What do you know about congenital heart defects and diseases of the third age?

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Health Europa presents recent research on the long-term effects of congenital heart defects on infants and their mothers.

Congenital heart defects – which include Ebstein’s anomaly, aortic valve stenosis and tricuspid atresia – are the most common birth conditions and affect around 1% of all newborn babies. Fortunately, more people with the disease are surviving into adulthood, but recent research has suggested a disturbing link between problems at birth and complications later in life, as Health explores. Europe.

Do congenital heart defects increase the risk of heart problems in adulthood?

Children born with relatively simple congenital heart defects are at an increased risk of developing heart problems as adults. This risk is so great that a child born with a congenital heart defect who leads a heart-healthy lifestyle is twice as likely to develop cardiovascular problems later in life than a child born without a defect who has a heart defect. abnormal heart lifestyle.

That’s according to new research conducted by scientists at Stanford University School of Medicine, USA – and published in the journal Traffic – suggesting that the medical community should monitor adults born with heart defects, no matter how minor, more closely.

“All of us in cardiology recognize that people with complex disease need lifelong follow-up care,” said Dr. James Priest, assistant professor of pediatric cardiology and lead author of the paper. “But for simple issues, we figured once you’ve closed the hole or fixed the valve, those patients are good to go.”

Using data from UK Biobank, Priest and colleagues – including Priyanka Saha, Stanford researcher (2017-2018) and lead author of the paper – examined the health and lifestyles of 2,006 elderly UK residents 37 to 73 years old with mild congenital heart defects.
For reasons unclear to the research team, this group of people was slightly more likely to be obese, smoke, have high blood pressure and have diabetes – all common risk factors for cardiovascular problems.

When adjusted for these factors, people with mild congenital heart defects were found to have a greatly increased risk of having poor cardiovascular health. Compared to those born without heart defects, they were:

  • 13 times more likely to develop heart failure or atrial fibrillation
  • Five times more likely to have a stroke
  • Twice as likely to suffer a heart attack.

Adult survivors of congenital heart defects with fewer risk factors for heart disease fared better than those with more. People with a heart-healthy lifestyle were about a third less likely to develop heart problems than those with five or more risk factors for cardiovascular disease.

The research team did not explain why adults born with heart defects were at higher risk of developing heart complications; however, they offered several possible theories, for example stress from surgery, genetic predisposition, and cellular dysfunction.

“Is it surgery? Could it be the drugs? Or is it something intrinsic to congenital heart disease? We don’t know,” Priest admitted. “We don’t know why infants have congenital heart disease to begin with.”

Saha added that new research on the link between congenital heart defects and cardiovascular problems in adulthood could help shape follow-up care. Before that, however, doctors might start helping patients by providing more support and monitoring.

How can congenital heart defects affect mothers after pregnancy?

It’s not just infants themselves with congenital heart defects who are at increased risk for future heart problems; according to research conducted in Canada, their mothers may also be more likely to suffer from cardiovascular complications later in life.

Published in Circulation, the research analyzed data from women who gave birth between 1989 and 2013 in Quebec, Canada, with critical, non-critical or none heart defects. They followed the women up to 25 years after pregnancy to study their likelihood of being hospitalized for cardiovascular disease, including heart attack, heart failure, atherosclerotic disorders and heart transplants.

Compared to mothers of infants without congenital heart defects, women who gave birth to children with critical heart defects were 43% more likely to be hospitalized and women whose children had non-critical defects were 24%.

The research does not explain exactly how congenital heart defects are linked to post-pregnancy cardiovascular disease in mothers, although it does not rule out a genetic component.

Lead author Dr. Nathalie Auger, an epidemiologist at the Center de recherche du Center hospitalier de l’Université de Montréal, offered another explanation: “Caring for infants with severe heart defects is associated with psychosocial stress and financial, which may increase the long-term risk of cardiovascular disease in mothers. .”

Auger believes the research offers these mothers the opportunity to benefit from early prevention strategies and counseling to reduce their risk of cardiovascular disease, the leading cause of death among women.

Health care providers, such as obstetricians, who treat and monitor mothers in the early stages of caring for children with heart defects “are in an excellent position to inform women of this possibility, the increased risk of disease heart disease, and to provide recommendations to target other risk factors like smoking, obesity, and physical activity,” she said.

Do congenital heart defects lead to dementia?

Elsewhere, new research from Cincinnati Children’s Hospital Medical Center, USA, and Aarhus University Hospital, Denmark, has for the first time revealed a potential link between congenital heart defects and dementia, which affects approximately 50 million people worldwide.

The study, which was published in Circulation, also found a particularly increased risk of early onset dementia in middle-aged adults.

“We learned that congenital heart disease is a lifelong disease,” said lead author and pediatric cardiologist Dr. Nicolas Madsen. “Research shows that children born with heart problems are at greater risk of having one or more neurodevelopmental problems compared to children without heart disease. We can now say that the risk of these types of problems continues into adulthood.

During the research, Madsen and his colleagues studied data from 10,632 adults born between 1890 and 1982 and used medical registers and a review of medical records covering all Danish hospitals to identify adults with diagnosed congenital heart defects. between 1963 and 2012.

They found a 60% higher risk of dementia compared to the general population. This figure rose to 160% when comparing the under 65s.

According to Madsen, these findings may be partly explained by the fact that many of the adults examined in the study were born at a time when medical and surgical interventions were more limited than they are today.

Still, he added, it’s important to understand the “health care needs and risk factors affecting the greatest number of middle-aged and older adults currently living with” heart defects. congenital.

Please note that this article will appear in issue 9 of Health Europa Quarterly, which will be available for reading in April 2019.

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