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Category: cardiovascular health

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I am starting to read more and more negative comments from physicians and researchers about the big pharma and medical society recommendations for treating currently healthy people with statins in the hope it may prevent a cardiovascular event in the future. Many point out that statin health benefits are overstated while negatives and side-effects have been minimized. Many are pointing out that instead of statins, there should be recommendations for lifestyle changes, such as reducing weight, increasing exercise, not smoking, reducing stress, and cutting back on alcohol consumption. After all, these lifestyle changes ONLY have positive effects, and zero negative side effects. From Medical Xpress:

Safety and life-saving efficacy of statins have been exaggerated, says USF scientist

Hailed as miracle drugs when they hit the market two decades ago, statins, the cholesterol-lowering drugs prescribed to prevent heart attacks, are not as effective nor as safe as we have been led to believe, say Dr. David M. Diamond, a professor of psychology, molecular pharmacology and physiology at the University of South Florida, and Dr. Uffe Ravnskov, an independent health researcher and an expert in cholesterol and cardiovascular disease.

According to Diamond and Ravnskov, statins produce a dramatic reduction in cholesterol levels, but they have "failed to substantially improve cardiovascular outcomes." They further state that the many studies touting the efficacy of statins have not only neglected to account for the numerous serious adverse side effects of the drugs, but supporters of statins have used what the authors refer to as "statistical deception" to make inflated claims about their effectiveness.

Their paper is an analysis of the data in the statin trials which led them to conclude that "statin advocates have used statistical deception to create the illusion that statins are 'wonder drugs,' when the reality is that their modest benefits are more than offset by their adverse effects."

The paper also describes how the basis of the deception is in how authors of the statin studies present the rate of beneficial and adverse effects. The effect of the drugs on the population is called the 'absolute risk,' which has shown that statins benefit only about 1% of the population. This means that only one out of 100 people treated with a statin will have one less heart attack. Statin researchers, however, don't present the 1% effect to the public. Instead they transform the 1% effect using another statistic, called the "relative risk," which creates the appearance that statins benefit 30-50% of the population. The exaggeration of beneficial effects of statin treatment was illustrated in their analysis of a subset of statin studies, including the Jupiter Trial (Crestor), the Anglo-Scandinavian Cardiac Outcomes Trial Lipid Lowering Arm (ASCOT-LLA), and the British Heart Protection Study.

"In the Jupiter trial, the public and healthcare workers were informed of a 54 percent reduction in heart attacks, when the actual effect in reduction of coronary events was less than 1 percentage point," said Ravnskov and Diamond.... there were heart attacks and deaths in 3% of the placebo (no treatment) group as compared to 1.9% in the Lipitor group. The improvement in outcome with Lipitor treatment was only 1.1 percentage point, but when this study was presented to the public, the advertisements used the inflated (relative risk) statistic, which transformed the 1.1% effect into a 36% reduction in heart attack risk.

The adverse effects suffered by people taking statins are more common than reported in the media and at medical conferences" explains Diamond and Ravnskov. According to the authors, "Increased rates of cancer, cataracts, diabetes, cognitive impairments and musculoskeletal disorders more than offset the modest cardiovascular benefits of statin treatment."

The authors emphasized that low cholesterol levels related to statin use have frequently been associated with an increased risk of cancer. They also noted that most statin trials are terminated within two to five years, a period too short to see most cancers develop. Nevertheless, studies have shown a greater incidence of cancer in people who take statins, and one long-term study demonstrated a dramatic increase in the incidence of breast cancer among women who had used statins for more than 10 years.

They emphasized that the public needs to be wary of conflicts of interest in the medical community and pharmaceutical industry when it comes to touting the benefits of statins and skewing the data in such a way as to make the drugs seem more effective at lowering cardiovascular disease and heart attack risks than they may actually be.

The authors advocate other health beneficial strategies that are known to reduce cardiovascular risk, such as cessation of smoking, weight control, exercise and stress reduction. They also emphasized the great value of a low carbohydrate diet for normalizing all of the biomarkers of cardiovascular risk, with excellent outcomes, especially for people with type 2 diabetes.

