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Category: cardiovascular health

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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.

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Again, the same message of what are healthy habits to prevent heart attacks and heart disease: not smoking, a normal body mass index, physical activity of at least 2.5 hours per week, watching seven or fewer hours of television a week, consumption of a maximum of one alcoholic drink per day on average, and a diet in the top 40 percent of a measure of diet quality.From Medical Xpress:

A healthy lifestyle may prevent heart disease in nearly three out of four women

A new study that followed nearly 70,000 women for two decades concluded that three-quarters of heart attacks in young women could be prevented if women closely followed six healthy lifestyle practices.

The study, published today in the Journal of the American College of Cardiology, followed participants in a study of nurses established in 1989, which surveyed more than 116,000 participants about their diets and other health habits every two years. Researchers from Indiana University, the Harvard School of Public Health, and Brigham and Women's Hospital analyzed data on 69,247 of the participants who met the requirements for their study. "Although mortality rates from heart disease in the U.S. have been in steady decline for the last four decades, women aged 35-44 have not experienced the same reduction," said Andrea K. Chomistek, ScD, a researcher from the Indiana University School of Public Health-Bloomington and lead author of the paper.

Healthy habits were defined as not smoking, a normal body mass index, physical activity of at least 2.5 hours per week, watching seven or fewer hours of television a week, consumption of a maximum of one alcoholic drink per day on average, and a diet in the top 40 percent of a measure of diet quality based on the Harvard School of Public Health healthy eating plate.

During 20 years of follow-up, 456 women had heart attacks and 31,691 women were diagnosed with one or more cardiovascular disease risk factors, including type 2 diabetes, high blood pressure or high levels of blood cholesterol. The average age of women in the study was 37.1 years at the outset; the average age of a heart disease diagnosis was 50.3, and the average age for diagnosis with a risk factor for heart disease was 46.8.

Researchers found that women who adhered to all six healthy lifestyle practices had a 92 percent lower risk of heart attack and a 66 percent lower risk of developing a risk factor for heart disease. This lower risk would mean three quarters of heart attacks and nearly half of all risk factors in younger women may have been prevented if all of the women had adhered to all six healthy lifestyle factors, the authors said.

Independently, not smoking, adequate physical activity, better diet, and lower BMI were each associated with a lower risk for heart disease. Women who consumed moderate amounts of alcohol—approximately one drink per day on average—saw the lowest risk compared to those who did not drink at all and those who drank more.

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Another excellent reason to start walking more and increasing daily physical activity. So get out there and walk, walk, walk...

From Science Daily: Significant link between daily physical activity, vascular health

As millions of Americans resolve to live healthier lives in 2015, research from the University of Missouri School of Medicine shows just how important diligent, daily physical activity is. The researchers found that reducing daily physical activity for even a few days leads to decreases in the function of the inner lining of blood vessels in the legs of young, healthy subjects causing vascular dysfunction that can have prolonged effects.

Paul Fadel, associate professor of medical pharmacology and physiology, and John Thyfault, associate professor of nutrition and exercise physiology, also found that the vascular dysfunction induced by five days of inactivity requires more than one day of returning to physical activity and taking at least 10,000 steps a day to improve.

"We know the negative consequences from not engaging in physical activity can be reversed," said Fadel. "There is much data to indicate that at any stage of a disease, and at any time in your life, you can get active and prolong your life. However, we found that skipping just five days of physical activity causes damage to blood vessels in the legs that can take a prolonged period of time to repair."

"Inactivity is typically going to lead to people being overweight and obese," said Fadel. "The next step after that is insulin resistance which leads to Type 2 diabetes and cardiovascular disease."

The researchers studied the early effects on the body's blood vessels when someone transitions from high daily physical activity -- 10,000 or more steps per day -- to low daily physical activity, less than 5,000 steps per day. Five thousand steps is the national average, but only half of the daily recommendation from the U.S. Surgeon General. The researchers found going from high to low levels of daily physical activity for just five days decreases the function of the inner lining of the blood vessels in the legs.

Counting steps and daily physical activity is different than defined exercise, such as working out at the gym. While there are significant benefits to defined exercise, Thyfault and Fadel's research is based on what amounts to 30 minutes of moderate activity per day.

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Air pollution is harmful on so many levels for all of us, (See recent Dec.post on harmful air pollution effects on pregnancy.) From Reuters Health:

Heart experts warn of air pollution dangers

Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

Citing pollution’s heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating. The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

Some of the authors’ advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads. And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

The use of fossil fuels for heating and energy should also be decreased, according to the statement.

Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

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Feeling younger than your chronological age is good! From Science Daily:

Feeling younger than actual age meant lower early death rate for older people, study finds

Turns out, feeling younger than your actual age might be good for you. Older people who felt three or more years younger than their chronological age had a lower death rate compared with those who felt their age or who felt more than one year older than their actual age, researchers found.

Self-perceived age can reflect assessments of health, physical limitation and well-being in later life, and many older people feel younger than their actual age, according background information in the report. Authors Isla Rippon, M.Sc., and Andrew Steptoe, D.Sc., of the University College London, examined the relationship between self-perceived age and mortality.

The authors used data from a study on aging and included 6,489 individuals, whose average chronological age was 65.8 years but whose average self-perceived age was 56.8 years. Most of the adults (69.6 percent) felt three or more years younger than their actual age, while 25.6 percent had a self-perceived age close to their real age and 4.8 percent felt more than a year older than their chronological age.

Mortality rates during an average follow-up of 99 months were 14.3 percent in adults who felt younger, 18.5 percent in those who felt about their actual age and 24.6 percent in those adults who felt older, according to the study results. The relationship between self-perceived age and cardiovascular death was strong but there was no association between self-perceived age and cancer death.

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Think of incense burning as indoor air pollution, with some of the same chemicals and particulates as cigarettes. From Environmental Health Perspectives:

Ritual Risk: Incense Use and Cardiovascular Mortality

Numerous studies have examined exposures to indoor combustion products such as secondhand smoke and emissions from burning of solid fuels. However, only a few have examined incense burning as a potential health threat, even though incense is commonly used for religious and ritual purposes in China, Taiwan, Singapore, India, and Middle Eastern nations.1,2In this issue of EHP, investigators report an association between long-term incense use and increased cardiovascular mortality.1

The study used data from the Singapore Chinese Health Study, which enrolled a cohort of 63,257 Chinese adults aged 45–74 years between 1993 and 1998. The authors identified cardiovascular deaths of cohort members via a nationwide death registry, checking the registry yearly through 31 December 2011.

More than three-quarters of the participants reported currently using incense, and another 13% were former users. Most had used incense daily for at least 20 years, typically keeping it burning intermittently throughout the day. The authors estimated that current long-term incense users had a 12% increased risk of cardiovascular mortality compared with former and never users, including a 19% increased risk for stroke and a 10% increased risk for coronary heart disease.1

Previous studies reported concentrations of volatile organic compounds and particulate matter in incense emissions similar to those in cigarette smoke.3,4 Others showed that long-term exposure to incense smoke increased blood vessel inflammation and affected blood flow in rats.5 In vitro studies have indicated adverse impact to human coronary6 and lung cells.4 

 In contrast with outdoor air pollution, incense exposure may be easier for an individual to avoid, but Yeatts says education will be needed to help people understand the risks of these exposures, similar to educational campaigns about cigarette smoking.Koh published an earlier prospective study that found an association between incense use and upper respiratory cancer.7

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This would be a major shift in advice. Take note: they found the benefits outweighed the cons only in women starting from the age of 65 and above. From Science Daily:

Cons of regular low-dose aspirin to stave off serious illness in women outweigh pros

The pros of giving healthy women regular low-dose aspirin to stave off serious illness, such as cancer and heart disease, are outweighed by the cons, suggests a large study.

But the balance begins to shift with increasing age, and limiting this form of primary prevention to women aged 65 and above, was better than not taking aspirin at all, or treating women from the age of 45 onwards, say the researchers.

They base their findings on almost 30,000 healthy women, who were at least 45 years old and taking part in the Women's Health Study.Participants were randomly assigned to take either 100 mg of aspirin or a dummy tablet (placebo) every other day, to see whether aspirin curbed their risk of heart disease, stroke, and cancer.

Compared with placebo, regular aspirin was linked to a lower risk of heart disease, stroke, bowel cancer, and in some women, other cancers, but only marginally so.And this slight health gain was trumped by the prevalence of internal gastrointestinal bleeding, which affected two thirds of the women  taking the non-steroidal anti-inflammatory drug.

The risk of gastrointestinal bleeding rose with age, but so too did the drug's impact on lowering the risk of bowel cancer and cardiovascular disease, with the balance appearing to tip in favour of the drug for women aged 65 and above..The researchers calculated that over 15 years, 29 over-65s would need to be treated with aspirin to prevent one case of cancer or heart disease/stroke...But they conclude that blanket treatment "is ineffective or harmful in the majority of women with regard to the combined risk of cardiovascular disease, cancer and major gastrointestinal bleeding."