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Category: cardiovascular health

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Another excellent reason to exercise - for better erectile and sexual function in men! The researchers say that their research supports the idea that "that exercise might one day be prescribed as a treatment for erectile dysfunction".

And they're not talking about that much exercise: the highly active men in the study did a moderately intense activity such as brisk walking, cycling, or tennis at least an hour 3 to 4 times a week. Other research has suggested that erectile dysfunction can be reversed naturally by changing lifestyle factors see October 27, 2014 post Reversing Erectile Dysfunction Naturally). From Reuters:

Older men who exercise more have better erectile function

Men who exercise more have better erectile and sexual function, suggests a small study of older overweight men. The authors say their results support the idea that exercise might one day be prescribed as a treatment for erectile dysfunction.

Vidal and colleagues examined exercise habits and sexual function in 295 healthy men who were part of a research project evaluating prostate cancer risk at the Durham Veterans Affairs Medical Center in North Carolina. On average, the men were about 62 years old, and they were all overweight or obese. Roughly one third had diabetes or a history of chest pain or heart attacks. About three quarters were current or former smokers. Ninety-three men, or about a third of the group, were African-American.

Men were scored based on a measure known as metabolic equivalent of task (MET) hours per week and placed in four categories ranging from sedentary, with three or fewer MET hours/week, to highly active, with at least 18 MET hours/week. Most often, the men were sedentary, with 44 percent reporting little activity. But a substantial proportion, 26 percent, were highly active.Researchers also questioned the men about their sexual function, focusing on their ability to get erections and have orgasms, as well as the quality and frequency of their erections...Added up, responses could lead to a total score from 0 to 100....Men who reported more frequent exercise also reported higher sexual function scores. Half of the highly active men reported sexual function scores of at least 70, compared with a median score of about 33 for sedentary men.

SOURCE: bit.ly/1NilZYI The Journal of Sexual Medicine, online March 20, 2015.

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After reading this article, I looked over my last year's posts and realized that the recent studies posted all found that eating fish showed health benefits (and they did not look at supplements). Once again, a food shows benefits while the supplement is debatable. Current advice: try to eat fish at least twice a week. From the NY Times:

Fish Oil Claims Not Supported by Research

Fish oil is now the third most widely used dietary supplement in the United States, after vitamins and minerals, according to a recent report from the National Institutes of Health. At least 10 percent of Americans take fish oil regularly, most believing that the omega-3 fatty acids in the supplements will protect their cardiovascular health. But there is one big problem: The vast majority of clinical trials involving fish oil have found no evidence that it lowers the risk of heart attack and stroke.

From 2005 to 2012, at least two dozen rigorous studies of fish oil were published in leading medical journals, most of which looked at whether fish oil could prevent cardiovascular events in high-risk populations. These were people who had a history of heart disease or strong risk factors for it, like high cholesterol, hypertension or Type 2 diabetes. All but two of these studies found that compared with a placebo, fish oil showed no benefit.

In theory at least, there are good reasons that fish oil should improve cardiovascular health. Most fish oil supplements are rich in two omega-3 fatty acids — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — that can have a blood-thinning effect, much like aspirin, that may reduce the likelihood of clots. Omega-3s can also reduce inflammation, which plays a role in atherosclerosis. And the Food and Drug Administration has approved at least three prescription types of fish oil — Vascepa, Lovaza and a generic form — for the treatment of very high triglycerides, a risk factor for heart disease. But these properties of omega-3 fatty acids have not translated into notable benefits in most large clinical trials.

Like many cardiologists, Dr. Stein encourages his patients to avoid fish oil supplements and focus instead on eating fatty fish at least twice a week, in line with federal guidelines on safe fish intake, because fish contains a variety of healthful nutrients other than just EPA and DHA. “We don’t recommend fish oil unless someone gets absolutely no fish in their diets,” Dr. Stein said.

But some experts say the case for fish oil remains open. Dr. JoAnn Manson, the chief of preventive medicine at Brigham and Women’s Hospital in Boston, said the large clinical trials of fish oil focused only on people who already had heart disease or were at very high risk. Fish oil has also been promoted for the prevention of a variety of other conditions, including cancer, Alzheimer’s and depression. Dr. Manson is leading a five-year clinical trial, called the Vital study, of 26,000 people who are more representative of the general population. Set to be completed next year, it will determine whether fish oil and vitamin D, separately or combined, have any effect on the long-term prevention of heart disease, Type 2 diabetes, and other diseases in people who do not have many strong risk factors.