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Chronic inflammation can have a variety of negative health effects. From Time:

13 Ways Inflammation Can Affect Your Health

You can't live without inflammation, but it can also be hazardous to your health. You’ve heard of anti-inflammatory medications and anti-inflammatory diets, but do you really know what inflamation is? In short, it’s the body’s response to outside threats like stress, infection, or toxic chemicals. When the immune system senses one of these dangers, it responds by activating proteins meant to protect cells and tissues. “In a healthy situation, inflammation serves as a good friend to our body,” says Mansour Mohamadzadeh, PhD, director of the Center for Inflammation and Mucosal Immunology at the University of Florida.” “But if immune cells start to overreact, that inflammation can be totally directed against us.” This type of harmful, chronic inflammation can have a number of causes, including a virus or bacteria, an autoimmune disorder, sugary and fatty foods, or the way you handle stress. Here are a few ways it can affect your health, both short-term and long.

It fights infection.Inflammation is most visible (and most beneficial) when it’s helping to repair a wound or fight off an illness...It prepares you for battles Another type of inflammation occurs in response to emotional stress. Instead of blood cells rushing to one part of the body, however, inflammatory markers called C-reactive proteins are released into the blood stream and travel throughout the body.

It can harm your gut Many of the body’s immune cells cluster around the intestines, says Denning. Most of the time, those immune cells ignore the trillions of healthy bacteria that live in the gut. “But for some people, that tolerance seems to be broken,” says Denning, “and their immune cells begin to react to the bacteria, creating chronic inflammation.” The immune cells can attack the digestive tract itself, an autoimmune condition known as inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease. 

It can harm your joints When inflammation occurs in the joints, it’s can cause serious damage. One joint-damaging condition is rheumatoid arthritis(RA)—another example of an autoimmune disorder that appears to have a genetic component, but is also linked to smoking, a lack of vitamin D, and other risk factors.

It’s linked to heart disease Any part of your body that’s been injured or damaged can trigger inflammation, even the insides of blood vessels. The formation of fatty plaque in the arteries can trigger chronic inflammation. The fatty plaques attract white blood cells, grow larger, and can form blood clots, which can cause a heart attack.Obesity and unhealthy eating increases inflammation in the body.

It’s linked to a higher risk of cancer Chronic inflammation has been linked to cancers of the lung, esophagus, cervix, and digestive tract, among others..The inflammation may be due to obesity, a chronic infection, a chemical irritant, or chronic condition; all have been linked to a higher cancer risk....It may sabotage your sleep In a 2009 study from Case Western Reserve University, people who reported sleeping more or less than average had higher levels of inflammation-related proteins in their blood than those who said they slept about 7.6 hours a night.

It’s bad for your lungs When inflammation occurs in the lungs, it can cause fluid accumulation and narrowing of the airways, making it difficult to breathe...Smoking, exposure to air pollution or household chemicals, being overweight, and even consumption of cured meats have been linked to lung inflammation... It damages gums Inflammation can also wreak havoc on your mouth in the form of periodontitis, a chronic inflammation of the gums caused by bacteria accumulation. 

It makes weight loss more difficult Obesity is a major cause of inflammation in the body, and losing weight is one of the most effective ways to fight it. But that’s sometimes easier said than done, because elevated levels of inflammation-related proteins can also make weight loss more difficult than it should be.... Inflammation can also increase insulin resistance (which raises your risk for diabetes) and has been linked with future weight gain.

It damages bones Inflammation throughout the body can interfere with bone growth and even promote increased bone loss, according to a 2009 review study published in the Journal of Endocrinology.  It affects your skin The effects of inflammation aren’t just internal: They can also be reflected on your skin. Psoriasis, for example, is an inflammatory condition that occurs when the immune system causes skin cells to grow too quickly. .... It’s linked with depression 

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Some weekly strenuous activity is best for women's health. From Science Daily:

Women active a few times weekly have lower risk of heart disease, stroke and blood clots

Middle-aged women physically active a few times per week have lower risks of heart disease, stroke and blood clots than inactive women. More frequent physical activity does not appear to lower the risks further, research shows.

In the study: - Women who performed strenuous physical activity -- enough to cause sweating or a faster heart beat -- two to three times per week were about 20 percent less likely to develop heart disease, strokes or blood clots compared to participants who reported little or no activity. - Among active women, there was little evidence of further risk reductions with more frequent activity. - Physical activities associated with reduced risk included walking, gardening, and cycling.

Participants included 1.1 million women in the United Kingdom with no history of cancer, heart disease, stroke, blood clots, or diabetes who joined the Million Women study in 1996-2001. Their average age when they joined the study was 56. The women reported their level of physical activity at the beginning of the study and three years later. Researchers then examined hospital admissions and deaths in relation to participants' responses. Follow-up was, on average, nine years.

