Being unmarried associated with higher risk of death in heart failure patients

WELLNEWS

Victor Romulo Gallardo Dumaguing, MD

MADRID, Spain -- Unmarried heart failure patients appear less confident in managing their condition and more socially limited compared to their married counterparts, according to research presented today at Heart Failure 2022, a scientific congress of the European Society of Cardiology (ESC).1 These differences may have contributed to the worse long-term survival observed in unmarried patients.
    “Social support helps people managing long-term conditions,” said study author Dr. Fabian Kerwagen of the Comprehensive Heart Failure Center at the University Hospital Würzburg, Germany. “Spouses may assist with drug adherence, provide encouragement and help with developing healthier behaviours, all of which could affect longevity. In this study, unmarried patients exhibited fewer social interactions than married patients, and lacked confidence to manage their heart failure. We are exploring, whether these factors could also partially explain the link with survival.”
    Previous studies have shown that being unmarried is an indicator of a less favorable prognosis both in the general population and in patients with coronary artery disease. This post-hoc analysis of the Extended Interdisciplinary Network Heart Failure (E-INH) study investigated the prognostic relevance of marital status in patients with chronic heart failure.
    The E-INH study included 1,022 patients hospitalized between 2004 and 2007 for decompensated heart failure. Out of 1,008 patients providing information on marital status, 633 (63%) were married and 375 (37%) were unmarried including 195 widowed, 96 never married, and 84 separated or divorced.
    At baseline, quality of life, social limitations and self-efficacy were measured using the Kansas City Cardiomyopathy Questionnaire, a questionnaire specifically designed for patients with heart failure. Social limitation refers to the extent to which heart failure symptoms affect patients’ ability to interact socially, such as pursuing hobbies and recreational activities, or visiting friends and family. Self-efficacy describes patients’ perception of their ability to prevent heart failure exacerbations and manage complications. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9).
    There were no differences between married and unmarried patients regarding overall quality of life or depressed mood. However, the unmarried group scored worse on social limitations and self-efficacy compared with the married group.
    During 10 years of follow-up, 679 (67%) patients died. Being unmarried versus married was associated with higher risks for all-cause death (hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.31–1.92) and cardiovascular death (HR 1.83, 95% CI 1.38–2.42). Widowed patients carried the highest mortality risk, with hazard ratios of 1.70 and 2.22 for all-cause and cardiovascular death, respectively, compared to the married group.
    Dr. Kerwagen said: “The connection between marriage and longevity indicates the importance of social support for patients with heart failure, a topic which has become even more relevant with social distancing during the pandemic. Health professionals should consider asking patients about their marital status and wider social group and recommending heart failure support groups to fill potential gaps. Education is crucial but health providers also need to boost patients’ confidence in their self-care abilities. We are working on a mobile health application which we hope will assist heart failure patients in the day-to-day management of their condition
    Your columnist is not suggesting that unmarried folks rush to get an instant spouse. Singles may not enjoy marital bliss, at least they are spared from marital blisters. As an added bonus, they don’t have a mother-in-law.

How harmful are kidney stones?

Victor Romulo Gallardo Dumaguing, MD

Our friends at the NKI- National Kidney Institute- in their news bulletin remind that June is Kidney health month, an issue of concern of some Ilocanos, Pangasinenses and Cordillerans  because most of our diet and daily food fare are dripping with purine foods which contribute the uric acid that would eventually lead to formation of the pesky bothersome kidneys stones- again our delicious dishes like igado, dinakdakan, pinapaitan, bopis, beans of all colors, our veggies and fruit like strawberries, tomatoes. At this juncture, it is good to remind our readers that stones do not just form in the kidneys; ureterolithiasis i the ureters, cystolithiasis in the urinary bladder. Thus, it would be good and even useful to take another look at urinary tract stones, not just kidney stones.
    Kidney stones are small, hard deposits of mineral and acid salts on the inner core of the kidneys. Normally, these stone are diluted and dissolved in the urine. When urine is too concentrated-normal specific gravity is 1.004-1.024- thus the advice to have 8-10 glasses of water per day-  these minerals may crystallize , stick together and solidify resulting to kidney stones. Most of these stones contain calcium- thus again a "kulit" reminder for those taking calcium with vitamin D, always take them with lots of water and preferably during the day. 
    Until a kidney stone moves into the ureter- the tube that connects the kidneys to the urinary bladder- you may not know that you have it. Signs and  symptoms may occur which include pain at the side and back, below the ribs, pain radiating to the lower abdomen and groin, bloody, cloudy or foul-smelling urine, dysuria or painful urination, nausea and vomiting, persistent urge to urinate and worse, fever and chills if infection has set in which can be explained by the fact that stones would have reached a size that obstructs or blocks urine flow, thus creating a conducive environment for microbes like E. coli and Proteus vulgaris to multiply and proliferate.
Complications of a long standing kidney stone that has become obstructive include hydronephrosis- enlargement of the kidneys due to swelling by excess fluid resulting from the back pressure build up secondary to the blockage. Sad to say, this would lead to an eventual deterioration of kidney functions as evidenced by abnormal or elevated blood levels of BUN- blood urea nitrogen and creatinine. By now, the public is aware of the role of the kidneys in blood pressure control, thus a kidney malfunction contributes to hypertension, which now becomes a vicious cycle- hypertension damages the kidneys, damaged kidneys further raises blood pressure.
    Kidney stones are diagnosed with routine urinalysis- hematuria or red blood cells, crystals of either urates, oxalates, phosphates and sometimes pyuria or pus in the urine when there's a UTI- urinary tract infection. Xrays like plain abdomen or KUB-kidney urinary bladder, ultra sound and CT scan.
    The Covid-19 pandemic had spawned global anxiety about its morbidity-illness and worse of mortality-death  so much so that there was a boom in the sales of anything- yes anything not poisonous- that claims to boost immunity. In fairness, vitamin C has been a reliable dependable micronutrient with so many helpful metabolic functions in the human body among which is its combination with zinc which has been proven to sustain the immune system of patients in warding off microbial infections, not only Covid. May we share that the MDR or minimum daily requirement- of Vitamin C or ascorbic acid is 75mg and the RDA-recommended dietary allowance- is 500mg per day. A medium size guava gives the eater the 75 mg, and fruits belonging to the citrus family combined with tomatoes would be enough for the 500 mg.
    The take home message or caveat is that, for those folks who take excess Vitamin C with the hope and purpose of strengthening their immunity; they might just be increasing the risk of forming calcium Oxalate stones in their urinary tract, especially those who don’t drink the recommended water intake per day, because with a concentrated urine, the ph is acidic which favors precipitation, crystallization and formation of calcium oxalate stones.

