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Category: CMHC

Cardiometabolic Health Congress

The Benefits of Bicycling

A recent study at the University of Glasgow, published in the British Medical Journal, indicates that those people who bicycle to work are 41 percent less likely to develop heart disease and cancer. While walking has clearly outlined benefits, it does not provide the same payback as bicycling.

The test was conducted with 264,337 people; compared to driving, cycling is linked to a 46 percent lower risk of cardiovascular disease. The same study demonstrated that walking reduced heart disease by 27 percent, but showed no links between lower risks of cancer or premature death.

Researchers and experts believe that the high health benefits of cycling may be linked to the fact that cyclists often travel longer distances, and exercise at higher intensities.

Dr. Jason Gill, a professor and scientist who helped execute the study, believes that the government should legislate easier ways for people to commute by bike, including the creation of “cycle lanes, city bike hire, subsidized cycle purchase schemes, and increasing provision for cycles on public transport.” These efforts have the potential to create significant opportunities for improvement of public health.

Perhaps most importantly, it is imperative to make physical activity both ‘easier and more accessible.’ Workplaces, local authorities, and the legislature should investigate ways to increase and enhance public transport—making it an ‘easy option’ to get to work.

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Pass the Butter!

A new editorial published by a group of cardiologists in the British Journal of Sports Medicine argues that saturated fats, found in foods like butter, cheese, and meats, does not clog arteries and ultimately lead to cardiovascular disease. The doctors report that a Mediterranean-style diet, coupled with minimal stress and daily exercise, should be the primary focus for the prevention of heart disease.

The authors cite systematic reviews and observational studies that show no correlation or association between consumption of saturated fat and increased risk of heart disease. British cardiologist Dr. Aseem Malhotra, of Lister Hospital, argues that even reducing saturated fat intake in people with pre-established heart disease does not minimize the risk of heart attacks. Yet for decades, researchers, doctors, and scientists believed that cutting out saturated fat would lower cardiovascular disease—despite firmly solid evidence.

While some people have transitioned to diets of carbohydrates, these also play a role in the gradual development of cardiovascular disease. Malhotra states that eating too much pasta, bread, and potatoes will rapidly spike blood glucose levels; our bodies respond to carbs by over-producing insulin. When insulin levels are consistently and constantly too high, the hormone is unable to deliver glucose to cells, in order to provide energy. Ultimately, an inflammatory response occurs when the body becomes resistant to insulin, which Malhotra and his colleagues believe is the true culprit.

The editorial sheds light upon the critical importance of diet, as a dietary imbalance of nutrients can ultimately damage arteries; the lipid, soft fat plaque that is more prone to rupturing is the ultimate cause of a sudden heart attack. The combination of a healthful diet, regular exercise, and stress reduction is considered to be the optimal way to reduce cardiovascular disease, and most other chronic diseases.

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Running Reigns Supreme

A recent review of evidence published in the journal Progress in Cardiovascular Disease indicates that runners live three years longer than no-runners, solidifying the hypothesis that longevity can be increased by exercise—to a substantial degree.

The research states that not only does running significantly reduce the risk of heart disease and premature death, but also demonstrates benefits even if other aspects of health are sub-par. Someone who drinks and smokes can still reduce early mortality by running: between 25% and 40%.

Running 5-10 minutes per day was found to reduce the risk of cardiovascular disease, in addition to death from any and all causes. The review’s authors state that there is no other exercise that yields such a significant impact; statistically, an hour of running will increase one’s life expectancy by seven hours—and prolong life more than other types of exercise including cycling, swimming, or walking.

The authors also confirm that even a jog counts as moderately vigorous exercise. Runners primarily have enhanced levels of aerobic fitness and lower levels of body fat, and enjoy an array of health and wellness benefits. Moreover, in terms of time, it takes 105 minutes of walking to produce the same benefits as a 25-minute run.

