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Cardio Metabolic Health Congress – Official Blog

Cheese: A Heart Healthy Snack?

Cheese is typically considered more of an indulgence than a health food, but a new review of research suggests that it may not be as bad for you as once thought. In fact, people in the analysis who ate a little bit of cheese every day were less likely to develop heart disease or have a stroke, compared to those who rarely or never ate cheese.

Cheese, like other dairy products, contains high levels of saturated fat—which has been linked to high cholesterol, atherosclerosis and an increased risk of heart disease. (Recently, however, some nutrition experts believe that saturated fat is more benign.) But cheese also contains potentially beneficial ingredients like calcium, protein and probiotics, wrote the authors of the new paper, published in the European Journal of Nutrition.

To learn more about how long-term cheese consumption affects a person’s risk for cardiovascular disease, researchers from China and the Netherlands combined and analyzed data from 15 observational studies including more than 200,000 people. All but one of the studies excluded people with existing heart disease, and all but two tracked people for 10 years or more.

The researchers’ findings were “certainly different from what people might expect,” says Dr. Allan Stewart, director of aortic surgery at Ichan School of Medicine at Mount Sinai Medical Center, who was not involved in the new analysis. Overall, people who consumed high levels of cheese had a 14% lower risk of developing coronary heart disease and were 10% less likely to have a stroke than those who rarely or never ate cheese.

The relationship, however, was U-shaped rather than linear—meaning that higher quantities of cheese were not necessarily better. The people who had the lowest risks for heart disease and stroke were those who consumed, on average, about 40 grams a day—about the size of a matchbook. (According to the review, the average American eats about 42.5 grams a day.)

“This is not the same as eating a big slice of cheesy pizza every day,” says Stewart. He also cautions against reading too much into data that’s self-reported—as much of the data was—because people tend to over- or under-estimate their consumption of specific foods.

Stewart points out that the study was only able to find an association between cheese consumption and decreased risk of heart disease, rather than a cause-and-effect relationship. It could be that people who eat cheese on a daily basis are healthier overall, or have more disposable income and higher socioeconomic statuses.

But it’s also possible that cheese has beneficial qualities that offset the negative impact of its high saturated fat content, says Stewart. “Cheese can be high in probiotics, which tend to put you in less of an inflammatory state,” he says. Cheese also contains conjugated linoleic acid (CLA), an unsaturated fatty acid that may increase the amount of of HDL “good” cholesterol and decrease “bad” LDL levels.

“There is some evidence that cheese—as a substitute for milk, for example—may actually have a protective effect on the heart,” says Stewart. “No one’s saying you should definitely go out and eat 40 grams of cheese a day. But on the upside, a bit of cheese on a cracker doesn’t sound unreasonable.”

The study did not look at different types of cheeses, and Stewart says more research is needed to know whether certain varieties hold more health benefits (or risks) than others. Overall, though, the news is good for cheese lovers.

“We’re always are searching for ways to minimize heart disease and reduce atherosclerosis,” he says. “It’s promising to find that something that actually tastes good—and pairs well with a nice glass of red wine—may offer some protection, as well.”

Weight Loss Counseling? Not So Much.

Adults who are overweight or obese report receiving little weight loss counseling, especially involving medications and surgery; however, many report trying to lose weight within the last 12 months, according to a speaker at ObesityWeek. 

“We know that less than 50% of patients with obesity have reported receiving weight loss counseling within a provider visit and most providers, primary care providers, provide no counseling at all,” Sean J. Iwamoto, MD, a postdoctoral fellow in the division of endocrinology, metabolism & diabetes at the University of Colorado School of Medicine, Anschutz Medical Campus, said during his presentation. “At baseline it seems that primary care providers seem to overvalue exercise, meaning they find its more comfortable to discuss exercise with their patients, as well as they feel it’s the most effective way to lose weight, and they undervalue other things like weight loss medications. We also know that obesity medications are effective but prescription rates are low.”

