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Month: January 2018

Simple & Preventive Changes to Combat CVD

Cardiovascular disease has the highest mortality rate in the United States, and billions of dollars are given to pharmaceutical industries each year in order to combat and reduce risks.

Yet recent research on cardiovascular risk factors offers renewed hope and optimism regarding heart disease, demonstrating a number of simple life changes to implement in order to prevent the onset of cardiovascular disease. Changing behavior can significantly lower risks, even for those genetically predisposed to heart disease—though it has long been thought that these factors were outside one’s control.

Data gathered from four large prospective cohort studies, all of which tracked thousands of people for years, analyzed and assessed the relationships between various risk factors and heart disease. Researchers examined the ways in which lifestyle factors were associated with outcomes, including not smoking cigarettes, not being obese, engaging in weekly physical activity, and following a healthy diet. The final criterion was based upon recommendations including eating more fruits, nuts, vegetables, whole grains, and not eating sugar-sweetened beverages, processed foods, etc.

The cumulative lifestyle factors were all associated with a significantly decreased risk of coronary events, and those who followed all of them had a favorable lifestyle. The reduction in heart attacks, bypass procedures, and deaths from cardiovascular causes was 45%: a 47% reduction even among those with genetic risks.

These numbers are substantial; the risk of a coronary event in a decade was halved. The data demonstrated that lifestyle changes were as powerful, if not more powerful, than many drugs and pharmaceuticals that are recommended. While there were caveats, including the sample size and population’s race and ethnicity, the lessons imparted must encourage us to understand and internalize that genetics do not necessarily determine overall health.

Changes in lifestyle can ultimately overcome many of the hurdles and challenges posed by DNA and genetics. These alternations will also reduce risks of other diseases like cancer, and a healthier lifestyle can have enormous implications for many more people across the globe.

Interested in learning about the latest updates in hypertension, heart failure, diabetes, lifestyle management, and cardiovascular health? Attend CMHC West, and listen to the nation’s top experts in cardiometabolic health while networking with hundreds of other healthcare professionals and practitioners. 

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Cardiovascular Morbidity and Mortality in Pregnancy

More than one fifth of all pregnancy-associated deaths during a 10-year period in Illinois were the result of cardiovascular causes, and the mortality rate resulting from cardiac causes rose with maternal age, new data study show.

Further, of the cardiac-associated deaths, 28.1% of them were potentially preventable, Joan Briller, MD, from the Division of Cardiology, Department of Medicine, and the Center for Research on Women and Gender at the University of Illinois at Chicago, and colleagues report in an article published online April 4 in Obstetrics & Gynecology.

Recent research has shown that the maternal mortality rate in the United States has risen substantially in recent years, with one study of national trends reported by Medscape Medical News indicating a relative increase of more than 25% between 2000 and 2014.

Because cardiovascular disease is recognized as a leading contributor to US maternal mortality, Dr Briller and colleagues sought to identify the most common etiologies of maternal cardiac death in Illinois and to assess their potential preventability.

The investigators reviewed data on pregnancy-associated cardiovascular deaths in the state from 2002 to 2011. Data were collected by a network of regional perinatal centers and recorded in the Illinois Department of Public Health maternal mortality review database. Illinois requires the reporting and review of all deaths to women within a year of pregnancy.

During the period of study, there were 636 deaths in women who were pregnant or within 1 year of pregnancy, reflecting an overall death rate of 37.1 per 100,000 live births. Of the deaths, 140 (22.0%) were cardiac-related, predominantly (97.1%) resulting from acquired heart disease. The most common etiology was cardiomyopathy (27.9%), followed by stroke (22.9%), hypertension-related death (12.9%), arrhythmias (10.7%), and coronary artery disease (9.3%). Of the 39 women who died of cardiomyopathy, 30.8% (n = 12) developed the condition during the peripartum period.

Of the cardiovascular deaths, those attributed to cardiomyopathy “were significantly more likely to be considered directly related to pregnancy (P<.01) than other cardiac etiologies,” the authors write, and women with cardiomyopathy “were more likely to be younger than women who died of other cardiovascular causes,” they observe. The cardiomyopathy mortality rate in women younger than 20 years was nearly three times that of women aged 20 to 29 years (rate ratio [RR], 3.38; 95% confidence interval [CI], 1.38 – 8.27).

More than half of the cardiovascular deaths in this patient population occurred during the first 6 weeks postpartum compared with deaths from noncardiac causes (56.7% vs 49.2%; P < .01). This suggests that women with hypertension, preeclampsia, or other cardiac risk factors or symptoms should receive more extensive postpartum care, the authors write.

“[T]he preponderance of cardiovascular deaths in the older population is especially striking given that only 40.1% of births occurred in women older than age 30 years of age,” the authors write. “Increasing cardiovascular death as women aged is partly explained by the rising prevalence of cardiovascular disease in the older population,” they explain.

Of the cardiac deaths, 28.1% were determined to be potentially preventable and point to aspects of care that are “amenable to change such as monitoring patients at risk for several weeks postpartum,” the authors write.

