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Category: CMHC

Cardiometabolic Health Congress

Stopping Cholesterol-Lowering Drugs Could be Deadly

A new study confirms that stopping a cholesterol-lowering drug can be critically dangerous. Researchers found that people who stopped taking statins, after reporting a side effect, were 13% more likely to die, or have a hear attack or stroke over the next four years.


Statins work by inhibiting the liver’s ability to produce cholesterol, while simultaneously helping the organ remove existing fats in the blood. These drugs are ‘almost universally prescribed’ to people with cardiovascular disease; moreover, the U.S. Preventive Services Task Force recommends the drugs to people ages 40-75, who have no history of heart disease, if they have one or more risk factors.

While there is extensive literature and clinical studies surrounding the efficacy of statins, a quarter to a half of patients stop taking the drugs within six months to a year, according to Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston. In order to determine whether people who continue taking statins fare better than those who do not, researchers analyzed data from two Boston hospitals between 2000 and 2011.

During that period, over 200,000 adults were prescribed and treated with statins; almost 45,000 of those people reported a side effect that they thought might be from the medication: generally muscle or stomach aches. The researchers focused on 28,266 people from those 45,000 with possible side effects: most of them, 19,989 individuals, continued to take the statins.

Approximately four years after the side effects were reported, 3,677 patients had died, or suffered a heart attack or stroke. Overall, researchers found that people who stopped taking statins were 13 percent more likely to die or have a heart attack, or stroke. According to Dr. Robert Rosenson, a professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York City, these new findings further confirm and expand on previous studies that demonstrated the benefits of continuing to take statins.

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Ozone Exposure Tied to Higher Cardiovascular Risk

Research findings recently published in the journal JAMA Internal Medicine, conducted by researchers from Duke University with colleagues from several educational institutions in China, indicate that exposure to high and harmful ozone levels can increase blood pressure: a primary risk factor for cardiovascular disease.

Senior author Junfeng Zhang, a professor in global and environmental health at Duke University, stated: “We know that ozone can damage the respiratory system, reduce lung function, and cause asthma attacks.” While exposure to ozone has been correlated with reductions in lung function, this new study of adults in China reveals that it is also strongly correlated with increased risks of heart attack and stroke. The study monitored 89 health adults in China from December 2014 to January 2015, measuring indoor and outdoor ozone levels, in addition to other pollutants. Other measured markers included levels of inflammation, oxidative stress, stiffness in arteries, blood clotting, blood pressure, and lung function.

After analyzing the data, the researchers confirmed that ozone exposure was “linked to markers of blood platelet activation and raised blood pressure;” the former is a high risk factor for blood clotting. The ozone exposure levels during the study were lower than levels that have been associated with impaired lung function: “The main basic for the current air quality standard set by the Environmental Protection Agency.”

Professor Zhang has said that in 2015, a third of the entire U.S. population (approximately 108 million people) lived in geographic regions in which ozone levels were higher than the set EPA standard. Moreover, as global ozone levels will increase due to climate change and the increasing warmth of the atmosphere, there will likely be an increased trend in these findings.

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Artificial Intelligence in Precision Cardiovascular Medicine

The rapidly growing field of Artificial Intelligence (AI)—a field of computer science that seeks to perform and directly mimic tasks that generally require human intelligence—has developed a series of techniques that have been applied in cardiovascular medicine. Designed to enhance patient care, improve cost-effectiveness, and reduce readmission and mortality rates, these machine-learning techniques have been increasingly used for cardiovascular disease diagnosis and prediction.

Researchers believe that AI, in the near future, will ultimately result in ‘a paradigm shift toward precision cardiovascular medicine,’ as its applications in clinical care have tremendous potential in facilitating improvements in care: including machine learning, deep learning, and cognitive computing. The term ‘big data’ connotes extraordinarily large sets of data, which cannot be neither analyzed nor interpreted through traditional methods of data-processing. This type of data includes statistics from mobile phone apps, wearable devices, social media, and ‘omic’ data (i.e. genomics and proteomics), in addition to data from standardized electronic health records.