Iwamoto and colleagues evaluated data from the Patient Outcomes Research to Advance Learning (PORTAL) on 2,811 adults (median age, 52 years; 54.2% white; 61.8% women; 79.4% with obesity) to determine weight-related health care experiences. Participants completed a survey in the summer of 2015 to report on personal experiences from providers.

Among participants with obesity, 79.8% tried to lose weight in the last 12 months, more than half exercised or changed eating habits and less than 9% used weight loss programs or medications. Fewer than 3% had weight loss surgery.

Participants reported that their health care providers only sometimes (49.5%) or never (17.1%) brought up weight at clinic visits. Discussions about lifestyle change (83.7%) and weight loss programs (62%) were reported more often than meal replacements (19.2%), surgery (15.6%) or medications (10.6%).

“Overall, most patients with overweight and obesity have tried to lose weight by changing eating habits and exercising, very few have tried medications, weight loss programs and surgery,” Iwamoto said. “Also, they have received little information about medications and surgery even when its indicated.”

Coffee & Cardiovascular Health

You can feel less guilty reaching for your third espresso shot in the midst of the holiday craziness this season— a recent study has linked that extra cup of coffee (up to six cups daily!) to a decreased risk of of heart failure, stroke and coronary heart disease.

Researchers from the University of Colorado School of Medicine presented their findings last week at the American Heart Association’s Scientific Sessions 2017, reporting that every 8-ounce cup of coffee per day reduced heart failure risk by 7 percent, stroke risk by 8 percent and coronary heart disease by 5 percent in comparison to non-coffee drinkers. While this is not the first study of its kind to identify a link between drinking coffee and cardiovascular health, it is the first study to offer numerical data to back up previous research suggesting that coffee’s antioxidant-rich, anti-inflammatory makeup contributes to overall heart health.

Researchers applied machine learning, a process that uses artificial intelligence to track algorithms and patterns within data sets, to analyze the relationship between drinking coffee and cardiovascular health from across three well-known studies: the Framingham Heart Study, the Cardiovascular Heart Study and the Atherosclerosis Risk In Communities Study. All three previous studies are recognized by the American Heart Association and contained useful data, tracking which food and beverages participants were consuming and how their cardiovascular health improved or worsened over time.

“Our findings suggest that machine learning could help us identify additional factors to improve existing risk assessment models. The risk assessment tools we currently use for predicting whether someone might develop heart disease, particularly heart failure or stroke, are very good but they are not 100 percent accurate,” said study author Laura M. Stevens, B.S. While the researchers confirmed that machine learning cannot definitively prove cause and effect, the correlations between coffee consumption and heart health were promising, paving the way for more studies to utilize machine learning in order to more deeply examine relationships between certain foods or beverages and health.

It’s critical to point out that the researchers were examining the effects of coffee and coffee alone—the positive health effects surrounding your morning cup aren’t taking into consideration what you’re adding into it. Businesses have adapted to the overwhelming amount of ways people take their coffee in 2017; Starbucks is perhaps the most infamous in its availability of choice, where it’s customary to get held up in line while the barista prepares a “Grande iced, Half-Caff Ristretto 4-Pump Sugar-Free Cinnamon Dolce Soy Skinny Latte,” for the person in front of you. Regardless of which type of milk, milk substitute, or sweetener you reach for, the research shows that black coffee is the safest and simplest way to consume coffee and reap its health benefits.

Canine Companions & Heart Health

The benefits that come with owning a dog are clear– physical activity, support, companionship — but owning a dog could literally be saving your life.

Dog ownership is associated with a reduced risk for cardiovascular disease and death, finds a new Swedish study published Friday in the journal Scientific Reports.

For people living alone, owning a dog can decrease their risk of death by 33% and their risk of cardiovascular related death by 36%, when compared to single individuals without a pet, according to the study. Chances of a heart attack were also found to be 11% lower.
Multi-person household owners also saw benefits, though to a lesser extent. Risk of death among these dog owners fell by 11% and their chances of cardiovascular death were 15% lower. But their risk of a heart attack was not reduced by owning a dog.

