Latest news with #cardiovascularHealth
Medscape
09-07-2025
- Health
- Medscape
Not Just Pills — Cardiologists Must Talk Spirituality
Spirituality is becoming an area of growing interest in cardiovascular medicine as evidence mounts linking it to improved physiological outcomes and treatment adherence. Emerging research suggests that qualities such as purpose in life, gratitude, and hope — even when not tied to religious practice — may positively influence cardiovascular health. At the 45th Congress of the Cardiology Society of the State of São Paulo, experts explored how this subjective dimension may contribute to fewer hospitalizations, better blood pressure control, and improved clinical outcomes in patients with heart disease. Opening the discussion, cardiologist and hypertension specialist Fernando Nobre, MD, PhD, emphasized the important distinction between spirituality and religiosity. While often used interchangeably, the two are not synonymous. Religiosity refers to structured beliefs, practices, and rituals associated with faith and community life. In contrast, spirituality encompasses moral, emotional, and mental values that shape an individual's behavior and decision-making. These can be assessed using scientific frameworks. 'Religiosity is about how connected someone is to their religion — attendance at services, observance of rituals. That can be part of spirituality, but spirituality goes further. It cuts across and transcends a person's life, shaping their choices and way of living,' said Nobre, who is also a professor at the University of São Paulo, São Paulo, Brazil. Patients with a stronger sense of spiritual engagement tend to have lower blood pressure and are less likely to develop hypertension. Studies suggest these effects may be linked to lower peripheral vascular resistance, improved cardiac output, and better adherence to prescribed treatment — particularly among women. One recent example is the Brazilian Feel study, led by cardiologist Maria Emília Figueiredo Teixeira, MD, PhD, at the Brazilian Federal University of Goiás, Goiânia, Brazil. Cited by Nobre, the study was published in 2024 and followed 100 individuals with hypertension over 12 weeks. The intervention group received short, non-religious videos and messages promoting spiritual reflection — delivered via WhatsApp — and were encouraged to write about gratitude, forgiveness, life purpose, and optimism. The group receiving the intervention showed a more significant drop in blood pressure and notable improvement in endothelial function, measured through flow-mediated dilation. 'If spirituality appears to influence both key components of blood pressure, that alone is reason enough for us to understand it better,' said Nobre. Heart Failure: Fewer Hospitalizations, Better Quality of Life In patients with heart failure, spirituality may influence not only psychological resilience but also the underlying pathophysiology of the disease. Studies have found that individuals with greater spiritual engagement show reduced sympathetic nervous system activity, lower levels of stress hormones, and decreased inflammatory cytokines. Clinically, these changes are associated with fewer symptoms, fewer hospitalizations, and an improved quality of life. At the session, cardio-oncologist Rafael Nunes, MD, PhD, of the Oswaldo Cruz German Hospital, São Paulo, highlighted a 2022 review published in JACC: Heart Failure . The review analyzed 47 studies examining spirituality in heart failure patients. Despite differences in methodology, the evidence consistently linked higher spirituality levels with lower rates of anxiety and depression, improved adherence to treatment, fewer hospital admissions, and, in some cases, reduced mortality. A follow-up review published in 2023 reinforced these findings and added an important distinction: Participation in religious organizations alone was not sufficient to deliver clinical benefit. 'It's the spiritual experience — the meaning a person assigns to their life, beliefs, and motivations — that is associated with positive outcomes,' explained Nunes. Another study underscored this point. Titled Is Belonging to a Religious Organization Enough? , the study separately assessed the effects of religiosity and spirituality. The results showed that spirituality was linked to lower levels of anger, anxiety, and emotional exhaustion. In contrast, religiosity alone — without deeper personal engagement — did not significantly impact emotional well-being. Coronary Artery Disease: Stress and Acute Cardiac Events While coronary artery disease can remain stable for years, its progression into acute myocardial infarction — one of the leading global causes of death — can be sudden and unpredictable. Although plaque accumulation is gradual, rupture events are often triggered by acute neuro-immuno-hormonal and inflammatory responses. Roberto Veiga Giraldez, MD, PhD, director of the Acute Coronary Care Unit at the Heart Institute, Hospital das Clínicas, University of São Paulo, cited research linking acute myocardial infarction to external stressors such as natural disasters or high-stakes sporting events. During these situations, sympathetic nervous system activation and systemic inflammation intensify, raising the risk of acute coronary syndromes. One study cited by Giraldez was conducted in South Korea, where cities vulnerable to earthquakes experienced a significant spike in acute coronary syndrome cases immediately following seismic events. Incidence peaked shortly after the quakes and gradually declined over time. Another analysis focused on the 2006 FIFA World Cup. In several German cities, rates of myocardial infarction rose during high-stakes national team matches — especially during tense or decisive games. The highest incidence occurred in the early minutes of play, when fan anxiety was likely at its peak. 