Dr. Manson says that although she recommends eating fatty fish first, she usually does not stop people from taking fish oil, in part because it does not seem to have major side effects in generally healthy people. “But I do think people should realize that the jury is still out,” she said, “and that they may be spending a lot of money on these supplements without getting any benefit.”

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More research showing health benefits of peanuts, including when eating them with a high fat meal. From Science Daily:

Adding peanuts to a meal benefits vascular health

A study of peanut consumption showed that including them as a part of a high fat meal improved the post-meal triglyceride response and preserved endothelial function.The purpose of this research was to evaluate vascular function after a high fat meal challenge.

Fifteen overweight males were randomized to either a peanut meal containing 3 oz. of ground peanuts (as a shake) or a control meal (a shake without peanuts) that were matched for energy and macronutrients...Flow-mediated dilatation (FMD) was measured to assess vascular function... The control meal decreased FMD by 1.2 percent compared to baseline. In contrast, there was no decrease in FMD after the peanut meal. These results demonstrate that the peanut meal maintained normal vascular function whereas the high fat-matched control meal impaired vascular function acutely.

Vascular dysfunction plays a major role in the development of atherosclerosis and the formation of coronary plaques and lesions that lead to coronary artery disease. Typically after a high fat meal, vascular function is reduced, albeit temporarily, until the fat that is in the blood (from the meal) is cleared. Strategies that can blunt this response to both dietary fat and its effect on vascular dysfunction may decrease the risk of coronary disease. Our finding demonstrated that that peanut consumption was shown to be atheroprotective as a part of high fat meal.

"Previous studies have shown that individuals who consume peanuts more than two times a week have a lower risk of coronary heart disease," said Liu. "This study indicates that the protective effect of peanut consumption could be due, in part, to its beneficial effect on artery health."

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This is the latest study raising health concerns about energy drinks, which include popular brands Red Bull and Monster. (See review article Energy Beverages: Content and Safety and from Time What’s In Your Energy Drink? ). And remember, they are not a "real food" when you look at the ingredients (e.g., caffeine, taurine and glucuronolactone, artificial flavors, artificial sweeteners, colors). From Live Science:

Energy Drinks Raise Blood Pressure, Study Finds

Energy drinks might give you some pep — but they might also be priming you for heart problems, a new study finds. Researchers found that energy drinks can raise blood pressure to potentially unhealthy levels. The effect was far more prominent in young adults who did not consume caffeine regularly, according to the study, presented March 14 at an American College of Cardiology meeting in San Diego.

In this study, the research team — led by Dr. Anna Svatikova, a cardiovascular-diseases fellow at the Mayo Clinic in Rochester, Minnesota — gave a can of a commercially available energy drink to 25 healthy volunteers, whose ages ranged from 19 to 40. On a different day, the participants drank the same amount of a placebo drink. The researchers measured the participants' heart rate and blood pressure before and after the drinks.

The participants experienced a more marked rise in blood pressure after consuming the energy drink than after drinking the placebo, according to the findings. The participants' average systolic blood pressure (the top number in a blood pressure reading) increased by 3 percent more after they drank an energy drink, compared with after they drank the placebo drink. [5 Health Problems Linked to Energy Drinks]

The effect was most dramatic in people who did not typically consume more than a small cup of coffee or other caffeinated drink daily. In this so-called "caffeine-naive" group, the blood pressure increase was twice as high as the increase seen in the people who drank at least the equivalent of a cup of coffee on a daily basis, the researchers said in a statement...Scientists do not know whether it is the caffeine, taurine or other ingredients found in energy drinks — or a combination of ingredients — that can adversely affect the heart.

In a separate study, presented last year at an American Heart Association meeting by Maj. Emily Fletcher of the David Grant Air Force Medical Center, healthy volunteers experienced a greater increase in blood pressure after they consumed an energy drink compared to after they drank a coffee drink that had an equal amount of caffeine. This result, Fletcher said, suggests that ingredients in the energy drink other than caffeine were conspiring to raise blood pressure.

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Can you have too high levels of vitamin D? The researchers themselves say that the results show there is a J shaped curve linking vitamin D levels in the blood and mortality - both too high and too low levels are linked to higher levels of mortality. From Science Daily:

High levels of vitamin D is suspected of increasing mortality rates

The level of vitamin D in our blood should neither be too high nor to low. Scientists have now shown that there is a connection between high levels of vitamin D and cardiovascular deaths.

In terms of public health, a lack of vitamin D has long been a focal point. Several studies have shown that too low levels can prove detrimental to our health. However, new research from the University of Copenhagen reveals, for the first time, that also too high levels of vitamin D in our blood is connected to an increased risk of dying from a stroke or a coronary.

