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Category: cardiovascular health

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Sounds like exercising in moderation has health benefits for all people, while "to excess" can be problematic. From Science Daily:

Contrary to popular belief, more exercise is not always better

There is strong epidemiological evidence of the importance of regular physical activity, such as brisk walking and jogging, in the management and rehabilitation of cardiovascular disease and in lowering the risk of death from other diseases such as hypertension, stroke, and type 2 diabetes. The Physical Activity Guidelines for Americans recommends about 150 minutes per week of moderate-intensity exercise or about 75 minutes of vigorous-intensity exercise. But there is clear evidence of an increase in cardiovascular deaths in heart attack survivors who exercise to excess.

Paul T. Williams, PhD, of the Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, and Paul D. Thompson, MD, of the Department of Cardiology, Hartford Hospital, Hartford, CT, studied the relationship between exercise and cardiovascular disease-related deaths in about 2,400 physically active heart attack survivors. This study confirmed previous reports indicating that the cardiovascular benefits for walking and running were equivalent, as long as the energy expenditures were the same (although when walking, as compared to running, it will take about twice as long to burn the same number of calories).

Remarkable dose-dependent reductions in deaths from cardiovascular events of up to 65% were seen among patients who were running less than 30 miles or walking less than 46 miles per week. Beyond this point however much of the benefit of exercise was lost, in what is described as a reverse J-curve pattern.

In the same issue, investigators in Spain report on a meta-analysis of ten cohort studies aimed at providing an accurate overview of mortality in elite athletes. The studies included over 42,000 top athletes (707 women) who had participated in a range of sports including football, baseball, track and field, and cycling, including Olympic level athletes and participants in the Tour de France.

"What we found on the evidence available was that elite athletes (mostly men) live longer than the general population, which suggests that the beneficial health effects of exercise, particularly in decreasing cardiovascular disease and cancer risk, are not necessarily confined to moderate doses," comments senior investigator Alejandro Lucia, MD, PhD, of the European University Madrid, Spain. 

"Extrapolation of the data from the current Williams and Thompson study to the general population would suggest that approximately one out of twenty people is overdoing exercise," comments James H. O'Keefe, MD, from the Mid America Heart Institute in Kansas City, MO... Along with co-authors Carl "Chip" Lavie, MD, and Barry Franklin, PhD, he explains that "we have suggested the term 'cardiac overuse injury' for this increasingly common consequence of the 'more exercise is better' strategy." 

O'Keefe, Franklin and Lavie point out that a weekly cumulative dose of vigorous exercise of not more than about five hours has been identified in several studies to be the safe upper range for long-term cardiovascular health and life expectancy, and that it may also be beneficial to take one or two days a week off from vigorous exercise, and to refrain from high-intensity exercise on an everyday basis. They propose that individuals from either end of the exercise spectrum (sedentary people and over-exercisers) would probably reap long-term health benefits by changing their physical activity levels to be in the moderate range.

"For patients with heart disease, almost all should be exercising, and generally most should be exercising 30-40 minutes most days, but from a health stand-point, there is no reason to exercise much longer than that and especially not more than 60 minutes on most days," says Lavie, who is a cardiologist at the John Ochsner Heart and Vascular Institute, New Orleans, LA. 

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This research review suggests that 5 servings a day of fruits and vegetables has the best health benefits. They surprisingly did not find that fruit/vegetable consumption was protective against cancer. But the authors point out that other studies of cancer and fruit/vegetable consumption have also been inconsistent, and this might be partly explained if certain fruits and vegetables only have effects on certain cancers. From Medical Daily:

An Apple A Day Keeps The Doctor Away? Actually It's 5 Apples, And They Keep Death Away

A review of the eating habits of more than 800,000 people seems to discredit the old maxim about "an apple a day." In fact, five servings of fruit and vegetables offers the best health benefits, particularly against heart disease, and reduces your chances of dying for any reason.

