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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

How Healthy is YOUR Town?

Health
Exercise has received a lot more stage time in the recent years, especially due to the enormous focus on nutrition and the current obesity epidemic in our country.

We may personally feel like more gyms are packed and the lines are longer at grocery stores selling organic foods. It is no lie that people are more conscious of diet and staying active.

But is this just where YOU live?

An interesting article surfaced in the New York Daily News which covered exercise based on region; specifically cities in the US. A 2015-2016 Gallup and Sharecare poll showed that across 189 cities in the U.S., a person’s exercise frequency had nothing to do with where they lived.

While we would most likely agree that out of the 350,000 people polled, the ones living in metropolitan areas would be more likely to exercise a lot more, this poll proved us all wrong!

At least we were right about our earlier points:

  1. The poll showed that regions with higher rates of regular exercise also had less chronic health issues like heart attack, diabetes, obesity, and depression. Exercise = less disease, less obesity, better health.
  2. 53% of Americans were classified as “regular exercisers” in 2016. This was the highest rate on record since the same company ran the first U.S. poll in 2008. So we are on the right track!

The cities with the higher volume of exercisers are argued to have made routine exercise MORE possible for their citizens than other cities. Wouldn’t you be more likely to exercise if your city had more safe, livable, bike-able, run-able and walkable spaces accessible to you?

Now we know you are curious…who won? Who lost?

Boulder, Colorado (population of 108,000 approximately) had the highest percentage of regular exercising citizens. These people exercise three or more days a week, for at least 30 minutes a day.

NYC was almost at the end of the list (167 out of 189) and as far as who lost: Hickory, N.C. with 42%!

Are you wondering about your city? U.S. Cities ranked by Exercise Rate

New York Daily News. The surprising cities with the highest and lowest rates of exercise.
http://www.nydailynews.com/life-style/surprising-cities-highest-lowest-rates-exercise-article-1.3509233.
September 20, 2017. Accessed October 5, 2017.

Linking Cancer & Heart Disease: The Root of 2 Killers May Be The Same?

Inflammation, which we have all heard is a root cause of many diseases and dysfunctions in our bodies, has just linked two regularly UNLINKED killers: Cancer and Heart Disease.

In an exceptionally written article in The New York Times Magazine last week, readers were introduced to a patient who suffered from two deadly forms of cancer: lung and melanoma. When asked what he almost died from, this patient shared it was actually not these cancers, but a heart attack.

Throughout the rest of this thought-provoking article, the author, a Pulitzer Prize-winning cancer physician and scientist at Columbia University, Dr. Siddhartha Mukherjee, shared that the two top killers in our country, heart disease and cancer may now be linked. He carefully explains how.

Before today (and for the most part still) the subspecialists dealing with these killers—Cardiologists and oncologists have lived in two very different medical jurisdictions. They attend different medical conferences, read very different medical journals and essentially do not speak the same medical language.

The author brings up a distinguished faculty member of ours at Cardiometabolic Health Congress, Dr. Peter Libby in his article. He explains that Dr. Libby, a cardiologist, along with Dr. Paul Ridker, brought to light an important variable in the early 2000’s that was never discussed in relation to heart disease and plaque formation – inflammation.

For several years therafter, Drs. Libby and Ridker focused on a specific molecule involved in inflammation. A new drug that inhibited this one specific molecule, was actually being used to treat very rare inflammatory diseases; and in 2011, Dr. Ridker’s team enrolled thousands of patients with signs of inflammation (and at very high risk for coronary disease) into a study to determine the effects of this new drug on heart disease.

The basis of this article lies in the results of this study which were published only 2 months ago.

With higher doses of the drug, there was a noticeable reduction in heart attacks, stroke and cardiovascular death.

However, what caught the author’s attention was a separate investigation that inquired: Would this drug also reduce cancer risks?

A medical journal titled The Lancet published a paper where Dr. Ridker and his team found that there was a drop in all cancer death in drug-treated patients; specifically, a decrease in the deaths from and occurrence of lung cancer.

Bottom line, this article seems to point out that a component of inflammation is driving plaque formation in coronary disease that is ALSO driving cancer progression.

The author explains that this study will need careful reproduction and that the analysis coming out of this investigation was not meant to prove a hypothesis, but only to suggest one.

