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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

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.

Less Screen Time, More Sports: Childhood Obesity & Cardiovascular Disease

A host of studies have confirmed the correlation between childhood obesity and adult cardiovascular disease, illustrating the consequences of obesity during childhood.

Because obese and overweight children are more likely to become obese adults than those who were not obese as children, they face an increased risk of developing chronic diseases such as CVD, type II diabetes, and certain cancers. Accelerated BMI (body mass index) in children puts children at the highest risk for cardiovascular disease in adulthood.

Therefore, it is critical to trace the growth of children in order to detect and prevent elevated and accelerated BMI gains during early development periods. There are pragmatic measures that parents can take to ensure that their children prevent the onset of heart disease, and lessen risk factors. Identifying opportunities to promote physical activity and a healthy diet will potentially limit the development of risk factors associated with CVD in adults, namely hypertension, high cholesterol, hyperglycemia, and being overweight or obese.

The strong correlation between obesity and CVD indicates a need for early intervention; early life is the most significant target time to address prevention and treatment of obesity. According to the American Academy of Pediatrics, “It is never too early for the family to make changes that will help a child keep or obtain a healthy weight.” Both parents and physicians must encourage children to maintain a healthy weight, in addition to promoting educational materials that illustrate potential risk factors for cardiovascular disease.

Current recommendations include reducing screen time—during which children are generally physically inactive—and increasing participation in extracurricular athletics and sports. The CDC has confirmed that sources such as families, schools, communities, and the media are all highly influential in the success of the aforementioned initiatives.

Parents must model healthy behaviors for children, spurring even small changes like healthier snacks in the home, adjusting bedtime to allow for at least 9 hours of sleep per night, and ensuring at least an hour of physical activity each day.

Take Care of your Ticker – American Heart Month

Knowing the Signs of Heart Disease:

Heart disease is the primary killer of both men and women in the United States. Statistics indicate that every 80 seconds, a woman dies from either cardiovascular disease, or a stroke—yet the American Heart Association reports that 80% of all heart-related maladies can be prevented by the implementation of healthy lifestyle changes and education.

In light of American Heart Month, it is timely and prudent to understand the context and background of heart dis
ease, coupled with the risks—and ways to prevent it. Heart disease occurs when there is a negative change in the heart’s structure or function, ofteninvolving blood vessels that are narrow or blocked. Examples include stroke, heart failure, arrhythmia, high bloodpressure, and coronary artery disease.

While there are certain risk factors linked to heart disease that are uncontrollable—like age, gender, race, and hereditary genetics—several modifiable lifestyle choices can influent heart health. Primary risks include smoking, which can increase the risk of heart attack by 70%, and poor diet and nutrition. The latter increases the likelihood of high cholesterol and atherosclerosis, both of which contribute to heart disease. Stress and lack of exercise also exacerbate the risk of blood clots, high blood pressure, and stroke. Physical activity strongly correlates to healthy blood flow, which improves overall heart health.

Several symptoms of poor heart health include fatigue, congestion or coughing, chest pain and pressure, leg or ankle swelling, and pain in the jaw and limbs. Successfully managing heart health entails staying aware of these warning signs, and engaging in an active, healthy lifestyle to promote overall wellness.

Special Feature – February Women’s Health Month

The Reality of Women and Cardiometabolic Disease

Perception has typically been that cardiovascular disease (CVD) is a man’s disease, but the reality is that CVD is, and has been, the leading cause of death in women. In 2013, according to US statistics, CVD accounted for more than 398,000 female deaths.1 Every 90 seconds in the United States, a woman suffers a myocardial infarction.2

Men tend to develop CVD earlier than women, but women develop CVD more rapidly after menopause due to hormonal changes, leading to the development of hypertension, changes in lipid concentrations, and central adiposity. Diabetes is also a more significant risk factor for CVD in women than men.3 Other factors that increase the odds of developing CVD include excessive alcohol use, family history of CVD, hypercholesterolemia, hypertension, obesity, physical inactivity, and smoking. Hypertension, hypercholesterolemia, and smoking in particular are key risk factors for the development of CVD and about half of American women (49%) have at least one of these three risk factors.2

However, women often remain unaware of their risk and differences have been observed in treatment and outcomes between men and women with cardiometabolic diseases. Preventive therapies are recommended less often to women. Women are more likely to be diagnosed and treated for hypertension, but are less likely to reach treatment goals.4 High-risk women, including those with diabetes, are less likely to be on lipid-lowering agents and reach an LDL cholesterol (LDL-C) level of less than 100 mg/dL. Women with diabetes are also less likely to reach an HbA1c less than 7%.