After calculating the odds, researchers write in the Journal of Epidemiology and Community Health that "the risk of all-cause mortality was decreased by 5 percent for each additional serving a day of fruit and vegetables." But, contrary to other reports, they found the benefits drop off after five servings, at which point, they wrote, "we observed a threshold." Previous studies have said seven fruit and vegetable servings is the optimum number.

Other studies have also made the case for fruits and vegetables as a ward against cancer. This one, led by Professor Frank B. Hu in the Harvard School of Public Health, saw no evidence for that. They did, however, find a "significant inverse association" between a fruit and veggie diet and death by heart disease. "The results support current recommendations to increase consumption to promote health and overall longevity," Hu and his colleagues wrote.

Of course, the authors admit, the studies they looked at may have been corrupted by participants lying or guessing on their diet questionnaires. But one thing this study has going for it is the massive sample size. They looked at 16 papers involving 833,234 people and 56,423 deaths. Most of those deaths — as is the case in the general population — were caused by cardiovascular disease and cancer. The people who lived longest adhered to what's called the Mediterranean diet, which favors carrots and tomatoes to steak and bacon.

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I've been seeing research report after report looking at how our lifestyle determines how we'll age - whether we'll be active and healthy well into our 80s or in terrible shape and dying young. Mind you, these are not "definites" because nothing can give you a guarantee, but they are ways we can improve our odds in living the long and healthy life that we want. From Medical Xpress:

A healthy lifestyle adds years to life

Live longer thanks to fruit, an active lifestyle, limited alcohol and no cigarettes. This is the conclusion of a study by public health physicians at the University of Zurich who documented for the first time the impact of behavioural factors on life expectancy in numbers. 

...Brian Martin and his colleagues from the Institute of Social and Preventive Medicine (ISPM) at the University of Zurich have examined the effects of these four factors – both individual and combined – on life expectancy. An individual who smokes, drinks a lot, is physically inactive and has an unhealthy diet has 2.5 fold higher mortality risk in epidemiological terms than an individual who looks after his health. Or to put it positively: "A healthy lifestyle can help you stay ten years' younger", comments the lead author Eva Martin-Diener.

"The effect of each individual factor on life expectancy is relatively high", states Eva Martin-Diener. But smoking seems to be the most harmful. Compared with a group of non-smokers, smokers have a 57 percent higher risk of dying prematurely. The impact of an unhealthy diet, not enough sport and alcohol abuse results in an elevated mortality risk of around 15 percent for each factor.

According to Martin an unhealthy lifestyle has above all a long-lasting impact. Whereas high wine consumption, cigarettes, an unhealthy diet and physical inactivity scarcely had any effect on mortality amongst the 45 to 55-year-olds, it does have a visible effect on 65 to 75-year-olds. The probability of a 75-year-old man with none of the four risk factors surviving the next ten years is 67 percent, exactly the same as the risk for a smoker who is ten years younger, doesn't exercise, eats unhealthily and drinks a lot.

From Medical Xpress:

Picking up healthy habits in your 30s and 40s can slash heart disease risk

The heart is more forgiving than you may think—especially to adults who try to take charge of their health, a new Northwestern Medicine study has found. When adults in their 30s and 40s decide to drop unhealthy habits that are harmful to their heart and embrace healthy lifestyle changes, they can control and potentially even reverse the natural progression of , scientists found. On the flip side, scientists also found that if people drop  or pick up more bad habits as they age, there is measurable, detrimental impact on their coronary arteries.

For this paper, scientists examined healthy lifestyle behaviors and coronary artery calcification and thickening among the more than 5,000 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who were assessed at baseline (when participants were ages 18 to 30) and 20 years later.The healthy  assessed were: not being overweight/obese, being a nonsmoker and physically active and having low alcohol intake and a healthy diet. 

