Latest / Morning Medical with Dr. Chow / Semaglutide for Heart Failure, Hypertension in Pregnancy, and Youth Mental Health Trends

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Semaglutide for Heart Failure, Hypertension in Pregnancy, and Youth Mental Health Trends · Morning Medical with Dr. Chow

0:00
Welcome to another episode of Morning Medical with Dr.
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Chow.
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I'm your host, Dr.
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Chi-Ming Chow, coming to you from Toronto, Ontario, where I wear many hats as a
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cardiologist, internist, and professor.
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Today, we're diving into some fascinating new findings in the field of cardiology,
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specifically focusing on heart failure and diabetes.
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In recent news, a secondary analysis of a placebo-controlled trial has shown promising
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results for patients with type 2 diabetes who also suffer from heart failure.
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The study centered around the use of an oral medication called semaglutide, which belongs to
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a class of drugs known as GLP-1 receptor agonists.
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This study, part of the larger SOUL trial, revealed that semaglutide can significantly
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reduce the risk of heart failure events in some patients.
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Now, let's break down these findings a bit.
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The analysis found that the risk of a composite heart failure outcome was reduced by twenty-two
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percent in patients with a history of heart failure and preserved ejection fraction—a
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condition where the heart muscle contracts normally but the ventricles do not relax as
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they should during heartbeats.
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Interestingly, this benefit was not observed in patients with reduced ejection fraction or
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those without any history of heart failure.
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The trial, which spanned multiple countries and included nearly ten thousand participants,
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highlighted that semaglutide not only helped those with a history of heart failure but also
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showed a trend towards reducing major adverse cardiovascular events, such as heart attacks,
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in patients without prior heart failure.
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This positions semaglutide as a potential game-changer in managing cardiovascular risks
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in type 2 diabetes patients.
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What's particularly noteworthy is that this medication, available in pill form as Rybelsus,
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is already approved for reducing the risk of major cardiovascular events in high-risk adults
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with type 2 diabetes.
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This makes it the first GLP-1 pill to hold such an indication, offering a new therapeutic
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avenue for clinicians managing patients with these complex conditions.
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While the study also examined the effects of semaglutide in conjunction with other
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medications like SGLT2 inhibitors, the findings suggest that the benefits of semaglutide are
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consistent regardless of these additional treatments.
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This is crucial as it underscores the potential of semaglutide to be integrated into existing
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treatment plans for more comprehensive cardiovascular care.
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The results of this trial are a step forward in our understanding of how to better manage heart
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failure in patients with type 2 diabetes.
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As always, it's important for patients to consult with their healthcare providers to
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understand the best treatment options available for their specific needs.
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Now, shifting our focus to a persistent challenge in the realm of hypertension
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management in the United States.
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Despite significant advances in medical treatment, a new report reveals that
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controlling high blood pressure still remains elusive for most American adults with
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hypertension.
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According to the latest data from the National Health and Nutrition Examination Survey,
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spanning 2021 to 2023, a staggering seventy-nine percent of adults with
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hypertension did not have their blood pressure within the recommended guidelines.
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This report, led by Shakia T.
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Hardy and her team from the University of North Carolina at Chapel Hill, and published in the
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Journal of the American Medical Association, highlights a significant gap in treatment.
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Most notably, sixty-one percent of those with uncontrolled hypertension were not receiving
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any blood pressure medication.
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Interestingly, many of these individuals were within ten millimeters of mercury of achieving
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their blood pressure goals, suggesting that initiating antihypertensive medication and
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lifestyle changes could potentially bring their blood pressure under control.
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For those already on medication, about half of them still had blood pressure readings at least
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ten millimeters of mercury above the target, indicating a need for more intensive treatment
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strategies, possibly involving combination therapy.
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The study also pointed out that a quarter of these individuals had blood pressure readings
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twenty millimeters of mercury or more over the goal, with about ten percent exceeding thirty
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millimeters of mercury.
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Improving blood pressure control on a national scale could have a profound impact on reducing
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the risks of cardiovascular disease and dementia.
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Hardy and her colleagues emphasize that implementing the American Heart Association and
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American College of Cardiology's 2025 guidelines, which advocate for earlier and more
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intensive treatment of hypertension, could be key to addressing this gap.
