09 September 2021

This week in PVD

Using oxygen aids exercise in PH-HFpEF patients without hypoxemia

Breathing oxygen-enriched air can significantly improve exercise performance in people with  pulmonary hypertension (PH) linked to heart failure with preserved ejection fraction (HFpEF), including those who might not use supplemental oxygen, according to a small clinical study.

Better blood-oxygen levels and more efficient breathing (exchange of carbon dioxide and oxygen), as well as a lower heart rate and less dyspnea (shortness of breath) were among other noted benefits of oxygen use during exercise in these patients.

The study, “Effect of Breathing Oxygen-Enriched Air on Exercise Performance in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction: A Randomized, Placebo-Controlled, Crossover Trial,” was published in the journal Frontiers in Medicine.

HFpEF occurs when the heart’s lower left chamber (ventricle) is not filling with blood as well as it should, so it pumps out less blood than the body needs. People with HFpEF can develop PH, leading to disease progression and exercise intolerance, lowering their quality of life and putting them at a greater risk of death.

On the international day of clean air for blue skies, The World Heart Federation calls for global action to mitigate the negative impacts of air pollution on people's health

GENEVA (7 September 2021) – The World Heart Federation (WHF) has developed a new policy brief aimed at reducing the negative impacts of air pollution on people’s cardiovascular and overall health.

Together with high blood pressure, unhealthy diets and physical inactivity, air pollution is one of the most important risk factors for heart attack, stroke, diabetes and respiratory diseases, and exposure to air pollution has also been linked with increased vulnerability to the more severe consequences of COVID-19. In 2019, an estimated 6.7 million deaths, or 12 percent of all deaths worldwide, were attributable to outdoor or household air pollution.  As many as half of these deaths were due to heart disease and stroke.

The WHF Air Pollution Policy Brief, Clean Air, Smart Cities, Healthy Hearts, highlights the need for policies and investments that support a reduction in air pollution at all levels of society, including cleaner transport, energy-efficient homes, power generation, industry regulation, access to clean fuels and technologies, and better municipal waste management, which can effectively reduce key sources of air pollution.

In addition to concrete policy action on an international scale, targeted patient interventions and key city-level infrastructure adjustments can do much to mitigate the negative impact of air pollution on the cardiovascular system.

Apabetalone fares well in early clinical trial

Apabetalone (RVX-208), Resverlogix‘s experimental treatment for pulmonary arterial hypertension (PAH), was well-tolerated in a small clinical trial, the company announced.

The trial met its primary goal of adding apabetalone to standard care to improve pulmonary vascular resistance (PVR), a measure that reflects the internal resistance to blood flow within the pulmonary arteries.

“The study successfully achieved its primary objective of confirming the feasibility of the clinical study design and demonstrated encouraging results of apabetalone treatment in patients with PAH,” Steeve Provencher, MD, said in a press release. Provencher is director of the pulmonary hypertension program at Laval University in Quebec, Canada, lead investigator for the trial, and also its sponsor.

Using oxygen aids exercise in PH-HFpEF patients without hypoxemia

Breathing oxygen-enriched air can significantly improve exercise performance in people with  pulmonary hypertension (PH) linked to heart failure with preserved ejection fraction (HFpEF), including those who might not use supplemental oxygen, according to a small clinical study.

Better blood-oxygen levels and more efficient breathing (exchange of carbon dioxide and oxygen), as well as a lower heart rate and less dyspnea (shortness of breath) were among other noted benefits of oxygen use during exercise in these patients.

The study, “Effect of Breathing Oxygen-Enriched Air on Exercise Performance in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction: A Randomized, Placebo-Controlled, Crossover Trial,” was published in the journal Frontiers in Medicine.

HFpEF occurs when the heart’s lower left chamber (ventricle) is not filling with blood as well as it should, so it pumps out less blood than the body needs. People with HFpEF can develop PH, leading to disease progression and exercise intolerance, lowering their quality of life and putting them at a greater risk of death.

Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial

There is an urgent need for effective and safe community-based treatments for COVID-19, especially for older people and those with comorbidities who are at higher risk of hospital admission and death.1 Inhaled corticosteroids are widely available, inexpensive, and generally safe, and have been proposed as a COVID-19 treatment because of their targeted anti-inflammatory effects in the lungs,2, 3 where they also reduce expression of ACE-2 and TMPRSS2,4, 5 which is relevant for airway epithelial cell entry by SARS-CoV-2.6 Inhaled steroids also reduce replication of SARS-CoV-2 in epithelial cells in vitro.7 Early in the COVID-19 pandemic, the low prevalence of asthma and chronic obstructive pulmonary disease among people admitted to hospital with COVID-19 led to speculation that the inhaled corticosteroids used to treat these conditions might be protective.2, 3 Furthermore, systemic corticosteroids reduce deaths in patients admitted to hospital with COVID-19,8, 9 probably because the hyperinflammatory state is responsible for the subsequent damage from SARS-CoV-2 infection.10 However, subgroup analyses in the RECOVERY trial suggested no benefit, and possible harm, with use of systemic corticosteroids in patients admitted to hospital not requiring oxygen.8 In addition, observational, population-based studies in primary care in the UK found an increased risk of COVID-19 hospital admission or death among people prescribed inhaled corticosteroids for chronic lung disease,11, 12 although residual confounding by unmeasured disease severity could not be ruled out. An efficacy trial of adults with early COVID-19 in the community found inhaled budesonide reduced COVID-19-related emergency assessments or hospital admissions, and time to self-reported recovery.13 However, thus far, there are no results reported from large effectiveness trials of inhaled budesonide for COVID-19.


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