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After COVID-19, Experts Say Watch for These Potential Heart and Brain Problems

Michael Merschel wrote . . . . . . . . .

COVID-19 was full of surprises early on, causing mild problems in the short term for some people and serious complications for others.

Long term, it may be just as capricious.

Studies are spotting potential heart and brain problems up to a year after infection with SARS-CoV-2, even in people who had mild COVID-19.

The possible long-term effects include “a myriad of symptoms affecting different organs,” said Dr. José Biller, director of the COVID-19 neurology clinic at Loyola Medicine in Maywood, Illinois. “So, it could be the lungs, it could be cardiovascular, it could be the nervous system, it could be mental health or behavioral problems.”

Estimates vary widely on how many people may be affected. Research suggests about 10% to 20% of people experience mid- or long-term issues from COVID-19, according to the World Health Organization.

That may sound small, but COVID has affected hundreds of millions of people, said Dr. Siddharth Singh, director of the post-COVID-19 cardiology clinic at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. In the U.S. alone, about 80 million people have been infected with the coronavirus since the pandemic started in early 2020.

There are many more questions than answers, including about who is most at risk for post-COVID problems and how long the effects might last. But experts say people who have had COVID-19 should be aware of these potential risks:

Heart disease and stroke

A study published in Nature Medicine in February concluded the risk of heart problems one year after COVID-19 infection is “substantial.”

Those heart problems include irregular heartbeats, heart failure (the inability of the heart to pump properly), coronary disease (buildup in arteries that limits blood flow), heart attacks and more.

The study included 153,760 U.S. veterans, most of them white and male, who tested positive for COVID-19 between March 1, 2020, and Jan. 15, 2021, and survived at least 30 days. They were compared to a control group of more than 5.6 million veterans without COVID-19.

Researchers adjusted for pre-existing conditions and found that after one year, those who had COVID-19 were 63% more likely to have some kind of cardiovascular issue, resulting in about 45 additional cases per 1,000 people.

Risks were elevated even among people who did not have severe COVID-19. That matches what Singh has seen in his post-COVID clinic, which began treating patients in December 2020. “A lot of patients that we have seen with long-haul symptoms had minor illness and had been treated at home.”

Singh also treats many people with postural orthostatic tachycardia syndrome, or POTS, which can cause dizziness, fainting and heart palpitations. “These palpitations mostly tend to happen when people are standing or sitting upright,” he said.

In rare cases, “smoldering inflammation around the heart or in the heart” can occur, Singh said.

The Nature Medicine study also found a 52% increased risk of stroke at one year among COVID-19 survivors, or about four extra strokes per 1,000 people.

Brain problems

Among the 113 patients in Biller’s long COVID clinic, almost 3 in 4 reported so-called brain fog. “They are unable to multitask, and have difficulties in learning new skills,” said Biller, who also leads the department of neurology at the Loyola University Chicago Stritch School of Medicine.

A recent Nature study of 785 people ages 51 to 81 found those who had COVID-19 lost more grey matter and had more brain shrinkage than those who had not.

Mental health

A study published in February in BMJ used the same pool of U.S. veterans as the Nature Medicine study and found a 35% increased risk of anxiety disorders after COVID-19, or 11 additional cases per 1,000 people after one year compared to those without COVID-19. The risk for depression was slightly higher.

When researchers compared people who’d had COVID-19 versus the flu, the risk of mental health disorders was again significantly higher with COVID-19.

“Mental health is closely tied to cardiovascular health,” Singh said. If somebody is anxious or depressed, “they’re not going to exercise that much. They’re not going to watch their diet, take control of their hypertension and other risk factors, their sleep is affected which can impact cardiovascular health, and so on.”

He said many COVID-19 survivors also have unresolved pain, grief and post-traumatic stress disorder, which can contribute to a decline in mental health.

Fatigue

At Biller’s post-COVID clinic, patients often describe experiencing “crushing” fatigue. Fatigue was the most common post-COVID symptom reported in a review of several studies published in August in Scientific Reports.