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Interestingly, the study found that most people with uncontrolled hypertension did have health
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insurance and access to routine healthcare.
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However, those not taking antihypertensive medication were typically younger, with an
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average age of forty-nine years, and were less likely to have a high risk of cardiovascular
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disease compared to those on medication, who averaged sixty-two years of age.
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The study, which included over three thousand participants aged twenty years or older, was
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designed to be representative of the U.S.
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population.
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It used the 2025 guidelines to define uncontrolled blood pressure, which consider a
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systolic blood pressure of at least one hundred thirty millimeters of mercury or a diastolic
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pressure of at least eighty millimeters of mercury as the threshold.
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Although the data was collected prior to 2025, the researchers acknowledged this as a
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limitation of their study.
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Furthermore, the survey relied on self-reported use of antihypertensive medication, which could
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introduce some reporting inaccuracies.
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Despite these limitations, the findings underscore the urgent need for improved
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strategies in managing hypertension, especially given the potential health benefits of better
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blood pressure control.
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According to a new long-term study published in the Journal of the American Heart Association,
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men face a higher risk of developing cardiovascular disease earlier than women, with
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this risk starting to rise significantly around the age of thirty-five.
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The research tracked over five thousand adults from young adulthood and discovered that men
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reached clinically significant levels of cardiovascular disease approximately seven
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years before women did.
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The study, led by researchers from Northwestern University Feinberg School of Medicine,
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examined the onset of cardiovascular disease, including coronary heart disease, stroke, and
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heart failure, in both Black and White adults across four U.S.
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states.
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Participants were initially healthy and free of cardiovascular disease when they enrolled in
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the study between 1985 and 1986.
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They were then followed for a median of over thirty-four years, allowing researchers to
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pinpoint when cardiovascular disease emerged.
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One of the key findings was that up until their early thirties, men and women shared a similar
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short-term risk of cardiovascular disease.
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However, around age thirty-five, the risk began to diverge, with men facing a consistently
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higher ten-year risk than women.
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By age fifty, the ten-year risk of cardiovascular disease was approximately six
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percent for men compared to about three percent for women.
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This highlights a significant difference in the timing of risk development between the sexes.
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Interestingly, the study noted that traditional risk factors such as blood pressure,
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cholesterol, and smoking did not fully explain the observed differences in cardiovascular
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disease risk between men and women.
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Dr.
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Iris Jaffe, not involved in the study, suggests that social determinants and biological
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differences may play a role, indicating areas where further research is needed to understand
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these disparities.
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Despite these findings, the study emphasizes that women should not become complacent about
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their heart health.
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Heart disease remains a leading cause of death for women, and their risk can accelerate after
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menopause, possibly due to changes in hormone levels.
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This underscores the importance of monitoring heart health and adopting preventive measures
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early in life for both sexes.
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The study’s results support the American Heart Association's updated guidelines that advocate
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for earlier risk assessment, starting at age thirty.
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These findings suggest that men, in particular, should increase their preventive care visits
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during their mid-thirties and forties, as they are generally less likely to see a doctor for
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routine care than women.
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Regular check-ups can facilitate early risk detection and counseling, potentially reducing
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cardiovascular disease risk.
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Experts recommend that young adults, regardless of gender, should follow the American Heart
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Association’s "Life’s Essential 8" guidelines to maintain cardiovascular health.
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These include managing traditional risk factors like blood pressure, cholesterol, and blood
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sugar, as well as adopting a healthy lifestyle through better nutrition, increased physical
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activity, and adequate sleep.
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Tracking these health markers can empower individuals to take proactive steps in managing
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their cardiovascular risk.
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In an insightful new study from South Korea, researchers have delved into the long-term
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cardiovascular risks associated with hypertensive disorders of pregnancy,
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highlighting that not all subtypes carry the same level of risk.
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This large-scale analysis, involving over half a million women, has brought to light some
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crucial findings that could reshape how we approach postpartum care for these patients.
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The study, led by Dr.
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Jun-Bean Park from Seoul National University College of Medicine, reveals that women who
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experience hypertensive disorders during pregnancy face an increased risk of
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cardiovascular events later in life.
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The analysis showed that having such a disorder was linked to a sixty-two percent higher
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incidence of cardiovascular events over a median follow-up of six and a half years.