Clinical care in cardiovascular medicine currently faces several challenges, most of which relate to high costs in prevention and treatment, low cost-effectiveness and inadequacy in patient care, and overutilization. Moreover, because cardiovascular diseases are inherently complex—due to the multiple genetic, environmental, and behavioral factors that cause them—deep learning in AI, through the use of big data, can be used in pattern recognition to heterogeneous syndromes and image recognition in CV imaging; deep learning also uses multiple layers and transformations through several algorithms.

The concept of deep-learning, a new machine-learning technique that plays a critical role in areas including image recognition, has been applied through ideas and inventions including Facebook’s facial recognition system, speech-recognition, self-driving cars, mobile apps, machine vision camera software, IBM Watson, and robots. Because AI can effectively ‘classify new genotypes or phenotypes of heart failure with preserved ejection fraction,’ AI can greatly improve the accuracy of cardiac imaging methods.

Moreover, using big data can automatically generate new hypotheses, allowing physicians to make improved clinical decisions and diagnoses. The role of AI applications, such as machine learning, deep learning, and cognitive computing, can enable precision cardiovascular medicine, and move beyond traditional statistical tools—which will improve the estimated CVD risk scores to automate prediction.

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The Benefits of Mindful Eating

Recent studies indicate that meal timing and frequency may impact cardiovascular health, and disease risks. While eating patterns vary from person to person, research indicates that effective management of cardiometabolic health should focus on ‘intentional eating’–paying attention to standardize eating times, meal sizes, and food content.

One of the primary critical factors in evaluating the effect of meal frequency and timing on cardiovascular health was what constituted a meal that potentially impacted metabolism. Data shows that distributing calories over a defined period of the day, coupled with maintaining a consistent overnight fast period, could ultimately yield positive benefits surrounding cardiometabolic health–in addition to eating a larger portion of one’s daily caloric intake earlier in the day.

Skipping meals and snacking, which have become increasingly prevalent, have various effects on cardiometabolic health markers: namely obesity, lipid profile, insulin resistance, and blood pressure. Because irregular eating patterns do not lead to a healthy cardiometabolic profile, intentional eating–with mindful attention to the timing and frequency of eating occasions–will lead to a healthier lifestyle. Most importantly, planning each meal with a variety of healthy foods, and timing meals, can help manage hunger, achieve desired portion control, and improve nutrition quality.

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Breastfeeding May Lower Risk of Heart Disease & Stroke

While there is extensive research documenting the benefits of breastfeeding for babies, a new study published in the Journal of the American Heart Association indicates that the practice may lessen a mother’s risk of heart disease and stroke. Moreover, researchers found that a mother’s risk of cardiovascular disease further decreased with each additional 6 months of breastfeeding. Previous studies have suggested that women who breastfeed may experience short-term reductions in blood pressure, cholesterol, and weight loss, which likely benefit cardiovascular health.

The study, conducted in China, analyzed data from 289,754 Chinese women who were free of cardiovascular disease at the study’s baseline; almost all participants had children. The study required the women to provide information surrounding reproductive history, including whether or not they had breastfed children and the duration of breastfeeding.

The researchers assessed the incidence of heart disease and stroke among the women over an eight year follow-up, ultimately finding that women who had breastfed children were at a 9% lower risk of heart disease and an 8% lower risk of stroke, compared to those who had not breastfed. When looking at the results by breastfeeding duration, results revealed that women who had breastfed children for 2 years or longer were 18 percent less likely to develop heart disease and 17% less likely to have a stroke. For every 6 additional months of breastfeeding, risks of heart disease and stroke were respectively reduced by 4% and 3%.

Heart disease is the leading cause of death for both men and women in the United States; statistics from the Centers for Disease Control and Prevention report that approximately 610,000 people die from heart disease each year, accounting for 1 in every 4 deaths. Likewise, stroke is one of the country’s leading causes of disability: there are more than 795,000 people in the U.S. who have a stroke annually.