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Link Between Alzheimer’s & Vascular Disease

The more risk factors for vascular disease one has in middle age, the higher the risk may be of developing Alzheimer’s disease in later life: the conclusion of a new study published in JAMA.

Vascular disease is defined as any condition that affects the circulatory system–the vessels that carry the blood to and from the heart. Types of vascular disease include atherosclerosis, the hardening or narrowing of the arteries due to plaque buildup, and peripheral artery disease, the narrowing of the arteries in the limbs. Obesity, high cholesterol, high blood pressure, diabetes, and smoking are some of the common risk factors for vascular disease.

Previous studies have suggested a link between vascular disease risk factors during midlife and increased risk of later-life dementia—particularly Alzheimer’s disease—the most common form of dementia.

However, Dr. Rebecca F. Gottesman – of the Department of Neurology at Johns Hopkins University School of Medicine in Baltimore, MD – and colleagues note that it has been unclear as to whether these risk factors are directly associated with the buildup of beta-amyloid in the brain.

Beta-amyloid is a protein associated with the development of Alzheimer’s disease. The protein can accumulate in the brain, forming “plaques” that disrupt communication between nerve cells. With the help of positron emission tomography (PET) brain imaging, Dr. Gottesman and team sought to gain a better understanding of how risk factors for vascular disease might affectbeta-amyloid accumulation in the brain.

The researchers analyzed the data of 346 dementia-free adults who had participated in the Atherosclerosis Risk in Communities (ARIC)-PET Amyloid Imaging Study for almost 25 years. Participants were a mean age of 52 years at the point of study enrollment between 1987 and 1989. At that time, subjects were assessed for the presence of vascular disease risk factors, including high cholesterol, smoking, high body mass index, high blood pressure, and diabetes.

Between 2011 and 2013 – at a mean age of 76 years – participants underwent PET imaging, which revealed the levels of beta-amyloid in their brains. “The availability of imaging biomarkers for brain amyloid allows the study of individuals before the development of dementia and thereby allows consideration of the relative contributions of vascular disease and amyloid to cognition, as well as the contribution of vascular disease to amyloid deposition,” note the researchers.

Compared with participants who had no risk factors for vascular disease at study baseline, those who had two or more risk factors were found to have significantly higher levels of beta-amyloid in their brains. The more vascular risk factors participants had, the higher were their levels of beta-amyloid.

Contrary to previous studies suggesting that the link between vascular disease risk factors and beta-amyloid levels varies by race, the researchers found that race did not influence their findings. Furthermore, the study results did not differ between people with and without the APOE e4 allele, which is a form of the APOE gene associated with an increased risk of Alzheimer’s disease.

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Announcing Dr. Paul Grundy for Boston’s Business of Medicine Pre-Conference

CMHC is excited to announce Paul Grundy, MD, MPH, FACOEM, FACPM as a speaker for the pre-conference Business of Medicine Day at the 12th Annual Cardiometabolic Health Congress in Boston. As Chief Medical Officer and Global Director of Health Transformation at IBM, Dr. Grundy is one of less than 100 IBM employees—and the only physician—selected into the company’s senior industry leadership forum: the IBM Industry Academy.

Dr. Grundy’s work focuses on shifting global healthcare delivery towards data-driven, consumer-focused, accountable systems, through the adoption of new information technologies and incentives systems. In his role, Dr. Grundy develops and executes strategies that support IBM’s healthcare-industry transformation initiatives, while acting as an active social entrepreneur, advocate, and speaker on global healthcare revolutions. His work has been published and reported widely in newspapers, radio, and television across the country, and he has been the recipient of the prestigious Barbara Starfield Primary Care Leadership Award, and the National Committee for Quality Assurance Award.

Dr. Grundy’s session, The Patient-Centered Medical Home: A Foundation for Patient Satisfaction, will begin at 11:00 AM on Wednesday, October 4th.  Visit www.cardiometabolichealth.org for more information and registration details.