"We have studied the level of vitamin D in 247,574 Danes, and so far, it constitutes the world's largest basis for this type of study. We have also analysed their mortality rate over a seven-year period after taking the initial blood sample, and in that time 16,645 patients had died. Furthermore, we have looked at the connection between their deaths and their levels of vitamin D," Professor at the Department of Clinical Medicine, Peter Schwarz explains.

The conclusion is clear: the study confirms that there is indeed a correlation between mortality rates and too low levels of vitamin D, but the new thing is that the level of vitamin D can also be too high.

"If your vitamin D level is below 50 or over 100 nanomol per litre, there is an greater connection to deaths. We have looked at what caused the death of patients, and when numbers are above 100, it appears that there is an increased risk of dying from a stroke or a coronary. In other words, levels of vitamin D should not be too low, but neither should they be too high. Levels should be somewhere in between 50 and 100 nanomol per litre, and our study indicates that 70 is the most preferable level," Peter Schwartz states.

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A big study that found that eating a greater proportion of plant-based foods (fruits, vegetables, grains, beans, potatoes, nuts, olive oil), as compared to animal-based foods, is linked to lower risks of dying from heart disease and stroke.

From Science Daily: Semi-veggie diet effectively lowers heart disease, stroke risk.

A pro-vegetarian diet -- one that has a higher proportion of plant-based foods compared to animal-based foods is linked to lower risks of dying from heart disease and stroke, according to new research presented at the American Heart Association EPI/Lifestyle 2015 meeting. In an observational study, researchers analyzed the eating and lifestyle habits of 451,256 Europeans.

People who ate the most pro-vegetarian style diets (up to 70 percent of food coming from plant sources) had a 20 percent lower risk of dying from cardiovascular disease, compared to those who were the least pro-vegetarian (<45 percent). "A pro-vegetarian diet doesn't make absolute recommendations about specific nutrients. It focuses on increasing the proportion of plant based foods relative to animal-based foods, which results in an improved nutritionally balance diet," said Camille Lassale, Ph.D., lead author and an epidemiologist at Imperial College London's School of Public Health.

Participants were part of the European Prospective Investigation into Cancer and Nutrition (EPIC) study, started in 1992. The study included nearly half a million people from 10 countries who were free of chronic diseases at the start of the study, 35 to 70 years and followed for 12 years on average....Researchers scored participants based on the types of foods they ate. Points were given for eating foods from seven plant food groups: vegetables, fruit, beans, cereals, potatoes, nuts, and olive oil. Points were subtracted for five animal food groups: meats, animal fats, eggs, fish, and other seafood or dairy products. Based on their scores, participants were categorized from the least pro-vegetarian to the most. 

Researchers analyzed the relationship between eating habits and death risks from heart disease and stroke."Instead of drastic avoidance of animal-based foods, substituting some of the meat in your diet with plant-based sources may be a very simple, useful way to lower cardiovascular mortality," said Lassale. These findings are in line with the wealth of evidence on benefits of eating plant foods to prevent CVD.

The American Heart Association recommends following a heart-healthy diet, which could also be described as a pro-vegetarian diet. It is high in fruits, vegetables, whole grains, legumes, beans, and nuts, low-fat dairy, beans, skinless poultry, and fish. It encourages eating foods low in saturated and trans fats and sodium, and limiting added sugars and red meats.

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A large study found that eating nuts or peanuts several times a week is associated with lower death rates, especially from cardiovascular disease. Note that a serving is a small handful or 1.5 ounces of whole nuts or 2 tablespoons of nut butter.

From Science Daily: Peanut consumption associated with decreased total mortality and mortality from cardiovascular diseases

If you're looking for a simple way to lower your risk of dying from a heart attack, consider going nuts. Researchers at Vanderbilt University and the Shanghai Cancer Institute examined the association of peanut and nut consumption with mortality among low-income and racially diverse populations and found that intake of peanuts was associated with fewer deaths, especially from heart disease.

"Nuts are rich in nutrients, such as unsaturated fatty acids, fiber, vitamins, phenolic antioxidants, arginine and other phytochemicals. All of them are known to be beneficial to cardiovascular health, probably through their anti-oxidative, anti-inflammatory and endothelial function maintenance properties," Shu said.

While research has previously linked nut consumption with lower mortality, those studies focused mainly on higher-income, white populations. This study was the first to discover that all races -- blacks, whites and Asians alike -- could potentially increase heart health by eating nuts and peanuts.