“A very interesting finding in our study was that dog ownership was especially prominent as a protective factor in persons living alone, which is a group reported previously to be at higher risk of cardiovascular disease and death than those living in a multi-person household,” said Mwenya Mubanga, an author on the study and PhD student at Uppsala University.

As a single dog owner, an individual is the sole person walking and interacting with their pet as opposed to married couples or households with children, which may contribute to greater protection from cardiovascular disease and death, said the study.

Owners of hunting breeds, including terriers, retrievers, and scent hounds, were most protected from cardiovascular disease and death. However, owning any dog will reduce an owners risk of death, just to different extents, said Tove Fall, senior author of the study and Associate Professor in Epidemiology at Uppsala University.

The study looked at over 3.4 million Swedish individuals between the ages of 40 and 80 sampled from a national database and the Swedish Twin Register over a 12-year study period. “We know that dog owners in general have a higher level of physical activity, which could be one explanation to the observed results,” said Fall. This includes taking the dog out for a walk in any weather condition. The findings also suggest increased social well-being and immune system development as additional reasons why dog ownership offers protection against cardiovascular disease and death.

One factor behind this may be because dogs bring dirt into homes and they lick you, which could impact your microbiome — the bacteria that live in your gut — and thus your health. “It may encourage owners to improve their social life, and that in itself will reduce their stress level, which we know absolutely is a primary cause for cardiovascular disease and cardiac events,” said Dr. Rachel Bond, Associate Director of Women’s Heart Health at Lenox Hill Hospital in New York City, who was not involved in the research.

The Co-Occurrence of Diabetes & Heart Disease

The number of people living with diabetes has tripled since 2000, leading to enormous financial ramifications: the global cost of the disease is $850 billion each year. The latest estimates from the International Diabetes Federation indicate that one in 11 adults worldwide have diabetes; most have type 2 diabetes, which is strongly linked to obesity and lack of exercise. There is a strong link between type 2 diabetes and cardiovascular disease, as people with diabetes are more than twice as likely to develop cardiovascular disease and lower life expectancy.

According to a study presented at the American Heart Association’s Scientific Sessions last week, data indicates that children and young adults with diabetes mellitus have a fivefold increased risk of all-cause mortality, and a sevenfold increased risk of sudden cardiac death, compared with age-matched individuals without diabetes. The findings highlight the critical need for continuous cardiovascular risk monitoring and management in young people with DM.

Less than half of those diagnosed with diabetes are aware that the diseases places them at a much higher risk for cardiovascular disease complications; the lack of awareness prevents addressing risks and improving health–often leading to preventable deaths. Ken Thorpe, Chairman of the Partnership to Fight Chronic Disease, urges education and the power of prevention. “We must do better to diagnose, treat, and prevent chronic conditions like diabetes and cardiovascular diseases, and one of the first and most important actions we can take is to raise awareness among patients, providers, and policymakers of the alarming co-existence of these two debilitating conditions, and what can be done to avoid them in the first place.”

The total number of diabetes worldwide is now 451 million, and is expected to reach 693 million by 2045 if current trends continue.

New Guidelines for High Blood Pressure

According to a joint statement issued Monday by the American Heart Association and the American College of Cardiology, nearly half of all adult Americans will be considered to have high blood pressure under new guidelines. “The numbers are scary,” said Dr. Robert M. Carey, professor of medicine at the University of Virginia and co-chair of the committee that formulated the new guidelines.

The nation’s leading heart experts state that tens of millions more Americans will now meet criteria for the condition of high blood pressure, as the redefinition is now a reading of 130 over 80, down from 140 over 90. The number of adults with high blood pressure, or hypertension, will rise to 103 million from 72 million under the previous standards—meaning that 46% of U.S. adults will be considered hypertensive.

Carey states that the reformulation stems from the recognition that blood pressure considered ‘normal’ in the past—or ‘pre-hypertensive’—actually placed patients at significant risk for heart disease and death and disability, as medical evidence confirms that people with high blood pressure in the 130-139 range carry a doubled risk of heart attack, stroke, and heart and kidney failure. “The risk hasn’t changed. What’s changed is our recognition of the risk.”