 

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Study Confirms Necessity of Nutrition Education

Necessity of Nutrition Education-04Recent statistics show that more than two-thirds of Americans are considered to be overweight or obese, generating a global obesity epidemic. With diabetes and obesity continuously on the rise, in addition to spikes in other lifestyle-related diseases, it has become critical to highlight the necessity of self-care and healthy living habits. Yet while physicians are generally considered to be reliable sources regarding nutrition, more than 50% of graduating medical students continue to rate their knowledge as ‘inadequate,’ and only one in eight patients receives counseling from their doctors on dietary health benefits.

A study designed to quantify the required number of hours of nutrition education at U.S. medical schools, in addition to an investigation regarding the types of courses offered, reaffirmed the supposition that medical students receive an inadequate amount of nutrition education. Only 27% of surveyed schools required a course dedicated to nutrition; on average, U.S. medical schools only offer 19.6 hours of nutrition education—across four years of medical school. Other informal polls and anecdotes uphold the studies’ findings, as students assert that nutrition education throughout medical school is, at best, minimal.

Throughout the past several decades, there has been a push towards improving the medical nutrition education that students receive. With suboptimal knowledge about dietary habits, future physicians are selling both themselves and their patients very short. It is imperative to equip health practitioners with the necessary tools and information that they can utilize in their practices, ultimately addressing the root causes of real, pervasive problems. Medical schools have the burden of responsibility to arm their graduates with the tools to tackle the biggest, most acute global health challenges: including obesity and nutrition problems.

All of our conferences this year highlight this topic, through specific sessions that discuss the need for nutritional education and awareness. At Regionals, we are hosting “Comprehensive Weight Loss Management in Primary Care Practice to Reduce Cardiometabolic Risk.” Our Annual event’s second session is dedicated to lifestyle management of cardiovascular disease, including “Cardiometabolic Disorders: Diet Quality, Quantity and Beyond,” “Sleep Science: Effect of the Circadian Rhythm on Obesity and CVD,” and “Lifestyle and Obesity Management in the Cardiometabolic Patient.” View the annual agenda, and learn more about our regional conference series.

Early Education & Awareness: Keys to Prevention

Early Education & Awareness-02In the United States, more than 1 in 3 adults—92.1 million people—have cardiov
ascular disease, accounting for 807,775 deaths in 2014. Based on the American Heart Association’s 2017 Heart Disease and Stroke Statistics most recent update, the number of adults living with heart failure increased from approximately 5.7 million (2009-2012) to about 6.5 million (2011-2014). These latest statistics indicate that the number of people diagnosed with heart failure is projected to rise by 46% by 2030, with an end result of over 8 million people living with heart failure.

While there are inevitably disparities in the groups that are primarily affected, other studies reveal that women must be equally vigilant: even in their 20s. A new survey has uncovered that a majority of women do not believe they require heart screenings until they are well into their 30s and 40s. Only 8% of women stated that heart screenings should begin in their 20s, despite the fact that plaque buildup in the arteries can manifest when people are in their teens.

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Caffeine: The Magic Bullet for Cardio Disease?

Cardio Disease & Caffeine 600W-03An abundance of recent research points to the ways in which caffeine, consumed in moderation, can be beneficial for the heart.

Recent research from Stanford revealed a connection between aging and systematic inflammation, cardiovascular disease, and coffee consumption. Through the investigation of blood samples, survey data, and medical and family histories, researchers confirmed that a fundamental inflammatory mechanism associated with aging—that helps spur the onset of cardiovascular disease—can be countered by nucleic-acid metabolites in coffee.