This study was based on three large ongoing cohort studies. Participants included more than 70,000 Americans of African and European descent from the Southern Community Cohort Study (SCCS), who were mostly low-income, and more than 130,000 Chinese from the Shanghai Women's Health Study (SWHS) and the Shanghai Men's Health Study (SMHS).... In total, more than 14,000 deaths were identified, with a median follow-up of 5.4 years in the SCCS, 6.5 years in the SMHS, and 12.2 years in the SWHS.

Peanut consumption was associated with decreased total mortality, particularly cardiovascular mortality (i.e., 17-21 percent reduction in total mortality, and 23-38 percent reduction in cardiovascular mortality for the highest quartile intake group compared to the lowest quartile group) across all three racial/ethnic groups, among both men and women, and among individuals from low-SES groups.

The American Heart Association recommends eating four servings of unsalted, unoiled nuts a week. However, nutrient-rich nuts are also high in calories, so don't eat too many if you're watching your weight. A serving size is a small handful or 1.5 ounces of whole nuts or 2 tablespoons of nut butter.

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More research linking moderate coffee consumption with a health benefit. From Medical Daily:

Moderate coffee consumption lessens risk of clogged arteries and heart attacks

People who drink a moderate amount of coffee daily are less likely to develop clogged arteries that could lead to heart attacks, reveals research published online in Heart. Researchers from South Korea found that people consuming three to five cups a day had the least risk of coronary calcium in their arteries.

There has been much debate over the effect of coffee consumption on cardiovascular health.Despite earlier concerns about a potential increase in heart disease risk associated with drinking coffee, a recent meta-analysis of 36 studies showed that moderate coffee consumption was associated with a decreased risk of heart disease. Coffee consumption has been associated with improved insulin sensitivity and reduced risk of type 2 diabetes, but it has also been linked to increased cholesterol concentrations and heightened blood pressure.

An international team of researchers led by the Kangbuk Samsung Hospital, Seoul, in the Republic of Korea, set out to examine the association between coffee consumption and the presence of coronary artery calcium (CAC) which is a early indicator of coronary atherosclerosis - a potentially serious condition where arteries become clogged up by fatty substances known as plaques or atheroma and which can cause the arteries to harden and narrow, leading to blood clots which can trigger a heart attack or a stroke.

They studied a group of 25,138 men and women - average age of 41 - who had no signs of heart disease, attending a health screening examination...They categorised coffee consumption as none, less than one cup a day, one to three cups a day, three to five per day and at least five or more per day. The researchers found the prevalence of detectable CAC was 13.4% amongst the whole group of people and the average consumption of coffee was 1.8 cups per day.

The calcium ratios were 0.77 for people who had less than one cup per day, 0.66 for those having one to three cups every day, 0.59 for those consuming three to five cups per day, and 0.81 for people having at least five cups or more every day compared with non coffee drinkers. The association was similar in subgroups defined by age, sex, smoking status, alcohol consumption, and status of obesity, diabetes, hypertension, and hypercholesterolaemia. The association, therefore, was U-shaped, with participants drinking three to five cups per day having the lowest prevalence of arteries that had clogged up.

Possible explanations for the findings, said the researchers, were that chronic coffee consumption had a possible link to reduced risk of type 2 diabetes, a strong risk factor for atherosclerosis, and that coffee drinking might improve insulin sensitivity and β-cell function.The authors concluded: "Our study adds to a growing body of evidence suggesting that coffee consumption might be inversely associated with CVD [cardiovascular disease] risk.

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Anecdotal evidence has been saying this for years.From Science Daily:

Keep calm, anger can trigger a heart attack!

The risk of a heart attack is 8.5 times higher in the two hours following a burst of intense anger, researchers have found after investigating the link between acute emotional triggers and high risk of severe cardiac episodes. High levels of anxiety were associated with a 9.5 fold increased risk of triggering a heart attack in the two hours after an anxiety episode.

"The data shows that the higher risk of a heart attack isn't necessarily just while you're angry -- it lasts for two hours after the outburst. In the study, 'anger' was qualified as 5 and above on a 1-7 scale, referring to 'very angry, body tense, clenching fists or teeth, ready to burst', up to 'enraged, out of control, throwing objects'. Anger below this level was not associated with increased risk. "The triggers for these burst of intense anger were associated with arguments with family members (29 per cent), argument with others (42 per cent), work anger (14 per cent) and driving anger (14 per cent)," said Dr Buckley.

"Increased risk following intense anger or anxiety is most likely due to increased heart rate, blood pressure, tightening of blood vessels and increased clotting, all associated with triggering heart attacks," he said.

