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Category: CMHC

Cardiometabolic Health Congress

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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Obesity Crisis Will Double Number of Stroke Victims

Fueled by the consistently worsening obesity crisis, cases of stroke victims are expected to almost double in the next two decades.

Experts note that the number of new strokes in the United Kingdom alone could jump by 44% by 2035; currently, more than one in four adults qualifies as obese or overweight—compared to one in thirty-five, a statistic from the 70s.

The Stroke Association has noted that poor lifestyles habits put people at a much greater risk of attacks, further commenting that the additional costs of skyrocketing cases could cripple public health service organizations.

While obesity significantly boosts the risk of stroke, some elementary lifestyle changes can be implemented in order to prevent cardiovascular disease: including eating healthier meals, and committing to an exercise routine. Statistics indicate that almost nine in ten strokes are due to long-term conditions like diet, lack of movement, and obesity.

Recent studies have also demonstrated that the risks for stroke also exist for younger people, not solely older adults. According to the Centers for Disease Control and Prevention, obesity has more than doubled in younger children and teens throughout the past three decades.

The findings highlight the need to recognize obesity as a risk factor for stroke in younger adults, and take steps to control related conditions like high blood pressure and hypertension.

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Obesity Causes Heart Changes—Even Among Youth

A high BMI is known to cause heart disease in mid-to-late life, but new research has revealed it can worsen cardiovascular health even in those as young as 17.

Obesity can cause poor cardiovascular health, even in the young, according to a new study.

European researchers say they’ve detected the development of cardiovascular changes known to be precursors of heart disease in those aged as young as 17 as a result of high body mass index (BMI).

The research was presented at the European Society of Human Genetics 2017 conference in Copenhagen, Denmark.

Higher than normal BMI is known to lead to cardiovascular ill-health in mid-to-late life, but there has been limited investigation of its effect in young, healthy adults.

Genomic analysis of thousands of 17-to-21-year-olds involved in the UK’s Avon Longitudinal Study of Parents and Children found a high BMI caused significant burden on the heart’s left ventricle.

A thickening of the left ventricle in the heart, known as hypertrophy, means it has to work harder to pump blood and is a common marker for heart disease.

Dr Kaitlin Wade from the Medical Research Council Integrative Epidemiology Unit at the University of Bristol led the study and says the results support efforts to tackle the obesity epidemic from an early age in order to prevent cardiovascular disease.

“Our results showed that the causal impact of higher BMI on cardiac output was solely driven by the volume of blood pumped by the left ventricle,” Dr Wade said.

This, she says, can partly explain the causal effect of higher BMI on cardiac hypertrophy, a thickening of the heart muscle, and higher blood pressure that was observed among the participants.

“It is the first time that the nature of this relationship has been shown in a group of young adults where it has been possible to draw improved conclusions about its causation,” Dr Wade said.

“We believe that there are clear messages for cardiovascular health in our findings and we hope that they may lead to increased efforts to tackle obesity from early life.”

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NCQA Patient-Centered Medical Home: Updated & Upgraded

 The National Committee for Quality Assurance (NCQA), an independent non-profit organization that works to improve health care quality, has recently given its patient-centered medical home ‘a makeover’ in order to “reduce documentation burdens, lower costs, and facilitate quality improvements.”

The NCQA’s move marks a growing effort spearheaded by the healthcare industry’s leadership organizations in response to new technologies, uncertainty surrounding reimbursements, and heightened reporting requirements. The organization’s recent announcement of a comprehensive overhaul will enact changes that aim to create “a much more user-friendly version of the popular practice transformation framework that avoids the pain points of previous iterations of the program,” said Michael S. Barr, MD, Executive Vice President of the Quality Measurement and Research Group at NCQA.

Due to a host of complaints from physicians and providers regarding the ‘unduly onerous’ recognition process, the NCQA wishes to reduce or eliminate costs, lower documentation burdens, and streamline some of the aspects of the recognition process that were devaluing patient care. A marked change is the abolition of distinctions between Level 1, 2, and 3; providers are now recognized or working towards recognition. The NCQA and healthcare industry realizes that ‘all-or-nothing measurements’ are not the optimal, most effective way to encourage innovation and improvement.

Moreover, the NCQA has replaced the three-year recertification cycle with annual check-ins, so that providers are not required to go through the entire recognition process again. Yearly meetings are designed to ensure that recognized practices are primarily focused on a high level of patient-centered care, and continuously improving. Each practice will also be assigned an NCQA representative, who can assist them in moving throughout the process, and also confirm and certify that the practice has met the necessary requirements.