By young adulthood (at the beginning of the study), less than 10 percent of the CARDIA participants reported all five healthy lifestyle behaviors. At the 20-year mark, about 25 percent of the study participants had added at least one healthy lifestyle behavior. Each increase in healthy lifestyle factors was associated with reduced odds of detectable  and lower intima-media thickness—two major markers of cardiovascular disease that can predict future cardiovascular events. Adulthood is not too late for healthy behavior changes to help the heart."

"That loss of healthy habits had a measurable negative impact on their coronary arteries," Spring said. "Each decrease in healthy lifestyle factors led to greater odds of detectable  calcification and higher intima-media thickness.

Spring said the healthy changes people in the study made are attainable and sustainable. She offers some tips for those who want to embrace a  at any age:Keep a healthy body weight; Don't smoke; Engage in at least 30 minutes of moderate to vigorous activity five times a week; No more than one alcoholic drink a day for women, no more than two for men; Eat a healthy diet, high in fiber, low in sodium with lots of fruit and vegetables.

From Science Daily:

Adults who lose weight at any age could enjoy improved cardiovascular health

Weight loss at any age in adulthood is worthwhile because it could yield long-term heart and vascular benefits, suggests new research. For the first time, the findings indicate that adults who drop a BMI category -- from obese to overweight, or from overweight to normal -- at any time during adult life, even if they regain weight, can reduce these cardiovascular manifestations. The findings are from a study examining the impact of lifelong patterns of weight change on cardiovascular risk factors in a group of British men and women followed since birth in March 1946. 

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Research reports and articles on the benefits of exercise have been piling up. Here are some worth looking at. From Science Daily:

Sitting too much, not just lack of exercise, is detrimental to cardiovascular health

Cardiologists have found that sedentary behaviors may lower cardiorespiratory fitness levels. New evidence suggests that two hours of sedentary behavior can be just as harmful as 20 minutes of exercise is beneficial.

From Science Daily:

Out of shape? Your memory may suffer

Here's another reason to drop that doughnut and hit the treadmill: A new study suggests aerobic fitness affects long-term memory. "The findings show that lower-fit individuals lose more memory across time," said a co-author. The study is one of the first to investigate young, supposedly healthy adults. 

From Science Daily:

Less exercise, not more calories, responsible for expanding waistlines

Sedentary lifestyle and not caloric intake may be to blame for increased obesity in the US, according to a new analysis. A study reveals that in the past 20 years there has been a sharp decrease in physical exercise and an increase in average body mass index (BMI), while caloric intake has remained steady. 

From Science Daily:

Older adults: Build muscle and you'll live longer

The more muscle mass older Americans have, the less likely they are to die prematurely, new research shows. The findings add to the growing evidence that overall body composition -- and not the widely used body mass index, or BMI -- is a better predictor of all-cause mortality. "In other words, the greater your muscle mass, the lower your risk of death," said the study's co-author. "Thus, rather than worrying about weight or body mass index, we should be trying to maximize and maintain muscle mass."

From Medical Xpress:

Keeping active pays off in your 70s and 80s

Older people who undertake at least 25 minutes of moderate or vigorous exercise everyday need fewer prescriptions and are less likely to be admitted to hospital in an emergency, new research has revealed.

Researchers from the Universities of Bath, Bristol and UWE-Bristol looked at data from 213 people whose average age was 78. Of people studied, those who carried out more than 25 minutes of moderate to vigorous physical activity per day – such as walking quickly, cycling or swimming - received 50 per cent fewer prescriptions than those who were more active over a four to five year period.

Such physical activity leads to a higher metabolism and better circulation, reducing the risk of conditions and diseases common in older age such as high blood presure, type 2 diabetes, coronary heart disease, and strokes.

From Everyday Health:

The Best Anti-Aging Medicine? Exercise

Everyone knows that exercise is good for you — it helps manage weight, improves muscle and bone strength, and even lifts your spirits. It can also add years to your life.“People have been looking for the secret to a long and healthy life for millennia,” said Neil Resnick, MD, chief of the division of geriatrics and director of the University of Pittsburgh Institute on Aging. “It turns out the most powerful intervention is exercise.”

