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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

Move — and Move Often!

While most physicians and nutritionists agree that low to moderate levels of weekly physical activity is often insufficient to significantly reduce body weight, studies indicate that those who transition from little to no daily physical activity to moderate levels have clinically meaningful reductions in cardiometabolic risk.

Scores of controlled trials over the last decade demonstrate that physical activity helps mitigate and reduce cardiometabolic risk via biologic mechanisms, which are not entirely dependent upon body weight or BMI reduction. Research increasingly supports that those who have prediabetes should consistently increase physical activity levels, despite little to no weight loss.

According to research published in the European Journal of Preventive Cardiology, the benefits of physical activity may outweigh the impact of being overweight and/or obese in middle-aged and elderly people. The observational study, conducted with a sample size of over 5,000 people aged 55 years and older, followed up with participants for 15 years. While overweightness and obesity is associated with a higher risk of cardiovascular disease, and weight loss is recommended, it is slightly different with the elderly population: weight loss, especially unintentional, is often associated with muscle loss and death.

Regardless of age, physical activity is associated with a lower risk of cardiovascular disease. Studies have further demonstrated that physical activity is protective for cardiovascular risk, playing a crucial role in the health of middle-aged and elderly people. Without adequate physical activity, those who are overweight and obese are at a significantly higher risk of developing cardiovascular disease.

The harmful effects of overweightness and obesity occur through adipose tissue, which accelerates the atherosclerotic process, thereby increasing cardiovascular risk. Exercise and physical activity lowers the harmful effects of atherosclerosis by reducing the stabilization of plagues on blood vessels, ultimately reducing the heart’s oxygen demand. Engaging in high levels of physical activity protects people from the harmful effects of adipose tissue on cardiovascular disease. The idea: move—and move often!

Announcing Dr. Paul Grundy for Boston’s Business of Medicine Pre-Conference

CMHC is excited to announce Paul Grundy, MD, MPH, FACOEM, FACPM as a speaker for the pre-conference Business of Medicine Day at the 12th Annual Cardiometabolic Health Congress in Boston. As Chief Medical Officer and Global Director of Health Transformation at IBM, Dr. Grundy is one of less than 100 IBM employees—and the only physician—selected into the company’s senior industry leadership forum: the IBM Industry Academy.

Dr. Grundy’s work focuses on shifting global healthcare delivery towards data-driven, consumer-focused, accountable systems, through the adoption of new information technologies and incentives systems. In his role, Dr. Grundy develops and executes strategies that support IBM’s healthcare-industry transformation initiatives, while acting as an active social entrepreneur, advocate, and speaker on global healthcare revolutions. His work has been published and reported widely in newspapers, radio, and television across the country, and he has been the recipient of the prestigious Barbara Starfield Primary Care Leadership Award, and the National Committee for Quality Assurance Award.

Dr. Grundy’s session, The Patient-Centered Medical Home: A Foundation for Patient Satisfaction, will begin at 11:00 AM on Wednesday, October 4th.  Visit www.cardiometabolichealth.org for more information and registration details.

Chronic Stress & Obesity: A New Perspective on “Comfort Food”

The biological connection between stress and obesity has long been suspected: during times of high anxiety and stress, people often crave ‘comfort foods,’ which are high in fat or sugar. Researchers have now found that specific hormones may play a significant role in this process: stress has been linked to biochemical changes that can trigger cravings, which lead to overeating, and ultimately result in obesity.

Specific biochemical reactions help explain this correlation: when we reach for fattening foods during stressful times, it is often an attempt to self-mediate—carbohydrates raise the body’s serotonin levels, the body’s ‘feel-good’ chemical. Researchers have also discovered that chronic stress can cause the body to release excess cortisol, a hormone critical in managing fat storage and energy use. Cortisol is known to increase appetite, and may encourage cravings for sugary and fatty foods.

More recent studies suggest that our bodies process food differently when under stress. One study found that lab mice, when fed a diet high in fat and sugar, gained significant amounts of body fat when placed under stressful conditions. Conversely, mice fed a normal diet did not gain as much weight—despite being placed under stressful conditions. Researchers linked this phenomenon to the molecule neuropeptide Y, which is released from nerve cells during stress and encourages fat accumulation. Diets high in fat and sugar appear to further accelerate the release of neuropeptide Y.

As physicians better understand the factors behind weight gain, they may be better equipped to help address the global obesity epidemic. Yet the most insidious aspect of the link between stress and obesity is that it is often self-reinforcing. When people are stressed and make unhealthy choices, they often gain weight, which only serves to further exacerbate stress.