The Illinois findings “add to our understanding of cardiovascular disease as a leading contributor to maternal mortality by addressing risk factors to be assessed and that a large proportion of maternal mortality is potentially preventable by addressing issues such as the importance of monitoring patients at risk for several weeks postpartum while hemodynamic changes are still in flux,” the authors conclude. “Our data support the need for more investigations into cardiovascular maternal mortality, organized communication between obstetricians and cardiologists, and the need for systems designed to better educate and communicate cardiovascular risk factors and warning signs to pregnant women and medical care providers.”

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Higher Risk Factors for Women

Fewer women who suffer a heart attack each year in the UK would die if they were simply given the same treatments as men, according to new research.

Scientists at the University of Leeds and the Karolinska Institute in Sweden used data from Sweden’s extensive online cardiac registry, SWEDEHEART, to analyze the outcomes of 180,368 patients who suffered a heart attack over a 10 year period to December 2013.

After accounting for the expected number of deaths seen in the average population, the researchers found that women had an excess mortality up to three times higher than men’s in the year after having a heart attack.

While the analysis uses Swedish data, the researchers believe that the situation for women in the UK is likely to be worse than in Sweden, which has one of the lowest mortality rates from heart attacks anywhere in the world. The study, published yesterday in the Journal of the American Heart Association, was co-funded by the British Heart Foundation.

Professor Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds, who co-authored the study, said: “We need to work harder to shift the perception that heart attacks only affect a certain type of person. Typically, when we think of a heart attack patient, we see a middle-aged man who is overweight, has diabetes and smokes. This is not always the case: heart attacks affect the wider spectrum of the population, including women. Sweden is a leader in healthcare, with one of the lowest mortality rates from heart attacks, yet we still see this disparity in treatment and outcomes between men and women. In all likelihood, the situation for women in the UK may be worse.”

Analysis of the Swedish data found that women who had a heart attack resulting from a blockage in the coronary artery were 34 per cent less likely than men to receive procedures which clear blocked arteries and restore blood flow to the heart, including bypass surgery and stents.

The paper reported that women were also 24 per cent less likely to be prescribed statins, which help to prevent a second heart attack, and 16 per cent less likely to be given aspirin, which helps to prevent blood clots. Critically, when women received all of the treatments recommended for patients who have suffered a heart attack, the gap in excess mortality between the sexes decreased dramatically.

Professor Gale, from the Leeds Institute of Cardiovascular and Metabolic Medicine, added: “The findings from this study suggest that there are clear and simple ways to improve the outcomes for women who have a heart attack – we must ensure equal provision of evidence-based treatments for women.”

Previous British Heart Foundation research has shown that women are 50 percent more likely than men to receive the wrong initial diagnosis and are less likely to get a pre-hospital Electrocardiogram (ECG) which is essential for swift diagnosis and treatment.

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “Heart attacks are often seen as a male health issue, but more women die from coronary heart disease than breast cancer in the UK. The findings from this research are concerning – women are dying because they are not receiving proven treatments to save lives after a heart attack.”

This year, attend our 13th Annual CMHC conference, taking place from October 24-27 in the heart of downtown Boston. We are hosting our first pre-conference Women’s Health Summit on October 24th: highlighting the latest research unique to women’s healthcare. Expand your therapeutic options to enhance and optimize your female patients’ health, while learning tangible solutions to complex medical problems. This day is designed for you to become well-versed in integrative practices and protocols, and understand the unique challenges faced by women.

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Middle-Aged? Reverse Heart Risk with Exercise

For those who fear it may be too late in life to improve their fitness and wellness, a recent study published in the journal Circulation has found that people into late middle age can reverse or reduce the risk of heart failure caused by decades of sedentary living by exercising.

There, is, however, a catch: research indicates that it takes two years of aerobic exercise, four to five days a week, to mitigate the risk of heart failure. Research has shown that sedentary behaviors – such as sitting or reclining for long periods of time – increase the risk of heart disease.

The study’s participants, all of whom did not exercise regularly, were divided into two groups, with one following an aerobic exercise routine that progressed in intensity over the two years and another doing yoga, balance training and weight training three times a week, also for two years.

The aerobic exercise group showed an 18% improvement in their maximum oxygen intake during exercise and a more than 25% improvement in “plasticity” in the left ventricular muscle of the heart – both markers of a healthier heart. However, the benefits were not seen in the second group.

Dr Benjamin Levine, lead author of the study and the founder and director of the Institute for Exercise and Environmental Medicine, a joint program between Texas Health Resources and UT Southwestern Medical Center Dallas, Texas, states: “The key to a healthier heart in middle age is the right dose of exercise, at the right time in life. We found what we believe to be the optimal dose of the right kind of exercise, which is four to five times a week, and the ‘sweet spot’ in time, when the heart risk from a lifetime of sedentary behavior can be improved – which is late-middle age. The result was a reversal of decades of a sedentary lifestyle on the heart for most of the study participants.”