Nevertheless, the report’s authors predict that few of those who fall into the new hypertensive category will require medication. Rather, the hope is that many with early stages of the condition will address it through lifestyle changes, including weight loss, diet improvements, increased physical activity, less alcohol and sodium consumption, and lowered stress. “An important cornerstone of these new guidelines is a strong emphasis on lifestyle changes as the first line of therapy. There is an opportunity to reduce risk without necessarily imposing medications,” said Richard Chazal, the immediate past president of the American College of Cardiology.

High blood pressure is the leading cause of death worldwide, and the second-leading cause of preventable death in the United States, after cigarette smoking. Hypertension is often a precursor for cardiovascular disease, strokes, severe kidney disease, and other disorders that kill millions annually. Thomas R. Frieden, the former director of the U.S. Centers for Disease Control and Prevention who now runs a global health initiative that focuses on heart disease and stroke, has called hypertension “the world’s most under-addressed preventable health problem.”

Big Data for Better Hearts

The genomics revolution has brought personalized medicine to cancer and rare diseases; an EU-funded initiative aims to bring cardiovascular care into the genomics era. The €19 million project, funded by the EU’s Innovative Medicines Initiative, was launched in order to apply the power of genomics and big data to cardiovascular health.

The project is a recognition that in the face of the enormous burden of heart failure, atrial fibrillation and acute coronary syndrome, the field lags behind other major disease areas in using genomic and big data to improve patient outcomes.

It is hoped that the outputs will lead to a major revamp of clinical guidelines in cardiology. The researchers involved in BigData@Heart have been instrumental in shaping current treatment and management of heart conditions and there is an emerging consensus that these should be updated to reflect advances in big data.

“Today’s treatment guidelines reflect the scientific constraints of an earlier era where clinical markers to guide therapy were limited to conventional risk factors and end-organ damage, and where the main endpoint in clinical trials is patient death and hospitalization,” said project member Stefan Anker of Charité University Medicine, Berlin. “Our goal is to build a much more personalized, data-driven system that brings cardiology into the ‘omics era.”

While the treatment of cardiovascular diseases has improved vastly in recent decades, the human and economic cost of lost productivity, hospitalization and death remains substantial, said Maureen Cronin of the pharmaceutical company Vifor Pharma, a co-lead of the project. “Advances in ‘omics have changed how we think about disease but have not been fully embraced in cardiovascular disease. If you look to oncology and rare diseases, there has been much greater progress.”

A simple blood test can help predict the risk of developing breast cancer, or guide doctors in selecting cancer drugs. This more personalized approach to cancer care is the result of decades of genetics research and advances in diagnostic testing. Similarly, genomics is making a major contribution to the diagnosis and treatment of rare diseases.

So for example, the National Health Service in England now makes DNA sequencing of tumors to identify mutations against which there are targeted drugs, an integrated part of clinical care. In inherited rare diseases, the genomes of patients are being sequenced in order to try and reach a diagnosis and to inform treatment. Cancers and rare diseases are amenable to this approach because in most cases they are driven by mutations. Cardiovascular diseases, in contrast, tend to have more heterogeneous etiologies, and patients often have comorbidities.

“In cardiovascular conditions, there is most likely a genetic component but the relative roles of genetics, comorbidities, such as hypertension, diabetes or kidney disease and risk factors, such as exercise and diet are not yet fully elucidated,” said Folkert Asselbergs of UMC Utrecht and University College London. “This complicates our understanding of a patient’s prognosis.”

However, advances in computing power and the availability of large patient data sets could allow researchers to build algorithms that take account of a patient’s genes, lifestyles and other chronic illnesses. Ultimately, said Asselbergs, this would pave the way for a more individualized and efficient approach to therapy.

BigData@Heart is one of four disease-specific projects exploring how to use patient information to improve outcomes being funded by IMI. The €5.3 billion collaboration between the pharmaceutical industry and the European Commission is designed to speed up drug discovery and development, through investments in research infrastructure, streamlining clinical trials processes and promoting data sharing.