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The researcher who led the study pointed out that millions of people live with and die from cardiovascular disease and that : "Many of these deaths may be prevented by the right lifestyle, including diet." Eating oily fish appears to be part of a healthy lifestyle. From Medical Xpress:

Consuming oily fish could repair damaged blood vessels

Eating oily fish may not only keep your heart healthy but it could actually help to fix damaged blood vessels faster, reducing your risk of cardiovascular disease, University of Reading scientists have found. It is well known that these high in omega-3 fatty acid foods can improve the elasticity of blood vessels and potentially protect against heart disease.

However the reasons for these positive effects are less clear. This study tested two new emerging markers of cardiovascular disease that are of particular interest to researchers in the quest for answers.

The first was endothelial progenitor cells (EPCs), stem cells made in the bone marrow that repair the linings of blood vessels when they become damaged. Previous studies associate a higher number of EPCs with a lower risk of heart disease. Over a period of eight weeks the researchers introduced small amounts (3 g per day) of fish oils to a volunteer group of people with mild risk of cardiovascular risk of a mixed age range. At the end of the eight weeks this study group increased their EPCs numbers by up to 15% compared to a control group.

The second marker, endothelial microparticles (EMPs), are tiny circular vesicles which are shed when the lining of blood vessels is damaged. High numbers of these indicates a high degree of blood vessel damage and are associated with higher risk of heart disease. At the end of the trial, the group consuming the oily fish decreased EMPs by 20% compared to the control group.

"Fish oil is known to increase the release of nitric oxide from the lining of the blood vessel wall which causes relaxation of the vessel and increases blood flow. Our study shows that fish oils could be better for our heart in more ways than previously thought, decreasing damage to the lining of blood vessels and by increasing the numbers of cells which repair those linings.

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Some good news research involving benefits of optimism, hugs, and couples adopting healthy habits together. From Science Daily:

Optimistic people have healthier hearts, study finds

Using the American Heart Association's criteria, a study of 5,000 adults found that the most optimistic people had twice the odds of being in ideal cardiovascular health as their pessimistic counterparts.

From Science Daily:

Hugs help protect against stress, infection, say researchers

Researchers tested whether hugs act as a form of social support, protecting stressed people from getting sick. They found that greater social support and more frequent hugs protected people from the increased susceptibility to infection associated with being stressed and resulted in less severe illness symptoms.

From Science Daily:

Couples more likely to get healthy together

People are more successful in taking up healthy habits if their partner makes positive changes too, according to research. Investigators found that people were more successful in swapping bad habits for good ones if their partner made a change as well. For example, among women who smoked, 50 per cent managed to quit if their partner gave up smoking too at the same time, compared with 17 per cent of women whose partners were already non-smokers, and eight per cent of those whose partners were regular smokers.

The study found that men were equally affected by their partners and were more likely to quit smoking, get active, or lose weight if their partner made the same behaviour change. The research looked at 3,722 couples, either married or living together and over the age of 50, who were taking part in the English Longitudinal Study of Ageing (ELSA)

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Yes, this finding is important , but what should be also noted is this sentence in the article: "He also noted that it may not be a disease itself, but the treatment for the disease, that's actually responsible for reproductive malfunction." It has been known for decades that men's sperm is affected by environmental chemicals (such as pesticides), alcohol, smoking, and medications. So it's important to figure out if it's the medicine or the health condition that's causing the problem - or perhaps it's both. From Science Daily:

Infertility is a warning: Poor semen quality linked to hypertension, other health problems

A study of men who were evaluated for the cause of their infertility finds previously unknown relationships between deficiencies in their semen and other, seemingly unrelated health problems. A study of more than 9,000 men with fertility problems has revealed a correlation between the number of different defects in a man's semen and the likelihood that the man has other health problems.

The study, conducted by investigators at the Stanford University School of Medicine, also links poor semen quality to a higher chance of having various specific health conditions, such as hypertension, and more generally to skin and endocrine disorders....A study Eisenberg co-authored a few years ago showed that infertile men had higher rates of overall mortality, as well as mortality linked to heart problems, in the years following an infertility evaluation. 

In the new study, Eisenberg and his colleagues analyzed the medical records of 9,387 men, mostly between 30 and 50 years old, who had been evaluated at Stanford Hospital & Clinics (now Stanford Health Care) between 1994 and 2011 to determine the cause of their infertility. ...So, using the database, the investigators were able to compare the overall health status of men who had semen defects to that of the men who didn't.

With a median age of 38, this was a fairly young group of men. However, 44 percent of all the men had some additional health problem besides the fertility problem that brought them to the clinic. In particular, the investigators found a substantial link between poor semen quality and specific diseases of the circulatory system, notably hypertension, vascular disease and heart disease. 

