Pulse of the Heart

Eggs and your heart - dispelling the myth

2006-05-05T23:55:00.000-04:00

Ingestion of several eggs a day tends to increase blood concentrations of cholesterol, particularly the amount circulating in low-density lipoproteins (LDLs)—the so-called bad cholesterol. However, a new study indicates eating eggs can increase the amount of cholesterol in high-density lipoproteins (HDLs)—the good cholesterol, too.

The study also showed that when people ate three or more eggs per day their bodies made bigger LDL- and HDL-lipoprotein particles than when they ate no eggs. That's important because other recent studies have suggested that larger LDLs are less likely than small ones to enter artery walls and contribute their cholesterol load to artery-clogging plaque. Similarly, larger HDLs are more robust than smaller ones at hauling cholesterol out of the bloodstream and, ultimately, out of the body.

The new findings contribute to a growing body of data suggesting that eggs shouldn't be construed "as a dietary evil."

Not all people respond similarly to cholesterol. Studies have shown that 30 to 40 percent of any given population is made up of "hyperresponders." In these people, blood-cholesterol concentrations spike disproportionately in response to dietary cholesterol. The study team decided to investigate whether such people put an egg's cholesterol into different-sized lipoproteins than most other people do.

So, the team recruited 29 postmenopausal women and 13 elderly men to take part in a dietary trial. None was taking cholesterol-lowering medicine at the time of the study, the author notes, which means that for a population of middle-aged-to-elderly people, the group was relatively heart healthy.

For 30 days, each volunteer received a liquid-egg product or a fat-and-cholesterol-free, protein-rich egg substitute in portions comparable to three large eggs per day. The real-egg ration delivered some 640 mg of cholesterol; the egg substitute contained no cholesterol. None of the participants knew which food he or she was getting until the end of the study.

After a month on the first diet, all volunteers took a 3-week breather and then resumed participation. For the second phase, each person received the alternative to the product he or she had initially received.

Throughout both phases of the trial, the amount of both HDL and LDL lipoproteins remained unchanged. However, the 15 hyperresponders among the volunteers had much higher amounts of cholesterol circulating with their lipoprotein particles while they were eating real eggs. "All of the increase went into large [lipoprotein] particles."

In contrast, among normal responders, only small increases in blood cholesterol occurred during the egg diet, and the size of LDL- and HDL-cholesterol particles covered the full range of lipoprotein sizes.

Not only did the two groups handle the eggs' cholesterol differently, but the hyperresponders handled the excess that showed up in their blood "in the most anti-atherogenic way"—by depositing it in the largest lipoproteins. The take-home message is that an LDL-cholesterol reading that ignores lipoprotein size may exaggerate the heart risks posed by eggs' cholesterol.

It's time to tell your healthcare provider to update his or her dietary recommendations.

Still nervous despite studies like this one? Then, try omega-3 eggs. You can now get them at most grocery chains.

Also, consider eggs to boost weight loss.

Insulin, NOT SODIUM, and hypertension

2006-05-03T22:54:00.000-04:00

Insulin rather than salt is the major driver of hypertension, according to an analysis of data from a prospective study of 23 patients with confirmed atherosclerotic cardiovascular disease.

In the study, obese patients consuming a high saturated fat, low starch diet increased daily sodium intake from less than 2 grams a day to more than 20 grams a day. But they also lost an average of 5.5 kg-or about 5% of their total body weight-in six weeks.

"At the same time there were dramatic and significant reductions in fasting insulin and in mean arterial pressure, researchers said. The finding strongly suggests that "we need to stop paying so much attention to sodium and pay much more attention to fasting insulin." Insulin rises in response to a high carbohydrate, high calorie diet.

"It all comes back to obesity." Asked whether a similar weight loss achieved with a restricted calorie diet or a low fat diet could produce the same results, they agreed that it could.

"We are testing that hypothesis with a new study that will begin enrollment this summer," authors said. "We will be comparing the high fat, no-calorie-restriction diet, to a low fat diet plus Xenical (orlistat)."

And, insulin resistance has now been linked to Alzheimer's.

More on insulin resistance.

Treating periodontal disease cuts heart risk

2006-05-01T23:17:00.000-04:00

Researchers aimed to estimate the effect of periodontal therapy on traditional and novel cardiovascular risk factors in systemically healthy individuals who have periodontitis.

A standard course of periodontal therapy (subgingival scaling and root planing) including the adjunctive use of a locally delivered antimicrobial, IPT, resulted in significant reductions in a cluster of inflammatory markers at 1 and 2 months together with an improvement in lipid markers at 2 and 6 months after therapy compared to subgingival scaling and root planing alone.

Intensive periodontal therapy produced greater reductions in IL-6 at 1 and 2 months, together with decreases in C-reactive protein and total cholesterol. Moreover, a 7 +/- 3-mm Hg decrease in systolic BP was observed at 2 months in the IPT group. Intensive periodontal therapy subjects exhibited a 1.53% +/- 1.20% and 2.00% +/- 1.42% decreases in cardiovascular risk scores (Framingham) at 2 and 6 months, respectively, when compared to those in the standard group.

The findings suggest that intensive periodontal treatment reduces systemic inflammatory markers and systolic BP, and improves lipid profiles with subsequent changes in cardiovascular risk when compared to standard therapy.

Twice a year dental visits.....a must.

It's Mom's fault?

2006-04-29T17:38:00.000-04:00

A patient's history of maternal coronary heart disease is a more significant risk factor than a paternal history, investigators reported here. But the risk escalates even more when both parents had the disease.

Compared with male patients with no family history of heart disease, men had a 55% greater risk of developing heart disease if they had a maternal history of coronary heart disease . Their risk was 41% greater if they had a paternal coronary heart disease history.

If both parents had heart disease, the risk for men more than doubled. For younger men, ages 30 to 39, the risk was up 500%.

Maternal transmission was also stronger in women, compared with reference women whose parents were not affected. Women had a 43% increased risk for maternal transmission, compared with a 17% increased risk for paternal transmission.

If both parents had coronary heart disease, the risks for women rose to 82%. Furthermore, like the men, the highest risk—up more than 450%—was found in the youngest age group, women 30 to 39.

The differences in percentages between men and women were not fully explained in the study. The transmission of coronary heart disease could be mediated through diabetes and hypertension but also through other genetic, biochemical, or behavioral factors.

However, study authors hypothesized that the increased maternal transmission may have been attributable to behavioral risk factors and to the fact that children spend more time with their mothers. As a result, children might be likely to pick up a mother's risky habits such as poor diet, smoking, and physical inactivity.

Now, that we're adults, and we have gotten over blaming our parents for all our thoughts and actions, isn't it time to get off the couch, get into the gym and the healthy kitchen, and take on Mom's genes?

Small changes 'add years to life'

2006-04-26T10:03:00.000-04:00

Making small changes to your lifestyle can have a significant impact on how long you will live, research has shown.

The Cambridge University study looked at over 25,000 people.

It found that stopping smoking, exercising more and eating better could give you the life expectancy of a person 11 to 12 years younger.

Eating five portions of fruit and vegetables a day can give you the life expectancy of someone three years younger.
Not smoking turned the clock back by four to five years.
Increasing exercise by a moderate amount can take up to three years off. (An office worker would need to do one hour of exercise, such as swimming or jogging, every day, while a person with a moderately active job, such as a hairdresser, would need to take 30 minutes exercise a day. People with active jobs, including nurses and bricklayers, do not need to do any extra exercise - as their work is strenuous enough.)

Find out more about the small change, big difference campaign.

Need to add fruits and vegetables to your diet? Need to know what an added portion equals? You'll find that information here and here.

More benefits from the Mediterranean diet

2006-04-21T22:50:00.000-04:00

A Mediterranean-style diet that appears to cut the risk of heart disease also may help protect against Alzheimer's disease, a new study suggests.

People who followed the diet were up to 40 percent less likely than those who largely avoided it to develop Alzheimer's during the course of the research, scientists reported.

The diet tested includes eating lots of vegetables, legumes, fruits, cereals and fish, while limiting intake of meat and dairy products, drinking moderate amounts of alcohol and emphasizing monounsaturated fats, such as in olive oil, over saturated fats. Previous research has suggested that such an approach can reduce the risk of heart disease.

The idea that a heart-healthy diet could also help fight Alzheimer's fits in with growing evidence that "the kinds of things we associate with being bad for our heart turn out to be bad for our brain."

Researchers followed 2,258 elderly residents of northern Manhattan for an average of four years. The participants were asked in detail about their dietary habits and evaluated every 18 months or so for signs of dementia. None showed any dementia at the start of the study, but by the end, 262 had developed Alzheimer's.

To look for an effect of diet, the researchers gave each participant a score of 0 to 9 to nine on a scale that measured how closely they followed the Mediterranean diet. Compared to those showing the lowest adherence, those who scored 4 or 5 showed 15 percent to 25 percent less risk of developing Alzheimer's during the study, while those with higher scores had about 40 percent less risk.

The Mediterranean diet.

See a video on the benefits of the Mediterranean-style diet. Scroll down to the November 28, 2005 entry.

Guess what else is good for the brain?

Microvascular disease in women - a real danger often overlooked

2006-04-19T22:18:00.000-04:00

Puzzling differences have emerged between men and women with heart disease, making it plain that past studies, mostly on men, do not always apply to women. Researchers have come to realize that to improve diagnosis and treatment for women, they must sort out the differences.

"Every time we turn around, we find more gender differences, so it's important to study," said Dr. C. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

Among the differences:

Women with chest pain and other heart symptoms are more likely than men to have clear coronary arteries when tests are performed, a surprising result that suggests there may be another cause for their problems.
When women do have blocked coronary arteries, they tend to be older than men with similar blockages and to have worse symptoms, including more chest pain and disability. And they are more likely than men to develop heart failure (most likely due to age of onset), a weakening of the heart muscle that can be debilitating and ultimately fatal.
When women have bypass surgery or balloon procedures for coronary blockages, they are less likely than men to have successful outcomes, and they are more likely to suffer from bad side effects.
Blood tests that pick up signs of heart damage in men do not always work in women.

For symptomatic women without clear atherosclerosis, the underlying problem may be a disorder called microvascular disease, a narrowing or stiffening of the smaller arteries that nourish the heart, vessels too tiny to show up on an angiogram. In microvascular disease, the small vessels lose their ability to dilate and increase blood flow to the heart. The cause does not seem to be fatty deposits such as the ones that can block the coronary arteries. Rather, the muscles in the arterioles thicken, and the walls may stiffen and begin to close in. The result is ischemia, lack of blood flow. Over time, it increases the risk of heart failure and heart attacks.

Three million women in the United States may have microvascular heart disease. Research, begun in 1996, included 936 women who had angiograms because of symptoms such as chest pain. The angiograms found that only a third had blockages in their coronary arteries. In men with similar symptoms, three-quarters or more would have had severe blockages.

Another third of the women had no blockages but did have low blood flow to the heart, most likely a result of microvascular disease. Among those with the disorder, the rate of deaths or heart attacks was 10 percent after four years, much higher than would be expected for women with normal angiograms.

The findings call for a major shift in the treatment of women with chest pain or other symptoms and normal angiograms, said Dr. George Sopko of the National Heart, Lung and Blood Institute. "Instead of tossing aside the angiogram and saying you're OK, let's make sure we are not missing anything."

High cholesterol and blood pressure are almost certainly among the causes of microvascular disease, and it is essential to treat them aggressively in women with chest pain and to urge women to exercise, avoid smoking and lose weight.

Read more on the WISE study and microvascular disease

Heart device reimbursement cuts

2006-04-17T22:33:00.000-04:00

Proposed cuts in government reimbursement for expensive but potentially lifesaving heart devices including defibrillators and stents have created a new financial challenge for the fast-growing industry.

The cuts, which device makers are opposing, could reduce by as much as a third the rate that Medicare pays hospitals for heart implants that aren't covered by private insurance.

The reimbursement cuts for stents, defibrillators and pacemakers will further complicate price negotiations between hospitals and the makers of the increasingly expensive devices. Piper Jaffray analyst Thom Gunderson said hospitals will be more inclined to use older and less expensive devices for some surgeries than they might otherwise use.

If the proposed cuts stand without modification, Medicare reimbursement for the most common type of stent procedure would be reduced by nearly 24 percent, according to an analysis by Gunderson. The cut would be 34 percent for a less-common procedure involving stents, metal-mesh devices used to prop open coronary arteries.

Reimbursement for defibrillators — which detect and electrically correct dangerous irregularities in heart rhythm, and can cost more than $40,000 to implant — would drop by 24 percent. Coverage for pacemakers — which use a mild electrical current to speed a slow heartbeat — would drop 13 percent.

Merrill Lynch analyst Katherine Martinelli said she had expected cuts in reimbursement rates for cardiovascular devices given CMS' concerns about the growing costs to treat these patients. However, the cuts were greater than some had anticipated, she said.

By contrast, the plan proposes only moderate changes to reimbursements for orthopedic devices such as hip and knee replacements, the analysts added.

Hopefully, they'll get a boost in the bottom line when they develop new heart devices, thus allowing them to charge more. Then again, with current cuts in the bottom line, maybe they'll have less to throw into research.

Who's going to pay?

How obesity may increase heart risk

2006-04-16T11:28:00.000-04:00

Fat cells around coronary arteries may play a key role in heart disease, research suggests.

University of Iowa researchers found the cells release chemicals which can trigger inflammation.

Under certain circumstances, they might also stimulate potentially damaging growth of new blood vessels.

The findings may help explain why obesity increases heart disease risk.

The researchers suspected that the chemicals pumped out by the fat cells surrounding the coronary arteries might play a role in triggering heart disease by contributing to the deterioration of these vessels.

They isolated and cultured these cells, known as epicardial adipocytes, and compared them with cells taken from other fat tissue.

Tests showed that the epicardial adipocytes were prone to release greater amounts of potentially harmful, inflammation-producing cytokines in response to certain stimuli.
Unlike fat cells from other tissue, they also stimulated the cells lining the arteries to begin the process of forming new vessels.

And when oxygen was in short supply, this process was stepped up.

The fat tissue surrounding the coronary arteries gets its blood supply directly from the vessel.
The Iowa team believe their work suggests that when this blood supply is reduced, possibly by a blockage in the blood vessel, the fat cells respond by releasing cytokines, which trigger inflammation and make the problem worse.

At the same time, the fat cells may also trigger excessive formation of new blood vessels which could raise the risk of cardiovascular disease by raising the risk of fatty deposits hemorrhaging and causing a dangerous blockage.

Lead researcher Dr Lynn Stoll said: "The fat cells surrounding coronary arteries may ultimately prove to be an important link between obesity, type two diabetes, and coronary artery disease, all of which are increasing at epidemic rates.

Another new study indicates that older adults who carry their fat around the middle may be at risk of chronic heart failure, even in the absence of other serious health conditions.

Abdominal fat may contribute to heart failure in several ways, including through increased pressure within the abdominal cavity. Abdominal obesity may also lead to an enlargement of the heart's main pumping chamber, or to stiffness in the aorta, the major artery supplying blood to the rest of the body.

In contrast, the researchers found, body mass index (BMI), a measure of weight in relation to height, was not a good predictor of heart failure once waist circumference was taken into account.

Coupled with past studies, the researchers conclude, the findings suggest that excess fat -- particularly in the abdomen -- should be added to the list of risk factors for heart failure.

Diabetes, A1C control....and your gums

2006-04-14T23:37:00.000-04:00

In a strongly worded review published in theThe Journal of the American Medical Association the head of the Johns Hopkins Diabetes Center urges physicians and patients to better use the blood-testing tools at hand to manage the disease and prevent most of its dire impact on the heart, kidneys, nerves and vision.

"The message is, we have tools that are very accurate, but they don't work at all if they are not used properly," says Christopher Saudek, MD, a former president of the American Diabetes Association and lead author of the article. "If the goal of treatment is to prevent morbidity and mortality, we need to do a better job of monitoring our patients, as well as advising them."

Researchers reviewed data from studies conducted between 1976 and 2005 and concluded that both self-monitoring of blood glucose (SMBG) and more precise physician testing of hemoglobin A1c (HbA1c) can help diabetics take proper control of their blood sugar levels and successfully manage their disease.

"Assessing glycemia in diabetes can be a challenge, but approaches are available that promote successful management of blood glucose and may lead to a significant reduction in incidence and in medical treatment of diabetes."

And, more interesting news for diabetics:

Results of a new study support the hypothesis that periodontal therapy may improve metabolic control (lower HbA1c) in diabetic patients.

The results suggest that periodontal therapy may reduce a diabetic patient's HbA1c count by as much as 20% at three and six months following treatment. "We found that conventional treatment for chronic moderate generalized periodontitis, which included a simple, non-surgical procedure called Scaling and Root Planing (SRP) lowered the study group's HbA1c count from 7.2 to 5.7," said the study authors.

Cholesterol gone haywire

2006-04-12T22:16:00.000-04:00

New research provides the first explanation of an active rather than passive process that leads to heart valve degeneration. Heart valve disease is caused not by a ‘wear and tear' phenomenon, but by an inflammatory process likely triggered by high cholesterol that stimulates certain cells to reprogram into bone cells in the aortic valve and cartilage cells in the mitral valve, according to researcher Nalini Rajamannan, MD of the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital and assistant professor of medicine, Northwestern University Feinberg School of Medicine, who examined diseased mitral and aortic valves removed during surgery for the study.

“Common wisdom in the medical community has always been that thickening of the mitral valves was part of the aging process as deposits of calcium, a mineral found in the blood, built up on the valves. Our findings open the door to the idea that medical therapies such as statins may be able to play a role in preventing or slowing the process and curtailing the need for surgery.”

In an earlier pioneering study, animals treated with statins had significantly less heart valve disease than the control animals that were not treated. The results from the animal studies and now with the human valves demonstrate that valvular heart disease has an active biology which can be treated with medications similar to that of coronary artery disease.

More incredible research. This actually is not new. An earlier study found that narrowing of the heart’s aortic valve is less than half as likely to worsen in patients taking statin drugs. Resaerchers concluded that "it is possible statins offer a triple benefit with regard to aortic stenosis by reducing cholesterol, inflammation and calcium deposition."

More on heart valve surgery, a procedure performed 100,000 times per year in the U.S.