“Thanks to this public-private partnership approach, BigData@Heart has access to most of the relevant large-scale European cardiovascular disease databases, ranging from electronic health records and disease registries to clinical trials and large epidemiological cohorts,” said Rick Grobee, UMC Utrecht and academic leader of the project. “This brings together data from more than five million cases of atrial fibrillation, heart failure and acute coronary syndrome, as well as [that of] over 16 million healthy individuals.”

Building on the experience gained in other IMI projects, the researchers will use machine learning and data mining to design prognosis algorithms that can predict patient outcomes. The system will use an individual’s medical history, along with hospitalization rates and country-specific statistics for similar patients, to advise on the best course of treatment and the likely results.

Along with more tailored use of existing treatments, the consortium hopes to identify new drug targets. The development pipeline for cardiovascular drugs is slow, expensive and high-risk, Cronin noted. “The chance of eventual approval for a cardiovascular disease drug candidate in Phase I trials is 7 per cent, the lowest of any disease category – along with oncology,” she said. “We need better definitions of these diseases, their markers and endpoints, as well as better segmentation of patient populations. In defining disease outcomes, we must listen to patients and take account of what matters to them, including functional capacity and quality of life.”

The project will run to 2022, focusing on six pilot studies and will also address ethical and regulatory issues. Central to this will be finding ways to access patient data while safeguarding personal privacy, and agreeing on the essential elements of electronic patient records. Cronin says getting that right will make or break Europe’s efforts to catch up with the US in the race to unlock the potential of big data in healthcare.

“The US precision medicine initiative is taking these issues seriously,” she says. “In the EU, the complexities of managing data in several countries, each with its own health system, mean there is a lot of catching up to do. We need to be sure that Europe is not left behind.”

Adolescent & Childhood Obesity Reaches All-Time High

The number of obese children and adolescents rose to 124 million in 2016: more than 10 times higher than the 11 million classified as obese 40 years ago, in 1975. A further 213 million children and adolescents were overweight in 2016, finds a new study published Tuesday in the Lancet.

Looking at the broader picture, this equated to roughly 5.6% of girls and 7.8% of boys being obese last year. Most countries within the Pacific Islands, including the Cook Islands and Nauru, had the highest rates globally, with more than 30% of their youth ages 5 to 19 estimated to be obese.

The United States and some countries in the Caribbean, such as Puerto Rico, as well as the Middle East, including Kuwait and Qatar, came next with levels of obesity above 20% for the same age group, according to the new data, visualized by the NCD Risk Factor Collaboration.

“Over the past four decades, obesity rates in children and adolescents have soared globally, and continue to do so in low- and middle-income countries,” said Majid Ezzati, professor of global environmental health at Imperial College London in the UK, who led the research. “More recently, they have plateaued in higher-income countries, although obesity levels remain unacceptably high,” he said.

Over the same time period, the rise in obesity has particularly accelerated in East and South Asia. “We now have children who are gaining weight when they are 5 years old,” unlike children at the same age two generations ago, Ezzati told CNN.

In the largest study of its kind, more than 1,000 researchers collaborated to analyze weight and height data for almost 130 million people, including more than 31 million people 5 to 19 years old, to identify obesity trends from 1975 to 2016.

“Rates of child and adolescent obesity are accelerating in East, South and Southeast Asia, and continue to increase in other low and middle-income regions,” said James Bentham, a statistician at the University of Kent, who co-authored the paper.

Obesity in adults is defined using a person’s body mass index, the ratio between weight and height. A BMI of 18.5 to 24.9 is classified as a healthy weight, 25 to 29.9 considered overweight and 30 and over obese. Cut-offs are lower among children and adolescents and vary based on age.

“While average BMI among children and adolescents has recently plateaued in Europe and North America, this is not an excuse for complacency as more than one in five young people in the U,S. and one in 10 in the UK are obese,” he said.