Many questions remain understandably, but if the findings hold true in future studies, any form of inhibiting the specific molecule, interleukin-1 beta, could eventually be ranked as one of the most effective prevention methods in cancer’s most recent history.

We are excited about anything that could potentially mean the prevention of cancer or heart disease here at CMHC, and we do know from a personal perspective how oncologists and cardiologists can benefit from networking and attending meetings together. We recognize this is only the beginning, but we encourage all specialists to check out our most recent meeting agenda, and help us congratulate our own distinguished faculty member, Dr. Peter Libby in his early discoveries of inflammation in the potential future prevention of cancer!

Dr. Peter Libby has graced our stage at CMHC in 2014 and most recently at our last meeting as our keynote in Oct. 2016. To read our blog based on Dr. Libby’s lecture last October, click here.

Heart Rate Variability

Thinking about your health means understanding your heart health, and paying attention to measures like cholesterol, blood pressure, and triglycerides. There is one more to add to the list: heart rate variability.

“Heart rate variability is the variation in the time between each heart beat,” explains John P. Higgins, MD, MBA, a sports cardiologist at McGovern Medical School at the University of Texas Health Science Center at Houston. This is different than your heart rate, which is measured by the number of times your heart beats per minute. And unlike your heart rate, which you can calculate by counting your pulse, heart rate variability is measured at the doctor’s office with an electrocardiogram (ECG or EKG) test that records the electrical activity of your heart.

When using the term variability, it refers to your heart beat’s ‘ability to shift throughout the day,’ as one’s heart rate is not meant to be the same, static speed; it changes depending on activities, emotions, and actions. A high HRV means that the body can efficiently change heart rate, depending on activity: intended to be a measure of the efficiency and performance of your cardiovascular system. Heart rate variability may also be a marker of the ways in which your body can handle stress, as a higher HRV communicates a better performance, whereas a lower HRV indicates that it would be difficult to ‘bounce back after a stressful situation.’

While age affects one’s HRV, being at an elevated risk for heart disease also affects it. Moreover, chronic stress, high blood pressure, and high cholesterol may impair functioning of this system, which leads to difficulties with heart rate and blood pressure–and ultimately HRV.

The best way to improve one’s HRV is exercise: even moderate workouts for 150 minutes per week. Biofeedback and meditation have also demonstrated usefulness in improving HRV, as deep & controlled breathing taps into the parasympathetic nervous system, causes one to destress and calm down.

Cardio Killers

Heart disease and tobacco ranked with conflict and violence among the world’s biggest killers in 2016, while poor diets and mental disorders caused people the greatest ill health, a large international study has found.

The Global Burden of Disease (GBD) study, published on Friday in The Lancet medical journal, found that while life expectancy is increasing, so too are the years people live in poor health. The proportion of life spent being ill is higher in poor countries than in wealthy ones.

“Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates. But we’ve been much less motivated to address issues leading to illnesses,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which led the study. He said a “triad of troubles” – obesity, conflict, and mental illness – is emerging as a “stubborn and persistent barrier to active and vigorous lifestyles”.

The IHME-led study, involving more than 2,500 researchers in around 130 countries, found that in 2016, poor diet was associated with nearly one in five deaths worldwide. Tobacco smoking killed 7.1 million people.

Diets low in whole grains, fruit, nuts and seeds, fish oils and high in salt were the most common risk factors, contributing to cases of obesity, high blood pressure, high blood sugar and high cholesterol.

The study found that deaths from firearms, conflict and terrorism have increased globally, and that non-communicable, or chronic, diseases such as cardiovascular disease and diabetes caused 72 percent of all deaths worldwide.

Heart disease was the leading cause of premature death in most regions and killed 9.48 million people globally in 2016. Mental illness was found to have a heavy toll on individuals and societies, with 1.1 billion people living with psychological or psychiatric disorders and substance abuse problems in 2016. Major depressive disorders ranked in the top 10 causes of ill health in all but four countries worldwide.

The GBD is funded by the Bill & Melinda Gates Foundation global health charity and gives data estimates on some 330 diseases, causes of death and injuries in 195 countries and territories.

Apple Cider Vinegar: More Than A Diet Trick?

While heart disease can be triggered by a poor diet, experts say apple cider vinegar may have positive benefits for certain cardiovascular risk factors, in addition to helping with weight loss.