Covid vaccines safe for patients with cardiovascular disease 

Victor Romulo Gallardo Dumaguing, MD

SOPHIA, ANTIPOLIS, France --  Covid-19 vaccination is not associated with an increased risk of heart attack or stroke in patients with established cardiovascular disease, according to a large study published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC).

“Our study showed that pre-existing cardiovascular disease should not prevent people from getting vaccinated against Covid-19,” said study author Dr. Esther W. Chan of the Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. “Vaccination is particularly important for this group since cardiovascular disease is associated with worse outcomes and a higher risk of death after Covid19 infection.” 

This was the first study to examine the association between Covid-19 vaccines and the risk of major adverse cardiovascular events (MACE) in patients with cardiovascular disease. The study focused on BNT162b2 and CoronaVac, the only Covid-19 vaccines authorised for emergency use in Hong Kong.

The researchers linked data from electronic health records managed by the Hong Kong Hospital Authority, which covers around 80% of hospital admissions, and vaccination records provided by the Hong Kong Department of Health. The first two doses of vaccine were included in the analyses. Individuals were not permitted to switch between vaccine types for the first two doses. 

The investigators identified patients with existing cardiovascular disease and a new MACE diagnosis between 23 February 2021, when the mass Covid-19 vaccination programme started in Hong Kong, and 31 January 2022. Established cardiovascular disease included coronary heart disease, cerebrovascular disease, peripheral vascular disease, and prior interventions such as stenting. MACE included myocardial infarction, stroke, revascularisation or cardiovascular death. 

The researchers used the self-controlled case series study design, which was developed to assess the risk of adverse events after vaccination. Each patient was compared with himself/herself for the risk of MACE up to 27 days after each vaccine dose (exposure period) versus the non-exposure baseline period. Dr. Chan explained: “A traditional cohort study would compare the vaccinated group with the unvaccinated group but the two groups could have different baseline characteristics. A self-controlled case series avoids the issue of differences between groups since each individual acts as his/her own control.” 

A total of 229,235 patients with cardiovascular disease were identified, of which 1,764 were vaccinated and experienced MACE during the study period (662 received BNT162b2 and 1,102 received CoronaVac). For BNT162b2 and CoronaVac, the researchers estimated incidence rate ratios (IRRs) to compare the risk of MACE during the 13 days after vaccination compared to the baseline period. IRRs were also calculated for the risk of MACE during days 14 to 27 post-vaccination versus the baseline period. The analyses were conducted for the first and second doses. 

There was no evidence of an elevated risk of MACE after the first or second dose of BNT162b2 or CoronaVac. For the first dose of BNT162b2, the IRRs were 0.48 (95% confidence interval [CI] 0.23–1.02) during the first 13 days post-vaccination and 0.40 (95% CI 0.18–0.93) during days 14 to 27 days after vaccination. For the second dose, the IRRs were 0.87 (95% CI 0.50–1.52) during the first 13 days and 1.13 (95% CI 0.70–1.84) during days 14 to 27 after vaccination.

For the first CoronaVac dose, the IRRs were 0.43 (95% CI 0.24–0.75) during the first 13 days and 0.54 (95% CI 0.33–0.90) during days 14 to 27 post-vaccination. For the second dose, the IRRs were 0.73 (95% CI 0.46–1.16) for the first 13 days and 0.83 (95% CI 0.54–1.29) during days 14 to 27 days after vaccination. 

Dr. Chan said: “The findings were consistent for women and men, individuals aged under and above 65 years old, and patients with different underlying cardiovascular conditions. The results should provide reassurance about the cardiovascular safety of these two vaccines.

This columnist understands individual differences which include beliefs and attitude on matters like vaccination. It is my sincere wish that everyone is safe and well.