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However, the magnitude of risk varied significantly by subtype.
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One of the most striking findings was that superimposed preeclampsia carried the highest
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risk.
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Women with this condition were nearly three times more likely to experience cardiovascular
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events compared to those without any hypertensive disorders during pregnancy.
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This highlights the need for tailored postpartum surveillance and care for women with
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superimposed preeclampsia.
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Interestingly, while all subtypes were associated with higher risks of heart failure
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and stroke, chronic and unspecified hypertension were notably linked to atrial
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fibrillation.
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Furthermore, unspecified hypertension was also associated with myocardial infarction.
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These findings suggest that each subtype of hypertensive disorder in pregnancy could
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potentially lead to different cardiovascular outcomes.
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Dr.
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Nicole Teal, a perinatologist at UC San Diego Health, commented on the implications of these
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findings, emphasizing that pregnancy should be viewed as a critical window for identifying
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women who might benefit from proactive cardiovascular care.
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She noted that these hypertensive disorders are not merely markers of preexisting risk but may
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in fact induce lasting cardiovascular vulnerability.
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The study analyzed data from South Korea's National Health Insurance Service, focusing on
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deliveries between 2010 and 2018 among women aged twenty to forty-nine.
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It excluded those without a health screening within two years before pregnancy and those
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with prior cardiovascular events.
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This rigorous selection process ensured a focus on new cardiovascular risks emerging
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post-pregnancy.
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Overall, the study reported an absolute risk increase of about two additional cardiovascular
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events per one thousand person-years, with superimposed preeclampsia presenting the
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highest cumulative incidence of such events.
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This reinforces the importance of incorporating the subtype of hypertensive disorder into
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postpartum risk assessment, as it could significantly influence the management and
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monitoring strategies for affected women.
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While the study was limited by its reliance on claims data, which could introduce some risk of
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misclassification, and by a relatively low incidence of cardiovascular events, it still
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provides compelling evidence of the varied cardiovascular risks associated with different
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hypertensive disorders of pregnancy.
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The findings underscore the need for personalized postpartum care strategies to
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mitigate these risks effectively.
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Today, we're delving into a concerning trend highlighted by a new study published in the
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Canadian Medical Association Journal, which reveals a rise in psychotic disorders among
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young people in Ontario.
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This extensive study analyzed health administrative data from over twelve million
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Ontario residents born between 1960 and 2009.
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Researchers focused on the diagnosis of psychotic disorders, such as schizophrenia, in
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individuals reaching at least fourteen years of age.
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The findings are quite striking.
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Over a thirty-year period, more than one hundred fifty-two thousand individuals were
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diagnosed with a psychotic disorder.
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The annual rate of these diagnoses increased by sixty percent among those aged fourteen to
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twenty, while remaining stable or even declining for those aged twenty-one to fifty.
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Schizophrenia, a chronic condition characterized by hallucinations and delusions,
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affects about one percent of Canadians based on federal data from 2016 to 2017.
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The study's lead researcher, Dr.
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Daniel Myran, a family physician and research chair at North York General Hospital in
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Toronto, sought to understand if the rate of psychotic disorders differed by birth cohorts.
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He found that rates indeed varied, with those born in the 1990s experiencing higher rates
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than those born in previous decades.
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Specifically, in the fourteen to twenty age group, the rate of psychotic disorders rose
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from sixty-two and a half cases per one hundred thousand people in the 1990s to nearly one
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hundred cases per one hundred thousand by the study's conclusion.
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This suggests a significant uptick in psychotic disorder diagnoses among younger generations.
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While the exact reasons for this increase remain elusive, Dr.
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Myran and his colleagues suggest several possible contributors.
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These include substance use, notably cannabis, as well as older parental age, socioeconomic
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stress, migration-associated stress, and negative childhood experiences like abuse.
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Substance use, in particular, is considered a leading possibility due to its prevalence over
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the past two decades.
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Psychiatrist Sarah Brandigampola from the Ottawa Hospital echoes these concerns, noting
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that early intervention is critical.
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She emphasizes that recognizing symptoms early and initiating effective treatment can
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dramatically alter the life trajectory of those affected by psychosis.
