A blog for Biomedical Laboratory Science, Clinical Laboratory Medicine, Medical Laboratory Technology with relevant news, abstracts, articles, publications and pictures for lab medicine professionals, students and others
Troponin is a widely used biomarker in patients with cardiac disease. The use of troponin is well established in patients with suspected acute myocardial infarction (AMI), but troponin measurement is also used in other acute and nonacute settings. In patients with suspected AMI, early decision-making is crucial to allow rapid treatment and further diagnostic evaluation. Current guidelines recommend serial measurements of troponin with a cut-off concentration at the 99th percentile to triage patients in the emergency department.
Newer, high-sensitivity assays for troponin enable the detection of distinctly lower concentrations. Using these assays and very low cut-off concentrations, several rapid diagnostic strategies have been reported to improve diagnosis in acute cardiac care. Furthermore, noncoronary and non-acute applications of troponin assays — for example as a biomarker in patients with heart failure, pulmonary embolism, or stable coronary artery disease — are on the horizon and might improve individual risk stratification.
In this Review, we provide an overview on the development of high-sensitivity assays for troponin, and their application in patients with cardiac disease.
Pathophysiological background of troponin and troponin release
in different settings.A schematic overview of myocardial structure
related to troponin (inset), as well as the plasma troponin concentrations
in different clinical settings (young and healthy, elderly or chronic diseases,
Many people enjoy relaxing and unwinding in a sauna. Steam rooms involve high humidity and moist heat as opposed to the dry heat of traditional Finnish saunas. It is vital to drink plenty of water after using a sauna.
Anyone worried about chest pain should not wait to get urgent medical care. They should call for an ambulance straight away, especially if the pain is unexplained, sudden, or severe.
Heart attack pain is caused when one of the arteries supplying the heart becomes blocked. Angina is a similar chest pain caused when these arteries are narrowed by heart disease.
Heartburn is a burning pain often felt in the upper belly or lower chest. It is caused by stomach acid going back up the food pipe.
A heart attack is when there is a loss of blood supply to part of the heart muscle. Though the pain is located in the chest, heartburn is not related to the heart in any way. Angiography, passing dye into the heart circulation, is one way doctors test for heart attack.
The connection between the gut microbiota and the etiology of obesity and cardiometabolic disorders is increasingly being recognized by clinicians. Our gut microbiota might affect the cardiometabolic phenotype by fermenting indigestible dietary components and thereby producing short-chain fatty acids (SCFA). These SCFA are not only of importance in gut health and as signaling molecules, but might also enter the systemic circulation and directly affect metabolism or the function of peripheral tissues.
In this Review, we discuss the effects of three SCFA (acetate, propionate and butyrate) on energy homeostasis and metabolism, as well as how these SCFA can beneficially modulate adipose tissue, skeletal muscle and liver tissue function.
Foods fortified with folic acid decrease rates of some types of congenital heart defects in Canada, finds new research published in the American Heart Association's journal Circulation.
Folic acid is a B vitamin that our bodies use to make new cells, and it is important for the development of a healthy fetus.
Adding folic acid to white flour, pasta, and cornmeal has been mandatory in Canada since 1998. Evidence of folic acid reducing neural tube defects, oral cleft, and cardiovascular anomalies led to the Government of Canada taking steps to help women of childbearing age increase the amount of folate they consume.
The United States Centers for Disease Control and Prevention (CDC) recommend that women take 400 micrograms of folic acid per day from at least 1 month before getting pregnant to prevent major birth defects of the baby's brain (anencephaly) and spine (spina bifida).
Some absolutely crucial advice: how to recognize a heart attack one month before it happens
Did you know that the main cause of early death in the US are heart attacks? The stressful way of life and the junk food we keep eating is a great contributor for this illness becoming so common and so dangerous over the last years.
Leading a healthy lifestyle and trying to decrease the levels of stress in your life can help protect you from heart failure, but another thing that can be very useful, even lifesaving, is knowing the symptoms of heart failure a month before it happens.
These are the symptoms that you might have a heart attack in a month. Make sure you always treat these as red flags.
A new meta-analysis, using data from hundreds of thousands of individuals, finds that gallbladder disease and heart disease are more intertwined than previously thought. The reasons behind this connection are, as yet, unclear.
Gallstones are small, hard deposits that form in the gallbladder - an organ that sits below the liver.
In wealthier countries, they are a common occurrence, affecting 10-15 percent of all adults.
Gallstones are thought to be produced due to an imbalance in the makeup of bile - a digestive aid produced by the liver and concentrated in the gallbladder.
Although generally small and often symptomless, over the years, gallstones can grow to the size of pebbles.
For patients with severe coronary artery disease, heart bypass surgery can reduce the risk of heart attack and improve overall quality of life. Now, researchers report the possibility of a new treatment that may be even more beneficial, without the surgery.
Coronary artery disease (CAD) is the most common form of heart disease in the United States, responsible for more than 370,000 deaths in the country every year.
