest that “optimal napping duration is 15 to 30 minutes”, however, larger studies are now needed to determine whether a short nap is preferable to not napping at all.

“There are numerous potential explanations for the associations between napping and health. For example, long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter night-time sleep, more nocturnal awakening and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels and reduce stress,” he said.

 

Meditating for 20 minutes a day could reduce depression, stress and anxiety in heart disease patients

Meditation can improve psychological symptoms and quality of life in patients with heart disease, new research has found.

Heart disease patients are twice as likely to develop a mental health condition. Many patients feel stressed, anxious and depressed following their diagnosis, and these factors are linked with the development and progression of heart disease.

Heart patients are typically offered an exercise-based cardiovascular rehabilitation programme, so the authors set out to compare whether this programme improved mental health in heart patients, and then compared this programme to meditation.

The study included 40 patients with coronary artery disease (median age 65 years, 20% women). These participants were then randomly allocated to four months of meditation practice on top of usual care, or usual care alone. Usual care was continuing with the exercise programme.

The meditation group had a weekly 90-minute mediation session (using karuna meditation, which focuses on breathing and compassionate thoughts) and were then asked to mediate for 20 minutes a day on their own or using a recording from the investigators.

Stress, anxiety, depression and quality of life were assessed at baseline and after four months using the Perceived Stress Scale, Beck Anxiety Inventory, Beck Depression Inventory and HeartQoL questionnaire, respectively.

In the meditation group, depression, stress and anxiety scores reduced by 44%, 31% and 29%, respectively. This compares to reductions of just 3%, 3% and 3% in the usual care group. Furthermore, average scores on the emotional dimension of quality of life increased by 60% in the meditation group but reduced by 2% in the usual care group.

Study author Ms. Ana Luisa Vitorino Monteiro, a meditation teacher and scientific researcher, says the results show that meditation could be a “useful addition” to standard exercise rehabilitation.

“Meditation is easy to do, can be done almost anywhere and does not require any equipment. Our study shows that meditation can improve psychological symptoms and quality of life in patients with heart disease, which we hope could also be the start of making healthier lifestyle choices,” she said.

 

EHRA 2023, Barcelona, Spain

Statin use may reduce risk of stroke in patients with atrial fibrillation

Patient with atrial fibrillation (AF) who start statins within a year of diagnosis may have a reduced risk of stroke and transient ischaemic attack (TIA or ‘mini stroke), according to a new study.

Patients with AF have a five times greater risk of stroke than their peers, and for this reason, they are often prescribed anticoagulant medication. However, this does not completely eliminate the risk.

Statins are therefore often used to lower blood cholesterol and reduce the likelihood of heart attack and stroke, but until now, the benefits of statins in AF patients have been unclear.

The researchers used data was from the Hong Kong Clinical Data Analysis and Reporting System and identified 51,472 patients (median age 75 years, 48% women) with a new diagnosis of AF between 2010 and 2018, of which 11,866 were classified as statin users and 39,606 were non-users

Participants were followed up until one of the primary outcomes occurred or until the study ended on 31 October 2022. These outcomes included: ischaemic stroke or systemic embolism, haemorrhagic stroke, and TIA.

Statin users were found to have a significantly lower risk of all primary outcomes compared to non-users: statin use was associated with a 17% reduced risk of ischaemic stroke or systemic embolism, a 7% reduced risk of haemorrhagic stroke and a 15% reduced risk of TIA.

Long-term use was associated with greater protection than short-term use, and patients using statins for six years or longer had a 43% lower risk of ischaemic stroke or systemic embolism compared to those using statins for three months to two years. They also had a 44% reduced likelihood of haemorrhagic stroke and 42% reduced risk of TIA.

Study author Jiayi Huang, a PhD student at the University of Hong Kong, China, says the data supports the use of statins to prevent stroke and TIA in patients with new-onset AF.

“The findings have important clinical implications particularly given that in atrial fibrillation patients, ischaemic strokes are often fatal or disabling, and have a high risk of recurrence,” she added.

 

Monitoring hypertrophic cardiomyopathy patients for 30 days detects more arrhythmias

Monitoring hypertrophic cardiomyopathy (HCM) patients with a Holter monitor – a portable electrocardiogram (ECG) – for 30 days detects more arrhythmias than the standard 24 to 48 hours, according to new research.

The use of 24-48-hour Holter monitoring is recommended to detect AF and non-sustained ventricular tachycardia (NSVT) is patients with HCM. However, previous research has shown that extended ECG monitoring can improve detection of AF.

So, the researchers set out to discover whether monitoring patients with HCM using a continuous recording system would identify a significantly greater number of clinically relevant arrhythmias compared with shorter measurement.

A total of 100 participants (median age 57, 22% women) underwent extended ECG monitoring for 30 days using a dedicated device. The primary outcome was the detection of AF, atrial flutter or NSVT during the first 24 hours of monitoring versus the whole 30 day period.

In the 24-hour monitoring period, 11% of participants were found to have a clinically relevant arrhythmia, this compares to 65% after 30 days of monitoring. The majority of patients had NSVT, which was detected in 62% of patients across 30 days compared with 8% in the first 24 hours.

Regarding atrial fibrillation, extended monitoring detected four more cases than 24 hour monitoring, including three patients without a prior diagnosis of this arrhythmia. The study’s authors say this result may have achieved statistical significance if the sample size was larger.

Principal investigator Dr. Juan Caro Codon of La Paz University Hospital, Madrid, Spain said the prevalence of arrythmias (particularly NSVT) was “shockingly elevated” compared to previous studies, which have shown a 20-30% prevalence. However, he said caution is needed regarding the significance of NSVT episodes during prolonged ECG monitoring.

“If a certain risk factor is so prevalent among a certain population, it is possible that it does not adequately discriminate the true risk of sudden cardiac death. This is especially relevant in the era of wearables, when a large number of patients will consult due to abnormal findings detected by their own devices.

“In fact, patients with NSVT during the first 24 hours, which would be detected by conventional Holter, had more aggressive NSVT. In the future, more complete phenotyping of the arrhythmic profile of a specific patient may aid in risk stratification. Extended ECG monitoring may also help, but further research is needed before it is ready for clinical practice,” he said.