ACE Inhibitors May Reduce Death, Heart Attack in Coronary Artery Patients

2006-04-10T22:47:00.000-04:00

Angiotension-converting enzyme (ACE) inhibitors, medications commonly used to treat hypertension (high blood pressure), may reduce cardiovascular risk and the risk of death in patients with coronary artery disease, according to a new analysis of previously conducted clinical trials.

Studies on the use of ACE inhibitors in patients with coronary artery disease but without heart failure or left ventricle dysfunction have had conflicting results.

Researchers analyzed seven previous randomized and controlled trials of ACE inhibitors in patients with coronary artery disease. The studies tested five different ACE inhibitors and included a total of 33,960 patients, who were followed for a minimum of two years and an average of 4.4 years. In each trial, some patients were randomly selected to receive ACE inhibitors and others to receive placebos.

A list of commonly used ACE inhibitors.
You will probably get similar results with the ARBs.

When the results of all the trials were analyzed together, treatment with ACE inhibitors significantly reduced the risk of death from any cause, cardiovascular death, myocardial infarction (heart attack) and stroke. The researchers also found that in studies that measured additional outcomes, ACE inhibitors appeared to reduce the risk of onset of diabetes, hospitalization for congestive heart failure and cardiac arrest.

The authors suggest that "ACE inhibitor therapy should be systematically used in all patients with documented coronary artery disease.”

How about adding them to the water supply along with the statins?

The exact way that these medicines work is not known. They block an enzyme in the body that is necessary to produce a substance that causes blood vessels to tighten. As a result, they relax blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart.

Why the bluebird pic? As it's now bluebird season, the postings may be more a bit more sporadic. Maybe I'll see you outside!

Lifestyle change and blood pressure

2006-04-07T23:34:00.000-04:00

Men and women with elevated blood pressure who make healthy lifestyle changes and sustain them for up to a year and a half can substantially reduce their rates of high blood pressure and potentially decrease their heart disease risk. With behavioral counseling, increases in physical activity, and adoption of a healthy eating plan called DASH, rates of high blood pressure dropped from 37 to 22 percent among participants in a study conducted by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

A total of 810 men and women ages 25 and older with either prehypertension (120-139mmHg/80-89mmHg) or stage 1 hypertension (140-159mmHg/90-95mmHg) but who were not taking medications to control blood pressure were randomly assigned to three groups.

Participants in two of the groups attended 18 counseling sessions during the first six months. They were prescribed goals for weight loss, physical activity, and given sodium and alcohol intake limits. One of these groups also received guidance on implementing the Dietary Approaches to Stop Hypertension diet (DASH), an eating plan rich in fruits and vegetables, low-fat dairy products and low in saturated, total fat and dietary cholesterol.
A third group served as a control, receiving only two 30-minute sessions of advice to follow standard recommendations for blood pressure control. A third session was offered at the end of the 18-month trial after measurements were completed.

The numbers of participants with high blood pressure declined in all three groups, but the reduction was greater in the intervention groups and most striking in the intervention group that included the DASH eating plan. While approximately 37 percent of participants in all three groups had high blood pressure at the study's start, this was reduced to 22 percent in the group following DASH and 24 percent in the intervention group without DASH. By comparison, the rate of hypertension fell only to 32 percent in the control group.

(The researchers say the study was limited in that it applied only to patients with borderline or mild hypertension who were not taking drugs to control their blood pressure.)

"These rates of hypertension control produced by the two interventions are even better than the 50 percent control rates typically found when single drug therapy is used to control high blood pressure."

DASH diet details

Memory and vascular disease - the blood pressure link

2006-04-06T22:34:00.000-04:00

Long-term treatment of high blood pressure may help keep the mind sharp in old age, a new study finds.

"For every year of hypertension treatment, there is increased protection against dementia," study lead author Rita Peila, an epidemiologist at the U.S. National Institute on Aging, said in a prepared statement.

"Hypertension treatment in the very old -- those aged 80 and older -- protects against stroke, heart disease and heart failure, and now we see that there is no harm -- and perhaps a benefit -- on cognitive function," Peila said.

After their initial evaluation at age 77, the men were checked again three and six years later.

Overall, each year of treatment for high blood pressure reduced the risk of developing dementia during the follow-up period by about three percent. Compared to the men who had never been treated for their high blood pressure, the risk of dementia among the men who were treated was:

6 percent lower in those treated less than five years,
48 percent lower in those treated from five to 12 years,
60 percent lower in those treated more than 12 years -- a risk similar to that of men with normal blood pressure.

"We found protection against both Alzheimer's disease and vascular dementia. There is more and more recognition that there is a vascular component to Alzheimer's disease."

And, more news on dementia:

New research suggests that removal of the ovaries significantly increases a woman's risk for cognitive problems later in life.

The lead author of a study released this week said the findings shouldn't prevent women from having their ovaries removed when they are diseased. However, Dr. Walter Rocca, a professor of neurology and epidemiology at Mayo Clinic, did advise that women be cautious, especially when they undergo the procedure to prevent a disease that hasn't appeared yet.

He added that, because estrogen might be at the root of the problem, estrogen-replacement therapy might help women who do undergo ovary removal avoid cognitive problems.

Keep your blood pressure in check, consider the effects of ovary removal, and of course, exercise to cut dementia risk.

Carbohydrates and your cholesterol

2006-04-05T22:52:00.000-04:00

The effect of dietary carbohydrate on blood lipids has received considerable attention in light of the recent trend in lowering carbohydrate intake for weight loss.

The association between carbohydrate intake and serum lipids was evaluated in 574 healthy adults in Central Massachusetts from 1994-1998.

Results suggest that there is a complex and predominantly unfavorable effect from increased intake of highly processed carbohydrate on lipid profile, i.e. more carbohydrates resulted in lower HDL levels and higher triglyceride levels.

And, how important (again) is HDL? In a large study of Japanese men (a group not known for a high incidence of myocardial infarction), the most important predictor was low HDL-cholesterol. It was suggested that low HDL plays a pivotal role in a population whose total cholesterol level is not high to begin with.

So, let's watch the carbs, especially the refined carbs, and follow a Mediterranean plan for balance.

Battle of the Bulge Wages On

2006-04-04T22:20:00.000-04:00

More American children, adolescents, and men have swelled the ranks of the overweight or obese since 1999, while the the decades-long trend of increasing obesity may be leveling off among women, according to new federal statistics.

The study found the percentage of men who are overweight rose to 71 percent in 2003-2004, from 67 percent in 1999-2000. The obese percentage rose to 31 percent, from 27.5 percent.
For women, both the overweight and obese percentages held steady, at about 62 percent and 33 percent, respectively.

U.S. lifestyle factors that have contributed to the obesity epidemic include increases in daily calorie consumption, more eating out and larger portion sizes in restaurants, consumption of more sugary beverages (specially among children), increased time spent in front of computers and televisions, and lack of physical activity.

One factor that may hinder the fight against obesity is doctors’ reluctance to inform children or their parents that a child is overweight. In a study last year, only about half (52%) of overweight teens were informed of their overweight status by a doctor.

Is a discussion of weight out of bounds when talking to a patient? Shouldn't it be one of the first things discussed? Why aren't our healthcare providers providing health care?

"Early recognition and discussion of overweight status is a necessary first step to developing healthier lifelong behaviors. Addressing overweight among children and teens requires recognition by health-care providers, discussion of potential consequences with families, acknowledgment of those consequences by families of affected children, and a commitment to work together toward attaining a healthier lifestyle."

Could this be one reason why we aren't taking strides to reduce obesity? (Obese people are accurate in assessing their height and weight, but only 15 percent think of themselves as obese.)

More news: Hundreds of thousands of obese U.S. children cannot fit into car seats, leaving them at risk in the event of a crash, researchers said.

Another study: Many parents do not identify their child as "overweight." Only about one third of parents correctly identified their child as overweight or at risk for becoming overweight. Researchers recommended that parents "play actively" with their children and "decrease the availability of opportunities for sedentary behavior."

Looks like we have a lot of work to do. And, by work, let's start with 30 minutes per day, every day, of physical activity.

Short sleep duration linked to high blood pressure

2006-04-04T19:32:00.000-04:00

Short sleep durations over a prolonged period appears to be an important and potentially modifiable risk factor for hypertension, according to a new study.

Among the subjects between 32 and 59 years of age, sleeping less than 6 hours per night raised the risk of hypertension by 2.10-fold, the report indicates. Moreover, this association remained significant after adjusting for obesity and diabetes, which were both hypothesized to be partial mediators of the relationship. the relationship was not observed among people age 60 or older. The differences between the younger and older subjects might be explained by the fact that advanced age is associated with difficulties in falling and staying asleep.

James E. Gangwisch, PhD lead researcher, says, "Sleep allows the heart to slow down and blood pressure to drop for a significant part of the day."

He continues, "However, people who sleep for only short durations raise their average 24-hour blood pressure and heart rate. This may set up the cardiovascular system to operate at an elevated pressure."

We've already seen how a lack of sleep can result in weight gain.

Chronic sleeping problems afflict as many as 70 million Americans, costing the nation billions in medical expenses, accidents and lost productivity, a new study reports.

So, how about getting a good night's sleep? See a recent short video on Getting a Good Night's Rest. (Scroll to the March 27th entry.) Or, check out some healthy sleep TIPS.

Noise linked to heart attacks

2006-04-02T11:35:00.000-04:00

Living or working in noisy surroundings may raise a person's risk of heart attack, a new study suggests.

Researchers in Germany found that urban middle-aged adults who lived near high-traffic roads were 46 per cent more likely to have a heart attack than those who lived in more peaceful neighbourhoods.

Similarly, men whose jobs exposed them to high noise levels were one-third more likely to have a heart attack than their peers in quieter workplaces.

To the body, loud noise acts as a "warning," and the normal stress response involves hormonal changes and a spike in blood pressure and heart rate. Researchers suspect that over time, chronic noise exposure may damage the cardiovascular system. A certain threshold -- about 60 decibels of street noise -- was important, the researchers report. Beyond that threshold, higher noise levels didn't worsen heart attack risk. And, annoyance from noise was less important than the noise itself, the study shows.

See the Noise Levels in Our Environment page for a list of common sounds and their associated decibel levels.

Carotid stents improve brain function

2006-04-01T16:40:00.000-05:00

Patients with carotid artery blockage, even when they're considered asymptomatic, experience significant improvements in neurocognitive function after they undergo carotid artery stenting, investigators reported.

These astonishing findings show that patients with narrowed carotid arteries were, in fact, having neurocognitive deficits involving memory and executive functions, and that these deficits improved after the interventional radiology treatment. This study corroborates results from two previous small studies out of the U.S. and Germany.

The study indicates that patients could benefit from being treated earlier in their disease than currently thought. In spite of being classified as "asymptomatic," these patients are clearly having a dampening in brain function.

The procedure also improves brain function in symptomatic patients, but "asymptomatic" patients had the biggest gain. Though all those studied showed improvement, the younger patients did better. They have more neurocognitive reserve and had the biggest gains in neurocognitive function. The improvement was due to the increase in blood flow to the brain, as shown on MRI after the procedure.

"These patients are seeing better and thinking better, and those with least degree of disease had the greatest gain. What we found was earth-shaking," presenter Dr. Rodney D. Raabe told Reuters Health. "These findings are going to change the way we think about carotid artery disease, carotid endarterectomy and the whole classification of patients as to whether they're symptomatic or asymptomatic."

"Some patients whose functioning was so poor that they were being considered for nursing home placement, are now doing quite well living independently at home. This study shows that people, even before they have a stroke, are probably not functioning as well as they could be." patients with early dementia may actually be experiencing the results of blocked carotid arteries and that their condition can be reversed.

Phenomenal stuff. Breakthrough research. Could this help someone you know? Sure, we need a control group for definitive proof, but hey, I'm ready to get in line for the study should I need it.

Now, what was that second study? Boy, is my memory..... Oh yeah, here it is:

There is bad news in the stroke research community, today. Only one in 10 people who suffer a mini-stroke make their way to the emergency department for prompt treatment and fewer than half get treatment quickly enough, according to a troubling new study.

The research, published in today's edition of the medical journal Stroke, is of concern because those who suffer transient ischemic attacks (TIAs or mini-strokes) are at high risk of being felled by a full-blown stroke within hours or days. One in five TIA sufferers will have a stroke within three months -- and many of these "brain attacks" occur within 48 hours.

Study authors recommend getting to the emergency room if you have these symptoms:

Sudden numbness or weakness of the face, limbs, or one side of the body
Sudden confusion, trouble speaking or understanding
Blurred vision in one or both eyes
Dizziness, loss of balance, or difficulty walking
Sudden severe headache

Fiber cuts CRP

2006-03-31T23:22:00.000-05:00

A fiber-rich diet may help control levels of a blood protein linked to an increased risk of heart disease, new research suggests.

In a study of 524 healthy adults, investigators found that those with the highest fiber intake had lower blood levels of C-reactive protein (CRP) than those who ate the least fiber. CRP is a marker of ongoing inflammation in the body, and consistently high levels of this protein have been identified in previous studies as a risk factor for future heart disease.

The new findings support the general recommendation that adults get 20 to 35 grams of fiber per day, in the form of fruits, vegetables, beans and whole grains. Study participants with the highest fiber intake typically got about 22 grams per day

Compared with subjects who ate the least fiber, those who ate the most were 63 percent less likely to have an elevated CRP number.

"This study," the researchers write, "suggests that a diet high in fiber may play a role in reducing inflammation and, thus, the risk of cardiovascular disease and diabetes."

What else lowers CRP?

What good is faith if it is not translated into action? (Gandhi)

2006-03-30T22:38:00.000-05:00

The common plea to "pray for me" doesn't seem to matter in the outcomes of patients having coronary artery bypass surgery (CABG), according to a multicenter study led by a Harvard group.

In a six-hospital randomized study of the clinical effects having others pray for them, there was no benefit. "Intercessory prayer itself had no effect on complication-free recovery from CABG," found Herbert Benson, M.D., of the Mind/Body Institute of Harvard's Beth Israel Deaconess Medical Center here, and colleagues. The prayers all came from persons unknown to the patients. The prayers that were offered were standardized. There was an average of 70 strangers praying for each prayed-for patient.

In fact, the complication rate was significantly higher for the 352 of 601 patients (59%) who were confident that others were praying for them, compared with the 315 of 604 (52%) of patients uncertain of such prayers. The complications were primarily atrial fibrillation.

The authors addressed an important limitation of the study. "We did not request that subjects alter any plans for family, friends, and/or members of their religious institutions to pray for them," they wrote.

"At enrollment, most subjects did expect to receive prayers from others, regardless of their participation in the study. We also recognize that subjects may have prayed for themselves. Thus, our study subjects may have been exposed to a large amount of non-study prayer, and this could have made it more difficult to detect the effects of prayer provided by the intercessors."

Nevertheless, the study was still well-controlled, long term, and had many participants.

Paul Kurtz, professor emeritus of philosophy at the State University of New York at Buffalo, and chairman of the Committee for the Scientific Investigation of Claims of the Paranormal, had a blunt response when asked why he thought the study found no effect of prayer.

"Because there is none," he said. "That would be one answer."

He added that while he tries to keep an open mind, he's seen no good evidence for such an effect in past studies. The new work, he said, "gives added emphasis to those who have been skeptical."

Dr. David Stevens, executive director of the Christian Medical and Dental Associations, said he believes intercessory prayer can influence medical outcomes, but that science is not equipped to explore it.

As for the new study, he said, "I don't think ... it's going to stop people praying for the sick."

I suggest that we spend time with those fighting disease. We call them often. We email them frequently. We visit and spend quality time with them.

Studies show that it may very well be the social support that benefits individuals who are regular churchgoers. Frequent church attendees have almost three times as many social support contacts as non-attendees. So, if you want to help, how about spending time with your friends and loved ones when it's most needed?

There's an old African proverb: "When we pray, we move our feet."

Let's act to really benefit others.

Exercise after a high-carb meal

2006-03-29T18:10:00.000-05:00

The magnitude and duration of after-meal blood glucose elevation seem to be important risk factors for diabetes Type 2 and coronary heart disease.

Researchers investigated whether post-meal light physical activity might reduce this blood glucose increase.

Day 1 - Blood glucose was determined while resting, before meal, and each 15 min for the next 2 hours after ingesting a high carbohydrate meal of cornflakes.
Day 2 was similar to Day 1 but included light bicycling exercise for 30 min after finishing the meal.

Results:

In all trials, irrespective of age and training condition, light bicycling for 30 min after the carbohydrate meal blunted the rise in blood glucose. The results demonstrate an acute blood glucose reducing effect of light physical activity and of a magnitude similar to that obtained by hypoglycemic (diabetes medications or sulfonylureas) drugs, even after intake of a large dose of high glycemic food.

A great prescription: take a leisurely walk or ride a bike after a high carbohydrate meal to prevent a rise in blood glucose. (Glucose levels peak at 1 hour after the start of the meal and then return to preprandial levels within 2–3 h.)

In a study of patients with type 2 diabetes with secondary failure of sulfonylurea therapy, researchers showed that improvement of postprandial hyperglycemia, using insulin lispro (Humalog) at mealtime in combination with a sulfonylurea, not only reduced 2-h postprandial glucose excursions, but also reduced both fasting glucose and A1C levels from 9.0% to 7.1% Subjects also benefited from significantly decreased total cholesterol levels and improved HDL cholesterol concentrations.

A stunning result. Lower the after-meal glucose (by the use of insulin in this study) and you significantly improve A1C levels, currently the most important marker for diabetes control. If we could burn some carbohydrates with exercise after a high carbohydrate meal, perhaps we might remain non-diabetic, or if we are diabetic, cut medication dosage or even become non-diabetic.

Do cardiologists practice what they preach?

2006-03-28T22:11:00.000-05:00

A new study surveyed all cardiologists in a large coalition of cardiology groups. A 1-page, 25-item anonymous questionnaire containing was used. Data from returned questionnaires were analyzed and compared with those in national databases.

Eight hundred surveys were sent, and complete data were available for analysis on 471 (59%).