The condition arises when plaque builds up in the coronary arteries, partially or fully blocking the flow of oxygen-rich blood to the heart muscle. This blockage can cause heart attack, angina - severe chest pain - and, over time, heart failure.
While lifestyle changes - such as adopting a healthy diet and regular physical activity - are considered key to improving CAD, some patients may require heart bypass surgery, which can help restore blood flow to the heart.
But, as with all surgery, it has its risks. These include chest wound infection, bleeding, stroke, heart attack, and kidney or lung failure.
In an analysis of global health differences in hypertension occurrence, researchers find that high blood pressure is more common in low- and middle-income countries for the first time.
High blood pressure is the leading preventable risk factor responsible for disease burden worldwide. Raised blood pressure - which can result in cardiovascular disease,heart disease, stroke, and chronic kidney disease - was accountable for around 9-12 million deaths globally in 2013.
According to research published in the American Heart Association's journal Circulation, more than 30 percent of the adult population worldwide has high blood pressure, and 75 percent of those people live in low- to middle-income countries.
Previous reports have indicated that the prevalence of hypertension in low- and middle-income countries is on the rise, and is steady or decreasing in high-income countries. However, recent estimates of the differences between high blood pressure worldwide were unknown.
Many transplant centers routinely reject hearts if the donor’s blood test reveals elevated levels of troponin I, a protein found in heart muscle that enters the bloodstream when there is a heart attack or other heart muscle damage. Donors with previous heart disease are automatically excluded.
Heart transplantation is one of the greatest achievements in modern medicine and patients with advanced heart failure in whom survival is measured in weeks and months are offered the potential for survival of equal to or greater than 10 years with excellent quality of life.
According to new research, a blood test that leads to donor hearts being rejected may not effectively predict whether a heart transplant will succeed or fail (Photo courtesy of the AMA).
A round one third of adults in the United States have high blood pressure, only half of whom have their high blood pressure under control. New research, published in the American Heart Association's journal Hypertension, identifies magnesium as a potential remedy.
With high blood pressure affecting around 70 million people in the U.S. and increasing the risk of two of the leading causes of death for Americans - heart disease and stroke - preventing or controlling blood pressure is an essential healthcare objective.
Labeled the "silent killer," due to often having no warning signs or symptoms, high blood pressure is a common and often dangerous condition.
A meta-analysis, funded by the Indiana University School of Medicine Strategic Research Initiative, details positive results that show an association between a daily intake of magnesium and a reduction in blood pressure.
Magnesium is already recognized as essential for over 300 biochemical reactions in the body.
The heart sits in the middle of the chest behind the sternum, and extends towards the left side. It is a strong muscular pump, about the size of its owner’s clenched fist. It has four chambers:
two atria, which receive blood to pump to the ventricles
two ventricles, one that pumps blood to the lungs (right), and another that pumps blood to the body (left)
In the average adult, the heart beats around 60 – 100 times per minute, sending about six litres of blood through well over 1,000 complete circuits of the body each day.
During a lifetime of 70 years, the heart will beat more than 2.5 billion times. The only rest it gets or needs is a split-second pause between beats.
MCQ 6. A very high percentage of male patients with proven coronary disease and/or raised lipid levels had an increased level of "pre-beta" lipoproteins in their blood.
What is also referred to as these lipoproteins? a. HDL b. VLDL c. LDL d. Lipo B
Eating foods rich in omega-3 fatty acids may lower the risk of death from heart attack. This is the finding of new research published in JAMA Internal Medicine.
Each year, around 735,000 people in the United States have a heart attack, which occurs when a section of the heart fails to receive enough oxygen-rich blood.
Adopting a healthy diet is considered a key factor in reducing the risk of heart attack, and many studies have suggested that including omega-3 polyunsaturated fatty acids as part of such a diet is particularly beneficial for heart health.
Other studies, however, have questioned the heart benefits of omega-3s, with some suggesting that fish oil supplements - a major source of the fatty acids - do not lower the risk of heart-related events.
Male family physicians, or general practitioners, may be overlooking the risk of cardiovascular disease in female patient because they more often see it as a man's issue, according to new research published in the European Journal of Preventive Cardiology.
Heart disease is a leading cause of death in the United States.
Since the 1980s, developed countries have seen a fall in the number of deaths from cardiovascular disease (CVD). Around 50 percent of this improvement is thought to be because of preventive action.
In men, the rates of mortality from CVD have dropped more than they have in women. There is also evidence that men receive better cardiovascular care after experiencing a cardiovascular problem, as well as better secondary prevention.
Could a robust immune system protect against heart attack? After studying a group of patients with high blood pressure, researchers found those with higher levels of certain antibodies had a lower risk of heart attack - regardless of other risk factors. They suggest a blood test to measure antibody levels could help assess a person's risk of heart attack.