What you can do

Even though the long-term risks from having COVID-19 may be real, Singh said, they should not cause most people to be terribly worried. Instead, he said, it’s a good time to be proactive:

  • Take care of yourself. “A lot of my family and friends have gotten COVID earlier this year and last year,” Singh said. “What I’m telling them is just to be a bit more vigilant when it comes to their cardiovascular health and making sure their cardiovascular risk factors are well-controlled. Obviously, if one is having chest pain, shortness of breath or palpitations, that should not be ignored.”
  • Symptoms lingering? See a doctor. “It can take anywhere from two to six weeks to completely bounce back from the infection,” Singh said. But if people have persistent physical and mental symptoms beyond four to six weeks, “it’s wise to get checked out.”
  • Pay attention to sleep. Sleep disorders – which are linked to heart problems – can develop after COVID-19, research shows. “The importance of good sleep cannot be overemphasized,” Singh said. If you’re having trouble, you might need to see a specialist.
  • Stay informed. As research continues to untangle the mysteries of COVID-19, people will need trustworthy information. The Centers for Disease Control and Prevention offers regular updates about the coronavirus, and the National Library of Medicine provides a tutorial for evaluating health information.
  • Get vaccinated. COVID-19 vaccines reduce the risk of infection and severe illness. And while it’s not yet clear whether vaccination influences long-term symptoms in people who get breakthrough infections, Biller said, “prevention is the key.”


Source: American Heart Association

Science Reveals How Red Meat Harms the Heart

Amy Norton wrote . . . . . . . . .

Red-meat lovers may raise their risk of heart disease through a chain of events that plays out in the gut, a new study suggests.

Many studies over the years have tied diets heavy in red and processed meats to a heightened risk of heart disease and stroke. That type of evidence does not, however, prove red meat is the problem — or, if it is, why.

The new findings offer more clues about the “why.”

Researchers found that particular gut bacteria, more abundant in red-meat eaters, are key in turning a dietary nutrient called carnitine into a foe: a chemical known as TMAO, which helps promote blood-clotting and clogged arteries.

For the average person, the insights reinforce what’s already known about heart-healthy eating, said study co-author Dr. Stanley Hazen, who directs Cleveland Clinic’s Center for Microbiome and Human Health.

In particular, he pointed to the traditional Mediterranean diet, which has been shown in clinical trials to cut the risks of heart disease and stroke.

That diet is high in fish, fruits and vegetables, legumes, olive oil and nuts — and low in red meat and processed foods.

The new study was published in Nature Microbiology. It is among the latest to delve into the relationship among diet, the gut microbiome and human health.

“Microbiome” refers to the vast collection of bacteria and other microbes that naturally inhabit the human body, especially the gut. Research in recent years has begun to reveal just how vital those gut microbes are — not only in digestion, but in immune system defenses, brain function and the health of the cardiovascular system.

It’s well-established, Hazen said, that people with diets high in red meat typically have a higher risk of heart disease and stroke than those who eat little red meat.

The traditional suspect was saturated fat, found almost exclusively in animal products. Saturated fat can boost “bad” LDL cholesterol, which contributes to cardiovascular disease.

But, Hazen said, research has shown that any ill effects of saturated fat are not enough to explain the excess heart disease risks linked to heavy red-meat consumption. There had to be other mechanisms.

The new findings point to one, said Lauri Wright, chair of nutrition and dietetics at the University of North Florida, in Jacksonville.

There is still much to learn about the gut microbiome, said Wright, who is also a spokesperson for the Academy of Nutrition and Dietetics. But in general, she said, diets rich in foods like vegetables, fruits and high-fiber grains help “feed” beneficial gut microbes.

“It still goes back to food,” Wright said.

Hazen, too, said he is a “big supporter” of using diet to change the gut microbiome, rather than adding certain bugs via probiotic supplements.

“Changing your diet changes the soil” that feeds gut microbes, he explained.

The latest findings build on earlier work by Hazen and his colleagues focusing on TMAO. The chemical is generated when gut bacteria break down carnitine, a nutrient particularly abundant in red meat.

The researchers had already shown that TMAO appears to raise the risk of heart disease and stroke. And in a 2019 study, they found that adding red meat to healthy people’s diets for a short time boosts blood levels of TMAO. Those levels went back down, though, when red meat was swapped for either white meat or vegetable proteins.