'These data illustrate how acute stress can influence outcomes in patients with coronary artery disease,' said Giraldez. 'Spirituality can help mitigate this impact. Resignation and faith — whatever form they take — can help individuals face stressful situations with greater composure.' How Should Clinicians Address Spirituality? According to Nunes, spirituality should be systematically integrated into clinical practice — always with sensitivity to the patient's values, preferences, and boundaries. 'We should approach spirituality with the same seriousness we apply to mental health and lifestyle habits. Understanding what matters to the patient and why they seek care can shape the therapeutic journey,' he said. He advocated for incorporating spiritual assessment into palliative care and broader multidisciplinary strategies, particularly in advanced stages of heart failure. 'Nutritionists, nurses, psychologists — everyone can play a role in listening,' he added. Nobre emphasized that addressing spirituality doesn't have to be complex — just intentional. 'During the medical history, when we ask about lifestyle, why not also ask how the illness is affecting them emotionally? Or whether they believe in something greater? For some, spirituality may be irrelevant, and that's fine. But if it matters to the patient, it can become a powerful ally — especially in supporting treatment adherence.' 'We're not necessarily talking about religion,' he continued. 'A person might be Catholic, Evangelical, Umbandist, or have no religion at all. The point is: Does it matter to them? When we make that connection, care moves beyond the physical body. It becomes whole-person care — addressing mind, emotions, and values. And that's when medicine reaches its fullest potential,' Nobre concluded.
Health Line
18-06-2025
- Health
- Health Line
Cannabis Use May Double Risk of Death From Cardiovascular Disease, Study Finds
A new scientific analysis indicates that cannabis use may increase the risk of cardiovascular health issues, including stroke. In an accompanying editorial, two health experts say these risks are serious enough to warrant the regulation of cannabis in the same manner as tobacco. Previous research has reported on the health benefits of cannabis for people with chronic pain and other ailments, but experts say the potential effects of cannabis should be discussed with your doctor. Medical experts are sending out another strong warning about cannabis use and the risk of cardiovascular health issues. In an analysis published in the journal Heart, researchers report heightened risks of stroke, acute coronary syndrome, and death from cardiovascular disease associated with frequent cannabis use. In an accompanying editorial, two health experts say the dangers from cannabis use are serious enough to warrant the substance being regulated much like tobacco. The editorial authors say the warnings are particularly important because the recent widespread legalization of the drug may have convinced many people that cannabis use is safe. 'Frequent cannabis use has increased in several countries, and many users believe that it is a safe and natural way to relieve pain or stress. In contrast, a growing body of evidence links cannabis use to significant harms throughout life, including cardiovascular health of adults,' wrote Stanton Glantz, PhD, an emeritus professor at the University of California San Francisco, and Lynn Silver, MD, a professor in UCSF's Department of Epidemiology and a program director at the Public Health Institute in Oakland, CA. 'Specifically, cannabis should be treated like tobacco: not criminalized but discouraged, with protection of bystanders from secondhand exposure,' the editorial authors added. Robert Page II, PharmD, a professor in the Department of Clinical Pharmacy and the Department of Physical Medicine/Rehabilitation at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, noted the analysis relied on observational studies, but said the message is clear. 'This meta-analysis validates current large observation studies that cannabis should be considered a potential risk factor for premature development of ASCVD (atherosclerotic cardiovascular disease), said Page, who was chair of an American Heart Association writing group that authored a 2020 report on cannabis, medical cannabis, and heart health. Page wasn't involved in the present study. 'If we ignore these signals, we are destined to repeat the fatal history of cigarette smoking, which took years to finally realize its devastating effects on cardiovascular health and mortality,' he told Healthline. Cannabis and heart health In their analysis, researchers looked at 24 studies published between January 2016 and January 2023 that included about 200 million people. The study participants were mostly between the ages of 19 and 59. Cannabis use tended to be more frequent in males and in younger people. The researchers said their analysis of that data revealed that cannabis use doubled the risk of dying from cardiovascular disease. They also reported that people who used cannabis had a 29% higher risk of acute coronary syndrome, a condition that causes sudden reduced or blocked blood flow to the heart, as well as a 20% higher risk of stroke. The researchers acknowledged that many of the studies they analyzed lacked information on missing data and had imprecise measures of cannabis exposure. Most of the studies