Additionally, as more than 90% of all noncommunicable diseases of aging are associated with chronic inflammation, it is well known that caffeine intake is also associated with longevity.

Another published study on the beneficial effects of tea has recently demonstrated that consuming the beverage on a daily basis was associated with lower risks of developing life-threatening heart disease. Through the assessment of over 487,000 adults in China, and part of the largest prospective study assessing the association between caffeine and incident ischemic heart disease, daily tea consumers were at a lower risk for cardiovascular disease than those who drank less than daily.

During the study’s follow-up period, there were over 24,000 cases of incident ischemic heart disease, and almost 4,000 cases of major coronary events—yet fewer events occurred for tea drinkers.

The aforementioned studies produce compelling evidence regarding the role of caffeine in health, and its ability to potentially curb the advancement of cardiovascular disease.

Hard on the Heart: Disease of Depression

Hard on Disease of Depression-02While medical experts have long known of the correlation between psychological and physical health, mental illness was not considered a major risk factor for cardiovascular disease—until a recent series of research confirmed that depression may serve as one of the most significant causes of heart problems.

Approximately 350 million people suffer from depression globally, according to data from the World Health Organization. According to new research, the risk of fatal heart disease in men due to depression is almost the same as the risk from elevated cholesterol levels, obesity, and smoking.  The findings further pointed to a greater need for heart health screenings among patients with depression, in addition to mental health checks for patients with cardiovascular disease.

The causality is twofold, as patients with pre-existing heart disease conditions are more likely to become depressed due to their poor health and otherwise healthy people diagnosed with depression are likewise significantly more apt to develop heart disease, compared to the general population. Viewed across the population, depression accounts for roughly 15% of cardiovascular deaths—comparable to the other known risk factors.

A professor of medicine at Harvard Medical School, Ahmed Tawakol, has conducted extensive research surrounding the connection between stress and heart health, stating that only over the past few decades “has mounting evidence suggested that stress and depression may be more than simple markers of heart disease; they might be important causes.”

While it remains unclear exactly how depression impacts heart health, it is likely that stress hormones play a critical role. Yet leading a healthy lifestyle—including diet, physical activity, managing stress, being smoke-free—is known to be effective in preventing and treating both depression and heart conditions.

The Link Between Stress & Strokes

LINK BETWEEN STRESS & STROKES-02A new study utilizing brain scans demonstrates the link between stress and heart attacks or strokes, confirming that people who have increased activity in their amygdala—often termed the ‘fear center’ of the brain—are at higher risks for cardiovascular disease. While stress can activate the amygdala, leading to extra immune cell production by the bone marrow, the arteries may become inflamed, leading to cardiovascular disease.

The study tracked the health of 293 adults for two to five years, during which 22 patients experienced a cardiovascular disease event, such as a stroke, heart attack, or coronary heart failure. Researchers found that those people with more active amygdalas were more likely to have a critically serious heart event over the next few years; additionally, they had more inflammation in their arteries, which ultimately leads to heart disease, and bone marrow activity that may be linked with blood clots. Read more

Obesity & Developmental Delays

OBESITY & DEVELOPMENTAL DELAYS-02A study conducted by researchers at the National Institutes of Health has found that children of obese parents are at higher risk for developmental delays, including less advanced motor skills and lower overall measures of social competence. The research, published in the journal Pediatrics, cited evidence that indicates approximately 1 in every 5 pregnant women in the United States qualifies as overweight or obese.

The investigators specifically found that children of obese mothers were more likely to fail tests of fine motor skills: the ability to control movement of small muscles, such as those in the fingers and hands. Children of obese fathers were more likely to fail measures of social competence, and those born to extremely obese couples also were more likely to fail tests of problem solving ability.

“The previous U.S. studies in this area have focused on the mothers’ pre- and post-pregnancy weight,” said the study’s primary author, Edwina Yeung, Ph.D., an investigator in NICHD’s Division of Intramural Population Health Research. “Our study is one of the few that also includes information about fathers, and our results suggest that dad’s weight also has significant influence on child development.” Read more