Results:

The average body mass index (BMI) was 25 and 8% were obese BMI >/= 30;
1.3% were active smokers;
89% exercised >/=1 time/week;
72% had >/=1 alcoholic drink/week. Red wine was the most frequently consumed alcoholic beverage;
Cardiovascular risks included dyslipidemia (28%), hypertension (14%), and diabetes mellitus (0.6%);
Four percent had experienced coronary events;
Compared with matched cohorts from the United States population, cardiologists reported lower rates of hypertension, dyslipidemia, and diabetes mellitus, and the rates of smoking and obesity were 1/18 and 1/3 those of the US population, respectively;
Aspirin and statins were each taken daily by about 1/3 of the participants.
A cardiologist with dyslipidemia was 5 times as likely to be treated and a cardiologist with hypertension was almost twice as likely to be treated as an American adult man with either of these disorders, respectively.

In conclusion, cardiologists appear to follow healthier lifestyles than the general adult US population.

Of course, people who tend to be healthier will more likely respond to these surveys, however they were anonymous responses, and they still had a pretty good number of returns. So, I'll take it with a grain of salt, but it's still nice to see that they practice what they preach.

Oh, and I still want THE specialist, a cardiologist, to listen to my heart.

Accoding to a new study, cardiologists are better than medical students, residents, and other practicing physicians at performing a bedside heart examination and in accurately identifying abnormal heart sounds, according to the findings of two studies reported in the Archives of Internal Medicine.

A total of 100 patients were each evaluated by an internal medicine intern, internal medicine resident, cardiology fellow, and cardiology attending. Their results were compared against those obtained by a phonocardiographic device, a machine that listens to and analyzes heart sounds.

Only the results obtained by cardiology fellows and attendings showed significant agreement with the phonocardiographic results. Moreover, the third heart sounds (the presence of a third heart sound often indicates important heart disease that requires further workup) identified by cardiology fellows and attending were better than those detected by residents and interns in distinguishing various heart abnormalities.

Stroke risk factors - control 'em and you win.

2006-03-27T21:39:00.000-05:00

Most data on favorable levels of risk relate to coronary heart disease, not stroke. This population-based, 12-sample, Italian study a with 10-year follow-up, assessed the relation of a low risk profile to stroke and implications for prevention.

Results:

No strokes occurred in low risk participants, and stroke incidence was low with borderline elevation of only one risk factor.
Four modifiable risk factors--elevated blood pressure, smoking, diabetes, and high total cholesterol/high density lipoprotein cholesterol ratio--related independently to stroke risk.
For those at low risk or who had only one unfavorable (but not high) risk factor, the stroke rate was 76% lower than for high risk participants.
For all persons not at high risk, the stroke rate was 57% lower than for those at high risk.
In sum, favorable risk factor levels assure minimal stroke risk.

Cut stroke risk with fruits and vegetables.

Cut stroke risk with statins.

Cut stroke risk with antihypertensives.

Cut stroke risk with exercise.

Cut cholesterol early for lifelong benefit

2006-03-26T22:14:00.000-05:00

Research from UT Southwestern Medical Center indicates that lowering "bad" blood cholesterol earlier in life, even by a modest amount, confers substantial protection from coronary heart disease.

The new findings found that people with genetic variations affording them lower low-density lipoprotein (LDL) cholesterol in their blood from birth were significantly less likely to develop coronary heart disease later in life than those without the variations.

Based on 15 years of data tracking more than 12,000 multiethnic subjects ranging in age from 45 to 64, the researchers found that people who had cholesterol-lowering genetic variations that lowered their LDL level by about 40 milligrams per deciliter were eight times less likely to develop coronary heart disease than those without the mutations.

"These data indicate that a moderate, life-long reduction in LDL cholesterol is associated with substantial reduction in the incidence of coronary events, even in populations with a high prevalence of other cardiovascular risk factors.'

'This study demonstrates the great importance of high blood cholesterol in causing coronary heart disease."

A summary of the study, which is to be published in the New England Journal of Medicine dated March 23, called the findings “dramatic”.

"These new findings suggest the need to redouble our efforts to reduce LDL cholesterol levels in younger persons by promoting healthy diets and reducing obesity. Even small successes will probably be leveraged for later gains in lowering the risk of cardiovascular disease."

Another new study shows that by giving cholesterol-lowering agents within 48 hours of a stroke, you can cut mortality risk by 80%.

Don't just take a drug. Cut cholesterol naturally and get plenty of healthy phytochemicals to boot with the Portfolio diet.

Fat not good, even if fit

2006-03-24T22:06:00.000-05:00

A large, new study concludes that while both fitness and fatness are important, no amount of physical activity can erase the risks of being overweight.

Researchers at Brigham and Women's Hospital in Boston measured a variety of risk factors for heart disease among more than 27,000 healthy middle-age women participating in the ongoing Women's Health Study.

Being either overweight or inactive each independently raised risk factors for heart disease, the researchers found. While women at any weight reduced their risks by exercising, being overweight appeared to be worse than being inactive, the researchers found. Even thin couch potatoes had lower risks than active women who were just a little overweight, the researchers found.

Compared with normal weight women, ''women who were overweight or obese had 2 to 10 times increased levels of risk factors that increase women's risk for heart attack and stroke, such as cholesterol and inflammation,'' Mora reported. Women who were physically inactive, whether they had normal weight or elevated weight, also had 5 to 50 per cent higher levels of these risk biomarkers, she added.

"The message should really be to get out there and be active no matter what you weigh, even if it's just for 30 minutes a day. Both are important."

Need another reason to exercise?

Sudden cardiac death during exertion is an extremely rare occurrence in women, and regular moderate to vigorous exercise may significantly lower the long-term risk, accoridng to a new study.

Omega 3s and your heart - link severed?

2006-03-23T19:57:00.000-05:00

Heart experts urged consumers to continue eating oily fish and foods high in omega-3 fatty acids despite research showing they may have no clear health benefits.

A review of 89 studies published by the British Medical Journal showed no strong evidence that omega-3 fats reduced deaths from cardiovascular disease. The few studies at low risk of bias were more consistent, but they also showed no effect of omega 3 on total mortality or cardiovascular events. But, Dr. Mike Knapton, of the British Heart Foundation, said more research is needed before people change their eating habits.

"To understand the effects of omega 3 fats on health, we need more high quality randomised controlled trials of long duration that also report the associated harms," they conclude.
"We are faced with a paradox," says Eric Brunner in an accompanying editorial. Health recommendations advise increased consumption of oily fish and fish oils. However, industrial fishing has depleted the world's fish stocks by some 90% since 1950, and rising fish prices reduce affordability particularly for people with low incomes.

"Whatever amount of oily fish you consume, the impact on your risk of heart disease is negligible compared to the benefits of quitting smoking, doing regular exercise and eating a diet low in saturated fats," Knapton added.

Though we await controlled research, his last statement is so true. Cut the saturated and trans fat. Lose weight and exercise. Eat 8-10 servings of fruits and vegetables per day.

The fish will thank you, too.

Angina missed in women

2006-03-22T21:52:00.000-05:00

Women with chest pains may be dying of heart disease unnecessarily because doctors underestimate the severity of their condition, research suggests.

A team from University College London found that angina - often the first sign of heart disease - affected women at the same rate as men. They studied the records of over 100,000 angina patients aged 45-89 years.

Researchers determined that women diagnosed with angina were less likely to be given follow-up tests to confirm their condition, such as angiograms or treadmill exercise electrocardiograms (ECGs). Without these tests patients do not qualify for surgical treatments, such as bypass operations.

The study also uncovered evidence that even when women were sent for ECG tests, the scans sometimes failed to pick up abnormalities.

"As women tend to be protected from angina until after the menopause, it has traditionally been thought of as a predominantly male affliction. This study confirms that after the age of 45 years women get as much angina as men but worryingly, they tend to fare worse than men when they get it. Women with angina should receive prompt and appropriate treatment to reduce their risk of suffering a heart attack."

----------

Most patients with angina complain of chest discomfort rather than actual pain. The discomfort is usually described as a pressure, heaviness, squeezing, burning, or choking sensation. Anginal pain may be localized primarily in the epigastrium (upper central abdomen), back, neck, jaw, or shoulders. Typical locations for radiation of pain are arms, shoulders, and neck. Angina typically is precipitated by exertion or emotional stress, and exacerbated by having a full stomach or cold temperatures (the "4 Es": exertion, emotion, eating and extreme temperature). Pain may be accompanied by sweating and nausea in some cases. It usually lasts for about 1 to 5 minutes, and is relieved by rest or specific anti-angina medication. Chest pain lasting only a few seconds is normally not angina.

Get treatment if you have any of these symptoms. Pain is a wonderful warning system. Unfortunately, denial is often the first response to these symptoms...and it could be your last.

In-stent restenosis - the best treatment, by far

2006-03-21T22:39:00.000-05:00

Insertion of stents that release the drug paclitaxel to treat stenosis within an implanted bare-metal stent in a coronary artery (in-stent restenosis or ISR) reduces the risk of subsequent re-narrowing within the stent, when compared with treatment using intra-coronary radiation (VBT), according to a new study.

"Although the initial success rate is high following repeat percutaneous coronary intervention for in-stent restenosis lesions, subsequent recurrence rates are further increased and refractory restenosis remains the single most common reason for referral to coronary artery bypass graft surgery after bare-metal stent implantation," the trial authors noted. "Identification of the optimal therapy for bare-metal in-stent restenosis carries significant public health implications."

We know that restenosis occurs in 10% to 50% or more of patients following implantation of the old bare-metal stents.
Drug-eluting (releasing) stents have been demonstrated to safely reduce restenosis compared with bare-metal stents.

Results of the study:

Paclitaxel-eluting stents reduced the 9-month composite rate of major adverse cardiac events by 43% compared with VBT. Patients with paclitaxel-eluting stents had a 53% lower rate of angiographic restenosis at 9 months, compared with VBT.

"The results from this trial in concert with other studies, indicate that drug-eluting stents should now be considered the treatment of choice for most patients with ISR of previously implanted bare-metal stents.

(Head-to-head trials of drug-eluting stent–in–drug-eluting stent -with the same vs. a different antiproliferative agent-will be needed.)

Looks like they just put the nail in the coffin for brachytherapy treatment for restenosis. ISR, the gold-standard for treatment of in-stent restenosis, popular in the late 1990s, may now have to bow out. But, it should be noted:

"There may remain a small fraction of patients with in-stent restenosis who will be better served with brachytherapy. These would include patients with bifurcation restenotic lesions; vessels or lesions with excessive calcification, tortuosity, or angulation; and other scenarios that may make repeat stenting unsuitable or lead to an increased risk of procedure-related ischemic events. In other words, vessels hard to reach or those with hardened, calcified plaque.

Periodontitis and heart disease - more bad news

2006-03-20T23:46:00.000-05:00

Patients with periodontitis, especially infections causing a high concentration of pathogens in the blood, have an increased risk of coronary heart disease (CHD), according to findings published in the Archives of Internal Medicine.

DNA testing in 789 subjects, including 263 patients with stable CHD and 526 without CHD, was used to analyze subgingival biofilm samples for pathogens that cause periodontal disease: Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola.

The results of analyses that considered other potential risk factors found a significant association between high levels of periodontal pathogen and the presence of CHD. A significant association was also found between the number of A. actinomycetemcomitans in periodontal pockets and CHD.

A potentially prominent role for A. actinomycetemcomitans is supported by the recent finding that high levels of A. actinomycetemcomitans antibodies also predict an increased risk of stroke.

Brush, floss, make regular visits to the dentist, and......drink red wine? Researchers say red wine may help keep gums healthy and strong.

Exercise intensity and body composition

2006-03-19T22:22:00.000-05:00

The aim of a new study was to compare the effect of two exercise training programs, one of low and one of high intensity, on body composition.

Group one: 4x week exercise on treadmill at 45% of V.O 2 max for three months, spending 370 calories per exercise session.
Group two: same frequency but greater intensity - 72% of V.O 2 max.
No dietary intervention

Results:

Body mass decreased significantly in both groups but more in the low-intensity than the high-intensity group.
The decrease in fat mass was significant in both groups, but not significantly different between them.
Fat-free mass (muscle) did not change significantly in either group, although the difference between groups tended to be significant.

In conclusion, exercise training at 45 % of V.O 2 max produced a higher weight loss than at 72 % of V.O 2 max and the higher intensity tended to maintain muscle, possibly, in part, through the smaller weight loss. Thus, both programs may prove useful in eliciting favourable changes depending on which target (weight loss or maintenance of muscle) is of higher priority.

Do both! Exercise at a lower intensity 3 days per week and a higher intensity 3 days per week. Remember, to burn the same number of calories, you'll have to exercise longer on the low intensity days. If there's no need to lose weight, it's probably still a good idea to back off the intensity to give you variety and to avoid injury.

Blood pressure drugs cut Alzheimer's risk

2006-03-18T22:00:00.001-05:00

Taking medications to lower blood pressure, particularly those known as diuretics, may be associated with a lower incidence of Alzheimer's disease (AD), according to a new study.

In a study of nearly 4,000 residents of Cache County, Utah, elderly individuals who were using antihypertensive medications at the beginning of the study were significantly less likely to have developed AD than those who were not at the end of the study, three years later. This relationship persisted when the researchers controlled for other factors, including gender, age, high cholesterol, diabetes and genetic risk.

When antihypertensives were broken down by type, diuretics were most strongly associated with a lower incidence of AD. More specifically, potassium-sparing diuretics, which contain additional components to preserve levels of the mineral in the body, were related to a more than 70% reduction in the risk of AD.

Beta blockers and antihypertensives known as dihydropyridine agents also were linked to a slightly protective effect against AD, while ACE inhibitors did not appear to be associated with the risk of developing the condition.

"Findings suggest that increased potassium levels may be associated with a reduced risk of dementia," study authors write. "Consistent with this idea are observations that low potassium concentrations are associated with oxidative stress, inflammation, platelet aggregation and vasoconstriction, all of which are possible contributors to AD pathogenesis."

That is a significant reduction, indeed.

We know that a high potassium diet protects against stroke and many small, undetected strokes may affect memory.
Adults should consume 4.7 grams of potassium per day. However, most American women 31 to 50 years old consume no more than half of the recommended amount of potassium, and men's intake is only moderately higher. African Americans generally get less potassium than whites, and because they have a higher prevalence of elevated blood pressure, increased potassium intake may have particularly significant benefits for them.
Potassium-sparing diuretics include Amiloride, Spironolactone, and Triamterene. These drugs are much weaker than the thiazides or the loop diuretics (potassium-wasting diuretcis). Even though they do not work quite as well, potassium-sparing diuretics do not reduce potassium levels nearly as much as other kinds of diuretics do. They may be used in combination with other diuretics, one example being Hydrochlorothiazide.
Diuretics can be used by themselves but many people with hypertension require more than one medication to effectively control their blood pressure. Because of this, diuretics are often put together into a single tablet or capsule with drugs from other classes of antihypertensives. For example, HCTZ has been combined with various ACE inhibitors, beta blockers, and angiotensin receptor blockers (ARBs). Examples include Avalide and Hyzaar.

This study indicates that while high blood pressure is thought to raise the risk of Alzheimer's, "the protective effects of these antihypertensive medications may be independent of their ability to control blood pressure." Maybe it's the potassium. Maybe, something else.

Eat like your ancestors - Up the Potassium!

Your waistline: clue to heart disease

2006-03-17T22:40:00.000-05:00

A new study finds that waist measurements are a better indicator of cardiovascular disease (CVD) than body mass index (BMI).

Data from 170,000 participants in the International Day for the Evaluation of Abdominal Obesity (IDEA) study show that a patient's waist circumference is directly associated with risk of CVD independent of the patient's BMI.

The study revealed a relationship between both BMI and waist circumference with physician-reported CVD and risk factors. Both were strong predictors, reported Dr Haffner. However, the association between waist circumference and CVD was stronger than for BMI. "The bigger the waist, the stronger the risk of vascular disease."

The study found that in men, the risk of heart disease increased by between 21 and 40 per cent for every 14cm (5.5in) increase in waist size. In women, the same increase in heart disease risk occurred for every 14.9cm growth in waist size.

The researchers say that fat deposited deep inside the abdomen, which is seen in an expanding waist, secretes toxins into the bloodstream, raises cholesterol and increases the body's resistance to insulin, essential for controlling blood sugar.

The study confirms the importance of measuring waist circumference, alongside current measures such as BMI, blood pressure, blood glucose and lipid levels, in identifying patients in a primary care setting who are at increased cardiometabolic risk.

To determine your waist circumference, locate the upper hip bone and place a measuring tape around the abdomen (ensuring that the tape measure is horizontal). The tape measure should be snug but should not cause compressions on the skin.

Is waist circumference a bigger predictor than fitness level? In this study of 50=95 year olds, adiposity and fitness continue to be significant predictors of insulin sensitivity into old age, with abdominal obesity being the most important single factor.

Now, there's evidence showing that the fastest way to burn off belly fat is with a combination of weight-training and aerobic exercise.

Some evidence for this comes from a six-month study of thirty obese women. They were separated into three groups: a control group, an aerobic exercise group and a combined exercise group.

The aerobic group did one hour of cardiovascular exercise (60-70% maximum heart rate) six days a week.
The combined exercise program involved weight training (3 days a week, Monday, Wednesday, Friday) and aerobic exercise (3 days a week, Tuesday, Thursday, Saturday).

The combined exercise group lost almost three times more abdominal subcutaneous fat and 13% more visceral fat than the aerobic-only group.

Time to go to the gym?

Cut heart disease events 75% by following guidelines

2006-03-16T22:13:00.000-05:00

As many as 2 million cardiovascular adverse events could be prevented each year if patients with high cholesterol and high blood pressure were diagnosed and prescribed the proper regimens, and if these patients adhered to their treatments.

Scientists analyzed data from the National Health and Nutrition Examination Survey (NHANES). The researchers used the Framingham Heart Study risk algorithm, which estimates total coronary heart disease (CHD) risk.

"We projected the 10-year risk of heart disease and the number of heart disease events, and what would happen if blood pressure were normalized."

Approximately one-fifth to one-half of coronary heart disease events could be prevented in US adults if hypertension was controlled. "This increases to 55% to 68% of coronary heart disease events preventable with additional optimal control of lipids.

If patients controlled blood pressure, LDL cholesterol and HDL cholesterol, a 75% decrease in the number of coronary heart disease events in the United States may oocur.