A recent study conducted at Harvard found that exercise can be at least as effective as prescription drugs when it comes to preventing common conditions such as heart disease, stroke, and diabetes.

Exercise at any age is beneficial. From Science Daily:

Seniors who exercise regularly experience less physical decline as they age

Older adults in retirement communities who reported more exercise experienced less physical decline than their peers who reported less exercise, although many adults -- even those who exercised -- did not complete muscle-strengthening exercises, which are another defense against physical decline.

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Some good foods to eat for their health benefits. The following articles are from Science Daily:

Almonds reduce the risk of heart disease, research shows

Eating almonds can reduce the risk of heart disease by keeping blood vessels healthy, research has shown. Research found that they significantly increase the amount of antioxidants in the blood stream, reduce blood pressure and improve blood flow. These findings add weight to the theory that Mediterranean diets with lots of nuts have big health benefits... "Our study confirms that almonds are a superfood. Previous studies have shown that they keep your heart healthy, but our research proves that it isn't too late to introduce them into your diet -- adding even a handful (around 50g) every day for a short period can help.

Could grapefruit be good for your kidneys?

A natural product found in grapefruit can prevent kidney cysts from forming, new research indicates. Naringenin, which is also present in other citrus fruits, has been found to successfully block the formation of kidney cysts, an effect that occurs in polycystic kidney disease, by regulating the PKD2 protein responsible for the condition. With few treatments currently available, symptoms include high blood pressure and loss of kidney function, and lead to the need for dialysis.

More evidence that dark chocolate is good for you. From Science Daily:

Polyphenols could yield small benefit for people with PAD

In a small study, people with artery problems in their legs (peripheral artery disease) walked a little longer and farther when they ate dark chocolate -- a food rich in polyphenols.The authors suggest that compounds found in cocoa -- polyphenols -- may reduce oxidative stress and improve blood flow in peripheral arteries....Many other polyphenol-rich foods would offer less added sugar, saturated fats, and calories than dark chocolate, such as cloves, dried peppermint, celery seed, capers, and hazelnuts, to name a few.

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But I wonder if the results would be different if the only processed meat (cold cuts, salami, prosciutto) you ate came from antibiotic, hormone, additive, and nitrate-free meat. From Science Daily:

Processed red meat linked to higher risk of heart failure, death in men

Men who regularly eat moderate amounts of processed red meat such as cold cuts (ham/salami) and sausage may have an increased risk of heart failure incidence and a greater risk of death from heart failure. 

Processed meats are preserved by smoking, curing, salting or adding preservatives. Examples include cold cuts (ham, salami), sausage, bacon and hot dogs."Processed red meat commonly contains sodium, nitrates, phosphates and other food additives, and smoked and grilled meats also contain polycyclic aromatic hydrocarbons, all of which may contribute to the increased heart failure risk," said Alicja Wolk, D.M.Sc., senior author of the study and professor in the Division of Nutritional Epidemiology at the Institute of Environmental Medicine, Karolinska Institutet in Stockholm, Sweden. "Unprocessed meat is free from food additives and usually has a lower amount of sodium."

The Cohort of Swedish Men study -- the first to examine the effects of processed red meat separately from unprocessed red meat -- included 37,035 men 45-79 years old with no history of heart failure, ischemic heart disease or cancer. 

After almost 12 years of follow-up, researchers found:  - Men who ate the most processed red meat had more than a 2-fold increased risk of death from heart failure compared to men in the lowest category. - For each 50 gram (e.g. 1-2 slices of ham) increase in daily consumption of processed meat, the risk of heart failure incidence increased by 8 percent and the risk of death from heart failure by 38 percent. - The risk of heart failure or death among those who ate unprocessed red meat didn't increase.

