"With prolonged dual-antiplatelet therapy, we need to be thoughtful in considering which patients are most suited to taking the regimen -- that is, those at high ischemic risk and low bleeding risk," said THEMIS co-chair Deepak L. Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs at the Brigham and professor of medicine at Harvard Medical School. "Our findings show that the greatest benefit occurred in those patients with diabetes and stable coronary artery disease with a history of prior stenting for whom ticagrelor, when added to aspirin, reduced important cardiovascular events, such as heart attacks, strokes and amputations."

THEMIS co-chair Philippe Gabriel Steg, MD, Chief of Cardiology at Hôpital Bichat, Greater Paris University Hospitals -- AP-HP, and professor at Université de Paris, stated, "The THEMIS population is a critically important one in which to understand the potential benefits of taking ticagrelor in addition to aspirin. As the number of people with diabetes continues to rise globally, we need to evaluate ways of improving long-term outcomes and preventing cardiovascular and ischemic events."

In THEMIS, the largest trial of patients with diabetes to date, more than 19,000 patients with stable coronary artery disease and diabetes were randomized to receive either ticagrelor plus aspirin or a placebo plus aspirin. Patients were followed for an average of more than three years. During that time, 736 of 9,619 patients (7.7 percent) taking ticagrelor plus aspirin experienced cardiovascular death, myocardial infarction, or stroke versus 818 of 9,601 patients (8.5 percent) taking placebo plus aspirin -- a 10 percent reduction.

"Given these results, it is my belief that all patients with high blood pressure should have an annual flu vaccination," said first author Daniel Modin research associate of the University of Copenhagen, Denmark. "Vaccination is safe, cheap, readily available, and decreases influenza infection. On top of that, our study suggests that it could also protect against fatal heart attacks and strokes, and deaths from other causes."

According to previous research, the stress flu infection puts on the body may trigger heart attacks and strokes. Patients with hypertension (high blood pressure) are at raised risk of heart attack and stroke. By stopping flu infection, vaccination could also protect against cardiovascular events, but until now this had not been investigated.

The study used Danish nationwide healthcare registers to identify 608,452 patients aged 18 to 100 years with hypertension during nine consecutive influenza seasons (2007 to 2016). The researchers determined how many patients had received a flu vaccine prior to each season. They then followed patients over each season and tracked how many died. In particular, they recorded death from all causes, death from any cardiovascular cause, and death from heart attack or stroke.

Finally, they analysed the association between receiving a vaccine prior to flu season and the risk of death during flu season. The analysis controlled for patient characteristics that could impact the likelihood of dying such as age, comorbidities, medications, and socioeconomic status.

Study author Professor Terence Dwyer of the University of Oxford, UK, said: "While previous research has found connections between smoking and BMI in childhood and adult cardiovascular disease, there was no data for blood pressure or serum cholesterol. In addition, it has not been possible to assess the contributions of BMI and smoking while taking cholesterol and blood pressure into account."

The study used data from the International Childhood Cardiovascular Cohort (i3C) Consortium. Data was pooled on serum cholesterol, blood pressure, BMI, and smoking from seven child cohorts in the US, Australia, and Finland. Information was collected from 1971 onwards on approximately 40,000 children aged 3 to 19 who were followed up at around age 50 for cardiovascular events leading to hospitalisation (heart attack, stroke, peripheral arterial disease) or all-cause death.

Hazard ratios for cardiovascular events were calculated for each risk factor separately, and for all risk factors simultaneously. The latter analysis estimated how important each risk factor might be when all the others are taken into account.

For cardiovascular events leading to hospitalisation, the associations for risk factors were:

  • BMI: 10% rise -- > 20% higher risk of an event.
  • Systolic blood pressure: 10% rise -- > 40% higher risk of an event.
  • Serum cholesterol: 10% rise -- > 16% higher risk of an event.
  • Adolescent smoking -- > 77% higher risk of an event.

About half of all heart attack victims are found to have additional clogged arteries in addition to the one that caused their heart attack. Previously, doctors focused on opening the one artery responsible for the heart attack, leaving the other blockages for treatment with medication alone. The new study, a collaboration of 130 hospitals in 31 countries, has shown that opening all the blockages is better than treating only the one blockage causing the heart attack. This led to a 26 per cent reduction in the patient's risk of dying or having a recurrent heart attack.

The study, known as the COMPLETE trial, was published today in the New England Journal of Medicine and presented as a late-breaking clinical science session at the European Society of Cardiology Congress together with the World Congress of Cardiology in Paris, France.

"Given its large size, international scope and focus on patient-centered outcomes, the COMPLETE trial will change how doctors treat this condition and prevent many thousands of recurrent heart attacks globally every year," said study leader Dr. Shamir R. Mehta of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.

He said that although it had been known that opening of the single blocked artery that caused the heart attack with stents was beneficial, it was unclear whether additional stents to clear the other clogged arteries further prevented death or heart attack.

Heterozygous familial hypercholesterolaemia (FH) is a life-threatening genetic condition linked with a high risk of premature cardiovascular disease, including heart attack and stroke. FH is one of the most common potentially fatal family disorders, with a prevalence estimated at 1/250 to 1/200, corresponding to 3.6 to 4.5 million individuals in Europe.

Patients with FH have high levels of "bad" cholesterol (low-density lipoprotein; LDL) due to a mutation in genes that clear cholesterol from the body. LDL particles accumulate in the blood and can ultimately build up in the coronary artery walls. Children of patients with heterozygous FH have a 50% chance of inheriting the disorder.

As LDL cholesterol levels are elevated as early as birth, the risk of heart attack in patients with FH is 10 to 13 times greater than that of the general population. Elevated LDL cholesterol plus family or personal history of early heart disease are key criteria for diagnosis, which may be confirmed by genetic testing. Management of FH includes a healthy lifestyle and medication.

This study examined the frequency of FH in the RICO survey, a large French database of patients hospitalised for a heart attack between 2011 and 2017. The researchers determined whether patients had FH using LDL cholesterol levels and family or personal history of premature coronary artery disease. Treatments, patient characteristics, and severity of coronary artery disease were compared between patients with and without FH.

Study author Dr Trine Moholdt of the Norwegian University of Science and Technology, Trondheim, Norway said: "Our findings imply that to get the maximum health benefits of physical activity in terms of protection against premature all-cause and cardiovascular death, you need to continue being physically active. You can also reduce your risk by taking up physical activity later in life, even if you have not been active before."

The aim of this study was to assess how changes in physical activity over 22 years were related to subsequent death from all causes and from cardiovascular disease. Most studies investigating the relationship between physical activity and longevity have asked participants about their level of physical activity only once, and then followed them for several years. But physical activity is a behaviour that changes in many people, so it is important to investigate how such changes over time relate to the risk of death in the future.

The HUNT study invited all residents of Norway aged 20 and older to participate in 1984-1986, 1995-1997, and 2006-2008. At all three time points, individuals were asked about their frequency and duration of leisure time physical activity. The current study used the data from the first and third surveys.

A total of 23,146 men and women were included in the analysis. Physical activity was categorised as inactive, moderate (less than two hours a week), and high (two or more hours per week).