were also observational. Nonetheless, their analysis comes less than a month after another study concluded that chronic use of cannabis is associated with a higher risk of endothelial dysfunction, a type of non-obstructive coronary artery disease in which there are no heart artery blockages but the large blood vessels on the heart's surface constrict instead of dilating. In addition, another analysis from earlier this year reported that cannabis users were six times more likely to have a heart attack than non-users. A 2024 study concluded that people who use cannabis to treat chronic pain had a higher risk of atrial fibrillation and other forms of heart arrhythmia. The researchers in the new analysis say their findings are particularly important because the use of cannabis has soared in recent years. They also note that the potency of the drug has increased. There was no delineation in the analysis, however, on the risks of smoking cannabis compared to ingesting it. Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California, said both methods may present health risks. Chen wasn't involved in the study. 'It is thought that ingesting THC increases systolic absorption of the chemical when compared to smoking THC and thus results in greater adverse effects,' he told Healthline. 'However, cannabis smoke comes with a separate set of health concerns, as the smoke contains many carcinogens and mutagens similar to tobacco smoke.' Ziva Cooper, the director of the UCLA Center for Cannabis and Cannabinoids, said the frequency someone uses cannabis, as well as the dosage, are also important factors. Cooper was likewise not involved in the study. She noted that new research is starting to show there are mental health risks to frequent cannabis use. One of those is cannabis use disorder, a condition that is estimated to affect 30% of people who use the substance. 'There are new risks that are emerging that weren't even on the radar,' Cooper told Healthline. She added cannabis can also impair people's ability to drive as well as impair their cognitive abilities. 'These are things that can affect a person's everyday life,' Cooper said. Defending cannabis use Paul Armentano, the deputy director of NORML, a non-profit that advocates for the responsible use of cannabis, acknowledges there are studies that report health risks associated with cannabis use. Armentano wasn't involved in the study. However, he told Healthline there are others who conclude there is no risk or even a decreased risk of cardiovascular disease from cannabis use. These include a 2023 study, a 2020 study, and a 2023 meta-analysis. 'In short, while tobacco smoke exposure's role in cardiovascular disease is well established, the potential role of cannabis smoke is not,' Armentano said. 'Nonetheless, persons wishing to mitigate their intake of cannabis smoke can do so via the use of herbal vaporizers, which heat cannabinoids to the point of activation but below the point of combustion.' Armentano cited studies in 2006 and 2007 that reported no health effects from vaporization. Some research has reported on some overall health benefits derived from cannabis use. A 2023 study concluded that medical cannabis can improve the quality of life for some people with chronic pain. Other research has reported that cannabis can be helpful to people with depression, social anxiety, and post-traumatic stress disorder (PTSD). There are also indications that cannabis products can help ease the side effects of cancer treatments. Talking with your doctor about cannabis In their editorial, Glantz and Silver encourage medical professionals to become leaders in cannabis education. 'There is an important role for public health and public policy in addressing the risks identified [in the new analysis],' they wrote. 'While the trend toward legalization is established, that does not mean that the risks of cannabis use should be minimized or its use encouraged.' Page said he takes cannabis use into consideration when assessing his patients' cardiovascular health. 'While many of the current cardiovascular risk calculators do not include smoking cannabis into their algorithms, I do include it (just like smoking cigarettes) when assessing patients' cardiovascular risk and consider it just as powerful a risk factor as smoking cigarettes,' he said. Page added that people should be informed about the many potential health issues of cannabis use before deciding whether to use it. 'Know the risks and talk to your primary care provider before considering any use, medical or recreational. Many younger adults feel invincible and have the belief that 'This will not happen to me' or 'I could never develop cannabis use disorder.' However, it does and can occur,' he said. 'For older adults, I caution them regarding potential drug-drug interactions as both THC [tetrahydrocannabinol] and CBD [cannabidiol] can have effects on a large majority of medications, both pharmacokinetically and pharmacodynamically,' Page added. Chen agrees that patients need to educate themselves about cannabis before trying it. 'Any form of cannabis use does involve some risk to your health. Everyone must decide for themselves how much risk they want to expose themselves to,' said Chen. 'I would advise people to avoid smoking cannabis, as the smoke can directly harm the lungs. Also, patients with known pre-existing cardiovascular disease or with cardiovascular risk factors should consider avoiding cannabis use in general, given the potential harm to heart health,' he added. Cooper noted that cannabis has 500 different chemical components, so its effects can vary greatly from person to person.
