Heart and Kidney Notes

By Mary Jane Dittmar

Cigarette Smoke Adversely Affects Heart and Lung Genes

We are all aware by now that cigarette smoke is harmful to our health. Another study, “Impaired Transcriptional Response of the Murine Heart to Cigarette Smoke in the Setting of High Fat Diet and Obesity,” has uncovered yet another detrimental aspect of inhaling cigarette smoke. Diana J. Bigelow and colleagues said their study suggests that active smoking doubles the risk of heart disease, and that exposure to secondhand smoke increases this risk by a third.

The researchers also found the following: “Mainstream smoke, and to a greater extent sidestream smoke, inhibits the activity of genes that protect the heart and lungs and activate genes associated with an increased risk of heart disease.” The study was published in Chemical Research Toxicology (2013, 26 (7), pp 1034–1042; Web June 7, 2013).

In addition, the researchers’ work with mice indicates that obese cigarette smokers experience a high risk of heart disease because cigarette smoke affects hundreds of key genes that both protect the heart and lungs and expose them to damage. The complete study is available at http://pubs.acs.org/stoken/presspac/presspac/full/10.1021/tx400078b.

Vitamin D and the Kidneys

A study published in the July issue of the American Journal of Kidney Disease suggests a possible association between a vitamin D deficiency and potential kidney disease. Researchers found that study participants deficient in vitamin D were more than twice as likely to have protein in the urine (albuminuria) over a period of five years. The kidneys release protein that should be retained for use in the body.

The study included 5,800 men and women who initially had no protein in the urine. Over the five-year follow-up period, 3.8 percent developed albuminuria. The vitamin D deficient (<15 ng/ml) participants were 84 percent more likely to have albuminuria than those with sufficient vitamin D levels. After adjusting for age and other lifestyle factors, those with low vitamin D levels had a 70 percent increase in albuminuria.

According to Thomas Manley, director of Scientific Activities for the National Kidney Foundation, multiple studies have established a relationship between vitamin D status and kidney disease. “This study,” he says, “supports that relationship and shows that a low vitamin D level increases the likelihood of developing protein in the urine, even among a general population.”

The study’s lead researcher, Matthew Damasiewicz, MD, says evidence is mounting on the benefits of correcting vitamin D deficiency to prevent albuminuria and that it is likely that patients with chronic kidney disease may need higher vitamin D levels than the general healthy population. The full study is at

Low vitamin D levels linked to early signs of kidney disease. Renal Business Today. June 27, 2013.

NIH study: Vietnam vet twins with PTSD more than twice as likely to have heart disease

A recent National Institutes of Health (NIH)-funded study of male twins who served in the Vietnam War has revealed that the twin with post-traumatic stress disorder (PTSD) was more than twice as likely to develop heart disease during a 13-year period than the brother without PTSD. The study used twin subjects to facilitate researchers’ controlling for the influences of genes and the environment on the development of heart disease and PTSD. Objective clinical diagnoses and cardiac imaging techniques were used in the study.

Gary H. Gibbons, M.D., director of NIH’s National Heart, Lung, and Blood Institute (NHLBI), which partially funded the study, noted: “Future research to clarify the mechanisms underlying the link between PTSD and heart disease in Vietnam veterans and other groups will help to guide the development of effective prevention and treatment strategies for people with these serious conditions.”

Researchers from the Emory University Rollins School of Public Health in Atlanta and colleagues from other institutions assessed the presence of heart disease in 562 middle-aged twins (340 identical and 222 fraternal) from the Vietnam Era Twin Registry. Twins with PTSD had a 22.6 percent incidence of heart disease (177 individuals); the incidence of heart disease in twins without PTSD was 8.9 percent (425 individuals). Heart disease was defined as having a heart attack, having an overnight hospitalization for heart-related symptoms, or having undergone a heart procedure. Nuclear scans used to photograph blood flow to the heart showed that individuals with PTSD had almost twice as many areas of reduced blood flow to the heart as those without PTSD.

Lead researcher Viola Vaccarino, M.D., Ph.D., professor in the department of medicine at Emory University and chair of the department of epidemiology at the Rollins School of Public Health, explains: “This study suggests a link between PTSD and cardiovascular health. For example, repeated emotional triggers during everyday life in persons with PTSD could affect the heart by causing frequent increases in blood pressure, heart rate, and heartbeat rhythm abnormalities that in susceptible individuals could lead to a heart attack.”  This NIH news release is at:

<http://www.nih.gov/news/health/jun2013/nhlbi-25.htm>.

Cola and Heart Rhythm Disturbances

Sometimes, the cause of arrhythmia is not always easily detectable. One possible cause could be cola consumption. “Cardiologists need to be aware of the connection between cola consumption and potassium loss and beverage habits and QT prolongation,” noted Dr. Naima Zarqane, who with Professor Nadir Saoudi, both from the princess Grace Hospital Centre, Monaco, presented a case study as an abstract at the EHRA EUROPACE 2013 meeting, in Athens in June. They reported that drinking excessive amounts of cola can cause unusual syncope (fainting) and symptoms of arrhythmia. Professor Andreas Goette, EHRA Scientific Programme Committee chairperson, emphasizes how important it is for clinicians to take detailed medical histories, including questions about dietary intake, for patients with unexplained arrhythmias.

Dr. Zarqane and Prof. Saoudi’s report was on a 31-year-old woman whose excessive consumption of cola drinks had caused a “marked potassium loss (hypokalemia), QT prolongation on ECGs, and potentially life-threatening arrhythmias.” The patient was admitted to the hospital for traumatic fainting. Tests revealed she had blood potassium levels of 2.4 mmol/L (normal levels are between 3.5 to 5.1 mmol/L). The QT interval on her ECG corrected for heart rate) was 610 ms (normal QTC for women is less than or equal to 450 ms).

Her medical history showed that the patient had exclusively replaced water with cola beverages since she was 15 years old. When she stopped consuming cola, as recommended by her doctors, her potassium level returned to 4.1 mmol/L at one week and 4.2 mmol/L at one month. Her QTc duration returned to 430 ms at one week.

Reference

1. N Zarqane, H Gaid, I Badea, et al. Syncope and hypokalemia with mild long-term mild cola consumption. FP  1085. Syncope Poster Session. 25 June. 08:30 local time.

ESC Launches Atrial Fibrillation Patient Web Site

The European Heart Rhythm Association of the European Society of Cardiology^® (ESC) has established the AFib Matters web site for patients with atrial fibrillation.

According to the ESC, atrial fibrillation is the most common cardiac rhythm disorder, affecting 1.5-2 percent of the general population in the developed world.Patients with atrial fibrillation have a substantially increased risk of stroke.

AFib Matters was developed by a multidisciplinary, international task force of expert clinicians and patient representatives. It discusses what atrial fibrillation is, its symptoms and complications, types of drugs, stroke prevention, frequently asked questions, and the latest developments in its treatment and management. The site will be updated at regular intervals.

A Less Toxic Form of Acetaminophen on the Horizon?

There seems to be progress in the search for a form of acetaminophen that is less toxic to the liver, according to ACS [American Chemical Society] Medicinal Chemistry Letters. Researchers Roman Shchepin and colleagues report that they have been testing two compounds that are similar in design to acetaminophen but were not toxic to liver cells grown in the laboratory. The researchers say further testing will be needed to confirm their suitability as replacements for acetaminophen.

Acetaminophen has been implicated in almost half of all acute liver failure cases in the United States. The full study is at: http://pubs.acs.org/doi/abs/10.1021/ml4000904?journalCode=amclct.

Photos courtesy of photos8.com.

MARY JANE DITTMAR is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.