The Framingham Risk Assessment tool. Are you at risk?
See the fascinating Framingham timeline.

What drives compliance? What type of prodding is needed for individuals to take medications regularly? Mail and telephone reminders to encourage patients to take their prescription medication as directed may be a pointless exercise, a study suggests.

"According to patients, the telephone and postal reminders did very little to improve their compliance or encourage risk-reducing lifestyle changes." Doctor-patient relationships drive compliance, not postal and telephone reminders."

Tell your doctor to get on your case. His or her work may still be needed once you leave the office. It's likely that he or she has needed the motivation from others at some time in their lives, too.

Already have a low LDL? Lower risk further by raising HDL.

2006-03-15T22:50:00.000-05:00

A sub-analysis of Torcetrapib/Atorvastatin Clinical Trial Program found that patients treated to LDL cholesterol levels that were below current medical guidelines showed a direct relationship between HDL cholesterol levels and the frequency of cardiovascular events.

"Clinicians know that HDL is important, but many think that it ceases to be important if we get LDL levels to below 100 mg/dL," chief investigator Philip Barter, MD, director of the Heart Research Institute in Sydney, Australia, stated.

"Our study, in which half the population achieved LDL levels below 80 mg/dL, clearly shows that even if LDL is low, HDL is still important," Dr. Barter said.

The study showed that every 1 mg/dL increase in HDL cholesterol concentration was associated with an approximate 2% reduction in the relative risk of a major cardiovascular event, even in those with LDL levels below 80 mg/dL.

Results indicated that 10% of such patients (those wwith LDLs below 80 mg/dL) with HDL levels below 38 mg/dL had a major event compared with 5% of those with HDL levels 55 mg/dL or higher. In addition, there was a 31% reduction in the risk of major events for every 1.0 reduction in the LDL-HDL cholesterol ratio.

"While lowering LDL cholesterol remains a critical focus in cardiovascular disease prevention, the TNT sub-analysis suggests that HDL cholesterol may also provide important therapeutic benefits that may result in further reductions in cardiovascular risk."

"If you look at all the LDL cholesterol–lowering studies, only 35% to 45% of patients benefit with a reduction in cardiovascular disease risk, so clearly other factors are at play."

This is why pharmaceutical companies are rushing to bring new drugs that raise HDL to the market.

Statins and kidney function: more incredible news

2006-03-14T22:19:00.000-05:00

Patients with coronary heart disease (CHD) and elevated cholesterol who took Pfizer's cholesterol- lowering medicine Lipitor experienced improved kidney function, and those improvements were significantly greater among patients taking the highest dose (80 mg).

An estimated 20 million Americans suffer from chronic kidney disease (CKD). In people with CKD, the kidneys cannot effectively filter the toxins from the blood, which can lead to kidney failure. People with elevated total cholesterol and high LDL cholesterol, or "bad" cholesterol are often at an increased risk of developing kidney dysfunction.

"We anticipated that atorvastatin might provide a protective effect and slow the typical decline in kidney function in this patient population, but we didn't expect to see this level of improvement."

Pfizer said that 8.5 percent of patients taking its 80-milligram dose of Lipitor had a significant improvement of kidney function, compared with a 5.6 percent improvement in patients taking the 10 milligram dose.

(In renal patients, the glomerular filtration rate (GFR) is used. This is calculated by comparing urine creatinine levels with the blood test results. It gives a more precise indication of the state of the kidneys. The GFR is expressed in ml/min. For most patients, a GFR over 60 ml/min is adequate. But, if the GFR has significantly declined from a previous test result, this can be an early indicator of kidney disease requiring medical intervention. The sooner kidney dysfunction is diagnosed and treated, the greater odds of preserving remaining nephrons, and preventing the need for dialysis.)

GFR naturally declines with age. Patients in the study did not experience a decline in GFR. Fifty percent of patients taking Lipitor 80 mg were no longer classified as having chronic kidney disease.

Startling! What a week for statin research. It doesn't get much more exciting than this!

Breakthrough for high-risk individuals

2006-03-13T20:33:00.000-05:00

Aggressive statin therapy with Crestor (rosuvastatin) can dramatically lower LDL levels, raise HDLs by an unprecedented amount, and even partially reverse coronary artery plaques volume, showed results of the ASTEROID trial that were revealed today.

Patients with coronary artery disease who took 40 mg of Crestor over two years had a mean reduction in LDL from 130 mg/dL to 60 mg/dL, a 53% drop, and a mean increase in HDL from 43 mg/dL to 49 mg/dL, an [astounding] 14.7% rise.

ASTEROID (A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden) was a prospective, open-label trial with blinded endpoints.
The trial was designed to answer the question of whether 24 months of intensive therapy with Crestor could result in regression of coronary atherosclerosis, as measured by intravascular ultrasound.

The authors found that in the 349 patients who were available for follow-up at 24 months, mean LDL declined from 130.4 mg/dL to 60.8, a mean reduction of 53.2%. Mean HDL went from 43.1 mg/dL at baseline to 49.0 mg/dL, an increase of 14.7%.

Depending on the efficacy parameter, coronary artery disease was seen to regress in 64% to 78% of patients, and was seen in both men and women, in older and younger patients. Total atheroma volume reduction: 6.8%.

"Coronary atherosclerosis has traditionally been considered a chronic disease for which therapy could slow, but not prevent, progression," the study authors said. "We now know that maximally intensive lipid lowering can partially reverse the atherosclerotic disease process."

"While there will still be skeptics out there, and may be skeptics in this room still, I think the data does show regression, reversal, and I think it's a very exciting finding scientifically," said Roger S. Blumenthal, M.D., of Johns Hopkins at a briefing.

Dr. Blumenthal and his Hopkins colleague, Navin K. Kapur, M.D., wrote an editorial accompanying the ASTEROID study results in JAMA. Limitations? "While the results of this study are exciting, they are tempered by the lack of a control group receiving a somewhat less intensive LDL-C lowering regimen, the absence of paired intravascular ultrasound measurements in less diseased coronary segments to demonstrate reproducibility of atheroma volume measurements, and exclusion of patients with coronary stenoses measuring greater than 50% throughout a target segment."

While intravascular ultrasound-documented atherosclerotic regression is an intriguing finding, clinicians must remember that this may not be the best measure of the treatment's effect on hard cardiovascular end points.

"Nevertheless, the pioneering work has revolutionized the current approach to understanding the anatomy and pathophysiology of coronary atherosclerosis as well as its responsiveness to medical therapy. The results of several ongoing trials will help determine what agent or combination of pharmacologic agents is most efficacious in the long-term management of at-risk patients."

Though Crestor is one of the strongest statin drugs on the market for cholesterol, concern over side effects has played a roll in its lower than expected market share. However researchers said that patients in this study did not suffer any significant side effects.

"We were taking away many years of accumulation of cholesterol plaque in the coronary arteries and we've never been able to achieve that before with a statin therapy,” said Dr. Steven Nissen of Cleveland Clinic.

A real breakthrough.

DVT: BIG killer

2006-03-12T22:25:00.000-05:00

March is DVT Awareness Month.

Deep-vein thrombosis (DVT) is a common but serious medical condition that occurs in approximately two million Americans each year. DVT occurs when a thrombus (blood clot) forms in one of the large veins, usually in the lower limbs, leading to either partially or completely blocked circulation. The condition may result in health complications, such as a pulmonary embolism (PE) and even death if not diagnosed and treated effectively.

According to the American Heart Association, DVT affects up to two million Americans annually. Of those who develop PE, up to 200,000 will die each year-more than from breast cancer and AIDS combined. Yet, a national survey sponsored by the American Public Health Association found that most Americans (74 percent) are unaware of DVT.

Symptoms of DVT may include pain, swelling, tenderness, discoloration or redness of the affected area, and skin that is warm to the touch. However, as many as half of all DVT episodes produce minimal symptoms or are completely “silent.”

Because a number of other conditions – including muscle strains, skin infections, and phlebitis (inflammation of veins) – display symptoms similar to those of DVT, the condition may be difficult to diagnose without specific tests.

DVT was first linked to air travel in 1954 and recent studies have suggested that it can increase the risk of a fatal clot by up to four times. Until today it was widely thought that it was brought on by long periods spent in cramped seats without exercise.

In an interesting new study, researchers discovered that DVT on flights may be caused by poor air quality.

Research from the World Health Organisation (WHO) published in The Lancet suggests "the low pressure and low oxygen environment during air travel may contribute to the development of DVT in some susceptible individuals".

The WHO research involved 71 health volunteers who were tested for possible blood clotting before, during and after an eight-hour flight.

The same volunteers were tested during eight hours of sitting in a cinema and during eight hours of regular activities.

The authors found increased concentrations in markers during flight compared to the other two situations. "Activation of coagulation (clotting) occurs in some individuals after an 8-hour flight, indicating an additional mechanism to immobilization underlying air travel related to thrombosis."

The study also found that that 43 per cent of those with the factor V gene (a clotting factor) who were taking the Pill were showing early signs of possible clotting. This compared with 9 per cent of those with one risk factor and 10 per cent of those with no risk factors.

What to do now?

The authors advised air travelers to avoid taking sedatives or drinking too much alcohol during flights to reduce the risk of DVT. Compressive stockings that improve blood flow could also help.

Complete the Risk Assessment Tool to determine your risk for a dangerous DVT.

David Bloom's DVT

Portfolio diet attacks cholesterol

2006-03-11T23:39:00.000-05:00

Cholesterol-lowering foods such as soy protein, almonds, plant sterol enriched margarines, oats and barley may reduce cholesterol levels more effectively when eaten in combination, says a new study.

After 12 months, more than 30 per cent of the participants had successfully adhered to the diet and lowered their cholesterol levels by more than 20 per cent. This rate is comparable to the results achieved by 29 of the participants who took a statin for one month under metabolically controlled conditions before following the diet under real-world conditions.

"The benefit of statins to individuals at high risk for cardiovascular disease is not in question here. Emphasizing diet changes in general can boost the success rate of statins while providing additional health benefits and a possible alternative for those for whom drugs are not a viable option."

"Taking a pill may give people the false impression that they have nothing further to do to protect their health and prevent them from making serious lifestyle changes."

Basics of the Portfolio Eating Plan:

Along with 5-10 servings of fruits and vegetables per day, the portfolio diet recipe for lower cholesterol focuses on four kinds of food:

The portfolio diet substitutes soy-based foods for meat. "We are looking at soy-based meat substitutes such as soy burgers, soy hot dogs, and soy cold cuts," Jenkins says. "And we also used soy milk as a dairy substitute."
The portfolio diet incorporates as much sticky fiber as possible. Those on the portfolio diet take three daily servings of the natural psyllium product Metamucil -- many use it to thicken their soymilk. Oats and barley replace other grains; preferred vegetables include eggplant and okra.
The portfolio diet replaces butter and margarine with plant sterol-enriched margarine. U.S. brands include Benecol and Take Control and brands in other countries are Becel and Flora pro-activ. Plant sterols are also available in capsule form as dietary supplements.
The portfolio diet includes nuts. Study participants ate a handful of almonds every day. The Almond Board of California backs portfolio diet research and offers portfolio diet recipes on its web site. However, other tree nuts also help reduce cholesterol.

Detailed information on the The Portfolio Eating Plan

ED : predictor of heart disease

2006-03-10T22:17:00.000-05:00

Recent evidence suggests a strong link between erectile dysfunction (ED) and atherosclerotic vascular disease. Researchers sought to predict heart disease occurrence by erectile dysfunction incidence.

Stress myocardial perfusion single-photon emission computed tomography (MPS) is a widely used noninvasive imaging modality that allows diagnosis of coronary heart disease and stratification of cardiovascular risk. Stress test results and patient characteristices were correlated with ED.

Patients with ED exhibited more severe heart disease and dysfunction of the left ventricle.
Patients with ED exercised for a shorter period of time and reached a lower maximal intensity level.
ED proved to be and independent predictor of severe heart disease.

The results suggest that questioning about sexual function may be a useful tool for stratifying risk in individuals with suspected coronary heart disease.

The Second Princeton Consensus on Sexual Dysfunction and Cardiac Risk has recently been released.

"Any asymptomatic man who presents with ED that does not have an obvious cause (e.g., trauma) should be screened for vascular disease and have blood glucose, lipids, and blood pressure measurements. Ideally, all patients at risk but asymptomatic for coronary disease should undergo an elective exercise electrocardiogram to facilitate risk stratification. Lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease, is literature-supported."

"The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise."

Austrian researchers note a relationship between high blood levels of homocysteine, an amino acid marker for heart disease, and erectile dysfunction. The researchers found that 20 of the 30 patients with erectile dysfunction they studied also had high homocysteine levels. "We also found that men with erectile dysfunction have higher levels of C-reactive protein [another blood marker for heart disease risk]."

"Don't just write erectile dysfunction off as being tired or being stressed."

What a perfect early warning sign! As we know, some individuals never feel "normal" chest discomfort and many, unfortunately, experience cardiac arrest as a first symptom. Now, men have a real canary in a coal mine right on their persons.

But, this is not just a story about men. Vasculogenic female sexual dysfunction may be related to atherosclerosis as indicated in this study. So, the ladies should also be alerted to changes in sexual function.

Lower cholesterol with plant sterols

2006-03-09T20:44:00.000-05:00

A pill of plant sterols can help lower cholesterol, according to a new study appearing in the Feb. issue of the American Journal of Cardiology.

In the study, researchers from Washing University School of Medicine in St. Louis followed 26 patients who were using the heart healthy diet recommended by the American Heart Association and taking statin drugs to control cholesterol to understand how intake of plant sterols affects cholesterol. Half of the participants were assigned to take four sterol pills twice a day while another half to take placebo pills.

Those who took plant sterol tablets lowered low density cholesterol or bad cholesterol on average by 9 percent. The total cholesterol was reduced by 6 percent. The cholesterol reduction was particularly significant among those who started with higher levels of bad cholesterol.

Researchers believe that plant sterols, similar structurally to cholesterol, reduce the adsorption in the gut by competing with cholesterol to get absorbed and transported into the body.

The highest amounts of plant sterols are found in broccoli, Brussels sprouts, cauliflower and olives.

Another study also showed significant cholesterol reductions with 2.2 grams of plant sterols per day. (A typical American diet provides approximately 0.25 g of plant sterol per day.)

Two easy ways to get plant sterols:

Benecol
Take Control

Look for more plant sterol-containing-products in the future.

Pollution and hospital admissions for heart disease

2006-03-08T22:17:00.000-05:00

Short-term exposure to ultrafine particulate air pollution increased the risk of Medicare-age hospital admissions for cardiovascular and respiratory ailments, according to a national database study detailed in this week's Journal of the American Medical Association.

Evidence for the health risks of inhaling particles as fine as 2.5 µm in aerodynamic diameter (PM2.5) came from a database of hospital admissions for 11.5 million Medicare enrollees. A new standard for small particles of less than or equal to 2.5µm was established in 1997 by the Environmental Protection Agency in response to growing evidence of adverse health effects from chronic exposure to airborne pollution. But the EPA also maintained the former indicator of PM10 for particulate matter. The PM10 for airborne particles does not protect public health with "an adequate margin of safety."

Hospitalizations included a primary diagnosis of cerebrovascular disease, peripheral and ischemic heart disease, heart rhythm irregularities, heart failure, chronic obstructive pulmonary disease, and respiratory disease. The largest association was with heart failure.

Cardiovascular effects may reflect neurogenic and inflammatory processes. Animal studies suggest that particulate matter may accelerate the development of atherosclerosis, the researchers said.

Ah. More evidence of the deleterious effects of urban air pollution. You think you're doing everything right: exercising, keeping weight down, eating right, taking prescribed medications, but WHAM! You boost your risk with every breath you take.

EPA Air Pollution Hearing Draws Outcry From Experts, Public Local Citizens And Advocates Call On Administration To Heed Science, Protect Public Health

How does air pollution cause heart disease?

Send a letter to the EPA in support of stronger air pollution standards.

Aspirin: more people can benefit

2006-03-07T19:15:00.000-05:00

Taking aspirin to prevent coronary heart disease is beneficial and cost-effective for a wider range of men than is often recognized, a study from the University of North Carolina at Chapel Hill has found.

Compared to no treatment, taking aspirin was less costly and more effective for preventing heart attacks and other events in men whose 10-year risk for coronary heart disease was 7.5 percent or greater. Before this analysis, most experts felt aspirin was beneficial in men with a 10-year risk of heart disease of 10 percent or greater, "Our analysis suggests that it is also beneficial for men between 5 percent and 10 percent risk."

The study also found that adding a statin, or cholesterol-lowering, drug to aspirin therapy became cost-effective only when the patient's 10-year risk for coronary heart disease was higher than 10 percent. "People should find out their cardiovascular risk and make decisions about preventive treatment based on that risk.

The study also showed that aspirin was not effective for men whose 10-year risk was below 5 percent, because the chance of adverse effects from bleeding cancelled the benefit from prevention of coronary heart disease events.

Is your chance for getting heart disease above 5% over the next 10 years? Click here to find out. (The test is for those who have not been diagnosed with heart disease.)

Rice Bran Lowers Blood Pressure

2006-03-06T21:50:00.000-05:00

Scientists in Japan have shown that the waste product of rice processing, called rice bran, significantly lowers blood pressure in rats. Adding rice bran to the diets of hypertensive, stroke-prone rats lowered the animals’ systolic blood pressure by about 20 percent and, via the same mechanism, inhibited angiotensin-1 converting enzyme, or ACE.

It’s still not clear whether simply eating more brown rice, which retains some of its bran, would reduce the risk of heart disease. However, previous research in humans, as well as animals with high cholesterol, does suggest that certain fractions of rice bran can lower levels of unhealthy LDL cholesterol.

Researchers conclude that rice bran fractions appear to have a beneficial dietary component that improves hypertension, hyperlipidemia, and hyperglycemia.

In fact, it may be the rice bran oil, and not the fiber that lowers cholesterol. And, tocotrienols, from rice bran, may reduce atherosclerotic lesion size.

It wouldn't hurt to eat more brown rice.

You can ask your doctor about supplementing with tocotrienols.