In addition, as the number of different kinds of defects in a man's semen rose, so did his likelihood of having a skin disease or endocrine disorder. When looking at the severity of all health problems, the scientists observed a statistically significant connection between the number of different ways in which a man's semen was deficient and the likelihood of his having a substantial health problem.... He also noted that it may not be a disease itself, but the treatment for the disease, that's actually responsible for reproductive malfunction. He said he is exploring this possibility now.

This article mentions a few of the other issues that are linked with male infertility.While incomplete, at least it mentions smoking, BPA exposure, binge drinking, obesity, and lack of sleep.From Medical Daily:

Your Sperm And Your Health: What Your Semen Can Tell You About Your Health

The following article focused on other links to male infertility. It also discussed an interesting 2012 study that looked at the effects of wearing tight briefs (which heats the genitals) versus boxers on sperm production (hint: briefs had very negative effect). From Five Thirty Eight Science:

Men, Those Tightie Whities Really Are Killing Your Sperm Count

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Over the past year I have seen a number of studies looking at alcohol consumption and health effects. Overall it seems that the effects of alcohol are complex and frequently result in a J-curve: abstainers have a higher mortality rate or problems, light or moderate drinkers do the best, and then heavier drinkers have the most problems and higher mortality rates. The following two studies support this. From Science Daily:

Drinking moderate amounts of alcohol is linked to reduced risk of heart failure, large study finds

Evidence already exists for the beneficial effects of drinking moderate amounts of alcohol on the risk of developing a number of heart conditions; however, the role it plays in the risk of developing heart failure has been under-researched with conflicting results. Now, a large study of nearly 15,000 men and women shows that drinking up to seven drinks a week in early to middle age is associated with a 20% lower risk of men developing heart failure in the future when compared to people who did not drink at all, and a more modest 16% reduced risk for women.

They defined a drink as one that contains 14g of alcohol, equivalent to approximately one small (125ml) glass of wine, just over half a pint or a third of a litre of beer, and less than one shot of liquor such as whisky or vodka. The study participants were divided into six categories: abstainers (people who recorded having drunk no alcohol at every visit by the researchers), former drinkers, people who drank up to seven drinks a week, or between 7-14 drinks, 14-21 drinks, or 21 or more drinks a week.

From Science Daily:

If you're over 60, drink up: Alcohol associated with better memory

For people 60 and older who do not have dementia, light alcohol consumption during late life is associated with higher episodic memory -- the ability to recall memories of events -- researchers report.

Moderate alcohol consumption was also linked with a larger volume in the hippocampus, a brain region critical for episodic memory. The relationship between light alcohol consumption and episodic memory goes away if hippocampal volume is factored in, providing new evidence that hippocampal functioning is the critical factor in these improvements.

Findings from animal studies suggest that moderate alcohol consumption may contribute to preserved hippocampal volume by promoting generation of new nerve cells in the hippocampus. In addition, exposing the brain to moderate amounts of alcohol may increase the release of brain chemicals involved with cognitive, or information processing, functions.

Although the potential benefits of light to moderate alcohol consumption to cognitive learning and memory later in life have been consistently reported, extended periods of abusing alcohol, often defined as having five or more alcoholic beverages during a single drinking occasion is known to be harmful to the brain.

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I feel like I'm posting the same thing over and over as study after study finds the same or similar results. Bottom line: sitting much is bad for health, so get up and move (walks are good). The more you move or exercise, the better for health.

From Science Daily: Sitting for long periods increases risk of disease and early death, regardless of exercise

The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise, according to a review study.

"More than one half of an average person's day is spent being sedentary -- sitting, watching television, or working at a computer," said Dr. David Alter, Senior Scientist, Toronto Rehab, University Health Network (UHN), and Institute for Clinical Evaluative Sciences. "Our study finds that despite the health-enhancing benefits of physical activity, this alone may not be enough to reduce the risk for disease." The meta-analysis study reviewed studies focused on sedentary behaviour.

The authors found the negative effects of sitting time on health, however, are more pronounced among those who do little or no exercise than among those who participate in higher amounts of exercise."The findings suggest that the health risk of sitting too much is less pronounced when physical activity is increased," said Biswas. 

In the interim, Dr. Alter underlines strategies people can use to reduce sitting time. The target is to decrease sedentary time by two to three hours in a 12-hour day...For example, at work, stand up or move for one to three minutes every half hour; and when watching television, stand or exercise during commercials."