Barr hopes that the revamped PCMH recognition process will help providers move towards a more efficient, effective way to deliver care, but admits that they will need more than yearly check-ins to succeed in an increasingly data-driven world. He urged stakeholders that it is time to “optimize electronic health records (EHRs), so that we can really align them with what we need to do to improve patient care.” Barr further clarifies that EHRs should be redesigned in order to effectively communicate the patients’ stories, and simultaneously equip providers with the necessary data to make informed, personalized, and effective choices with the patient and caregivers.

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Non-O Blood Types: Higher Heart Attack Risk?

Research suggests that those people with a non-O blood group have a slightly increased risk of cardiovascular disease: specifically, heart attack and stroke.

The research analyzed studies involving 1.3 million people; the data was presented at the European Society of Cardiology. The data found that 15 in1,000 people with a non-O blood group suffered a heart attack, compared to 14in 1,000 people with the O blood group. While the increase seems small, ‘when applied to a whole population the numbers become more important.’

Scientists suggest that these findings can be attributed to the fact that people with A, B, and AB blood have higher levels of a blood-clotting protein. Previous research has found that people with AB blood, the rarest type, are 23%more likely to suffer heart disease—the most vulnerable population.

Notwithstanding the findings, most cardiologists and physicians agree that a person’s risk estimation for cardiovascular disease is primarily determined by age, genetics, and other modifiable factors including nutrition and diet, and level of physical activity.

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Calling All Cheese Lovers

A large-scale analysis indicates that cheese, and other dairy products, do not lead to an increased risk of death from heart disease or stroke.

A study published in the European Journal of Epidemiology involving scientists at the Institute for Food, Nutrition, and Health at the University of Reading, England analyzed 29 studies that collectively represented almost 1 million people and 93,000 instances of death.

Within the studies, the team focused on diet—specifically, whether or not participants consumed large amounts of dairy products—and the rates of CVD, coronary heart disease, and death.

The conclusions and findings showed no correlation or association between a diet high in dairy and risk of heart disease, combining data from 29 prospective cohort studies.

One of the study’s authors, Jing Guo, stated that this latest analysis provides “further evidence that a diet high in dairy foods is not necessarily damaging to health.” The evidence supports previous findings that demonstrate the health benefits of dairy foods in an integrated, well-balanced diet.

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Risk of Heart Disease with Painkillers

A large-scale study several years ago indicated that common painkillers like ibuprofen and naproxen are considered risky for people who have had heart attacks. New research indicates that the risk can begin within the first week of usage.

The study involved NSAIDs: non-steroidal anti-inflammatory drugs, including ibuprofen—generically known under its brand names Advil and/or Motrin.Researchers at McGill University pooled extensive studies and clinical research on NSAIDs and heart attacks, using a data pool of over 446,000 people who used the drugs, including 385,000 participants who did not have heart attacks.

The report, published in the British Medical Journal, stated that current use of a NSAID is “associated with a significantly increased risk of acute myocardial infarction,” the medical terminology for a heart attack. Moreover, the risk began within a week of usage. The data demonstrated that those who used NSAIDs were more likely to have a repeat heart attack, or die within the next 5 years. In the first year post-heart attack, 20 percent of NSAID users died, compared to approximately 12 percent of non-users. The death rate of NSAID users remained about double than that of non-users in the next few years.

A number of studies have consistently revealed similar patterns concerningNSAIDs and heart disease, coupled with biological reasons that NSAIDs could be risky for people with heart disease. Evidence suggests that the drugs may impact and affect blood clotting, blood vessel function, and blood pressure.Because NSAIDs are available over the counter, many patients and consumers believe that there is no danger involved.

The U.S. Food and Drug Administration has already added ‘black box warnings’ to NSAIDs, warning people with higher risks for heart disease and blood pressure to avoid using them without the recommendation of a physician. Dr. Gordan Tomaselli, chief of cardiology at Johns Hopkins University, advises: “if you’ve ever had a heart attack, you should use NSAIDs with caution.”

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Type 2 Diabetes and Heart Failure: A Deadly Combination

An in-depth session titled “Heart Failure: The Frequent, Forgotten, and Often Fatal Complication of Type 2 Diabetes” was presented last week at the American Association of Clinical Endocrinology’s 26th Annual Scientific and Clinical Congress. The cited evidence and research pointed to a high frequency of heart failure, accompanied by an increased risk of mortality, for patients with diabetes.