Marital spats and heart disease

2006-03-05T21:57:00.000-05:00

Marital spats do not just produce harsh words and hot air - they can harden your arteries too, a study suggests.

The cause of the damage differs depending on your gender: arterial disease in women was linked to either partner demonstrating hostility, but in men it was linked to either showing controlling behaviour.

It was found that the wives who made the most hostile comments during a family discussion had a greater the degree of artery calcification, which indicates that plaque is building up in the arteries that supply blood to the heart.

Husbands who displayed more dominance or controlling behaviour, or whose wives displayed such behaviour, were more likely than other men to have more severe hardening of the arteries.

"If someone said, 'what's the most important thing I can do to protect my heart health?', my first answers would be 'don't smoke', 'get exercise' and 'eat a sensible diet'," study authors stated. "But somewhere on the list would be 'pay attention to your relationships.' "

See an interview about the study with Dr. Emily Senay. Click on the CBS NEWS video.

Shoot for a healthy marriage. It's good for your health.

Antidepressants Boost Heart Patients' Death Risk

2006-03-04T23:38:00.000-05:00

In a surprising finding, patients with coronary artery disease who take commonly used antidepressant drugs may be at significantly higher risk of death, Duke University Medical Center researchers have found.

Researchers found that heart patients taking antidepressant medications had a 55 percent higher risk of dying. Previously, Duke researchers reported that the presence of depression is an important risk factor for heart patients. This new finding of the risk from anti-depressants raises issues about the optimal way to treat depression in cardiac patients, the researchers said.

According to Duke team leader Lana Watkins, Ph.D., the researchers believe their findings add further support for the potential role of non-pharmocological approaches to treating depression, such as exercise, in reducing the risk of death in depressed heart patients. She said that physicians caring for heart patients who are taking antidepressants should monitor patients closely. Reasons for the association are not clear.

This is an intriguing study, though a placebo-controlled study is needed to help prove causation. However, one thing we do know is that exercise is a very good mood-booster.

Lipid profiles and the Framingham study

2006-03-03T22:21:00.000-05:00

The current cholesterol treatment guidelines have designated low-density lipoprotein (LDL) cholesterol as the major target for the treatment of dyslipidemia.

But what about HDL and total cholesterol?

This report, from the long-running Framingham study, examined the influence of the total/HDL cholesterol ratio on coronary heart disease (CHD) risk at high, medium, and low levels of total and LDL cholesterol. This tests whether the level of the components of the total/HDL cholesterol ratio need to be taken into account in assessing dyslipidemic risk and response to treatment.

Results:

Little difference was found in the effect of the total/HDL cholesterol and LDL/HDL ratios as predictors of the risk of CHD. It thus appears that the ratios can be used to determine CHD risk efficiently, irrespective of the LDL cholesterol level, particularly in men.
It appears that when the total/HDL or LDL/HDL cholesterol ratio is favorable, the level of the lipids that compose the ratio on CHD risk has little influence. This suggests that a favorable ratio justifies a conservative approach for elevated lipids (with diet, exercise, and weight control), rather than aggressive drug treatment.
In men, the LDL cholesterol level reflected the lowest risk factor (relative risk 1.9), and the total/HDL cholesterol ratio predicted the greatest risk (relative risk 2.9).
In women, LDL cholesterol imparted the highest risk of the individual lipids (relative risk 3.9), and this was not exceeded by the lipid ratio (relative risk 3.8).

The total/HDL ratio is very important for both sexes and indications are that the total/HDL and LDL/HDL ratios are more powerful predictors than the lipids from which they are comprised. The total/HDL ratio appears to predict CHD equally well at low and high total cholesterol values.

More reason to raise the HDL as modest increases cut risk significantly.

Clinical strategies to elevate HDL.

Statins and HDL

2006-03-02T18:19:00.000-05:00

Continuing the discussion of the role of HDL cholesterol and heart disease, we have a study that indicates treatment with a cholesterol-lowering statin can significantly reduce the risk of heart disease and death only in those elderly individuals with low HDL.

Researchers examined the role of lipoproteins including high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol in persons over the age of 70, and found that HDL was a better predictor of cardiovascular risk and treatment benefit than LDL in this group.

In the study, at-risk men and women aged 70 and older were given a statin or placebo. Those with initial HDL cholesterol levels below 45 mg/dL who received statin therapy were one-third less likely to have a non-fatal heart attack or die of heart disease. In contrast, men and women with higher levels of good cholesterol did not appear to benefit from statins.

“We did not expect the benefits of statin therapy to vary according to starting HDL level. Also, unlike statin studies in younger persons, LDL was not what mattered."

“Since we knew from epidemiological studies that LDL has virtually no association with coronary risk in the elderly and also that a statin’s primary effect is to lower LDL, some questioned whether the drug would do any good at all in this age group.”

At the start of the study, two groups had average HDL levels of 50 mg/dL, average LDL levels of 147 mg/dL, and average total cholesterol levels of 221 mg/dL. At 3.2 years follow up, researchers found no association between baseline LDL levels and the risk of a coronary event in either the statin or placebo groups.

“If statin therapy could be targeted to at-risk elderly with low HDL levels who would benefit most, fewer people would have to be treated — a substantial time and cost saving,” said Packard.

So why do statins help only those elderly with low HDL levels?

“Since low HDL is associated with high inflammation, itself a risk factor for heart disease, and we know statins have anti-inflammatory properties, [the] working hypothesis is that statins block inflammation and thereby reduce the deleterious effects of low HDL, researchers said.

In another interesting study, HDL, not LDL cholesterol levels influence short-term prognosis after acute coronary syndrome (ACS). The finding suggests that the clinical benefit of the statin, atorvastatin, after ACS is mediated by qualitative changes in the LDL particle and/or by non-lipid-lowering effects of the drug.

Are they referring to inflammation reduction? Is this why a high HDL is so effective and why many biotechs are focusing on raising HDL?

What can you do naturally, now, to raise HDL?

So, let's do an unscientific study. Your homework for the weekend: Ask somebody, over age 70, without heart disease, and not on a statin, what his or her HDL level is. Let us know.

Targeting HDL

2006-03-01T18:21:00.000-05:00

There is substantial evidence from clinical trials that lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk. There is less evidence for the salutatory effects of raising high-density lipoprotein cholesterol (HDL-C).

Study authors identified a cohort of all 6928 patients in an urban primary care practice who had two or more lipid measurements between January 1985 and December 1997.

Adjusting for other risk factors, a 10-mg/dL higher initial HDL-C was associated with an 11% lower risk of coronary events.
A 10-mg/dL increase in HDL-C between lipid measurements was associated with a 7% lower risk of events.
Neither initial or change in triglycerides nor LDL-C predicted subsequent coronary events.

CONCLUSION: High-density lipoprotein cholesterol measurements and change in HDL-C predicted major adverse coronary events in this urban practice, which provides support studying interventions targeting HDL-C for cardiovascular risk reduction.

A very interesting study, don't you think? LDL change had no effect, but HDL did? Treatment has focused on lowering LDL, but now companies are moving research dollars toward raising HDL cholesterol and, I suspect, we will all benefit.

See a previous post on raising HDL.

Cocoa cuts heart disease mortality

2006-02-28T16:06:00.000-05:00

Eating or drinking cocoa products such as dark chocolate may help lower blood pressure and reduce the risk of death from any causes including heart disease in older men, according to a new Dutch study.

The study found that older men who ate the highest amount of cocoa were half as likely to die of cardiovascular disease as those who ate less or no cocoa.

Scientists believe the health benefits are largely attributed to flavanols, which have been linked to lower blood pressure and protect the endothelial cells lining the blood vessels from being damaged.

Consuming cocoa in a range of forms - in dark or milk chocolate, biscuits, spreads, mousses, and drinks appeared to cut the risk of death overall and could even help guard against some cancers. The researchers said the elderly men got two-thirds of their cocoa from chocolate confectionery.

In a study at the Agriculture Research Service, here in Beltsville, researchers evaluated the total amounts of flavanols and antioxidant capacity in cocoa and chocolate.

How about cocoa instead of a chocolate bar? A cup of hot cocoa may sound like a healthy drink filled with antioxidants, but almost all cocoa drink mixes contain cocoa treated with alkali (also called Dutch cocoa) to produce a darker, richer taste. This process significantly reduces flavonoid content.

Unless you find a chocolate mix made with untreated cocoa, start with plain cocoa (not Dutch) and add your own sweetener and milk to make a flavonoid-rich cup. The result is a low fat, healthy drink. You can try Hershey's. (Notice the Hershey's Special Dark is dutch processed, so avoid this one.)

If you like those chocolate bars, don't worry. Surprisingly, the fat content of chocolate is not a reason to avoid it. Chocolate contains cocoa butter, which is high in saturated fat, yet one-third of chocolate's fat comes from stearic acid. Although it's a saturated fat, stearic acid does not raise LDL cholesterol (the bad cholesterol) as do most other saturated fats. Stearic acid is converted in the liver to oleic acid, a heart-healthy, monounsaturated fat.

Another one-third of chocolate's total fat comes from oleic acid itself. In a recent study, volunteers followed a diet with the majority of their fat calories coming from either chocolate or from butter. The volunteers who consumed chocolate fat did not show an increase in their cholesterol levels, but those who ate butterfat developed elevated LDL cholesterol levels.

I'm hungry. Gotta go.

Genes, salt, and hypertension

2006-02-27T18:18:00.000-05:00

Researchers have demonstrated that looking for several variations of genes that control blood pressure can predict the risk for high blood pressure caused by high levels of salt. Once it is fully developed, this effective diagnostic test will be the first of its kind.

When a subject had three or more variations in these genes, the new genetic test correctly predicted risk for salt-induced high blood pressure in 94 percent of cases. (Health is adversely affected by high salt intake in up to half of Americans.) The more gene variants, the bigger the health problems.

"A genetic test for high blood pressure and/or salt sensitivity will be instrumental in motivating Americans to adopt heart healthy lifestyles and help to improve their overall health and quality of life," researchers said.

Studies now show that salt-sensitivity is harmful in the presence of a high-salt dietary regimen.

Serum markers of inflammation and endothelium-dependent vasodilation are altered in salt-sensitive hypertension. These alterations could help to explain the greater target organ damage and cardiovascular risk observed in salt-sensitive subjects.

What to do about salt-sensitivity, besides taking effective antihypertensive medication?

Follow the DASH plan. By following the DASH regimen you will be lowering your dietary sodium content. The first D.A.S.H. (Dietary Approach to Stopping Hypertension) study had even shown that you could lower blood pressure without altering sodium intake. It showed that by boosting other minerals, you will excrete more sodium in your urine. This is also evident in a recent study.

Of course, it's most effective to lower salt and eat the DASH way as shown in the second DASH study. In fact, it's the way our ancestors ate. Their sodium/potassium ratio was a healthy 1:4, the result of eating plenty of fresh fruits and vegetables. Our current ratio is reversed to an unhealthy 4:1, the result of too much salt (especially in processed foods) and too few fresh fruits and vegetables.

To be salt sensitive is to have your blood pressure increase more than 10 percent following a high-salt meal, though this is not a foolproof test.

Your doctor can help you ascertain your sensitivity level, but the wise call is for all of us salt users to take steps to shake the habit.

Do your genes increase your risk for CAD?

2006-02-26T11:43:00.000-05:00

The risk of coronary artery disease is increased by 15% to 31% by genetic variants in a pair of genes that regulate the formation of blood clots, according to researchers in the most comprehensive assessment to date of the role of hemostasis genes in risk of coronary artery disease.

A meta-analysis of 191 studies, which tracked seven genes that regulate hemostasis, determined that a mutation of the factor V gene increased the relative risk by 17%while a variant of prothrombin was associated with a 31% increase in relative risk.

The genetic variants aren't common, with about 3 percent of whites carrying the protein V version and 1 percent carrying the prothrombin version.

"They are not common enough or associated with enough risk to warrant screening for them. In the future, if a number of weakly acting gene variants are identified, that might warrant screening. At the moment, the question is hypothetical."

Yet, the findings have important implications for "designing new therapies that target blood clotting pathways to help prevent heart disease. More generally, they suggest that bigger and deeper studies than have been customary will be needed to identify the genetic causes of heart attacks."

A must-read on blood clotting disorders. I've known many who have heart disease without common risk factors. This information could be very valuable for them and their blood relatives.

Prehypertension danger reaffirmed

2006-02-25T23:17:00.000-05:00

People who have "prehypertension," blood pressure levels just below the cut-off for a diagnosis of high blood pressure (in the range of 120/80 to 139/89 mm Hg), have an increased risk of cardiovascular disease, according to a report in The American Journal of Medicine.

Researchers investigated the relationship between prehypertension and the risk of new cardiovascular disease in nearly 9,000 men and women. The rate of cardiovascular disease over the 11.6 years of follow-up increased significantly as blood pressure levels increased. Compared with patients with optimal blood pressure, those with high-normal blood pressure had a 2.5-fold risk of developing cardiovascular disease, after consideration of other cardiovascular risk factors.
Cardiovascular disease risk was especially high among blacks, diabetics, obese patients and those with LDL levels, the "bad" type of cholesterol, between 100 mg/dL and129 mg/dL, the investigators observed.

Prehypertension is clearly associated with a significant increase in cardiovascular disease," the researchers conclude.

High blood pressure affects 65 million Americans.
The American Heart Association estimates that 59 million Americans have prehypertension
High blood pressure is a factor in 77 percent of strokes – the #3 cause of death in the United States.
High blood pressure causes more visits to doctors than any other condition, accounting for 48 million visits per year.

Follow the guidelines to lower blood pressure.

Statins and impotence: Going beyond Viagra

2006-02-24T19:17:00.000-05:00

Researchers at the University of Pennsylvania School of Medicine say preliminary results of a small study show promise in improving erectile dysfunction (ED) in men who had shown minimal reaction to Viagra.

"It's already known that there is a connection between erectile dysfunction and coronary disease. The risk factors are the same for both, and thus, ED can be a marker for coronary disease," explains the lead author.

"Normal erections are caused when nitric oxide is made, but with endothelial dysfunction, the body doesn't make enough of it, causing the erectile dysfunction. Normally, Viagra prevents the breakdown of the little nitric oxide that is there, so that there is enough of it for an erection to occur." However, about 10-30 % of men are classified as "Viagra non-responders" - in these men, Viagra did not significantly help their erectile dysfunction.

Patients with ED took Lipitor or a placebo. They were rechallenged with Viagra and asked if the ED had improved. "There did seem to be some improvement for those who received Lipitor versus the placebo. We theorized that if you could make the edothelium healthier through the use of statins -- so that there is more nitric oxide available -- you would improve the endothelial dysfunction and Viagra would work better for the patient."

"These preliminary results show promise. They support the hypothesis that erectile dysfunction may be one sign of a generalized vascular disorder characterized by endothelial dysfunction and that statin drugs may improve the endothelial dysfunction, even before altering the lipid profile

Past studies have shown that statins improve endothelial dysfunction in other arteries, including the aorta, an important location for the development of plaque that can break away and cause a stroke.

Maybe statins should be in the water supply. At least partners of the 10-30% probably think so.

Research reinforces gum disease-atherosclerosis link

2006-02-23T23:14:00.000-05:00

New research is reinforcing the longstanding belief that a connection exists between periodontal disease, or severe gum inflammation, and cardiovascular disease. The researchers hypothesize that the atherosclerosis may be a result of bacteria from gum infection entering the bloodstream, creating inflammation in other parts of the body.

It is too early to know if treating gum disease lowers the risk of heart disease, but gum disease may be a risk factor for heart disease -- one that can be prevented.

In other words, brush, floss and see your dentist regularly.

"If you have a healthy mouth, chances are you have a healthy body," the study author said.

The study is in its fifth year and includes more than 1,000 participants. Researchers are looking forward to more conclusive results in about five years.

Try this alcohol-free product to lower bacteria levels.

Cholesterol drug combination: Good news.

2006-02-22T18:47:00.000-05:00

Ezetimibe plus simvastatin, a combination of two anti-cholesterol drugs marketed by Merck/Schering-Plough Pharmaceuticals as Vytorin, is no more damaging to muscles than simvastatin alone, a team at Rush University Medical Center in Chicago reports in the American Journal of Cardiology.

Ezetimibe reduces cholesterol levels by blocking dietary absorption, while simvastatin works by reducing cholesterol produced by the body.

Previous reports have linked "statin" drugs, like simvastatin, with muscle side effects, but it was unclear if adding ezetimibe would lead to even greater risks.

The authors found that the likelihood of muscle problems did not increase when ezetimibe was used in combination with simvastatin. Moreover, none of the patients developed rhabdomyolysis, a potentially fatal condition involving muscle breakdown.

This drug combination is especially effective in lowering cholesterol.

VYTORIN 10/40 mg decreased LDL cholesterol by 59 percent compared to 48 percent for Lipitor 40 mg in a 2004 study.

Significant differences in LDL cholesterol reductions, at all doses compared, resulted in more high risk patients achieving LDL cholesterol levels less than 70 mg/dL with VYTORIN as compared to Lipitor. In particular, 57 percent of high risk patients taking VYTORIN 10/40 mg achieved a LDL cholesterol goal of less than 70 mg/dL as compared with 23 percent of the patients (n=115) taking Lipitor 40 mg.

VYTORIN has continued to gain share in the U.S. market.

A smooth landing into a diagnosis of heart disease

2006-02-21T19:16:00.000-05:00

Taking prescription beta blocker or statin drugs may boost the chances of having only mild chest pain instead of a heart attack as the first symptom of heart disease, U.S. researchers reported on Monday.

Previous studies had shown those types of drugs cut heart disease risk overall, but the new research is the first to demonstrate they may reduce the chances of someone having a sudden heart attack without earlier symptoms.

"If there are warning symptoms like angina with exercise, there is enough time to see a doctor and get started on effective treatments that reduce risk," said Mark Hlatky, one of the study's authors.

"Having a heart attack causes permanent damage, even if it doesn't kill you," he added.

Among 916 patients whose first heart disease symptom was a heart attack, 20 percent were taking statins. In a group of 468 patients with chest pain, 40 percent took statins.

Nineteen percent of heart attack patients were on beta blockers, compared with 48 percent of those with chest pain.