While stress is an inevitable part of life, it does not necessarily need to lead to weight gain. By keeping portion size in mind, not allowing yourself to become too hungry, eating healthy snacks, and becoming more mindful about nutrition, we can avoid gaining weight when times are tough.

In order to gain more information surrounding nutrition, weight, and cardiometabolic disease, attend our CMHC Regional Conference Series. These one-day intensive workshops are designed to instruct participants in weight management, nutrition, and the prevention, management, and treatment of cardiovascular disease. Our upcoming agenda in Atlanta features a session titled Good Weight Management is Good Cardiometabolic Risk Management, delivered by Donna H. Ryan, MD.

Heart Failure in the South

A recent ethnographic study titled “Heart Failure Incidence and Mortality in the Southern Community Cohort Study (SCCS)” investigated heart failure incidence, and post-heart failure survival, by race and sex among low-income adults in the southern parts of the United States.

Heart failure risk factors in the study included hypertension, diabetes, myocardial infarction, and obesity. The participants—27,078 white and black men and women enrolled during 2002 to 2009 in the SCCS—had no history of heart failure. Over a median follow-up of almost 5 ½ years, 4,341 participants were diagnosed with heart failure. Among these cases, 952 deaths occurred over a median follow-up of 2.3 years. Researchers ultimately concluded that heart failure in this population was higher for all race-sex groups than previously reported in other studies.

While this segment of the population, geographically located in the South, had a significantly high instance of heart failure, a number of other studies have indicated that heart disease burden has shifted to the Southern United States. Study findings published in the American Heart Association journal Circulation reveal that the highest death tolls have shifted to the Deep South over the past few decades.

Researchers at the Centers for Disease Control and Prevention analyzed heart-related deaths across the United States and found that trends often vary by factors like gender, race, and location. In order to learn more about the geographic trends, researchers analyzed U.S. mortality statistics from 1973 to 2010, calculating mortality rates in two-year intervals and including heart-related deaths in adults 35 years or older.

By 2010, researchers found that the highest death rates were in Southern states like Alabama, Mississippi, and Arkansas. Researchers further noted that declines in heart disease mortality have been slowest in Southern states, compared to the rest of the country.

These findings highlight the need to address significant health disparities in the United States; the concentration of heart disease in the Southern United States is likely due to geographic and racial differences in heart disease prevention and treatment. In order to fully understand these geographic trends, it is critical to recognize the biological, behavioral, and environmental factors that influence them.

Learn more about the prevention, diagnosis, and treatment of cardiovascular disease at our upcoming CMHC Regional Conference in Atlanta, Georgia. The last session of the day will be “Getting to the Heart of the Matter: Diagnosis and Treatment of HTN and HF in Primary Care.” 

The Urgency of Obesity: “The HIV of our age”

Across the world, experts on cardiovascular health and obesity are regularly discussing the urgency regarding the global health epidemic of obesity, considered to be the ‘HIV of our age. The metaphor is eerily accurate; obesity routinely kills millions of people across the world, and costs health institutions billions of dollars—despite its preventability. A 2007 Government Foresight Report estimated that approximately half of the UK population would be obese by 2050, but researchers believe that it might occur even sooner. A report published today by Aetna International, one of the world’s leading health insurance providers, reaffirms the urgency required to limit the global fallout from rising obesity levels.

The report, titled “Globesity: Tackling the world’s obesity pandemic,” calls upon major institutions, governments, food producers, retailers, and insurance companies to collectively combine efforts in order to cooperatively tackle the growing global obesity crisis. Statistics from the World Health Organization indicate that obesity rates have more than doubled since 1980: currently, 13% of adults are classified as obese; nearly 40 meet the criteria for being overweight.

Moreover, a host of studies have found strong correlations between at least 15 cancers and obesity, in addition to an extensive list of severe health problems, including type 2 diabetes, fatty liver disease, arthritis, coronary heart disease, and stroke.

The necessity of education improvement, in order to promote healthy living, is critically pressing—particularly as the obesity pandemic begins to affect increasing numbers of children. Implementation of public education programs would begin to raise awareness, specifically concerning the strong link between obesity and heart disease. The sole way to solve the obesity crisis is through a holistic approach, one that combines health incentives, taxes, and education programs. Studies have confirmed that one of the most effective ways in which to reduce obesity is to clearly communicate information about its direct correlation with health and disease.