In the latest study, looking at both humans and lab mice, the researchers found that a cluster of gut bacteria — within a group called Emergencia timonensis — transform carnitine into TMAO. While meat-eaters harbor a decent amount of those microbes, longtime vegetarians and vegans have very few.

In the experiments with mice, the researchers found that introducing E. timonensis boosted TMAO levels and the blood’s propensity to form clots.

The researchers also analyzed stool samples from people who took part in the 2019 diet study. They found that when participants were eating a lot of red meat, their stool harbored more of the culprit E. timonensis microbes; when they switched to non-meat protein sources, those microbial levels dropped.

There are blood tests available to measure people’s TMAO levels. And Hazen said that these could potentially allow health-care providers to give patients more personal diet advice: If someone’s TMAO levels were high, limiting red meat would be particularly important.

But what you take in, Wright noted, is as important as what you limit. She said that fermented foods like yogurt and kimchi, which contain certain microbes, can be good choices. But again, she stressed, overall diet is what’s key in supporting a healthy gut.


Source : HealthDay

Statins: Good for the Heart, Maybe Not So Good for Diabetes

Steven Reinberg wrote . . . . . . . . .

Statins are proven to lower cholesterol, but they may also come with a downside for patients with diabetes: A new study finds they may make the blood sugar disease worse.

Researchers found that among those taking statins, 56% saw their diabetes progress, compared with 48% of those not taking statins. And the higher the dose of the statin, the faster the progression of the diabetes.

“This study should be a start to more research examining the balance of benefits and harms of statins in patients with diabetes,” said senior researcher Dr. Ishak Mansi. He is a professor in the Departments of Medicine and Data and Population Science at the University of Texas Southwestern in Dallas.

“We know well about the benefits of statins, but the harms are much less investigated,” Mansi said. “Specifically, what is the population that may benefit less from the use of statins for primary prevention or be harmed? Answering these questions impact hundreds of millions of patients and cannot be postponed.”

He cautioned that based solely on this one finding, no patient should stop taking their statins and that association does not prove causation.

For the study, Mansi and his colleagues collected data on more than 83,000 diabetic patients who used statins and more than 83,000 who didn’t.

Those who were taking statins were more likely to see their diabetes progress and need to start using insulin and other types of drugs to lower high blood sugar levels sooner than those who weren’t taking statins.

“The study may alert clinicians that they may need to pay close attention and expect to adjust anti-diabetes medications when they initiate statins,” Mansi said.

Dr. Joel Zonszein, an emeritus professor of medicine at the Albert Einstein College of Medicine in New York City, said that blood sugar is not the only key to managing type 2 diabetes.

“Management of type 2 diabetes is not centered on lowering blood sugars,” explained Zonszein, who wasn’t part of the study. “In addition to lifestyle changes, medications are often necessary to prevent or attenuate complications. Statins are highly effective in lowering cholesterol and protecting against heart attacks and strokes.”

Statins do not cause diabetes and the modestly increased rate in precipitating new-onset diabetes is well-known, though the exact mechanism remains unknown, he said.

“The benefits of statins in patients with type 2 diabetes are far greater than the potential side effects,” Zonszein added.

Millions of people have been treated with statins, and its widespread application has been a major public health advance, he noted.

Treatment of obesity, hypertension and high cholesterol is as important as improving glycemic control, Zonszein added, and statins are one of the best medications for these in patients with type 2 diabetes.

“When prescribing any medication, a careful balance between benefits and side effects is discussed between the health care provider and the patient,” Zonszein said. “In the case of statins, the benefits, particularly in patients with type 2 diabetes, are by far better than potential side effects.”

The report was published online in the journal JAMA Internal Medicine.


Source: HealthDay

Study: Alcohol Can Cause Immediate Risk of Atrial Fibrillation

Elizabeth Fernandez wrote . . . . . . . . .

A single glass of wine can quickly – significantly – raise the drinker’s risk for atrial fibrillation, according to new research by UC San Francisco.

The study provides the first evidence that alcohol consumption substantially increases the chance of the heart rhythm condition occurring within a few hours. The findings might run counter to a prevailing perception that alcohol can be “cardioprotective,” say the authors, suggesting that reducing or avoiding alcohol might help mitigate harmful effects.