Because the study was not prospective, it lacked information on confounding factors such as the use of aspirin therapy to prevent coronary heart disease," Dr. Smith added. "If aspirin therapy was strongly associated with the use of statins and beta-blockers, it could explain some of the effect of these two drugs."

"Although our findings must be confirmed by randomized studies, they suggest that use of statins and beta-blockers for primary prevention may not only reduce the incidence of coronary artery disease but may also increase the likelihood of more stable, lower-risk clinical presentation of coronary atherosclerosis," the authors concluded.

This is a terrific study. I applaud the study authors for looking over patient records and drawing the potential lifesaving conclusions that came from this analysis. We all fear that out-of-the-blue heart attack and wonder if we should be paying attention to every little chest discomfort, arm or neck pain, shortness-of-breath issue. This can create such anxiety. Perhaps these two classes of drugs will allow symptoms of heart disease to be more readily apparent through a classic clinical presentation of increasing symptomatic warnings with activity which allows a thorough workup without the danger of a sudden change in clinical status.

Aspirin cuts severity of stroke

2006-02-20T21:25:00.000-05:00

Aspirin, the wonder drug, is in the news again.

It is well known that the use of aspirin and other anti-platelet therapies reduces the risk of recurrent stroke and ischemic events. Now, a study presented here recently at the International Stroke Conference (ISC) has reported that people who use anti-platelet therapies prior to having a stroke also have significantly better outcomes compared with those who do not use them. And, the findings seem to apply to all anti-platelet medications, not just aspirin.

After a mean of 16 months of follow-up, patients who had been using antiplatelet therapy had a significantly lower stroke score (4.8 for users vs. 8.0 among non-users) if they had no history of prior ischemic event. Conversely, there was no meaningful score difference among patients who had had a prior event depending on whether they had been using an antiplatelet drug or not (4.91 vs. 4.86, respectively).

On the basis of these data, Dr. Sanossian said it appears that antiplatelet therapies are underutilized. Even if the stroke risk scores did not reflect a benefit to taking antiplatelet among patients who had a history of prior ischemic events, past research has shown that these agents greatly reduce the risk of a subsequent events.

These data demonstrate that antiplatelet use can contribute to a less severe stroke in those with no history of prior event.

Heart Health Quiz

2006-02-20T21:14:00.000-05:00

True of False?

An aspirin a day keeps the heart attack away.
Lack of sleep can harm your heart.
Chocolate is good for your heart.
Crushing chest pain is the telltale sign you're having a heart attack.
Drinking alcohol can lower your risk for heart disease.

See the video for the answers. Scroll to the February 18th entry, Heart Health Quiz.

Link between stress and heart disease

2006-02-19T12:06:00.000-05:00

More and more evidence suggests a relationship between the risk of cardiovascular disease and environmental and psychosocial factors. These factors include job strain, social isolation and personality traits.

Studies using psychosocial therapies to prevent second heart attacks are promising.

As part of the CBS "Early Show" HeartScore 2006 series, Dr. Emily Senay speaks about the dangers of stress, which can have a detrimental effect on your heart.

See the video. Scroll to the February 15th, 2006 entry, Stress and Heart Disease.

Want to maintain weight loss? Be vigilant.

2006-02-19T10:59:00.000-05:00

Losing that extra weight is one thing. Keeping it off requires a lifetime of counting calories. That's the message from a more than two-decade study of monkeys.

The latest study with rhesus monkeys has shown that lifetime calorie restraint to prevent obesity is the most powerful way to reduce age-related health problems such as high blood pressure and high triglycerides and to prevent or delay the progression of insulin resistance toward diabetes. Monkeys whose food intake was maintained in amounts to assure a constant healthy body weight were not only healthier; on the average they lived longer than their counterparts who ate as much as they wanted. Monkeys fed 30 percent less over the long term extended their lifetimes to 30 years from an average of 23 years.

Genetic differences allow some primates to remain thin and others to grow fat when fed an identical diet over the years, the study found.

Other monkeys, when forced to slim down by as much as 25 percent, regained the weight they'd lost once caloric restrictions were lifted — regardless of whether they'd been on a diet for two months or two years.

Studies have shown that each person has an age-related “set point" for weight somehow regulated by physiology and genetics. This may help explain why more than 95 percent of dieters who shed 35 extra pounds or more eventually regain the weight. “Basically, while your weight may fluctuate throughout life, your body’s natural tendency is to return to its individually programmed body composition.”

What's the message?

“I highly recommend the bathroom scale model of weight loss. If you see your weight creeping up, then cut back on your portions,” study author Barbara Hansen, PhD, said.

I'm a big fan of Barbara Rolls' research at Penn State University. Out of the research, she developed the Volumetrics Plan.

Here is a sample menu of the low-energy-density plan.

Uncontrolled high blood pressure and your brain

2006-02-18T18:40:00.000-05:00

Uncontrolled high blood pressure can increase your risk of short-term memory problems and decreased verbal ability as you age.

A study on a group of otherwise healthy, older males found that men with hypertension (high blood pressure) who are unable to control it with medication performed poorly on short-term recall and verbal tests in comparison to other men.

Having high blood pressure that was adequately controlled by medication did not appear to affect the men's cognitive abilities. Nor did having untreated high blood pressure - a surprising finding. The researchers speculate this could be because the men in this group may only be at the early stages of hypertension, and able to control their blood pressure through lifestyle changes rather than medication.

The researchers also note that the fact that there was no difference in performance between men with blood pressure that was successfully controlled by medication and men with normal blood pressure suggests that blood pressure medications do not negatively affect men's cognitive abilities.

After analyzing the data, the researchers found a significant interaction between age and hypertension, with older men who had uncontrolled high blood pressure performing significantly worse on tests measuring verbal fluency (the ability to generate words in a specific category) and short-term memory (the ability to immediately recall words on a list).

"Do age effects on cognition vary as a function of hypertensive status?" wrote the authors. "The answer is, yes."

Therefore, if you are having memory troubles, you may not be able to blame your antihypertensive medication side effects. It could be aging, but it could also be uncontrolled hypertension.

(According to a national survey, 70 percent of Americans are aware of their high blood pressure, 59 percent are being treated for it, and 34 percent of those with hypertension have it under control.)

Unraveling heart disease myths

2006-02-18T18:25:00.000-05:00

Myth: Heart disease only affects older people
Myth: Since I am thin and I exercise, I am not at risk for a heart attack
Myth: Symptoms will warn me that a heart attack is coming
Myth: Heart disease doesn't really affect women
Myth: A low-fat diet is all I need to work on for heart health

Why are they myths? The reasons.

See the video. Scroll down to the February 18th entry: "Heart disease misconceptions."

When will you die?

2006-02-18T17:53:00.000-05:00

Researchers at the San Francisco VA Medical Center have created an index that is 81 percent accurate in predicting the likelihood of death within four years for people 50 and older.

The index, which weighs different mortality risk factors according to a simple point system, is potentially useful to health care providers, policymakers, and researchers, say the study authors.

The information can be obtained using a 12-question form that "could be completed in a few minutes by a patient or medical office receptionist.

A patient who scores 0-5 has a less than four per cent risk of dying within four years.
A score of 6 to 9 points predicts a 15-per-cent risk of death.
10 to 13 a 42-per-cent risk,
and 14 or more points a 64-per-cent risk of dying within four years.

The test could help doctors identify high-risk patients so that specific interventions could be targeted to them. (It's probably not useful for younger people, however, because four-year mortality is already low in people younger than 50.)

Here's the test:

FOUR-YEAR MORTALITY INDEX FOR OLDER ADULTS

1. Age 60-64: one point
65-69: two points
70-74: three points
75-79: four points
80-84: five points
85: seven points

2. Sex (Male/Female) Male: two points

3. a. Weight:
b. Height:
703 X (weight in pounds divided by height in inches) squared
BMI** less than 25: one point

4. Has a doctor ever told you that you have diabetes or high blood sugar? (Y/N)
Diabetes: two points

5. Has a doctor told you that you have cancer or a malignant tumour, excluding minor skin cancers? (Y/N)
Cancer: two points

6. Do you have a chronic lung disease that limits your usual activities or makes you need oxygen at home? (Y/N)
Lung Disease: two points

7. Has a doctor told you that you have congestive heart failure? (Y/N)
Heart Failure: two points

8. Have you smoked cigarettes in the past week? (Y/N) Smoke: two points

9. Because of a health or memory problem do you have any difficulty with bathing or showering? (Y/N)
Bathing: two points

10. Because of a health or memory problem, do you have any difficulty with managing your money -- such as paying your bills and keeping track of expenses? (Y/N)
Finances: two points

11. Because of a health problem do you have any difficulty with walking several blocks? (Y/N)
Walking: two points

12. Because of a health problem do you have any difficulty with pulling or pushing large objects such as a living room chair? (Y/N)
Push or Pull: one point

Total Points:

-----------------------------------------------------------------------------------------------

Surprisingly, and controversially, having a body mass index (BMI) of 25 -- the "overweight" category -- seemed to be protective, as long as the person doesn't have diabetes. On the other hand, a BMI less than 25 was associated with a shorter life expectancy.

** Simple BMI calculators are readily available on the Internet. Calculator

New CVD treatment approaches

2006-02-17T19:22:00.000-05:00

Several new approaches to treatment and diagnosis of cardiovascular disease (CVD) hold out the promise of immediate response in emergency situations.

In part three of the CBS "Heartscore" series, The Early Show medical correspondent Dr. Emily Senay discusses the newest tools in the field.

See the video. (Scroll to the January 16th entry, "Heart disease breakthroughs.")

Iron and heart disease

2006-02-17T18:51:00.000-05:00

It has been suggested that iron plays a role in the development of cardiovascular disease (CVD) through its pro-oxidant properties. However, epidemiological studies on iron status and the risk of CVD have yielded conflicting results. A prospective study to evaluate the relationship between iron status and CVD in a middle-aged French population was performed.

Serum ferritin was positively associated with total cholesterol, serum triglycerides, systolic and diastolic blood pressure, body mass index and hemoglobin. However, no linear association was found between serum ferritin and heart disease risk in men or in women. The researchers concluded that the data do not support a major role of iron status in the development of heart disease in a healthy general population.

This was an intriguing look at ferritin, a measure of the iron stores in the body, and the association with cardiovascular disease. Many believe that the pro-oxidant, iron, damages arteries, increasing the risk of heart disease. Perhaps the elevated levels of ferritin in diseased tissue arteries are a consequence of the heart disease process, not a cause. In fact, in one study, low iron concentration was associated with with inflammation and infection, boosting the risk of heart disease.

So, eating lean foods higher in iron, may be OK. Just keep the saturated fat content low and monitor other risk factors, as mentioned above.

When stroke hits, call 911.

2006-02-16T22:14:00.000-05:00

Two new studies show that getting an ambulance is the best way to receive quick, lifesaving treatment for patients suffering a stroke.

One study found that patients who dialed 911 to get an ambulance were seen by doctors within 30 minutes. Those who walked in were evaluated within 34 minutes and those who came by public transportation were not seen for 55 minutes.

Dr. Yousef M. Mohammed, director of the stroke fellowship program at Ohio State University, says the four-minute difference may seem insignificant. But he adds that "a stroke is an emergency, and 'time is brain.' If you walk in or come by car or taxi, we are losing valuable time here."

Seventy-three percent of those arriving by ambulance received brain imaging by computed tomography or magnetic resonance imaging. Only 63 percent of the walk-ins and 60 percent of those arriving by other mean received these services.Moreover, 97 percent of ambulance arrivals were evaluated by a staff doctor, rather than a nurse, physician assistant or doctor-in training, compared to 89 percent of walk-ins and 82 percent of those arriving by other means.

People need to learn the warning signs of stroke and call 911 immediately if they think someone might be having a stroke.

When lights and sirens are blaring, "the floodgates open up and everyone pays attention," as opposed to a woman quietly pushing her husband in a wheelchair, said Dr. Joseph Broderick, a stroke expert from the University of Cincinnati.

The top warning signs of stroke include:

Sudden numbness or weakness of the face, limbs, or one side of the body
Sudden confusion, trouble speaking or understanding
Blurred vision in one or both eyes
Dizziness, loss of balance, or difficulty walking
Sudden severe headache

Defibrillators cut from budget

2006-02-16T21:22:00.000-05:00

President Bush has requested billions more to prepare for potential disasters such as a biological attack or an influenza epidemic, but his proposed budget for next year would zero out popular health projects that supporters say target more mundane, but more certain, killers.

If enacted, the 2007 budget would eliminate federal programs that support inner-city Indian health clinics, defibrillators in rural areas, an educational campaign about Alzheimer's disease, traumatic brain-injury centers, and a nationwide registry for Lou Gehrig's disease. It would cut close to $1 billion in health care grants to states and would kill the entire budget of the Christopher and Dana Reeve Paralysis Resource Center.

The spokesman for the American Heart Association said he cannot fathom why the administration has recommended eliminating a $1.5 million program that provides defibrillators to rural communities and trains local personnel on how to use the machines to restart hearts that go into cardiac arrest.

"Coronary heart disease is the number one killer in the United States. This is actually something we can arm ourselves with."

Do defibrillators work?

The American Heart Association estimates that at least 100,000 of the 335,000 U.S. cardiac arrest deaths each year could be prevented if defibrillators were in common use, and that includes having them for first-responders such as police.

As an example:

Pete Candelaria and his family are pleased that at least some Bernalillo County sheriff's deputies carry heart defibrillators in their patrol cars.

The family plans to help lobby for more of the devices.

Bernalillo County, N.M., Deputy David Brown saved Candelaria's life with one of the computerized machines last week after Candelaria suffered a heart attack while riding in his truck on I-40.

Candelaria's wife was racing toward the nearest emergency room in Albuquerque when Brown caught up to the truck. He is one of 40 deputies trained to use defibrillators. When he didn't find a pulse on Candelaria, he hooked up the machine to the man's chest, followed the commands to perfection— including performing CPR— and shocked him twice with the device. Emergency medical crews arrived and Candelaria was taken to a hospital, where he remains in stable condition.

Oh, yes. They work.

See an Automatic External Defibrillator demonstration. Know this BEFORE you need to use one.

Also, consider taking an instructional course in the use of the device given by your local American Heart Association or Red Cross affiliates.

Hidden heart dissease in women

2006-02-15T23:22:00.000-05:00

For years, researchers have suspected that women develop heart disease differently than men.

Now, according to CBS's Early Show medical correspondent Dr. Emily Senay, the latest results from ongoing studies of heart disease in women offer new evidence that those suspicions are correct, when it comes to diseased heart arteries.

See the video. Scroll to the February, 14, 2006 video: "Heart disease in women."

Atrial fibrillation and the Mini-Maze

2006-02-15T22:49:00.000-05:00

Harry Whittington, the 78-year old lawyer who was accidentally shot by the Vice President over the weekend, suffered "atrial fibrillation" (a particular type of irregular heart rhythm) and a "minor heart attack."

Atrial fibrillation can be controlled. Dr. Calvin Weisberger, a regional chief of cardiology for Kaiser Permanente, about 8% to 10% of people over age 80 have a history of atrial fibrillation. Mr. Whittington's atrial fibrillation could be due to his age, the stress of the accident, or the biochemical response of the heart to the pellet.

There's a new procedure to treat atrial fibrillation, a rhythm that, though benign, can increase one's risk of stroke and may cause fatigue and a loss of well-being.

The maze procedure can cure atrial fibrillation by creating barriers to the electrical pathways, in the form of scar tissue, in the atria (the heart's upper chambers).

In the procedure, the surgeon creates multiple cuts into the atria muscle in an intricate pattern, or maze, and then stitches the incisions together to produce scars. Because the scars do not carry electrical signals, they interfere with stray electrical impulses that cause atrial fibrillation and, as a result, allow the heart to restore a regular, coordinated heartbeat.

What was once an open-heart procedure may be no longer. For here comes the mini-maze, the new minimially invasive maze procedure.

Read an interview with the inventor of the mini-maze.
Television segment on the mini-maze.
Webcast of the mini-maze procedure.

Angioplasty: threading the catheter through the wrist

2006-02-14T22:41:00.000-05:00

..."Basically," he explains, "the same catheter we introduce into the groin artery, we are going to introduce into the radial artery (in the wrist). … It gives us the opportunity to have easy control of the bleeding, and for that reason, the patients don't necessarily have to stay overnight."

"The patients love it. It's much more comfortable. They don't have to lay flat. … They can get up. They can walk around. They can hang out with their families. They can go down the hall immediately."

See the video: Day one of the CBS Heathwatch series, Heartscore 2006. (Click play on the right side of the page.)

Estrogen: reassuring news

2006-02-14T22:17:00.000-05:00

Post-menopausal estrogen therapy does not appear to protect women in their 60s and older from heart disease, but researchers say it may have some protective effect for women in their 50s.

The Women's Health Initiative, which conducted the research, stopped the analysis in March 2004 because of a higher risk of stroke among women taking estrogen. But further examination of the data shows that, at least for women between 50 and 59, the hormone may provide a boost to heart health. Researchers did not examine stroke risk.

Given the new findings, some experts said Food and Drug Administration warnings in package inserts of estrogen pills might be too stringent, though some experts say the study still does not offer a ringing endorsement for prescribing estrogen.

Researchers found that 201 estrogen takers required bypass surgery or angioplasty; had heart attacks, episodes of angina or died from a cardiac problem, compared with 217 on a placebo who had related heart events. Of the more than 10,000 in the study, 1,396 women between 50 and 59, had heart problems so dramatically less frequent that researchers attributed it to the daily dose of estrogen. Thus, there is intriguing evidence that the risks associated with estrogen and estrogen-plus-progestin may be limited to women who start taking the hormones later in life.

The estrogen findings should be seen as reassuring to women considering hormone therapy to relieve hot flashes and other symptoms of menopause.

Another study, recently performed, on estrogen benefits and timing, echoes these current findings. This is good news all around for women who feared estrogen supplementation. However, stroke risk needs further clarification.

Good blood sugar....now bad?

2006-02-13T22:14:00.000-05:00

Blood sugar levels should be kept as low as possible in men with heart disease, suggests a new study scheduled to appear in the Feb 15 issue of the American Journal Epidemiology.