Researchers believe that apple cider vinegar could have a protective effect on your heart. Consuming a few teaspoons before breakfast has become a health trend, due to claims that it aids weight loss, yet apple cider vinegar may also help boost heart health.

Research has suggested that it assists with lowering cholesterol and triglyceride levels, which have been linked to increased risk of heart attacks.

What’s more, studies found it protects against LDL cholesterol oxidation – which could lead to heart disease – and can reduce blood pressure. “Several ‘risk factors’ for heart disease and strokes have been shown to be improved by apple cider vinegar consumption,” said Fleur Brown, a nutritionist and author of Beat Chronic Disease – The Nutrition Solution. “It contains the antioxidant chlorogenic acid, which has been shown to protect LDL cholesterol particles from becoming oxidised, a crucial step in the prevention of heart disease process.

Additionally, there are also some studies showing that the vinegar can help reduce blood pressure. It appears to have the ability break down fat deposits in the body, improve circulation and thus lower pressure in the arteries. High insulin and blood glucose levels are also thought to contribute to heart disease, and apple cider vinegar can reduce both.

This is particularly important since diabetics are at an increased risk of heart disease as they have raised insulin and blood glucose levels., Additionally the knock-on effect of lowered levels of insulin is weight loss: being overweight can increase the risk of cardiovascular disease, therefore losing weight with the aid of apple cider vinegar can lower the risk of heart attacks and strokes.”

Nevertheless, research done so far to support apple cider vinegar’s direct positive effects on the heart, such as a 2015 study published in the Journal of Diabetes Research, have been conducted on animals. As yet, there have been no human studies, meaning we cannot know for certain that it would yield the same results.

“There is a limited amount of research to show that apple cider vinegar may help to lower blood cholesterol levels and so be good for the heart but most of this research comes from studies in rats, so we need to be careful about extrapolating to humans,” explained Dr Sarah Schenker, a registered dietician and nutritionist. What has been shown in humans is that apple cider vinegar can help with weight loss – which can also help heart health. “Several human studies suggest that apple cider vinegar can increase satiety, making you feel fuller more quickly,” said Brown.

Human studies have demonstrated that drinking apple cider vinegar along with high-carb meals can increase feelings of fullness and make people eat 200 to 275 fewer calories for the rest of the day. Reducing calories on a daily basis can result in reduced weight over time, and reduced risk of developing cardiovascular disease.”

Pick Up the Pace!

According to a new study, healthy adults who are slow walkers are twice as likely to die from heart disease as those of us who walk at a more brisk pace. “This suggests that habitual walking pace is an independent predictor of heart-related death,” lead author Professor Tom Yates said.

Researchers from the University of Leicester followed 420,727 people over a period of six years to assess death rates.  Those who were slow walkers were found to be between 1.8 and 2.4 times more likely to die of heart disease – which is the world’s biggest killer – during the timeframe.

The researchers took into account risk factors including smoking, BMI and diet, but found that the conclusion still applied to both men and women. However, it was actually adults with the lowest BMIs who were found to have the highest risk from walking slowly.

The study’s authors believe that walking pace is an indicator of overall health and fitness as it’s strongly linked to exercise tolerance.

“Self-reported walking pace could be used to identify individuals who have low physical fitness and high mortality risk,” said Professor Yates. The researchers also looked into whether walking pace could be linked to cancer, but no connection was found.

This is not the first study to link heart disease and walking pace though – research from 2009 concluded that walking slowly is “strongly associated” with an increased risk of dying from cardiovascular disease, including heart disease and stroke.

Heart disease is often a result of high blood pressure, obesity and high cholesterol, and is the leading cause of death in the US, second only to dementia in the UK.

Heart Disease: Linked to Dementia

A recent NIH-funded study suggests that middle-aged people with risk factors for cardiovascular disease, including heart attacks and stroke, are more likely to develop dementia in old age than people without vascular risk factors.

The study, published in JAMA Neurology, included factors like diabetes, high blood pressure and smoking. “With an aging population, dementia is becoming a greater health concern. This study supports the importance of controlling vascular risk factors like high blood pressure early in life in an effort to prevent dementia as we age,” said Walter J. Koroshetz, MD, director of NIH’s National Institute of Neurological Disorders and Stroke.