Senior author Zhengming Chen of the University of Oxford states that “the findings should encourage more widespread breast-feeding for the benefit of the mother as well as the child.”

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Coconut Oil: Not So Healthy?

 A recent new advisory report from the American Heart Association advises against the use of coconut oil, a popular trend in the health and wellness industry.

The Dietary Fats and Cardiovascular Disease, after viewing existing data on saturated fats, has demonstrated that coconut oil specifically increased LDL—known as ‘bad’ cholesterol—in seven out of seven controlled oils. 82% of the fat in coconut oil is saturated, according to data: exceeding butter, beef fat, and pork lard.

The advisory stated: “Because coconut oil increases LDL cholesterol, a cause of cardiovascular disease, and has no known offsetting favorable effects, we advise against the use of coconut oil.” Marie-Pierre St-Onge, associate professor of nutritional medicine at Cornell University Medical School, believes that coconut oil is so popular for weight loss due to her research on medium-chain triglycerides. Because coconut oil has a higher proportion of medium-chain triglycerides than most other fats or oils, and her research indicated that medium-chain triglycerides may increase the rate of metabolism, many now believe that coconut oil can be responsible for weight loss.

However, St-Onge’s research used a ‘designer oil’ that was full of 100% medium-chain triglycerides; traditional coconut oil only contains about 13-15%. Moreover, another study published by St-Onge reveals that smaller doses of medium-chain triglycerides does not help with weight loss in overweight adolescents.

“You can put it on your body, but don’t put it in your body,” said Frank Sacks, lead author on the report.

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1/3 of World = Overweight

A new study reports that more than two billion adults and children across the globe are overweight or obese, and suffer from related health problems. Spurred by poor nutrition and low levels of physical activity, this number equates to one-third of the world’s population.

While 2.2 billion people can be classified as overweight or obese, more than 710 million are obese: 5% of all children, and 12% of all adults, can be categorized in this segment. The United States has the greatest percentage of obese or overweight children and young adults, at 13%.

The study, published in the New England Journal of Medicine, states that a growing number of people across the globe are dying from poor health, and problems linked to being overweight. “People who shrug off weight gain do so at their own risk–risk of cardiovascular disease, diabetes, cancer, and other life-threatening conditions,” said Dr. Christopher Murray, director of the Institute for Health Metrics and evaluation at the University of Washington, who worked on the study.

Researchers analyzed data collected between 1980 and 2015 from 68.5 billion people, and revealed that the number of people affected by obesity has doubled since 1980 in 73 countries, and continued to rise across most other countries in the analysis. Although the percentages of obese children were lower than adults, that rate at which their numbers have increased was greater–indicating greater future risk if nothing is done to alleviate and curb the growing problem.

“This raises the alarm that we may be facing a wave of obesity in the coming years across high and low income countries,” states Goodarz Danaei, assistant professor of global health at the Harvard T.H. Chan School of Public Health. Because obesity levels have risen in all countries, irrespective of income levels, the issue does not simply boil down to wealth. The paper reads: “Changes in the food environment and food systems are probably major drivers.”

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Most Cardiologists Lack Nutrition Education

A recent study has found that the majority of cardiologists lack current, up-to-date education surrounding nutrition and diet. A report published by the American Journal of Medicine, authored by a dozen healthcare professionals in the United States and Spain, titled “A Deficiency of Nutrition Education and Practice in Cardiology” details that less than a third of cardiologists describe their nutrition knowledge as “mostly up to date” or better.

Although the leading cause of premature death and disability in the United States is heart disease, most cardiologists report inadequate training in nutrition. “Using nutrition as medicine is probably one of the most cost effective ways to treat disease but is incredibly underutilized by healthcare providers,” explained Andrew Freeman, M.D., a cardiologist at National Jewish Health in Denver, and one of the study’s co-authors. “If we could empower healthcare providers with information on how to implement this in daily practice, we could transform healthcare rapidly, prevent healthcare cost explosions, and reduce morbidity and mortality.”