The paper is published in Annals of Internal Medicine.

“Contrary to a common belief that atrial fibrillation is associated with heavy alcohol consumption, it appears that even one alcohol drink may be enough to increase the risk,” said Gregory Marcus, MD, MAS, professor of medicine in the Division of Cardiology at UCSF.

“Our results show that the occurrence of atrial fibrillation might be neither random nor unpredictable,” he said. “Instead, there may be identifiable and modifiable ways of preventing an acute heart arrhythmia episode.”

Atrial fibrillation (AF) is the most common heart arrhythmia seen clinically, but until now research has largely focused on risk factors for developing the disease and therapies to treat it, rather than factors that determine when and where an episode might occur. AF can lead to loss of quality of life, significant health care costs, stroke and death.

Large studies have shown that chronic alcohol consumption can be a predictor of the condition, and Marcus and other scientists have demonstrated that it is linked to heightened risks of a first diagnosis of atrial arrhythmias.

The research centered on 100 patients with documented AF who consumed at least one alcoholic drink a month. The patients were recruited from the general cardiology and cardiac electrophysiology outpatient clinics at UCSF. People with a history of alcohol or substance use disorder were excluded, as were those with certain allergies, or who were changing treatment for their heart condition.

Each wore an electrocardiogram (ECG) monitor for approximately four weeks, pressing a button whenever they had a standard-size alcoholic drink. They were also all fitted with a continuously recording alcohol sensor. Blood tests reflecting alcohol consumption over the previous weeks were periodically administered. Participants consumed a median of one drink per day throughout the study period.

Researchers found that an AF episode was associated with two-fold higher odds with one alcoholic drink, and three-fold higher odds with two or more drinks within the preceding four hours. AF episodes were also associated with an increased blood alcohol concentration.

The authors note study limitations, including that patients might have forgotten to press their monitor buttons or that they minimized the number of button presses due to embarrassment, although these considerations would not have affected alcohol sensor readings. Additionally, the study was limited to those with established AF, not to the general population.

“The effects seem to be fairly linear: the more alcohol consumed, the higher the risk of an acute AF event,” said Marcus. “These observations mirror what has been reported by patients for decades, but this is the first objective, measurable evidence that a modifiable exposure may acutely influence the chance that an AF episode will occur.”


Source: UCSF

Exercise Boosts Survival for People With Implanted Defibrillators

Just small amounts of exercise can benefit people with implanted heart defibrillators, new research shows.

An implantable cardioverter defibrillator (ICD) is a battery-powered device placed under the skin to detect abnormal heart rhythms and deliver an electric shock to restore a normal heartbeat.

The new study found that even slight increases in physical activity reduced the risk of hospitalization and early death after patients got an ICD. And that was true even if their fitness boost wasn’t from a formal rehabilitation program, according to findings published in the journal Circulation: Cardiovascular Quality and Outcomes.

“Cardiac rehabilitation programs offer patients a safe environment to increase physical activity after ICD implantation,” said study author Dr. Brett Atwater, director of electrophysiology at the Inova Heart and Vascular Institute in Fairfax, Va.

“Evidence has also shown cardiac rehab lessens the risk of additional hospitalization and death, but cardiac rehabilitation programs are underutilized, especially among women, the elderly, people from diverse racial and ethnic groups and those living in rural areas,” he said in a journal news release.

Atwater and his team examined data on nearly 42,000 Medicare patients (average age: 75) who got ICDs between 2014 and 2016.

Of those, 3% took part in a heart rehab program. During rehab, their physical activity rose by nearly 10 minutes a daily, compared to a minute-a-day drop off among patients not in rehab.

Those in a rehab program were 24% less likely to die within three years of getting their ICD than patients who were not in rehab.

The study also linked every 10 minutes of increased daily activity to a 1.1% reduction in death from all causes during that time span — whether patients were in a formal rehab program or not.

“Our study examined whether physical activity outside of a formal cardiac rehabilitation program could yield similar benefits, and we found it did,” Atwater said. “This suggests that additional options like home-based cardiac rehabilitation might help more patients realize the health benefits of increased physical activity.”


Source: HealthDay