"To reduce your risk of heart failure and other cardiovascular diseases, we suggest avoiding processed red meat in your diet, and limiting the amount of unprocessed red meat to one to two servings per week or less," said Joanna Kaluza, Ph.D., study lead author and assistant professor in the Department of Human Nutrition at Warsaw University of Life Sciences in Poland. "Instead, eat a diet rich in fruit, vegetables, whole grain products, nuts and increase your servings of fish."

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Interesting to think of bacteria and biofilms (bacterial communities resistant to treatment) involved in stress related heart attacks. From Science Daily:

Bacteria help explain why stress, fear trigger heart attacks

Scientists believe they have an explanation for the axiom that stress, emotional shock, or overexertion may trigger heart attacks in vulnerable people. Hormones released during these events appear to cause bacterial biofilms on arterial walls to disperse, allowing plaque deposits to rupture into the bloodstream, according to research published in published in mBio®, the online open-access journal of the American Society for Microbiology.

"Our hypothesis fitted with the observation that heart attack and stroke often occur following an event where elevated levels of catecholamine hormones are released into the blood and tissues, such as occurs during sudden emotional shock or stress, sudden exertion or over-exertion" said David Davies of Binghamton University, Binghamton, New York, an author on the study.

Davies and his colleagues isolated and cultured different species of bacteria from diseased carotid arteries that had been removed from patients with atherosclerosis. Their results showed multiple bacterial species living as biofilms in the walls of every atherosclerotic (plaque-covered) carotid artery tested.

In normal conditions, biofilms are adherent microbial communities that are resistant to antibiotic treatment and clearance by the immune system. However, upon receiving a molecular signal, biofilms undergo dispersion, releasing enzymes to digest the scaffolding that maintains the bacteria within the biofilm. These enzymes have the potential to digest the nearby tissues that prevent the arterial plaque deposit from rupturing into the bloodstream. According to Davies, this could provide a scientific explanation for the long-held belief that heart attacks can be triggered by a stress, a sudden shock, or overexertion.

To test this theory they added norepinephrine, at a level that would be found in the body following stress or exertion, to biofilms formed on the inner walls of silicone tubing."At least one species of bacteria -- Pseudomonas aeruginosa -- commonly associated with carotid arteries in our studies, was able to undergo a biofilm dispersion response when exposed to norepinephrine, a hormone responsible for the fight-or-flight response in humans," said Davies. Because the biofilms are closely bound to arterial plaques, the dispersal of a biofilm could cause the sudden release of the surrounding arterial plaque, triggering a heart attack.

To their knowledge, this is the first direct observation of biofilm bacteria within a carotid arterial plaque deposit, says Davies. This research suggests that bacteria should be considered to be part of the overall pathology of atherosclerosis and management of bacteria within an arterial plaque lesion may be as important as managing cholesterol.

Note the red biofilm bacterial colonies within the diseased arterial wall:

Bacteria stained with a fluorescent bacterial DNA probe show up as red biofilm microcolonies within the green tissues of a diseased carotid arterial wall.

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Moderate levels of exercise seems to have tremendous benefits for everyone, but there are downsides to being an extreme exerciser.  From Science Daily:

Elderly men with high blood pressure lower death risk with moderate fitness

Elderly men with high blood pressure can lower their risk of death with even moderate levels of fitness. "This level of fitness is achievable by most elderly individuals engaging in a brisk walk of 20 to 40 minutes, most days of the week," said Charles Faselis, M.D., lead author of the study.

For the study, researchers assessed the fitness status of 2,153 men, aged 70 years and older with high blood pressure by a standard treadmill exercise test. Researchers applied the international units used to measure fitness, called metabolic equivalents (METs), to determine the men's peak fitness levels. After an average follow-up of nine years, researchers found that the risk of death was 11 percent lower for every one-MET increase in exercise capacity.

"For every 100 people who died in the least-fit category, 82 died in the low-fit, 64 in the moderate-fit and 52 in the high-fit categories," Kokkinos said. "The death rate is cut in half for those in the highest fitness category."