Like HIV, obesity has the makings of a ‘public health catastrophe’—one that must be averted at all costs.

Unscrambling Eggs: Nutrition Science

A recent article published through National Public Radio analyzes and assesses one of humankind’s most reliable source of calories: eggs, which have historically been obtained “with minimal exertion and zero horticulture skills.”

In the late 1970s, specifically, the appreciation of eggs was at an all-time high, as physicians began to realize that excess cholesterol is a strong predictor for a higher risk of cardiovascular disease. Subsequently, many doctors assumed that eating high-cholesterol foods like meat, butter, and eggs would likely have a negative impact on health, and should thus be avoided.

Yet the nutritional science behind eggs, and foods generally high in cholesterol, is more nuance and complex. While cholesterol objectively can contribute to heart disease by literally blocking the body’s blood vessels, and eating foods high in cholesterol can raise its levels in the blood, an emerging and growing body of research has shown that the consumption of sugar, transfats, and excessive saturated fat is far more harmful to cholesterol levels than actual dietary cholesterol.

Studies and scientific research have gradually come to the consensus that some degree of cholesterol consumption is harmless—if not outright healthy—and that eggs should not be feared and avoided at all costs. Conversely, experts worry that if science is ‘misinterpreted and spun by the media,’ both the egg industry and opportunistic doctors will spin through the perpetual cycle of self-help revenue that is the foundation of diet science.

Dr. Walter Willett, chair of the Harvard T.H. Chan School of Public Health’s Nutrition Department, was one of the first U.S. physicians to determine that while previous findings have demonstrated that cholesterol in the blood has a correlation with a higher risk of heart disease, no studies had indicated that cholesterol consumption actually increases blood levels. Remember: correlation does not necessarily indicate causation.

Willett and his colleagues have since studied thousands of patients for years, and have found no evidence that moderate dietary cholesterol or egg consumption increases the risk for heart disease and stroke—except in people with a particularly strong genetic risk for high cholesterol. These findings reiterate and reaffirm those from a 2013 published study, which report that eating one egg per day is not associated with impaired heart health.

Further complicating this, however, is an abundance of studies funded by the egg industry that support egg consumption, which loosely interpret scientific data in the interest of profit. While there is no strong data upon which to base a specific numerical limit to a dietary cholesterol intake, guidelines continue to recommend that cholesterol intake should be as low as possible, and part of a generally healthy diet that is primarily rooted in fruits, vegetables, nuts, and whole grains—all thought to lower blood cholesterol and the risk of cardiovascular disease.

“An Apple A Day…”

A multitude of research indicates that consuming at least ten portions of fruits and vegetables per day significantly lowers the risk of cancer and heart disease. While the “five-a-day-rule” yields significant benefits, an extra five portions even further reduces the chance of disease development.

A study published in the International Journal of Epidemiology predicts that if everyone ate ten portions of fruits and vegetables per day, approximately 7.8 million premature deaths could be prevented—including a dramatic decrease in stroke, heart attacks, and cardiovascular disease. While the current UK guidelines are to eat at least five portions, or 400 grams, per day, fewer than one in three adults are thought to meet this target.

Yet researchers found that even smaller intakes had benefits: a daily intake of two-and-a-half portions was associated with a 16% reduction in heart disease, a 4% decrease in cancer, and a 15% lessening in the risk of premature death. The consumption of ten portions per day was associated with more dramatic decreases—the maximum protection against disease and premature deaths.

The scientific studies reveal that fruit and vegetables reduce cholesterol levels, blood pressure, and boost the health of blood vessels and the overall immune system. Compounds called glucosinolates in cruciferous vegetables—such as broccoli—activate enzymes that may also help prevent cancer. Fruits and vegetables may also have a beneficial effect on the naturally occurring gut bacteria, and contain many antioxidants that may reduce DNA damage.

It is critical to eat whole plants in order to receive the aforementioned benefits, as the beneficial compounds cannot be easily replicated in a supplementary pill. As a high intake of fruit and vegetables holds tremendous health benefits, we should all attempt to increase their intake in our diets.

Unhealthy “Health Fads”

A new paper recently published in the Journal of the American College of Cardiology outlines several trendy ‘health fads’ that—in reality—are actually detrimental to a solidly nutritious diet.

While juicing has long been touted as a popular method to detoxify the body and lose weight, studies now demonstrate that while juicing may improve absorption of some plant nutrients, it leaves out a considerable amount of the fiber found in whole fruits and vegetables. Moreover, people who drink large quantities of juice tend to drink more concentrated calories, without feeling full and satiated afterwards. Research indicates that drinking calories is not as fulfilling as chewing them.