The conclusion that heart failure requires increased scrutiny, as a risk factor and complication of type 2 diabetes, has been oft quoted and researched—yet it is still not widely known how common the condition is. While microvascular effects of type 2 diabetes are well known and understood—such as neuropathy and diabetic retinopathy—and macrovascular conditions including stroke and peripheral vascular disease, heart failure almost inevitably raises mortality.

Researchers at the University of Alabama at Birmingham School of Medicine have performed series of clinical trials in an effort to determine whether or not heart failure should be more rigorously treated, in order to alleviate and mitigate the poor outcomes often seen in patients. Conclusions indicate that between 40 and 45 percent of patients with diabetes in the United States suffer from heart failure, vs. 12 percent of non-diabetes.

David S.H. Bell, MD showcased studies that specifically assessed and evaluated the complex effects of diabetes and contributing factors to the three primary causes of the heart failure, while other physicians highlighted relations between glycemic control and heart failure risk—focusing on strong correlations between the high incidence of heart failure and type 2 diabetes. Other researchers pointed to the fact that autonomic system dysfunction, a predictor of cardiovascular risk, often occurs in pre-diabetes—which might offer opportunities for early intervention. Technological advancements of the past decade currently allow for identification of the early stages of autonomic dysfunction, through the utilization of concrete, tangible standardized measurements.

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Air Pollution & Traffic: Environmental Impacts on the Heart

Recent findings that are part of the Multi-Ethnic Study of Atherosclerosis, an ongoing examination in six U.S. communities of the lifestyle factors that predict development of cardiovascular disease, indicate that traffic-related air pollution may increase heart disease risk by lowering levels of so-called “good” cholesterol.

In a study of 6,654 middle-aged and older adults from diverse ethnic backgrounds, participants living in areas with high air pollution levels tended to have lower high-density lipoprotein, or HDL, levels.Researchers also found men and women responded to air pollutants differently:The HDL was lower at higher pollution exposure for both sexes, but the difference was greater in women.

The link between air pollution and an increase in cardiovascular disease is not new. In 2004, an American HeartAssociation scientific statement concluded exposure to air pollution contributes to cardiovascular illness and death. A 2010 update elaborated on those risks.
But this new study begins the work at understanding the biology behind the link.
It is the first large study to examine associations between air pollution and HDL particle number, said lead author Griffith Bell, Ph.D.,from the University of Washington School of Public Health in Seattle. The study was published in the journal Arteriosclerosis, Thrombosis, and VascularBiology.

The pollution-heart disease connection may be explained by a reduction in the number of small, cholesterol-depleted HDL particles, which leaves the average amount of cholesterol in HDL particles higher on aper-particle basis. Recent evidence suggests that the number and functionality of HDL particles may be a better gauge of HDL’s heart-healthy effects than their cholesterol content, Bell said.

HDL is known as “good” cholesterol because it helps remove other forms of cholesterol from the bloodstream. Experts believe HDL acts as a scavenger, carrying LDL – or “bad” – cholesterol away from the arteries and back to the liver, where it is broken down and passed from the body.

Researchers found:
–Higher exposure to black carbon, a marker of traffic-related pollution, averaged over a year was significantly associated with a lower level of “good” HDL cholesterol.
–Higher particulate matter exposure over three months was associated with a lower HDL particle number.
–Changes in HDL levels may already appear after brief and medium-length exposures to air pollution.

More and more researchers are examining air pollution and its effects on the heart.
In February, researchers at the University of California, Los Angeles, found that exposure to pollution caused mice to experience changes in the normal composition of gut bacteria. The changes, according to their study published in the journal Nature, promoted the circulation of cholesterol in the bloodstream, and that, in turn, promoted the formation of plaque in the arteries, known as atherosclerosis.

Many previous studies on the health effects of air pollution assumed people living in the same city have the same level of air pollution exposure. But this new study used cohort-focused monitoring campaigns looking at time and place to estimate air pollution exposure for each study participant, Bell said.

This study measured HDL particle numbers, so “we were unable to examine whether they changed over time,” Bell said. That means more study is needed. Continuing to track how HDL levels change with extent of exposure to traffic air pollution and investigating how air pollution interferes with HDL’s activity in the body will help confirm and understand the role of HDL.

“Our study helps strengthen the biological plausibility of the link between traffic-related air pollution and cardiovascular disease,” he said. “We’re slowly beginning to understand some of the biology of how that link works.”

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