Too much exercise also has negatives for men. From Medical Xpress:

Too much prolonged high-intensity exercise risks heart health

Overdosing on high intensity exercise may actually increase the risk of death from a heart attack or stroke in those with existing heart disease, suggests German research published online in the journal Heart.

Similarly, a second Swedish study in the journal suggests that young men undertaking endurance exercise for more than five hours a week may increase their risk of developing an irregular heart rhythm in later life.

Both sets of findings indicate a J-shaped curve for the health benefits of exercise... And they describe "a similar U-shaped or reverse J-shaped pattern for the dose-response effect of exercise: maximum cardiovascular benefits are obtained if performed at moderate doses, while these benefits are lost with (very high) intensity and prolonged efforts."

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It seems that research showing benefits of exercise is multiplying. This study only looked at men, and if you look at the "after age 40 group", their average age of starting endurance training was 48. From Science Daily:

Forty not too old or too late to start endurance training

A study of healthy senior men has found that "relatively intensive" endurance exercise confers benefits on the heart irrespective of the age at which they began training. The benefits were evident and comparable in those who had started training before the age of 30 or after the age of 40. As a result, said the investigators, 40 is not too old to start endurance training.

The study was performed in 40 healthy men (without cardiovascular risk factors) aged between 55 and 70 years who were divided for assessment according to the level of exercise they took and the ages at which they began. Thus, 10 of the men had never exercised for more than 2 hours a week throughout their lives, and 30 had exercised for at least 7 hours a week for over five years.

The regular exercise they took was either running or cycling. Those beginning before the age of 30 had been training for an average of 39 years (since the age of 22) and those starting at 40 for 18 years (since the age of 48).

First, resting heart rate was found to be similar between the two exercise groups (T30 56.8 bpm, T40 58.1 bpm), but significantly faster in the non-exercising men (69.7 bpm). Maximal oxygen uptake was also similar between the T30 (47.3 ml/min/kg) and T40 groups (44.6 ml/min/kg), but significantly lower in the non-exercising men (33.0 ml/min/kg).

The study also found no difference between T30 and T40 in cardiac echocardiography tests. "Thus," said Matelot, "despite biological changes with age, the heart still seems -- even at the age of 40 -- amenable to modification by endurance training. Starting at the age of 40 does not seem to impair the cardiac benefits.

Matelot pointed out that aging is associated with adverse structural and functional changes to the cardiovascular system. And, while physical activity is unable to prevent these changes, it is able to slow them down.

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Once again research shows problems with physical inactivity: this time heart disease risk in women. From Science Daily:

From age 30 onwards, inactivity has greatest impact on women's lifetime heart disease risk

From the age of 30 onwards, physical inactivity exerts a greater impact on a woman's lifetime risk of developing heart disease than the other well-known risk factors, suggests research published online in the British Journal of Sports Medicine. This includes overweight. the findings show, prompting the researchers to suggest that greater effort needs to be made to promote exercise.

The researchers wanted to quantify the changing contribution made to a woman's likelihood of developing heart disease across her lifetime for each of the known top four risk factors in Australia: excess weight (high BMI); smoking; high blood pressure; and physical inactivity. Together, these four risk factors account for over half the global prevalence of heart disease, which remains the leading cause of death in high income countries.

They based their calculations on estimates of the prevalence of the four risk factors among 32,154 participants in the Australian Longitudinal Study on Women's Health, which has been tracking the long term health of women born in 1921-6, 1946-51, and 1973-8, since 1996.

Combining the prevalence and relative risk data, the researchers found that up to the age of 30, smoking was the most important contributor to heart disease, with a PAR of 59%. But from age 30 until the late 80s, low physical activity levels were responsible for higher levels of population risk than any of the other risk factors.

The researchers estimate that if every woman between the ages of 30 and 90 were able to reach the recommended weekly exercise quota -- 150 minutes of at least moderate intensity physical activity -- then the lives of more than 2000 middle aged and older women could be saved each year in Australia alone.