The study by a team of scientists at UCLA and Cedars-Sinai Medical Center in Los Angeles found that even in the normal range, a lower blood sugar level was linked with a lower risk of death from cardiovascular disease. "Our findings suggest that for men with cardiovascular disease, there is apparently no 'normal' blood sugar level."

"For these men, across the normal range, the lower their blood sugar, the better. Their death rate over a two-year period soars from slightly more than 4 percent at a glucose level of 70 (mg/dl) to more than 12 percent at 100 (mg/dl) -- an enormous increase."

Interestingly, a blood sugar level higher than 100 mg/dl is no different from 100 mg/dl in the death risk. Men with a blood sugar at 100 and men with 150 mg/dl had the same risk of death from heart disease and stroke.

Women, however, had a different pattern of death risk. "For women, we found no evidence of any change in risk across the normal range, from 70 to 100, but then their risk seems to rise quickly through the impaired range and continues to increase with higher glucose in the diabetic range; therefore a blood sugar level of 100 seems to be a sensible cut point for women with cardiovascular disease," the authors said.

This is a fascinating study with extremely important implications. I remember meeting Willaim Castelli, third director of the Framingham Heart Study, in 1997, and I asked him how he treats a non-diabetic's (less than 126) blood glucose. He stated that he treats anyone with a glucose at or above 100 with diabetes medications along with lifestyle changes. Nine years later, we have good evidence that pre-diabetes should be treated agressively.

Systolic BP trumps diastolic BP in the elderly

2006-02-12T21:06:00.000-05:00

A study was conducted to clarify the relationship between mortality due to cardiovascular diseases (CVD) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) in young and elderly Japanese men in the absence of antihypertensive treatments.

Both SBP and DBP levels were significantly and linearly related to CVD mortality in the age groups 30-64 years.
In those at least 75 years old, however, no significant increase in the relative risk of CVD was observed with increasing DBP levels, whereas the relative risk of CVD increased significantly with increasing SBP levels.
Adjusting for major risk factors confirmed these relationships.

These data show that elevated SBP is an independent risk factor for CVD mortality for Japanese men of all ages, whereas elevated DBP is not an independent risk factor for CVD mortality for elderly men.

The old adage that your systolic BP (top number) can go up 10 mmHg per decade of life without ramifications is proven wrong again.

Drugs that treat the angiotensin system and calcium channels are excellent choices for managing systolic hypertension. Salt reduction can also reduce systolic hypertension.

Whole grains good for the diabetic heart

2006-02-12T00:29:00.000-05:00

Women with type 2 diabetes who incorporate more whole grains, bran, and cereal fiber into their diets may reduce their risk of heart disease, according to a new study.

"To adapt a diet high in whole grains and low in glycemic load will help diabetic patients to reduce the risk of cardiovascular disease," the study author stated.

Women who reported eating more whole grains, bran, and cereal fiber tended to have lower levels of two markers of blood vessel inflammation that have been linked to heart disease - CRP and TNF-R2.

In fact, whole grain cereal, which contains the bran and germ layer, "may confer stronger effects than fibers from other food sources such as fruit and vegetables."

Whole grains are also a rich source of minerals, vitamins and antioxidants."These compounds may have important biological functions, which as a whole could make an important contribution to reductions in diabetes and ischemic heart disease," the study's authors wrote, speculating that slower digestion is likely a key factor as well.

Here are some easy directions for cooking whole grains.

Check out this HOT CEREAL SCORECARD.

20 ways to lower your blood pressure

2006-02-11T13:40:00.000-05:00

Like bananas, apricots are a particularly good source of potassium, the blood pressure-lowering mineral. Eating a handful of aprciots, a particularly healthy snack, is just one of 20 ways to lower your blood pressure according to a good article in Reader's Digest. (Yes, I know it's not a medical journal, but it still offers some very good tips.)

Adopt a few of them and see if you notice a change. Of course, you will need to purchase a home blood pressure device to see if there's improvement. Research indicates that home monitoring helps control blood pressure.

Red grapefruit could lower heart disease risk

2006-02-10T17:32:00.000-05:00

Eating a red grapefruit a day could reduce cholesterol by 15 per cent and triglycerides by 17 per cent and protect against heart disease, according to research from Israel.

Fifty-seven post-operative bypass patients with high triglyceride levels in the blood (hypertriglyceridemia) were divided into three groups. The standard anti-atherosclerosis (9% fat) diet of two groups was supplemented by one Israeli Jaffa red or white grapefruit for 30 days. The third group ate the standard diet and was considered the control group.

“The results of the investigation in humans have shown that a generally accepted antiatherosclerosis diet supplemented with fresh red or blond grapefruits positively influences the serum levels of total cholesterol and [bad LDL cholesterol]. However, only a diet supplemented with red grapefruit was effective in significantly lowering the level of serum triglycerides."

Many experts now recommend that you should not mix grapefruit juice and certain medications.

Chemicals in grapefruit interfere with enzymes that break down certain drugs in your digestive system. This can result in abnormally high blood levels of these drugs and an increased risk of serious side effects.

If you are currently not taking your medications with grapefruit juice, don’t start. If you already eat grapefruit regularly and take any of these medications, talk with your doctor before making a decision to increase your grapefruit intake or stop it.

Minimally invasive aorta surgery

2006-02-09T18:32:00.000-05:00

A minimally-invasive procedure can repair a wide range of problems in the upper part of the aorta, the giant blood vessel leading out of the heart. In this region, called the thoracic aorta, the intense force of blood pulsing out of the heart can rip the aorta's walls apart or cause them to balloon outward, eventually leading to a rupture that brings almost certain death.

For decades, patients have had a choice between open-chest surgery and waiting for the "time bomb" to explode. Some haven't had a choice, because their age or health makes them too high-risk for surgery. More than 15,000 Americans die each year from ruptured thoracic aortic aneurysms, dissections and other problems.

An experimental procedure called endovascular thoracic aortic repair, or ETAR, has now been shown to shore up the aorta without surgery. Devices called stent-grafts are inserted by snaking a long tube up into the aorta from a small incision in the leg or belly. Only in the last year has the U.S. Food and Drug Administration approved the first device designed for this purpose, paving the way for more hospitals to offer it.

Earlier this week, in a presentation at the Society of Thoracic Surgeons meeting, a multi-specialty University of Michigan Cardiovascular Center team gave data from 73 patients who had ETAR at U-M over the last 12 years. Three-quarters of them were considered too high-risk to have surgery. The average survival was nearly four years, and almost half of the patients are still alive today and have not needed additional procedures, though the researchers say close monitoring is needed after a patient has ETAR.

"The minimally invasive approach to major aortic problems promises to revolutionize the way a broad spectrum of patients are treated," says Himanshu Patel, M.D., the lead author of the STS scientific poster. "Even in high-risk patients who would not otherwise be treatable, we see acceptable, encouraging results.

Thoracic aneurysms occur in the ascending aorta (25% of the time), the aortic arch (25% of the time), or the descending thoracic aorta (50% of the time).

An aneurysm is an abnormal widening or ballooning of a portion of a blood vessel. The blood vessel wall becomes weaker in this location. The most common cause of aneurysm? Atherosclerosis.

See a picture of a thoracic aorta aneurysm.

Will you get heart disease?

2006-02-08T18:31:00.000-05:00

The number of cardiovascular risk factors people have at age 50 can have a dramatic impact on their life expectancy, researchers are reporting.

The findings, based on a large, long-running U.S. study, suggest that 50-year-olds who are free of major risk factors are unlikely to suffer coronary heart disease or stroke in their lifetime.

Moreover, 50-year-olds without cardiovascular risk factors could expect to live about a decade longer than their peers with multiple risk factors.

Among men who were free of risk factors at age 50, only 5 percent developed atherosclerosis-related heart disease or stroke by the age of 95. That compared with 69 percent of men who had two or more risk factors at age 50.

The difference was substantial among women as well - 8 percent, versus 50 percent.

These low-risk 50-year-olds tended to live into their 90s. That meant that they were not overweight, did not smoke, and did not have diabetes, high cholesterol, and high blood pressure.

Few people in the current study had "optimal risk factor levels" at the age of 50 -- just 3 percent of men and 4.5 percent of women.

“It sounds trite, but physical activity, eating a healthy diet, and maintaining a healthy weight could make all the difference."

Your prescription:

30-60 minutes of physical activity on most days
don't smoke
lose weight, especially abdominal fat. An unhealthy waist circumference is above 35 inches (women), or above 40 inches (men).
control high blood pressure. (less than 140/90, preferably less than 120/80)
lower cholesterol (preferably LDL less than 100)
become non-diabetic

Low fat diet disappointment

2006-02-07T19:18:00.000-05:00

Low-fat diets failed to reduce the risk of breast and colon cancer and also fell short for cardiovascular disease, according to a large controlled intervention trial.

One group of women followed a low-fat diet, while another did not reduce the amount of fat they ate. The low-fat group showed slightly lower rates of breast cancer, colorectal cancer and heart disease -- but the differences were so small that they could be due to chance.

Researchers suggested that the women in the long-running study — with an average age of 62 — may have started their healthy eating too late. They also didn’t reduce fats as much as the diet demanded, and most remained overweight, a major risk factor for cancer and heart problems.

However, there were trends toward greater reductions in coronary heart disease risk in those with lower intakes of saturated fats or trans fats and higher intake of vegetables and fruits.

To Stanford University researcher Dr. Marcia Stefanick, chair of the Women's Health Initiative steering committee, "just adopting a low-fat diet is not enough. We really need to home in on getting nutritious foods into our diets.''

The researchers said they were not overly disheartened by the results. They said that the importance of different types of fat was not recognised when the investigation started, so the women were merely asked to reduce total fat consumption. In an editorial commenting on the study, Cheryl A.M. Anderson, Ph.D., M.D., and Lawrence J. Appel, M.D., M.P.H,. both of the Johns Hopkins School of Public Health, stressed that dietary policy has changed since the start of this study with more emphasis on types of fat.

With more data to come from this study in the future, the current research should allow those, who prefer the higher fat Mediterranean plan, where focus is put on the type of fat consumed, to rest more comfortably. The Mediterranean diet focuses specifically on the type of fat ingested. I think it's a winner.

(Dr. Dean Ornish responds to the study.)

Latest roadway hazard - heart attacks

2006-02-06T18:19:00.000-05:00

Seven per cent of men having a heart attack drove themselves to hospital and only 60 per cent went by ambulance, according to research published in the latest Journal of Advanced Nursing.

The study, which looked at 890 heart attack patients admitted to six major teaching hospitals in Dublin, Southern Ireland, also found that it took women five times as long as men to go to casualty departments after their symptoms first started. But only one per cent got behind the wheel and drove to the hospital.

“People who drove themselves to the hospital said they did it because it was the quickest way to get to the hospital, they felt well enough to make the journey and they would have pulled over if necessary.

“However, many also reported that they felt they were going to collapse when they arrived in the casualty department.The average time it took women to get to hospital after the onset of initial symptoms was 14 hours, compared with 2.8 hours for men.

Only 63 per cent of women and 60 per cent of men travelled by ambulance. Many said they were too embarrassed to go in an ambulance or that they should be used for more urgent cases.

Seven per cent of men and one per cent of women drove themselves to the hospital and a further four per cent of men and three per cent of women used public transport. 33 per cent of women and 29 per cent of men were driven to the hospital.

“Women need to be much more aware of the risks they face from heart attacks and the importance of seeking prompt treatment.”

As mentioned in a previous post, the ACT IN TIME campaign, a National Heart, Lung, and Blood Institute education campaign has now begun. Check it out. It's short, concise, and very important. Remember:

The longer an artery is blocked and the blood supply is cut off, the more heart muscle will die and be replaced by scar tissue. Depending on the extent of heart muscle damage, a heart attack can be deadly or disabling.

Best gluteal exercises

2006-02-05T21:21:00.000-05:00

How are you doing with your weight training program? Research tells us that weight training is good for the muscles, including your heart muscle.

The American Council on Exercise (ACE) recently announced research that determines the most effective gluteal exercises. “The results of this research showed that several of the exercises were as effective as the traditional squat at targeting the gluteal muscles. This study confirmed the relative value of alternative exercises such as lunges, step-ups, quadruped hip extensions, and four-way hip extensions, providing viable options for individuals who may have difficulty properly performing traditional squats.”

Some of these exercises can be safer, yet effective, for those with joint problems.

Here is a detailed look at the exercises.

Statins vs. arrhythmias after bypass

2006-02-05T12:08:00.000-05:00

Atrial fibrillation (AF) is a common arrhythmia following open heart surgery. Patients who develop postoperative atrial fibrillation are more likely to have other complications during or after surgery, including, heart attack, congestive heart failure and respiratory failure. Postoperative atrial fibrillation is associated with longer Intensive Care Unit and hospital stays.

Age has been identified as the major independent predictor of post-operative AF. Increasing age of patients accounts for the higher incidence of postoperative AF in recent years. Incidence of AF after CABG far exceeds the reported prevalence in the general population and in patients with coronary artery disease(CAD). Similarly, it is significantly higher than the reported incidence of AF after major noncardiac surgery regardless of CAD status.

The mechanisms responsible for the high incidence of AF after CABG surgery is unclear. Some of the mechanisms suggested are:

ß-blocker withdrawal,
the use of cardiopulmonary bypass,
inadequate atrial protection,
and overmanipulation of the right atrium.

According to a new report, treatment with a cholesterol-lowering statin drug appears to reduce the risk of atrial fibrillation following coronary artery bypass grafting (CABG) by about 50%.

Overall, 28% of subjects developed atrial fibrillation. A history of atrial fibrillation raised the risk of postoperative atrial fibrillation by nearly 12-fold, whereas statin use cut the risk by 48%.

The study findings "may have important clinical implications because atrial fibrillation is a frequent complication after cardiac surgery that increases in-hospital morbidity and mortality and prolongs hospital stay," the authors conclude.

Hypertension risk factors and relation to CVD

2006-02-04T20:59:00.000-05:00

Data from the Strong Heart Study estimating hypertension incidence and hypertension risk factors and their association with cardiovascular disease (CVD) was recently reported.

Risk of developing hypertension:

prehypertension: 3.2 times the risk
microalbuminuria: 1.7 times the risk
diabetes: 1.5 times the risk
overweight: 1.3 times the risk
obese: 1.5 times the risk
consuming alcohol 1.2 times the risk

(microalbuminuria: leakage of small amounts of protein (albumin) into the urine. An early warning of kidney damage)

Risk of developing cardiovascular disease:

controlled hypertensives: 2.2 times the risk of those with normal blood pressure
uncontrolled hypertensives: 2.8 times the risk of those with normal blood pressure
prehypertensives: 1.7 times the risk of those with normal blood pressure

(Prehypertension: A systolic pressure of 120 to 139 mm Hg or a diastolic pressure of between 80 and 89 mm Hg.)

So, there are a number of risk factors that lead to the development of high blood pressure and once you develop hypertension or prehypertension, you boost your risk for CVD.

You know your Framingham heart risk. Should you get a stress test?

2006-02-03T11:26:00.000-05:00

The value of exercise testing (ET) in individuals without symptoms remains controversial. You might think you need an exercise stress test, yet your doctor doesn't, and vice versa.

The results from a new study indicate that ET improves the prediction of a first coronary event only in those individuals who are already at an elevated risk based on the Framingham risk assessment.

Positive exercise testing was associated with coronary event (CE) occurrence (including cardiac deaths, acute myocardial infarction and stable or unstable angina) only in subjects with higher test risk, defined by a 10-year Framingham score of greater than 10.4%.

In other words, if your test result was less than 10.4%, a stress test provided no more information on risk. If greater than 10.4%, then additional information was provided on your risk for a subsequent CE. As a matter of fact, subjects with a result between 10-15% and positive ET had a probability of CE largely equivalent to the probability in subjects with known coronary heart disease.

What is YOUR risk? Use the Framingham risk assessment tool to find out. (If you already have heart disease, stroke, peripheral arterial disease, abdominal aortic aneurysm, diabetes mellitus, or chronic kidney disease, you’re automatically considered to be at high risk.)

Today is National Wear Red Day

2006-02-03T10:09:00.000-05:00

February 3, 2006, is National Wear Red Day!

National Wear Red Day is a day when Americans nationwide will wear red to show their support for women's heart disease awareness.

One in three women dies from heart disease. It’s the #1 killer of women, regardless of race or ethnicity. It also strikes at younger ages than most people think, and the risk rises in middle age. And, two-thirds of women who have heart attacks never fully recover.

New guidelines for the prevention and treatment of women with heart disease have been published. (If you already have heart disease, stroke, peripheral arterial disease, abdominal aortic aneurysm, diabetes mellitus, or chronic kidney disease, you’re automatically considered to be at high risk. Also, some women with genetic cholesterol problems may also be at high risk.)

Determine your risk for getting heart disease in the next 10 years.
Once you determine your risk, read the heart disease prevention strategies based on your risk category.

A national study conducted by the American Heart Association showed that just over 50% of American women know that heart disease is their leading killer. Spread the "Love Your Heart" message to your friends by wearing red today!

Depression and cardiac arrest

2006-02-02T21:48:00.000-05:00

There appears to be an association between depression and an increased risk of sudden cardiac death, independent of established coronary heart disease risk factors, the findings of a multicenter study suggest.

The analysis showed that depressed subjects were 43 percent more likely to experience cardiac arrest than non-depressed subjects. Moreover, the link between depression and cardiac arrest was noted regardless of gender, age, or whether the patient had heart disease or not. The association remained significant, suggesting that atherosclerosis may in part be implicated.

Patients with milder depression had a 30 percent increased risk of cardiac arrest, whereas those with severe depression had a 77 percent increased risk.

Poor adherence to treatment and unhealthy lifestyle habits may explain the association. Also, a decrease in heart rate variability may be a factor.

As mentioned in a previous post, a single bout of exercise can help lift depression. Another recent study indicates that attainment of personal goals (in this case, exercise goals) appears to be of particular importance for lowering depressive symptoms.

Healthcare givers should help patients set goals and develop self-management strategies to achieve those goals.

Will you have a stroke?

2006-02-02T08:32:00.000-05:00

The estimates for lifetime risk (LTR) of stroke has been reported for the United States population based on data from the Framingham study.

Lifetime risk was the same at ages 55, 65, and 75 years for study participants:

1 in 5 for women,
1 in 6 for men.