Dr Richard Siow, vice-dean for the faculty of life sciences and medicine at King’s College London and director of aging research at King’s, told the BBC the study was valuable in that shows we can delay cardiovascular aging. Dr. Siow said that it provided further evidence that “we can, in a way, rejuvenate or make the cells in the heart, and also in the blood vessels for that matter, resemble younger cells through an exercise program”.

“I think that’s a very important take-home message for those of us who may have a doom and gloom view there’s nothing we can do about it. Yes there is, we can start by getting off the couch to have a more active lifestyle.”

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Physical Activity to Combat Cardio Risk

A study of close to 500,000 people without cardiovascular disease at baseline showed that total physical activity related to work, recreation, or utilitarian needs such as walking to do errands was associated with a lower short-term risk of developing CVD. The researchers found that there is a “clearly positive . . . dose-response relationship between levels of total activity and risks of major CVD,” senior author Dr Zhengming Chen (University of Oxford, UK) told theheart.org | Medscape Cardiology.

Lead author Dr Derrick A Bennet (Oxford University) and colleagues analyzed data from adults who participated in the China Kadoorie Biobank study, and their findings were published November 8, 2017 in JAMA Cardiology.
Compared with people in high-income countries, these participants in middle-income China had a much higher average level of physical activity: 21.5 metabolic equivalents of task (MET) hours/day, which equals 5 hours of cycling or brisk walking a day.

With each added 4 MET hours/day of physical activity—roughly equal to 1 extra hour of brisk walking per day—people had a 5% to 12% lower risk of developing different types of CVD during a 7.5-year follow-up. The association was similar in men and women, and young and old, Chen noted. However, among patients with hypertension, the benefits of physical activity in lowering risk of CVD—especially stroke—were weaker, although fewer than 10% of these patients had properly controlled hypertension.

Dr Scott A Lear (Simon Fraser University, Vancouver, BC) told theheart.org | Medscape Cardiology that this “huge study in the largest population in the world” showed that “being physically active is associated with a substantial reduction in risk for major CVD events,” which “is as good as or better than some of the most effective CVD pharmaceuticals we have.” Added to other evidence, it emphasizes that “more attention needs to be paid to prescribing physical activity as an effective and low-cost intervention with few side effects,” he said. “Public-health policy and other administrative units need to be involved (since it is rare that healthy people see a clinician) to ensure being physically active is the easy choice.”

The study also supports World Health Organization (WHO) recommendations of 20 or 30 minutes of moderate intensity exercise on most days, which would reduce the risk of premature death by 20% compared with people who do not meet this target.

“Our study is the first really large study in low- and middle-income countries of the effects of physical activity on CVD risks, and the study findings support current WHO guidelines that promote any type of activity to reduce the risk of major chronic disease,” said Chen. The challenge, say Lear and Yusuf, is for low- and middle-income countries to find ways to mitigate the decrease in occupational physical activity that follows economic prosperity and for high-income countries to find ways to increase fitness levels when most people have sedentary jobs.

On an individual level, people with sedentary jobs “can do simple things,” they advise, such as getting up every 20 to 30 minutes for a 2-minute walk, taking the stairs instead of an elevator, and parking further from their destination. However, individual changes only go so far, they note, and for substantial increases in physical activity to be achieved “national and community-level programs are needed.” Having safer neighborhoods where people can access parks and bicycle paths can help, and in China, building bike lanes would not only increase activity, but reduce traffic and air pollution, they point out.

“If the entire population met the WHO [physical activity] guidelines, whether through recreational, occupational, household, or other obligatory activities, this would prevent around one in 12 (or approximately 3.0 million) premature deaths in adults worldwide,” they conclude.

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Cardiovascular Mortality Rates Vary by Geography

It’s a testament to modern medicine that death rates from heart disease around the nation have been cut in half, yet new research sheds light on the wide disparities in cardiovascular death rates depending on geography. Using death certificate data, a research group led by University of Washington Medical Center cardiologist Dr. Gregory Roth conducted the most comprehensive analysis of deaths due to cardiovascular diseases in history.

Their findings indicated that cardiovascular death rates have been cut in half since 1980, though cardiovascular disease still represents the cause of death in the United States. In 2014, for instance, cardiovascular diseases accounted for more than 846,000 deaths, according to the research, which was published in the Journal of the American Medical Association.

But death rates can vary widely: for example, cardiovascular death rates are twice as high in Richmond, Martin and Columbus counties as they are in Chatham County. “This kind of variation occurs on a really small geographic level. So even from one county to the next we see these huge gaps in health related to heart disease,” said Roth. “We clear see higher rates of cardiovascular deaths in places that are poor, and we know that health care quality is worse in locations with lower incomes and lower levels of education.”

Moreover, there are early warning signs. Across the state and nation, cardiovascular death rates have begun to creep up again. “Cardiovascular disease is down on average in the United States, but the rate that it’s been going down has really flattened and in the last year or two we’ve seen very little decline at all. And in some states and counties we are actually seeing it go up again for the first time in 50 years,” said Roth.

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