Patient-reported triggers of paroxysmal atrial fibrillation can be avoided

A study published in the Journal of Heart Rhythm reported that the most common triggers of atrial fibrillation (AF) are avoidable behaviors like drinking alcohol, coffee consumption and exercise.  

Of 1295 participants with symptomatic AF, 957 (74%) reported triggers for episodes of AF. In comparison to participants without triggers and after multivariate adjustment, those reporting triggers had a 71% lower odds of congestive heart failure and a >2-fold greater odds of a family history of AF.  The most commonly reported triggers were alcohol (35%), caffeine (28%), exercise (23%), and lack of sleep (21%). Patients reported a median of 2 different triggers.  Female sex, Hispanic ethnicity, obstructive sleep apnea, and a family history of AF were each associated with a greater number of AF triggers. Vagal nerve mediated triggers tended to cluster together within individuals.

The authors concluded that the majority of patient-reported triggers are modifiable, thus potentially identifying accessible means to prevent and reduce AF episodes. 

Is one blood pressure measurement enough?

While In the U.S., 116 million adults have high blood pressure, it is estimated in the world nearly 1.5 billion adults will have hypertension in the decade ahead.

Ι analyzed 107 consecutive blood pressure (BP) measurements that were obtained between June 1 and November 20, 2019.  The BP measurements were obtained with an Omron BP-monitor; model BP786N, a device that obtains 3 consecutive measurements at one-minute intervals, which it also averages.   All four measurements were recorded.  

The average BP measurements were grouped in the following four categories; Normal readings were those systolic blood pressure was less than 120mmHg.  Elevated readings were those with systolic blood pressure between 120 and 129mmHg.  Hypertension-1 were those with systolic blood pressure between 130 and 139mmHg and hypertension-2 were those with systolic blood pressure over 140mmHg.   

In the normotensive category with readings under 120mmHg, in 12 of 59 readings or 20.3% the first of the 3 measurements were over 120mmHg.  In those patients treatment will be initiated incorrectly in the U.S.

In the elevated category with readings between 120 and 129mmHg 8 of the 20 measurements or 40%, were over 130mmHg which means treatment will be initiated incorrectly in Europe.

In the hypertension-1 category with readings between 130 and 139mmHg 2 of the 15 readings or 13% were below 130mmHg, which means treatment will not be initiated incorrectly in Europe.

In the hypertension-2 category with average measurements over140mmHg, 12 of 13 readings or 92.3% the first reading was over 140mmHg and 1 measurement was over 130mmHg, which means treatment would have been correctly initiated in 100% of the cases in both the U.S. and Europe.

We conclude both in the U.S. and Europe if the first measurement is over 140mmHg patients should be placed on hypertensive medications.  If the first measurement is less than 139mmHg then 3 measurements should be obtained and treatment or not should be initiated based on the average of 3 blood pressure measurements.   

Measles Outbreak 2019

From January 1 to November 7, 2019, the Center for Prevention and Disease Control (CDC) reported 1,261 cases of measles in 31 States in the USA.  

The World Health Organization (WHO) confirmed that measles is the world's largest and fastest-moving epidemic and that it has infected over 165,000 and has killed nearly 5,000 people 90% of who were children under the age of 5 in the Democratic Republic of Congo alone since the beginning of 2019.

Measles is a highly contagious disease that spreads through coughing and sneezing. Up to 90% of the people close to the infected person, who are not immune, will also become infected. 

UNICEF said it was urgently trying to vaccinate more children against measles and rushing life-saving medicines to health centers to help prevent deaths. WHO said that it was working with the government in Congo and other NGO groups in an effort to vaccinate 825,000 children. 

WHO says that the largest numbers have been reported in Congo Madagascar, Ukraine, Angola, Cameroon, Chad, Kazakhstan, Nigeria, Philippines, South Sudan, Sudan and in Thailand. 

Rates of crash fatalities involving kids on foot or cycling continue to decline in America

A study published in the journal of Injury Prevention found the rates of crash fatalities involving kids on bikes or foot continue to decline each year.   The authors reviewed police reported crash reports from 26 States between the years 2000 to 2014.  They calculated rates of pedestrian and bicycle crashes. 

School-age children accounted for nearly one in three pedestrians and one in two cyclists struck by motor vehicle from 2000 to 2014. Interestingly, the rates of these crashes declined 40% and 53%, respectively, over that time, even as adult rates rose. Average crash rates varied geographically from 24 to 100 pedestrians and 15 to 56 cyclists struck per 100 000 youth. 

Despite substantial progress, motor vehicle crashes remain a leading killer of US children.  Although there were recent increases in adult pedestrian crashes, younger pedestrians and bicyclists experienced ongoing declines in motor vehicle crashes through 2014 across the USA.

Many Vaping-related lung injuries tied to illegal marijuana products

According to a report released by the Centers for Disease Control and Prevention(CDC) many people with vaping-related lung injuries used illegal marijuana products. Health officials in Wisconsin and Illinois, where the first cases were reported conducted in-depth interviews with 86 patients who said they used a wide range of e-cigarette products, and found that the vast majority reported using illicit products containing THC, the psychoactive component of marijuana. The health officials also named several specific products tied to cases of vaping-related injuries, including “Dank Vapes,” “Moon Rocks,” “Off White,” and “TKO”.  The CDC warned people to stop using e-cigarettes, especially those with THC.

In a letter published in the NEJM pathologists at the Mayo Clinic who examined lung tissue specimens from 17 patients sent to them from around the country said that some vaping-related lung injuries resemble chemical burns.   The Mayo clinic physicians also cast doubt on the notion that vitamin E oil or other thickeners were the cause of the vaping-related lung injuries.

As of today there have been 1,080 cases of vaping-related lung illness, including 18 deaths, according to the CDC.

Statins may be beneficial for people after 75

A retrospective study published in the European Heart Journal reports  that people who continue taking statins even after they turn 75 reap benefits. 

A total of 120 173 subjects were followed for an average of 2.4 years.  17 204 (14.3%) discontinued statins and 5396 (4.5%) were admitted for a cardiovascular event. The adjusted hazard ratios for statin discontinuation were 1.33   for any cardiovascular event, 1.46 for coronary event, 1.26 for cerebrovascular event, and 1.02 for other vascular events.

The authors concluded that statin discontinuation was associated with a 33% increased risk of admission for cardiovascular events in 75-year-old primary prevention patients.

Over seven percent of cancers are attributable to obesity

According to a study published in JAMA Oncology more than seven percent of cancer cases in the United States are attributable to excess body weight (EBW). 

This nationwide study of US adults found that the proportion of cancers attributable to obesity ranges from 3.9% to 6.0% among men and from 7.1% to 11.4% among women, with the highest proportions found in several Southern and Μidwestern states, Alaska, and the District of Columbia.

Each year, an estimated 37 670 cancer cases in men (4.7%) of all cancers excluding non-melanoma skin cancers and 74 690 cancer cases in women (9.6%) 30 years or older in the United States were attributable to EBW.

The researchers concluded that the number of cancers attributable to obesity varies among states, but EBW accounts for at least 1 in 17 of all incident cancers in each state.