Another trend that has emerged as a global ‘dietary craze’ is coconut oil—yet it is naturally loaded with unhealthy, saturated fats. Additionally, the widespread gluten-free diet ultimately yields little positive health benefit for people not afflicted with gluten sensitivity or celiac disease. Using olive and vegetable oils in cooking is both more prudent and nutritious, as they contain healthy unsaturated fats.

The aforementioned conclusions are part of a newly released review of the latest scientific evidence concerning food and nutrition, initially conducted to shed light on the latest diet fads. The review’s lead author Dr. Andrew Freeman, co-chair of the American College of Cardiology’s Lifestyle and Nutrition Work Group, has articulated that there is a widespread confusion in terms of nutrition. The review of medical evidence related to overall healthy eating patterns and specific popular dietary fads in the country further reveals that high-dose antioxidant dietary supplements do not produce any more benefits than simply eating foods rich in antioxidants.

Eating a well-balanced diet generally does not require additional vitamin supplementation, and whole grains are ultimately healthier for people than gluten-free alternatives, which are often higher in processed carbohydrates. Researchers conclude that the best route to health is a predominantly plant-based diet that concentrates on whole unprocessed foods, with fruits and vegetables that are “antioxidant-rich nutrient powerhouses.”

Failing Fertility: Obesity & Conception

A recent study has found that obese couples likely take longer to conceive.

An analysis from the U.S. National Institutes of Health suggests that when both a woman and her partner meet the criteria for obesity, their chances for pregnancy are approximately half that of a couple with normal weights.

While this research analyzes a new risk factor for obesity, previous studies have indicated a strong correlation between female obesity and reduced odds for pregnancy during a menstrual cycle—in addition to an association between men’s increased body weight and lower sperm count.

This study is particularly groundbreaking as it utilized couples hoping to get pregnant, not couples undergoing fertility treatments. Researchers took measurements of body fat before they conceived, and followed each couple for a year—or until pregnancy occurred. Moreover, many studies on fertility and body composition have previously focused on the female partner, yet these findings highlight the importance of including both partners’ weights

“Overall, obese couples were found to have approximately half the fecundability as couples with normal BMI,” wrote Rajeshwari Sundaram, from the National Institute of Child Health and Human Development.

According to statistics, more than a third of Americans are obese, which consistently causes a variety of health issues. Obese and overweight people tend to have higher levels of inflammation in their bodies; fat cells also produce hormones that may interfere with the hormones involved in conception.

A project conducted by the Trust for America’s Health projects that by 2030, 44% of Americans will be obese.

Shoveling in Snowstorms: Bad for the Heart?

A new study published in the Canadian Medical Association has found that the days following a heavy snowfall often carry a significantly greater risk of heart attacks for men.

The medical community has long suspected that snow shoveling can increase heart attacks at a population level, yet this study concretely confirms the link between snowfall and heart attacks.

Researchers from the University of Montreal gathered reports of 128,073 hospital admissions and 68,155 deaths from heart attacks in Quebec between the months of November and April, every year between 1981 and 2014. The team also obtained weather information that corresponded to the time frames and regions included in the study.

When comparing the medical and weather data, the researchers found that the most dangerous days occurred immediately following snowfalls: almost one third of all hospital admissions and deaths due to heart attacks occurred on these days. Moreover, the risk was even greater subsequent to snowfalls that lasted two to three days.

The findings serve as a reminder that people should remain vigilant about potential cardiovascular risks, in addition to automobile accidents and snow-related falls. Furthermore, snow shoveling is challenging for the heart, and can pose an extreme strain and danger if overdone.

Because the study analyzed trends over time, it did not establish a specific cause-and-effect relationship between snow-related activities like shoveling and heart attacks. Yet the authors’ hypothesis—that men are more likely to shovel post-snowstorm, and that shoveling is responsible for the increased risk of heart attacks—is more than plausible, and reason enough to approach shoveling with care and caution.

The study further indicates that the physical exertion and cold temperatures associated with shoveling snow set the stage for an “eco-biological-behavioral perfect-storm,” particularly for those out of shape, or people with other heart disease risk factors.

While shoveling is likely the primary reason that heart attacks increase after a snowstorm, it is critical to be mindful of heart health all year round. In addition to avoiding shoveling, people should also be physically active and have a nutritious diet.