Participants with a normal BP, less than 120/80, had approximately half the LTR of stroke compared with those with high BP,140/90 mm Hg.

The LTR of Alzheimer's disease at age 65 approximated 1 in 5 for women and 1 in 10 for men.

The LTR of developing either stroke or dementia approximated 1 in 3 in both sexes.

Conclusion:

The LTR of stroke in middle-aged adults is 1 in 6 or more, which is equal to or greater than the LTR of Alzheimer's disease.
Women had a higher risk because of longer life expectancy.
BP is a significant determinant of the LTR of stroke, and promotion of normal BP levels in the community might be expected to substantially reduce this risk.

As hypertension is the BIG risk factor for stroke, Americans should closely monitor their numbers. Sure, it's nice that life expectancy has increased, but it's the quality that counts. Here are the latest blood pressure guidelines: follow them to make sure your later years are healthy ones.

February is American Heart Month

2006-02-01T19:39:00.000-05:00

I, GEORGE W. BUSH, President of the United States of America, do hereby proclaim February 2006 as American Heart Month, and I invite all Americans to participate in National Wear Red Day on February 3, 2006. I also invite the Governors of the States, the Commonwealth of Puerto Rico, officials of other areas subject to the jurisdiction of the United States, and the American people to join me in recognizing and reaffirming our commitment to combating heart disease.

If you're in the Washington D.C. area in 2006, consider visiting the "Healthy Heart" exhibit at the National Museum of Health and Medicine in the Walter Reed Army Medical Center.

To see the Invision Guide to a Healthy Heart, the basis for the exhibit, visit this interactive site.

Word from the WISE on women and heart disease

2006-02-01T16:53:00.000-05:00

The word from the WISE investigators is that doctors are missing the diagnosis in up to three million women with coronary heart disease because their clinical and diagnostic signs differ from a male presentation.

Gender differences in cardiovascular risk factors and in the clinical presentation of coronary artery disease may explain why some women with coronary arteries that appear to be clear on angiography are actually at high risk for ischemic heart disease, reported investigators who analyzed data from the Women's Ischemia Syndrome Evaluation, or WISE study.

The lack of angiographic evidence of frank stenosis in women may cause them to be overlooked as candidates for more aggressive interventions, the researchers said.

"When there are no blockages, everybody slacks off, including the patient, and we don't want to do that," said Dr. George Sopko of the National Heart, Lung and Blood Institute. Such patients almost certainly need treatment, he said.

Women may complain of chest discomfort, dizziness, shortness of breath, or fatigue, have a negative stress test, and then a negative angiogram which only spots large blockages. Doctors offer no treatment and may even give a patient the impression that she is neurotic or needs to be treated for depression.

In the government-sponsored study, only a third of a group of women had obvious blockages in their coronary arteries. In a similar group of men, three-quarters or more would have a severe blockage, said Dr. Carl J. Pepine, the chief of cardiovascular medicine at the University of Florida in Gainesville.

In the remaining two-thirds of the women, those without blockages, more than half had abnormalities in their arteries, like an inability to dilate when needed, that could cause ischemia, Dr. Pepine said. The abnormalities occurred in both the coronary arteries and smaller ones that feed the heart, a network of tiny vessels called the microvasculature. Tests showed that the artery walls were full of plaque but had grown outward to accommodate it, so that the opening appeared normal. But eventually, the condition may progress enough to start pinching the artery shut, Dr. Pepine said.

After four years, the rate of deaths or heart attacks in the group without blockages was 10 percent.

"That's much too high for somebody with a normal coronary angiogram," Dr. Pepine said.

It is not clear why women seem more prone to the hidden vascular disease, the researchers said, though it may be linked to hormonal imbalances and a greater tendency to suffer from inflammation, which plays a role in artery disease.

What to do?

Identify candidates for exercise stress testing vs. medication stress testing: Using the evaluative tool Duke Activity Status Index (DASI) in women with heart disease symptoms prior to stress testing can help determine who would be eligible for an exercise stress test versus a stress test using intravenous medications to increase the heart load instead of exercise. Current guidelines offer physicians little guidance on how to identify women who would not be able to sufficiently complete the exercise test.
Determine Role of Pre-menopausal Hypertension in Disease Risk: Women who have high blood pressure before menopause, especially high systolic blood pressure, should be considered at a higher risk and treated accordingly.
Recommend stress echocardiography and single positron-emission computed tomography studies. They appear to be much better at estimating near-term prognosis (event-free survival) in women with chest pain symptoms.

Finally, patients with microvascular disease, who have gone through an entire battery of tests, with positive or negative results, are often treated with medications. All tests may be negative, but if the medication helps you with your symptoms, then physicians will want you to stick with the medications.

It's often a tough nut to crack. Don't ignore symptoms. Gain knowledge of the condition, be assertive, and work closely with your healthcare givers. The result should be in your favor.

Friday is National Wear Red day.

Future predictors of high blood pressure

2006-02-01T07:35:00.000-05:00

Will certain metabolic factors and their change over time influence the development of high blood pressure in adults with initially optimal blood pressure (BP) ?

Researchers analyzed associations of BP in the optimal range, less than 120/80, metabolic risk factors, and their changes over 4-year follow-up, with 8-year incident hypertension, in a cohort of American Indians with a high prevalence of obesity.

Results:

1. Baseline normal glucose
Next exam(4 years later): baseline level of BP and decrease in beneficial HDL were the most potent predictors of hypertension 8 years later. Contributing factors: waist circumference, increase in BP, and presence of diabetes at the second examination.

2. Baseline abnormal glucose or diabetes
Next exam(4 years later): presence of diabetes was the most potent predictor of hypertension 8 years later. Contributing factors: an increase in BP and LDL cholesterol over the first 4 years.

Thus, hypertension can be predicted by initial metabolic profile (glucose and cholesterol) and unfavorable metabolic variations over time, in addition to initial BP.

So, if you have an optimal initial BP, increasing abdominal obesity, abnormal lipid profile, and presence of diabetes are major predictors of the development of high blood pressure.

Reason to get off of the couch:

A new study indicates that the addition of exercise to a low calorie diet is crucial to reducing abdominal fat cell size in obese individuals. The exercise could be of a low- or high-intensity nature. Diet alone, diet plus low-intensity exercise, and diet plus high-intensity exercise reduced body weight, fat mass, percent fat, and waist and hip girths to a similar degree. However, only exercise added to the dietary regimen, reduced fat cell size at the waist as determined by tissue biopsy.

Danger: apple-shaped women

2006-01-31T08:48:00.000-05:00

In a recent study, researchers propose that women who develop thick waists and high cholesterol at menopause may be at higher risk of heart disease because they also have more damage to their arteries.

After menopause many women undergo a shift in body fat so that there is more fat in the abdomen. This can cause the sympathetic nervous system, which controls blood vessel function, to become elevated and stiffen the arteries.

And because the women are no longer producing estrogen, a natural antioxidant, they begin to suffer from artery disease.

Are you an apple? Ladies, measure your waist circumference and your hip circumference, then calculate your waist to hip ratio. If you are .80 or above you are an apple. Below .80 you are a pear.

Marie Savard. M.D. explains how body shape can forecast health destiny and offers steps to take to decrease health risk. Also, view an interview with the author-internist. Just click "play" to see the video here.

Friday, National Wear Red Day, is fast approaching. Learn more about it.

Raised glucose and raised blood pressure - syngergistic effect

2006-01-31T07:57:00.000-05:00

Arterial stiffness is an indicator of arterial damage and cardiovascular risk. A study was performed to see if elevated blood glucose and raised blood pressure, even at levels below what is defined as diabetes and hypertension, might work synergistically to increase arterial stiffness.

Raised blood pressure was defined as 130/85 or higher. Raised blood glucose was defined as 110mg/dL or higher. Results of the 3-year study on 2080 Japanese men, average age 42, indicated that the estimated annual rate of increase of arterial stiffness (pulse wave velocity) was higher in subjects with both the abnormalities than in those with either abnormality alone or neither of the 2 abnormalities.

Researchers concluded that blood pressure and fasting plasma glucose levels, even below those defining hypertension and diabetes, may synergistically lead to progression of arteriosclerotic arterial damage. This synergistic progression may contribute to the additive increases in the risk of cardiovascular events, at least in part.

What to learn from this? Physicians and patients should aggressively treat these two risk factors for cardiovascular disease even if they are not elevated enough for one to diagnose hypertension or heart disease. And, this is especially true for small elevations of both.

(Hypertension is "officially" defined as having a reading equal to or above 140 and/or 90.
Diabetes is "officially" defined as having a reading equal to or above a fasting level of 126 mg/dL.)

We now see that results lower than the official minimums, when combined, act to increase arterial stiffness and, perhaps, cardiovascular risk.

New research could help diagnose heart disease in women

2006-01-30T09:42:00.000-05:00

A team at the St. Louis School of Medicine, has new data on the use of dobutamine stress echocardiography – a test that enables doctors to better predict future heart disease.

Researchers studied 421 women between the ages of 49 and 75, an age range historically mis- and under-diagnosed for heart disease.“Our research is extremely important to women in this age group." By detecting problems earlier, we can help prevent heart attack or death and extend these women’s lives.”

Dobutamine stress echocardiography tests are ultrasound heart scans in which patients are injected with a drug that makes the heart beat faster to determine if they have abnormalities of the heart wall. No exercise is involved. Traditional echocardiography tests are performed without the aid of drugs by having patients run on a treadmill to increase their heart rate.

Researchers followed the patients for two years and found that women who tested positive on the stress test were more likely to experience cardiac events, heart attacks, and even heart failure and death: 18% had had a heart attack, and 5% had died of one.

In a second study researchers studied 1,404 patients who underwent preoperative dobutamine stress echocardiography to determine if they had ischemia. “In the medical community, it is common to believe the heart rate must be at least 85 percent of the maximal heart rate,” Dolan says. “However, we found that a negative dobutamine stress test without abnormalities has a strong predictive value whether the heart rate is maximal or not.”

The implications for such results are that doctors ordering stress echocardiography can have more confidence in tests returning negative for ischemia than they had previously thought, effectively broadening the parameters normally used to rule out ischemia – meaning some patients will not have to undergo additional heart scans to rule out the condition before they undergo surgery. This is good news for individuals who cannot achieve a maximal heart rate on a treadmill stress test for reasons such as muscle discomfort, arthritis, shortness of breath from lung disease, etc.

Echocardiography combined with exercise stress testing is a well-tolerated and valuable procedure for noninvasive evaluation of coronary artery disease. The sensitivity and specificity is comparable to that of nuclear perfusion imaging (thallium stress testing.)

It's also good to see more cardiac research being performed on women. Friday, National Wear Red Day, is fast approaching. Learn more about it.

The overlapping stent choice

2006-01-30T08:55:00.000-05:00

As mentioned in a recent post, the sirolimus-eluting CYPHER stent is the stent of choice in complex cases.

Now, the FDA has revised instructions for use of the CYPHER Sirolimus-eluting Coronary Stent. The labeling now reflects FDA's review of clinical trial data that suggests there is no increased risk of heart attack with the use of overlapping CYPHER Stents in comparison to bare metal stents. This labeling change is based on a retrospective analysis of several clinical studies of overlapping CYPHER Stents examining more than 900 patients. The CYPHER Stent is the only drug-eluting stent with this new label.

Overlapping stents are most often used in patients with complex coronary artery disease in which the blockage is too long for a single stent. Today, approximately 25 percent of stenting procedures involve the use of overlapping coronary stents.

The study data leading to the revised instructions.
The CYPHER site for more general information.
Surgical webcast of CYPHER stent implantation. (Click on View Archived Webcast on the right side of the page.) Highly recommended.

Heart Attack Patients Do Best at Hospitals That Specialize

2006-01-29T15:31:00.000-05:00

Patients are less likely to die during their hospital stay, and will receive faster treatment, if they have their emergency angioplasty at hospitals where it is the "default" treatment, used on the vast majority of heart attack patients, according to a study in the journal Circulation.

By contrast, the in-hospital death risk and risk of delayed treatment were both higher for angioplasty patients treated at hospitals where emergency angioplasty was used in a minority of heart-attack patients. On the whole, they were significantly more likely to die before leaving the hospital, and waited an average of 20 minutes longer for treatment, than those treated at hospitals where most heart attack patients received angioplasty.

Also, according to the study, it's not the number angioplasties that are performed each year that's most important, but "the overall commitment to doing emergency angioplasties, and the protocols and staffing that come out of that commitment."

"The bottom line for anyone having a heart attack," says lead author Brahmajee Nallamothu, MD, MPH, "is still to call 911 and let the emergency medical staff decide which hospital to choose.

You want the "door to balloon" time to be less than 90 minutes.

A study last year indicated that just under 50% of those whose heart attacks occurred during business hours were treated within the 90 minutes recommended by AHA. After hours, only 25% were treated that quickly. The "door to balloon" times for angioplasty patients rose from 95 minutes during business hours to 116 minutes after hours.

You may want to inquire as to whether the hospitals near your home and workplace perform emergency angioplasties within 90 minutes of arrival. Keep the list of those that do in your head. Then, perhaps, you can make suggestions to the emergency personnel as to which hospital to go to.

Contact your local hospitals.

AHA updates BP guidelines - focus on diet, weight loss

2006-01-28T23:45:00.000-05:00

The American Heart Association (AHA) updated its position statement on lifestyle modifications for the prevention and treatment of high blood pressure (BP). The modified guidelines are published in the February issue of Hypertension.

Because cardiovascular disease (CVD) risk increases progressively throughout the range of BP, beginning at 115/75 mm Hg, efforts to reduce BP in both nonhypertensive and hypertensive individuals are warranted. Dietary changes alone can lower BP and prevent hypertension in nonhypertensive individuals. In uncomplicated stage I hypertension, defined as systolic BP of 140 to 159 mm Hg or diastolic BP of 90 to 99 mm Hg, dietary changes are a useful first step before starting drug therapy.

For patients with hypertension who have already started drug therapy, reduced salt intake and other lifestyle modifications can further reduce BP. The guidelines emphasize increased intake of fruit and vegetables, and limiting alcohol intake to moderate levels for patients who drink alcohol.

Recommendations:

Maintain normal weight or lose weight if overweight
Reduce salt intake to about 1.5 g/day
Eat 8 to 10 servings of fruits and vegetables daily
Moderate alcohol intake
Follow the DASH diet

Dietary measures thought to have a limited or uncertain effect on BP include fish oil supplementation, other types of fat, fiber, calcium, magnesium, carbohydrates, and protein.

"The key message is simple: as a person ages, blood pressure rises," Dr. Appel says. "While an individual's BP may be normal now, 90% of Americans over 50 years of age have a lifetime risk of high BP. Americans should take action before being diagnosed with hypertension."

DASH diet details.

Categories: BloodPressure, Nutrition

Stents in small vessels - which to use?

2006-01-28T17:10:00.000-05:00

The two most popular drug-eluting stents, one coated with the drug sirolimus (Cypher; Johnson & Johnson) and the other coated with the drug paclitaxel (Taxus; Boston Scientific) are amazing devices that have revolutionized the treatment of coronary artery disease.

Both, sirolimus- and paclitaxel-eluting stents effectively reduce restenosis in small coronary vessels. But, which one is more effective?

A new study indicates that the sirolimus-eluting stent performs better in small coronary vessels. Angiographic restenosis was found in 19.0% of the lesions in the paclitaxel-eluting stent group and 11.4% of the lesions in the sirolimus-eluting stent group. Target lesion revascularization was performed in 14.7% of the lesions treated with paclitaxel-eluting stents and 6.6% of the lesions treated with sirolimus-eluting stents.

Therefore, the paclitaxel-eluting stent is associated with a greater late luminal loss (loss of artery opening when compared to the lumen post-implantation) and is less effective in reducing restenosis in small coronary vessels than the sirolimus-eluting stent.

A 2005 study on individuals with diabetes came to the same conclusion.
A 2005 meta-analysis also came to the same conclusion.

Dr. David J. Moliterno, a cardiologist at the University of Kentucky in Lexington stated that, "the large majority of patients...will have extremely terrific outcomes with either stent."

However, the Cypher stent may be useful in more complex cases, such as insulin-dependent diabetics, those with kidney disease or patients who have already had a stent implanted and now require second procedure. [And, now, in patients who have stenoses in small arteries.]

He noted that it's unlikely that the components influencing the differences in outcomes will ever be identified, since new stents with various stent struts, polymers and drugs are under development.

"Because the rate of failure is so low, future studies will need to be either very large or among particularly high-risk patients to discern a possible difference between future generation stents," he said.

Categories: Procedures

Hormone replacement therapy timing and heart disease

2006-01-27T22:27:00.000-05:00

Women who began hormone replacement therapy (HRT) within four years of menopause had about a 30% lower risk of heart disease than did women who never used hormones, said Francine Grodstein, Sc.D., and colleagues at Brigham and Women's Hospital here.

However, when therapy was initiated 10 or more years after menopause there was no significant association with coronary heart disease, the researchers reported in the January issue of the Journal of Women's Health.

"This study helps to untangle some of the confusion about the heart-protective effects of hormone therapy by indicating that the timing of starting hormones relative to a woman's age and onset of menopause plays a key role," said Joann E. Manson, M.D., Dr.P.H., also of Brigham and Women's Hospital, a co-author.

In older women, existing damage to vessels may be the reason HRT does not protect them from heart disease," said researcher Dr. JoAnn E. Manson, the chief of the division of preventive medicine at Brigham and Women's Hospital, in Boston. "If a blood vessel already has advanced atherosclerosis, hormone therapy may be more likely to cause a clot. However, if the blood vessel is open, the increase in clotting risk usually will not translate into a heart event, and some of the benefits may predominate as improvement in cholesterol, improvement in insulin sensitivity and antioxidant effects. Estrogen may actually delay the development of artherosclerosis in those women."

This is welcome news for those newly-menopausal in need of therapy because of troubling menopausal symptoms or osteoporosis. Concerns had been raised about an increased risk of stroke or no heart disease benefit, so women of all ages had stopped taking HRT. Further analysis of these earlier studies indicated that the study participants were older, had never been on HRT, and were already at risk. Still, the study authors cautioned that their results do not yet support hormone therapy for prevention of coronary heart disease.

Categories: Medication