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This wonderful opinion piece is by Dr. John Mandrola, a cardiologist who also posts on his own blog at http://www.drjohnm.org/ . The bottom line: lifestyle is more important than drugs in preventing heart disease. The following is from Medscape:

Heart Disease and Lifestyle: Why Are Doctors in Denial?

I think and write a lot about the role of lifestyle choices as a treatment strategy. As an endurance athlete, I know that exercise, diet, sleep, and finding balance in life are the key components of success. It is the same in cardiology.

In a randomized controlled trial of primary prevention, no cardiologist would want to be compared against a good physical trainer or nutritionist. We would get trounced. Our calcium scores, biomarkers, pills, and procedures would not stand a chance. The study would be terminated early due to obvious superiority of lifestyle coaching over doctoring—which would blunt the true treatment effect and make us look less bad. (Wink to my epidemiology friends.)

I write a post about new oral anticoagulant drugs or statins or AF ablation, and people pay attention. You see it in the traffic. It's the same story at medical meetings: sessions on drugs and procedures draw the crowds. Late-breaking studies rarely involve the role of exercise or eating well. Exercise, diet, and going to bed on time have no corporate backing. The task of drawing attention to the basics is getting harder, not easier.

And this is our problem. I believe the collective denial of lifestyle disease is the reason cardiology is in an innovation rut. This denial is not active or overt. It is indolent and apathetic. Bulging waistlines, thick necks, sagging muscles, and waddling gaits have begun to look like normal. During the electronic medical record (EMR) click-fest after seeing a patient, I rarely click on "normal" physical exam. The general appearance is abnormal—either overweight or obese.

This is how I see modern cardiology. Our tricks can no longer overcome eating too much and moving too little. We approach health but never get there. If you waddle, snore at night, and cannot see your toes while standing, how much will a statin or ACE inhibitor or even LCZ696 help?

In fact, a reasonable person could make an argument that our pills and procedures might be making patients sicker.

When I started electrophysiology, I mostly treated people with fluky problems. My ablation procedures were on people with supraventricular tachycardia (SVT) due to aberrant pathways. My devices were mostly pacemakers in the elderly—a disease due to aging. These sorts of problems are (mostly) independent of how many sugar-sweetened beverages one drinks.

Now it is different. My practice is dominated by atrial arrhythmia—a disease now recognized as being due (in large part) to excesses of life, such as obesity, high blood pressure, sleep disorders, and overindulgence in alcohol. In other words: unnecessary. I make hundreds of dollars putting a hundred burns in a left atrium for a disease that a poorly paid physical trainer might prevent or treat. This has become cardiology writ large.

But the thing I cannot get over is that I am doctor, not a proceduralist. I am tasked with helping people be well. I fail in that task if I ignore the most effective and safest treatment option. I fail if I take the easy path. The prescription pad is easy. The EP lab is easy. The truth is hard... New anticoagulant drugs are easy. Ablation technology is easy. Statins are even easier. The truth—nutrition, exercise, balance in life—is hard.

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I bet eating fresh blueberries daily instead of blueberry powder would not only be more delicious, but also have even more health benefits. From Science Daily:

Blueberries may help reduce blood pressure and arterial stiffness

Just one cup of blueberries per day could be the key to reducing blood pressure and arterial stiffness, both of which are associated with cardiovascular disease. .... Johnson said she is interested in looking at how functional foods -- foods that have a positive impact on health beyond basic nutrition -- can prevent and reverse negative health outcomes, particularly for postmenopausal women.

Over an eight-week period, 48 postmenopausal women with pre- and stage-1 hypertension were randomly assigned to receive either 22 grams of freeze-dried blueberry powder -- the equivalent to one cup of fresh blueberries -- or 22 grams of a placebo powder. Participants, meanwhile, continued their normal diet and exercise routines.

At the end of the eight weeks, participants receiving the blueberry powder on average had a 7 mmHg (5.1 percent) decrease in systolic blood pressure, which is the top number in the blood pressure reading that measures the pressure in the arteries when the heart beats. They also saw a 5 mmHg (6.3 percent) reduction in diastolic blood pressure, or the bottom number measuring the pressure in the arteries between heartbeats.

Additionally, participants in the blueberry-treated group had an average reduction of 97 cm/second (6.5 percent) in arterial stiffness.They also found that nitric oxide, a blood biomarker known to be involved in the widening of blood vessels, increased by 68.5 percent. That is important, Johnson said, because arterial stiffness and the narrowing of blood vessels are both a part of hypertension. This rise in nitric oxide helps explain the reductions in blood pressure.