The NIH has funded a public health campaign titled “Mind Your Risks,” with the goal of raising awareness of the strong correlation between cardiovascular and brain health. “What’s good for the heart is good for the brain,” says Koroshetz. Among the study’s participants, smoking in middle age was associated with 41% higher odds of dementia; diabetes was linked to a 77% greater risk.

The study’s results contribute to a growing body of evidence and scientific literature that links midlife vascular health to dementia, including the potential of modifying the vascular risk factors to lessen the possibility of dementia. Factors like obesity, diabetes, high blood pressure, and smoking can all be controlled–over time, reducing the risk of dementia.

By focusing on risk factors before middle age, patients have an opportunity to treat and reverse these factors, with the ultimate goal of reducing dementia risk before it is too late.

Reducing Inflammation Lowers Risk of Heart Attack

It turns out that cholesterol isn’t the only thing you have to worry about to keep your heart healthy. In recent years, doctors have started to focus on inflammation — the same process that makes cuts red and painful — as an important contributor to a heart attack. It’s the reason doctors recommend low-dose aspirin to prevent recurrent heart attacks in people who have already had them, why they also prescribe statins, which lower both cholesterol and inflammation, and why they have started to measure inflammation levels in the blood.

But it’s never been clear exactly how much inflammation adds to heart disease risk. Since statins lower both, it’s hard to tell whether inflammation or cholesterol has the bigger impact on heart problems.

But in a new paper published in the New England Journal of Medicine and presented at the European Society of Cardiology meeting, scientists say they now have proof that lowering inflammation alone, without affecting cholesterol, also reduces the risk of a heart attack.

In the study, 10,000 people who have already had a heart attack were randomly assigned to get injected with a placebo or different doses of a drug called canakinumab. Canakinumab, made by Novartis, is currently approved to treat rare immune-related conditions and works to reduce inflammation but does not affect cholesterol levels. After four years, the people who received the drug had a 15% lower chance of having a heart attack or stroke compared to people who didn’t get the drug. The medication also reduced the need for angioplasty or bypass surgery by 30%.

“Even I am pinching myself,” says Dr. Paul Ridker, who led the study and is director of the center for cardiovascular disease prevention at Brigham and Women’s Hospital and is a pioneer in exposing the role inflammation plays in heart disease. “This outcome is more than we hoped for. The bottom line is we now have clear evidence that lowering inflammation through this pathway lowers rates of heart attack and stroke with no change at all in cholesterol.”

About a quarter of people who have heart attacks will have another heart event even if they keep their cholesterol at recommended levels. For them, it may not be cholesterol so much as inflammation that is driving their heart disease. So the study further solidifies the fact that heart doctors should be measure inflammation as well as cholesterol in their heart patients. An inexpensive blood test that looks for a protein that rises in the blood with inflammation, called C-reactive protein (CRP), can tell doctors how much inflammation their patients have. Beginning in 2003, the American Heart Association started to provide guidelines on how doctors should use CRP testing; for patients like those in the current trial, the group did not see any additional benefit to CRP testing since those patients should already be treated with statins, which can lower both cholesterol and inflammation.

But with the new results, those guidelines may change. Ridker says the findings should clarify how doctors can optimize the way they treat their heart patients — about half of people who have had a heart attack tend to have high levels of inflammatory factors, while half have high cholesterol levels. The inexpensive CRP test could identify those with higher inflammation, who might be candidates for taking a drug like canakinumab.

The drug is not currently approved for any heart conditions, but Novartis will likely look at doing more studies to confirm its effectiveness in treating heart disease.

Perhaps more intriguing are additional results that Ridker reported, related to cancer. In a separate study published in the Lancet using data from the same study, he found that people taking canakinumab lowered their risk of dying from any cancer over four years by 50%, and their risk of fatal lung cancer by 75%.

While the connection between heart disease and cancer may not seem obvious, Ridker says that many people who have had heart problems, like those in the study, are former or current smokers, since smoking is a risk factor for heart attacks. And smoking increases inflammation. “People who smoke a pack of cigarettes a day are chronically inflaming their lungs,” he says. That’s why he decided to look at cancer deaths as well as heart events in his study population.