Ninety percent of cardiologists surveyed reported receiving no or minimal nutrition education during cardiovascular fellowship training; 59 percent reported no nutrition education during international medicine training; 31 percent reported no nutrition education throughout medical school. Almost two-thirds of all surveyed cardiologists reported spending three minutes or less per visit discussing nutrition with their patients.

The report further noted that the total annual cost related to heart and vascular diseases in the United States is $315 billion, much of which could be lessened with proper nutritional training and implementation.

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Heart Disease Among Chinese Americans: Frequently Overlooked

A new study published by the Centers for Disease Control and Prevention indicates that risk factors for heart disease among Chinese Americans are often overlooked, as the standard generally utilized to determine a healthy weight is commonly not adjusted for Asian populations.

The study, “Obesity and Modifiable Cardiovascular Disease Risk Factors Among Chinese Americans in New York City, 2009—2012” examined the relationship between body mass index (BMI) and risk factors for cardiovascular disease among New York City’s Chinese Americans.

Simona Kwon, lead investigator of the study and director of New York University’s Center for the Study of Asian Health, reported that Asian Americans are often left out of health research analysis, “Because it looks like we’re not experiencing health disparities in cardiovascular disease.”

Kwan reports that there is a well established link between high rates of diabetes and South Asian communities, yet there is a ‘model minority’ of East Asians having less risk of cardiovascular disease. While the World Health Organization defines a ‘normal’ BMI as between 18.5 to 24.9, ‘overweight’ as 25 to 29.9, and ‘obese’ as 30 or higher, people of Asian descent tend to have higher body fat percentages—so BMI measurements must be adjusted.

Measured against standard BMI values, the authors found a low prevalence of Chinese Americans who were overweight and obese, yet when they used the BMI cut points adjusted or the Asian population, the numbers went up. Researchers state that Chinese Americans are disproportionately affected by cardiovascular disease risk factors that are preventable and treatable, like diabetes and high blood pressure.

Because physicians decide whether or not to screen patients for diabetes based on BMI, authors of the article suggest that patients of Asian descent should use lower BMI cut points; traditional cutoffs would miss Chinese Americans at risk of diabetes.

“There’s a need to disaggregate data on Asian Americans and focus on subgroups because when you look at Asian Americans as a whole, a lot of differences get masked,” says Kwan.

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Sleep Hygiene & Heart Disease

A recent study indicates that getting sufficient sleep is especially critical for those at risk for heart disease and diabetes, as less than six hours per night may increase their risk of premature death.

Participants in the study who had a high body mass index (BMI) and elevated cholesterol, in conjunction with several other risk factors for cardiovascular disease and diabetes—a combination termed metabolic syndrome—and slept less than six hours per night were twice as likely to die of heart disease or stroke over a nearly 17-year period, as people without the syndrome.

Lead study author Julio Fernandez-Mendoza, an assist professor of psychiatry and Penn State College of Medicine, stated: “If you have several heart disease risk factors, taking care of your sleep and consulting with a clinician if you have insufficient sleep is important if you want to lower your risk of death from heart disease or stroke.”

The study involved 1,344 adult participants, 39.2 percent of which had metabolic syndrome. After following the people for almost 17 years, the researchers analyzed the relationship between metabolic syndrome, the length of time the participants slept at the outset of the study, and risk of death throughout the next almost two decades. The data signified that people with metabolic syndrome who slept at least 6 hours at the beginning of the study were 1.5 times more likely to die of cardiovascular disease than those without metabolic syndrome; however, people with metabolic syndrome who slept less than 6 hours were 2.1 times more likely to die.

Moreover, the people who slept less—and also had metabolic syndrome—were twice as likely to die from any given cause during the study period as the people who did not have the syndrome. Comparatively, the people with metabolic syndrome who slept 6 or more hours were 1.3 times more likely to die from any cause. The results demonstrate a strong link between shorter sleep duration and mortality among people with metabolic syndrome, indicating the need for proper and consistent sleep hygiene.

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