Being obese as a child comes with a high likelihood of being obese as an adult and the many health consequences that come with it, including the increased risk of diabetes, cardiovascular disease and some cancers. The potential for these chronic conditions into adulthood also puts an increased burden on health systems — and financial constraints on individuals.

“We are seeing very worrying trends with pediatricians who have children come in as young as 7 with type 2 diabetes,” said Temo Waqanivalu, programme officer for population-based prevention of non-communicable diseases at the World Health Organization. WHO co-led the research with Imperial College London.

African-Americans More Likely to Die from Cardiovascular Disease

According to the American Heart Association, African Americans experience significantly worsened cardiovascular health, and thus face greater mortality rates from heart disease. African Americans die an average of 3.4 years before white Americans, a gap largely attributable to prevalent cardiovascular disease and risk factors. Recent publication of a scientific statement from the organization reads: “The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites.”

Dr. Mercedes R. Carnethon from Northwestern University Preventive Medicine in Chicago states that traditional cardiovascular risk factors—including high blood pressure, diabetes, obesity, and atherosclerosis—are not only more common among African Americans, but also manifest at relatively young ages. Data indicates that high blood pressure is diagnosed in 13.8 percent of black children, compared to 8.5 percent in white children. The risk of persisting hypertension in black adults, throughout adulthood, is 1.5 times higher than in whites. “Interrupting this process by preventing the early onset of cardiovascular diseases is one strategy to reduce disparities in cardiovascular disease mortality,” Dr. Carnethon writes.

The research team at the American Heart Association notes that circumstances have remained fairly stagnant since 2005; relatively little has changed since 2005, when the same journal pointed to disparities in the rates of cardiovascular disease, disease management, and outcomes for African Americans. While genetic differences between African Americans and other groups do not account for the disparities in cardiovascular disease rates and outcomes, many of the variances arise from “unhealthy behaviors, lower implementation of guidelines shown to improve cardiovascular health, ingrained cultural preferences and attitudes, and lack of persistence in following lifestyle changes that need to be lifelong.”

While Dr. Carnethon’s team notes that cardiovascular disease is often preventable through the implementation and continued practice of a healthy, nutritious lifestyle, she discusses the difficulties faced by many African Americans—particularly those in lower income groups—in accessing the necessary resources to lead healthy lifestyles: specifically, access to healthful foods, safe spaces for physical activity and exercise, and homes that allow for restorative sleep. Moreover, she argues that despite the strides our country has made in broadening access to healthcare, many African-Americans are still unable to afford and prioritize preventive care visits.

Dr. LaPrincess Brewer from the Mayo Clinic in Rochester, Minnesota has continuously worked to promote cardiovascular health in African-American communities, promotes “culturally relevant, community-based cardiovascular health interventions that focus more on positive motivation towards promoting cardiovascular health rather than the negative impact of cardiovascular disease.” Through increased awareness, and a collective, collaborative effort on the part of clinicians, public health workers, researchers, social services, and community stakeholders, the high burden of traditional risk factors among African Americans can be addressed—in tandem with the inherent social and environmental contextual barriers faced by this specific population.

Trick-Or-Jump

A recent article[1] revealed what happens if you frequently visit your office’s Halloween candy stash, or you eat your kid’s leftover Trick-Or-Treat candies…

Jumping Jacks. 

Lots and lots of them, if you want to burn off what you ate! Although Halloween candies often come in smaller, “mini” versions of the regular candy sizes, they are all still packed with calories and sugar.

The article provided this handy but SCARY chart* (how appropriate for Halloween), which shows us just how many minutes of jumping jacks you need to do in order to fight off the evil Halloween candy you consume…

*Calculations based on a 150-pound woman

[1] Popsugar. Sugar, Jenny. “This Is How May Jumping Jacks You Need to Do to Work Off Halloween Candy.” https://www.popsugar.com/fitness/How-Burn-Off-Halloween-Candy-42393489?utm_source=facebook.com&utm_medium=social&utm_campaign=popsugar.com. October 29, 2017. Accessed October 30, 2017.