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Interestingly, the Ontario study aligns with findings from recent research in Denmark and
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Australia, which also reported increases in schizophrenia diagnoses among younger
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individuals.
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This suggests a potentially global trend that warrants further investigation.
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One poignant story from the study is that of Samantha Mercanti, who experienced her first
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psychotic episode in her twenties.
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Despite the initial fear and confusion, she received help and now leads a fulfilling life,
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highlighting the importance of early diagnosis and treatment.
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Her story serves as a beacon of hope, demonstrating that recovery is possible even in
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the face of significant mental health challenges.
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Ultimately, while the rising incidence of psychotic disorders among young people is
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concerning, it also underscores the need for increased awareness and improved mental health
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services.
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By understanding these trends and their potential causes, we can better equip ourselves
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to support those affected and work towards reducing the prevalence of these conditions in
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future generations.
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As we face the heart of winter, it's crucial to address the potential dangers posed by freezing
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temperatures, especially when power outages occur.
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Even when the temperatures aren't extreme, the prolonged cold can be taxing on the body and
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heart.
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Today, I'll be sharing some vital tips from emergency department doctors on how to stay
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safe during these challenging conditions.
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First, let's talk about hypothermia, a condition where the body loses heat faster than
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it can produce it, leading to dangerously low body temperatures.
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According to the Cleveland Clinic, mild hypothermia occurs when body temperature falls
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to between eighty-nine point six and ninety-five degrees Fahrenheit, causing
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symptoms like shivering, exhaustion, and clumsiness.
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Moderate hypothermia, with temperatures between eighty-two point four and eighty-nine point six
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degrees Fahrenheit, can lead to slurred speech and slowed heart rate.
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If body temperature drops below eighty-two point four degrees Fahrenheit, severe symptoms
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like coma and even death can occur.
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If you notice someone shivering for an extended period, it's crucial to get them to a warmer
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environment promptly.
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If more severe symptoms appear, don't hesitate to call emergency services.
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It's important to recognize that cold weather can subtly sneak up on you.
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Even temperatures between thirty to forty degrees Fahrenheit can pose risks if exposure
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is prolonged.
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Shivering is a natural response but can become exhausting over time, especially for older
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adults or those with underlying health issues.
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Dr.
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Ben Weston from the Milwaukee County Office of Emergency Management emphasizes the importance
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of recognizing when you need to seek warmth, even if you think you're adequately dressed.
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Staying hydrated is another critical factor, as dehydration can occur without us even realizing
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it, especially in cold weather.
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Drinking water and nonalcoholic warm beverages can help maintain body warmth.
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Alcohol, on the other hand, can impair your body's ability to handle the cold and affect
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your judgment, so it's best to avoid it.
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When it comes to clothing, layering is key.
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The North Carolina Department of Emergency Management suggests wearing warm,
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loose-fitting, lightweight clothing in layers to trap heat effectively.
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Pay special attention to covering your head, hands, and feet, as these areas lose heat the
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fastest.
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Be cautious of internet hacks like wearing latex gloves under your winter gloves or using
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cayenne pepper in socks, as these can cause more harm than good.
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Finding a warm space is essential during power outages.
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Dr.
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Weston recommends closing off rooms to concentrate heat and suggests using a portable
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heater safely in one room.
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Dr.
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Abhi Mehrotra from the University of North Carolina advises creating a small, enclosed
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space using a tent or sleeping bag indoors to retain body heat.
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However, be extremely cautious with heat sources.
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Avoid using gas stoves or ovens indoors as they can emit carbon monoxide, an odorless gas that
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is deadly.
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If anyone shows signs of carbon monoxide poisoning, such as headaches or nausea, it's
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imperative to move them to fresh air immediately.
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Lastly, community awareness and support are crucial during these cold spells.
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Vulnerable groups such as young children, older adults, and those with chronic health
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conditions are at higher risk.
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Checking on your neighbors, especially those who might need assistance, can make a
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significant difference.
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Often, people might not realize they need help until someone reaches out.
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That wraps up today's episode of Morning Medical with Dr.
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Chow.
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I hope these tips help you stay safe and warm during these cold winter months.
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Remember, preparation and awareness are key to navigating the challenges that come with
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freezing temperatures and power outages.
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Stay safe, and we'll see you next time for more medical insights and updates.