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Heart Failure in the South

A recent ethnographic study titled “Heart Failure Incidence and Mortality in the Southern Community Cohort Study (SCCS)” investigated heart failure incidence, and post-heart failure survival, by race and sex among low-income adults in the southern parts of the United States.

Heart failure risk factors in the study included hypertension, diabetes, myocardial infarction, and obesity. The participants—27,078 white and black men and women enrolled during 2002 to 2009 in the SCCS—had no history of heart failure. Over a median follow-up of almost 5 ½ years, 4,341 participants were diagnosed with heart failure. Among these cases, 952 deaths occurred over a median follow-up of 2.3 years. Researchers ultimately concluded that heart failure in this population was higher for all race-sex groups than previously reported in other studies.

While this segment of the population, geographically located in the South, had a significantly high instance of heart failure, a number of other studies have indicated that heart disease burden has shifted to the Southern United States. Study findings published in the American Heart Association journal Circulation reveal that the highest death tolls have shifted to the Deep South over the past few decades.

Researchers at the Centers for Disease Control and Prevention analyzed heart-related deaths across the United States and found that trends often vary by factors like gender, race, and location. In order to learn more about the geographic trends, researchers analyzed U.S. mortality statistics from 1973 to 2010, calculating mortality rates in two-year intervals and including heart-related deaths in adults 35 years or older.

By 2010, researchers found that the highest death rates were in Southern states like Alabama, Mississippi, and Arkansas. Researchers further noted that declines in heart disease mortality have been slowest in Southern states, compared to the rest of the country.

These findings highlight the need to address significant health disparities in the United States; the concentration of heart disease in the Southern United States is likely due to geographic and racial differences in heart disease prevention and treatment. In order to fully understand these geographic trends, it is critical to recognize the biological, behavioral, and environmental factors that influence them.

Learn more about the prevention, diagnosis, and treatment of cardiovascular disease at our upcoming CMHC Regional Conference in Atlanta, Georgia. The last session of the day will be “Getting to the Heart of the Matter: Diagnosis and Treatment of HTN and HF in Primary Care.” 

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The Urgency of Obesity: “The HIV of our age”

Across the world, experts on cardiovascular health and obesity are regularly discussing the urgency regarding the global health epidemic of obesity, considered to be the ‘HIV of our age. The metaphor is eerily accurate; obesity routinely kills millions of people across the world, and costs health institutions billions of dollars—despite its preventability. A 2007 Government Foresight Report estimated that approximately half of the UK population would be obese by 2050, but researchers believe that it might occur even sooner. A report published today by Aetna International, one of the world’s leading health insurance providers, reaffirms the urgency required to limit the global fallout from rising obesity levels.

The report, titled “Globesity: Tackling the world’s obesity pandemic,” calls upon major institutions, governments, food producers, retailers, and insurance companies to collectively combine efforts in order to cooperatively tackle the growing global obesity crisis. Statistics from the World Health Organization indicate that obesity rates have more than doubled since 1980: currently, 13% of adults are classified as obese; nearly 40 meet the criteria for being overweight.

Moreover, a host of studies have found strong correlations between at least 15 cancers and obesity, in addition to an extensive list of severe health problems, including type 2 diabetes, fatty liver disease, arthritis, coronary heart disease, and stroke.

The necessity of education improvement, in order to promote healthy living, is critically pressing—particularly as the obesity pandemic begins to affect increasing numbers of children. Implementation of public education programs would begin to raise awareness, specifically concerning the strong link between obesity and heart disease. The sole way to solve the obesity crisis is through a holistic approach, one that combines health incentives, taxes, and education programs. Studies have confirmed that one of the most effective ways in which to reduce obesity is to clearly communicate information about its direct correlation with health and disease.

Like HIV, obesity has the makings of a ‘public health catastrophe’—one that must be averted at all costs.

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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.

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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.

Read more

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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.

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