The study, from Imperial College London in the United Kingdom, is published in the journal EbioMedicine. It describes how the team discovered a link between blood levels of Immunoglobulin G (IgG) antibodies and reduced chances of having a heart attack.
Lead investigator Dr. Ramzi Khamis, a consultant cardiologist and clinical research fellow, says:
"Linking a stronger, more robust immune system to protection from heart attacks is a really exciting finding. As well as improving the way we tell who is at the highest risk of a heart attack so that we can give them appropriate treatments, we now have a new avenue to follow in future work."
Salt intake has become a major health concern in the United States. An array of studies have claimed too much salt in the diet can increase the risk of serious illness, such as heart disease and stroke, prompting recommendations to lower salt intake. But how much is "too much" when it comes to salt consumption?
The Dietary Guidelines for Americans recommend that adults consume less than 2,300 milligrams of sodium each day - the equivalent to around 1 teaspoon of salt - as part of a healthy diet.
A report from the Centers for Disease Control and Prevention (CDC) released earlier this year, however, found that around 90 percent of adults and children in the U.S. consume more than the recommended sodium intake, with most adults consuming more than 3,400 milligrams daily.
Vitamin D is a precursor of the steroid hormone calcitriol that is crucial for bone and mineral metabolism. Both the high prevalence of vitamin D deficiency in the general population and the identification of the vitamin D receptor in the heart and blood vessels raised interest in the potential cardiovascular effects of vitamin D. Experimental studies have demonstrated various cardiovascular protective actions of vitamin D, but vitamin D intoxication in animals is known to induce vascular calcification. In meta-analyses of epidemiological studies, vitamin D deficiency is associated with an increased cardiovascular risk. Findings from Mendelian randomization studies and randomized, controlled trials (RCTs) do not indicate significant effects of a general vitamin D supplementation on cardiovascular outcomes. Previous RCTs, however, were not adequately designed to address extra skeletal events, and did not focus on vitamin D-deficient individuals. Therefore, currently available evidence does not support cardiovascular benefits or harms of vitamin D supplementation with the commonly used doses, and whether vitamin D has cardiovascular effects in individuals with overt vitamin D deficiency remains to be evaluated. Here, we provide an update on clinical studies on vitamin D and cardiovascular risk, discuss ongoing vitamin D research, and consider the management of vitamin D deficiency from a cardiovascular health perspective.
Key points
The vitamin D receptor (VDR) and enzymes for vitamin D metabolism are expressed throughout the cardiovascular system
VDR and 1α-hydroxylase knockout mice have hypertension with myocardial hypertrophy and increased activity of the renin–angiotensin–aldosterone system
The molecular effects of VDR activation indicate various anti-atherosclerotic and protective effects on the heart and on common cardiovascular risk factors
Observational studies have shown that low 25-hydroxyvitamin D levels are associated with an adverse cardiovascular risk profile and significantly increased risk of cardiovascular events
Mendelian randomization studies and randomized clinical trials have not shown significant effects of vitamin D on cardiovascular events, but these trials were not designed to investigate cardiovascular outcomes in vitamin D-deficient individuals
Vitamin D supplementation is currently not indicated for the purpose of cardiovascular disease prevention, but treatment of vitamin D deficiency is critical for skeletal health
Introduction
The critical involvement of vitamin D in bone and mineral metabolism is historically known. The identification of the vitamin D receptor (VDR) in almost all human organs including the heart and the blood vessels, and observations that individuals deficient in vitamin D are at increased risk of various extraskeletal diseases, stimulated research on the role of vitamin D for overall and cardiovascular health. In this Review, we summarize the existing knowledge on the effects of vitamin D on cardiovascular diseases and associated risk factors, with a particular focus on meta-analyses of large, epidemiological studies and randomized, controlled trials (RCTs). First, we provide a short summary of vitamin D metabolism and current vitamin D guidelines, a historical perspective on vitamin D and cardiovascular diseases, and a brief overview on the mechanistic effects of VDR activation on cardiovascular risk factors, the blood vessels, and the heart. The principal aspect of this Review is an update on observational studies, Mendelian randomization studies, and RCTs on vitamin D and cardiovascular risk. Finally, we outline and discuss ongoing vitamin D research, including large RCTs, and present our conclusions on how to deal with the management of vitamin D deficiency from a public health and cardiovascular health perspective.
For the first time, a team of international experts recommends that most people do not need to fast before having their cholesterol and triglyceride levels tested.
Fasting is a problem for many patients, they explain, and note the latest research shows that cholesterol and triglyceride levels are similar whether people fast or not.
The experts represent the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) joint consensus initiative.
They refer to new research from Denmark, Canada, and the United States that included over 300,000 people and found it is not necessary to have an empty stomach to check cholesterol levels.
Apart from Denmark, all countries require that patients fast for at least 8 hours before checking their cholesterol and triglyceride levels - referred to as "lipid profile." In Denmark, non-fasting blood sampling has been in use since 2009.