The study was an investigation of consecutive patients suspected of heart attack and confirmed by angiography reports at Royal North Shore hospital. Patients confirmed with acute coronary blockage were admitted, interviewed about their activities in the 48 hours before the onset of symptoms, and usual frequencies of activities were recorded for comparison.

"Although the incidence of anger-triggered heart attacks is around 2%, of the sample, those people were 8.5 times more likely to have a heart attack within two hours of the emotional episode. So while the absolute risk of any one episode triggering a heart attack is low, this data demonstrates that the danger is very present.

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This article raises serious questions about the recently published American College of Cardiology and American Heart Association calculators to predict future cardiovascular events (heart attack, strike, etc) which then give recommendations for who needs to take daily statins while they are still healthy. This calculator (ACC/AHA risk calculator) has sparked much debate because many experts believe it overestimates risk. Now a study that looked at untreated people (MESA) showed that the calculator (as well as 3 other calculators) seriously overpredict the chance of a future cardiovascular event. In other words, many, many healthy people told they "may" have a chance of an event in the future are actually not at risk and so statins would not help them, but may harm them. Remember, all medicines have side-effects. Written by cardiac electrophysiologist Dr. John Mandrola (who has his own blog-site www,drjohnm.org) . From Medscape:

Statins in Primary Prevention: Welcome to the Gray Zone

A new study published in the Annals of Internal Medicine confirmed something that ought to be obvious: predicting the future is hard—especially when it comes to cardiovascular events.

We know cardiovascular disease is the number-one killer of humans; we know its first manifestation is often heart attack, stroke, or death; and we know all medical therapy comes with trade-offs. Medical treatment of healthy people in the name of preventing something that may or may not happen in the future is dicey. Think do no harm. That is where risk prediction comes in. You have to know the odds of something (or nothing) happening without treatment. The gamble of statins and aspirin, for instance, looks most favorable in patients who are most likely to have an event.

 But where to draw that line, at what future risk is it worth taking a chemical, is the issue at hand. The extreme cases are easy. Most everyone agrees that statins and aspirin provide enough benefit in patients who have suffered a cardiovascular event. For secondary prevention, future risk is high, so benefits outweigh harms. It's the opposite in very low-risk patients. The middle ground is not so easy.

Here is where we have to consider the tools—calculators—to predict future risk. We know certain conditions, such as age, gender, blood pressure, diabetes, smoking, biomarkers, family history, and coronary calcium, contribute to future risk. Numerous expert panels, including the American College of Cardiology and American Heart Association, have compiled different calculators to predict the future. The ACC/AHA risk calculator for atherosclerotic CVD (ASCVD) has sparked debate because many experts believe it overestimates risk.

Dr Andrew DeFillippis (University of Louisville, KY) and a team of Multi-Ethnic Study of Atherosclerosis (MESA) coinvestigators used this community-based, sex-balanced, multiethnic cohort to compare the calibration and discrimination of the new ASCVD risk score with alternative risk scores.They compared the observed and expected events for the ASCVD score with three Framingham-based scores and the Reynolds risk score in 4227 MESA subjects aged 50 to 74 years over a 10-year follow-up. Using this real-world population, they found four of the five risk scores overestimated risk. Calibration was worse in men: overestimates ranged from 37% to 154%. In women, three of four scores overestimated risk by 46% to 67%, and the Reynolds Risk score underestimated risk by 21%. 

It's worth saying this another way: when the ACC/AHA ASCVD score predicted event rates of 7.5 to 10%—a range deemed above the statin-benefit cutoff—the actual events were just 3%.

Speaking by phone (we live in the same city), lead author Dr DeFillippis explained to me the important business of looking only at untreated patients. He described their sensitivity analysis, which excluded all patients who received aspirin or any lipid-lowering or antihypertensive drug. To lessen the chance of bias, they analyzed this drug-free group of 790 patients separately and found the same overprediction.The authors concluded that if these findings are validated, overestimation of ASCVD risk may have substantial implications for individual patients and the healthcare system.

On that modern theme, Dr DeFillippis made an interesting point to me about the overall best-performing Reynolds Risk score. He noted the Reynolds score uses genetics (family history) and CRP (inflammation) levels to predict the future. Bookmark that for the future—genetics and inflammation, that is.

These findings have major implications. Drugs are not free. Aspirin and statins come with side effects and dollar costs. The patient who takes these drugs in hopes of preventing future events makes the gamble that the costs are worth the benefit. Policy makers who recommend these drugs expose millions of people to a therapy that turns on delicate balance between future benefit and harm.

The final point to make is that the use of statins and other drugs for the prevention of future events is not a doctor's or professional society's decision. The human being who swallows a drug must ultimately decide whether the gamble is favorable.