The Guardian
16-06-2025
- Health
- The Guardian
Is it true that … there's no gain without pain?
The words may have been printed on gym vests for decades, but is 'no pain, no gain' actually true when it comes to the benefits of exercise, such as improved cardiovascular health or increased muscle mass? 'Not strictly,' says Dr Oly Perkin from the University of Bath's Centre for Nutrition, Exercise and Metabolism (CNEM). 'A better way of putting it is that you may make more gains if you experience a bit of pain.' The kind of 'pain' we're talking about isn't necessarily harmful. It's your body's way of signalling effort – 'and more effort tends to signal more reward'. This may include a feeling of discomfort and a desire to stop if you have a racing heart or burning muscles: a stress response that evolved to regulate exertion. Perkin adds: 'If exercise didn't induce some discomfort, we'd all just do it constantly, and be fatigued.' Then there's delayed onset muscle soreness (Doms), the ache you can feel a day or two after a workout. 'It's thought it may be a protective mechanism – your body's way of telling you that muscle needs time to recover,' says Perkin. But your starting point matters. When you begin exercising, movement may feel more uncomfortable, but as your body adapts, you may move more efficiently or develop stronger mental resilience. Then it will feel easier, but you'll probably still be making gains. Doms is also more likely to be caused by some exercises than others, no matter your level of exertion. Workouts that are new to you are more likely to trigger it, so can those, like running downhill, that cause muscles to stretch while under tension. 'You don't need to experience a lot of pain to make improvements,' says Perkin, especially if you're starting from a low baseline. Low-impact exercise such as walking and cycling can be really effective – particularly when done for extended periods of time. 'Any movement – even if it doesn't feel tough – is far better than doing nothing,' he says.
Medscape
11-06-2025
- Health
- Medscape
Peptide Predicts Cardiac Risk in Women With Unblocked Arteries
In women with angina pectoris but no obstructive coronary artery disease (ANOCA), a high concentration of pro-C-type natriuretic peptide (proCNP) is linked to a 73% increased risk for all-cause mortality. The substance also shows a positive association with atherosclerotic markers and a negative association with generalized inflammation. METHODOLOGY: The analysis focused on baseline associations between proCNP concentrations in plasma and clinical data in 1508 women with ANOCA, with exploratory analyses examining correlation patterns between proCNP and 185 cardiovascular plasma markers. Primary outcomes included all-cause death and a composite endpoint of cardiovascular events. Hazard ratios (HRs) were adjusted for age and creatine concentration, which have been linked to proCNP-derived peptides in plasma. TAKEAWAY: A high concentration of proCNP (≥ 53.4 pmol/L) was associated with a diagnosis of hypertension ( P = .001) and diabetes mellitus ( P < .001), postmenopausal status ( P < .001), but not age. = .001) and diabetes mellitus ( < .001), postmenopausal status ( < .001), but not age. The researchers identified 38 plasma markers significantly associated with proCNP, showing positive correlation with atherosclerotic markers and a negative correlation with pro-inflammatory markers. Women with high concentrations of proCNP were at increased risk for all-cause mortality (crude HR, 1.73; 95% CI, 1.10-2.73; P = .02) and adjusted HR, 1.57; 95% CI, 0.99-2.49; P = .06). = .02) and adjusted HR, 1.57; 95% CI, 0.99-2.49; = .06). No significant difference was found in rates of cardiovascular events between groups (crude HR, 1.08; 95% CI, 0.72-1.62; P = .71; and adjusted HR, 1.03; 95% CI, 0.68-1.56; P = .90). IN PRACTICE: 'The association between high proCNP concentrations and diabetes in women is notable as diabetes is associated with an excess risk of > 40% of fatal ischemic heart disease in women compared with men,' the researchers reported. 'Our findings thus raise the question whether increases in proCNP among elderly women are part of an adaptive vascular response to cardiovascular risk factors after menopause. Taken together, the baseline associations of the present study show high proCNP concentration in women with ANOCA is associated with a cardiovascular risk profile independent of NT-proBNP and low-grade inflammation.' SOURCE: This study was led by Peter D. Mark, MD, PhD, of the University of Copenhagen, in Copenhagen, Denmark. It appears online in the July 1 issue of JACC: ADVANCES . LIMITATIONS: As only women were examined in this study, it was impossible to evaluate whether the findings would be mirrored in men with ANOCA. Biomarkers, except for proCNP and high-sensitivity C-reactive protein, were quantified as relative plasma levels rather than absolute concentrations, limiting the interpretation of the statistical analyses. DISCLOSURES: This study received support through the Danish Biotek program via a grant from the Danish Health Ministry. The senior author, Jens P. Goetze, has served as a consultant for Novo Nordisk on biochemical method development.
Medscape
05-06-2025
- Health
- Medscape
Walking Speed Test Predicts Heart Risk Pre–Kidney Transplant
A simple test of walking speed before kidney transplant could predict the risk for mortality and cardiovascular events, enabling clinicians to quickly activate patients with good cardiovascular fitness and target further screening or prehabilitation to those who need it. METHODOLOGY: Researchers retrospectively studied 995 patients (median age, 56 years; 36% women) assessed for kidney transplant at the Royal Free London NHS Foundation Trust from June 2014 to August 2022 to determine whether a simple walking speed test could predict the likelihood of abnormal cardiac stress test results and posttransplant outcomes. Walking speed was assessed by timing patients as they walked 130 m along a hospital corridor — walking to the end, touching the wall at the end of the corridor, and returning to the start point — as fast as they could; participants were then stratified into four quartiles based on the walking speed from fastest (> 1.83 m/sec) to slowest (< 1.35 m/sec). Pretransplant cardiovascular testing included stress echocardiography or myocardial perfusion scanning, with cardiovascular events defined as non–ST-elevation myocardial infarction, ST-elevation myocardial infarction, and cerebrovascular events. The mean follow-up duration was 54.2 months. TAKEAWAY: The mean time to complete the walking test was 86.9 seconds; 89 patients were unable to complete the test. Patients in the fastest walking quartile had significantly lower rates of cardiac events (1.62% vs 10.6%) and mortality (5.3% vs 27.9%) and a higher rate of activation for transplant (90.6% vs 55.3%) than those in the slowest walking quartile ( P < .001 for all). < .001 for all). Patients in the fastest walking quartile also had a lower rate of abnormal cardiac stress test results and a reduced need for coronary angiography, with none requiring coronary intervention prior to activation. Walking time was a significant predictor of cardiac events ( P = .048) with a high negative predictive value (86.2%) for stress test outcomes. IN PRACTICE: "Our study would suggest that a simple and low cost evaluation of walking speed may predict outcomes in patients being evaluated for kidney transplant and provide a good screening test to avoid significant cardiac work up in fitter patients, thus allowing greater scrutiny, with or without attempts to improve cardiovascular reserve, in patients with poorer exercise capacity," the authors wrote. SOURCE: This study was led by Pranav Satish of the Royal Free Hospital, Pond Street, London, England. It was published online on May 29, 2025, in Nephrology Dialysis Transplantation . LIMITATIONS: T he study's retrospective design and a single assessment of walking speed at the initial evaluation, rather than repeated measures, may have limited the interpretation of the findings. This study did not account for possible changes in walking speed before or after the assessment, which may have affected the reliability of the results. Although the 130-m timed corridor walk test provided a rapid assessment of the cardiorespiratory reserve, it is not internationally standardised. DISCLOSURES: This study received no financial support . The authors declared no conflicts of interest.