The cancer data is still preliminary, and needs to be confirmed with additional studies, but it’s encouraging, says Dr. Otis Bradley, chief medical officer for the American Cancer Society, who was not involved in the study. “We know that free oxygen radicals and inflammation can damage DNA and can cause cancer,” he says. “This all makes sense to me.” Studies have already shown, for example, that inflammation may be a factor in prostate cancer and colon cancer.

But whether anti-inflammatory agents, like canakinumab, or even over-the-counter drugs like aspirin, should be part of standard cancer treatment isn’t clear yet. There are a number of different inflammatory pathways, and canakinumab targets just one. Other pathways, along with new anti-inflammatory drugs, may emerge with more research.

When it comes to heart disease, however, it’s clear that inflammation-fighting medications like canakinumb may represent the next generation of treatment. “Ten years from now we will be doing more personalized medicine,” says Ridker. “Some people will get more cholesterol lowering. Some will get more inflammation-lowering drugs. Some will get other agents that we haven’t considered yet. It’s a wonderful new era in heart disease treatment.”

Increases in Pediatric Hypertension

More children and teens are likely to be categorized as having abnormal blood pressure during their annual wellness visits, based on new recommendations released this week by the American Academy of Pediatrics.

High blood pressure is mostly a “silent” condition, with no visible symptoms. Yet it can have long-term health consequences, including cardiovascular disease. The new guidelines, aimed at prevention, were published Monday in the journal Pediatrics. They include new diagnosis tables based on normal-weight children.

The academy convened a 20-person committee to update the previous guidelines, issued in 2004, and develop new evidence-based recommendations. As part of its work, the committee reviewed nearly 15,000 articles focused on diagnosis, evaluation and early management of abnormally high blood pressure in children and teens.

An estimated 3.5% of all children and teens in the United States have hypertension, according to the guidelines. “The prevalence of 3.5% is based on fairly recent large-scale screening studies,” said Dr. Joseph T. Flynn, lead author of the guidelines and a professor of pediatrics at University of Washington. In the past, the percentage of children diagnosed with high blood pressure was lower, he said: “based on previous studies, maybe 1% to 2%.”

The cause of hypertension depends on the age group. “In infants and very young children, we worry about an underlying cause like kidney disease,” Flynn said. With older school-age children and teenagers, the cause is more likely to be primary hypertension, sometimes called essential hypertension, “where there’s no specific problem,” he said. “This is like adults.”

Obesity does contribute to higher blood pressure, yet the physiological mechanisms causing high blood pressure are very complicated, and not all kids who are overweight or obese are hypertensive, while some normal-weight kids may be.

“If, for example, a child is known to have kidney disease or heart disease, then they would be at higher risk for hypertension. Another group would be kids whose parents have hypertension,” Flynn said. The guidelines include updated blood pressure tables based on normal-weight children for more precise classifications of hypertension. As a result, more children will be categorized as needing treatment.

“Untreated, we believe that high blood pressure in a child will lead to high blood pressure when that child becomes an adult, so that would potentially lead to an increased risk of cardiovascular disease later in life,” Flynn said, adding that untreated hypertension can also cause heart and kidney damage. The new guidelines are aligned with those for adults, according to Flynn. “The blood pressure levels that are concerning in adults would also be concerning in an older teenager,” meaning those age 13 and older. “It simplifies things for doctors,” he said.

The major thing parents need to know is that their children should have their blood pressure checked when they see a doctor, Flynn said. Also, know that hypertension can be managed with lifestyle change: for example, more exercise or changing the diet. Sometimes, though, the condition requires medication. Another change in the new guidelines is an emphasis on confirmation of the diagnosis.

“Ambulatory blood pressure monitoring is a procedure in which the person wears a blood pressure cuff for 24 hours, and their blood pressure is measured periodically over 24 hours,” Flynn said. “This is very important in children because there’s a very high rate of what’s called white coat hypertension, where blood pressure is high in the office (due to fear of doctors) but not at home.”

The new recommendation is that ambulatory blood pressure should become standard practice in children after any abnormal in office reading, Flynn said. Dr. Sophia Jan, director of general pediatrics at Cohen Children’s Medical Center in New Hyde Park, New York, said the rationale behind the new guidelines makes sense. With evidence that there may be consequences for kids whose high blood pressure is not treated at lower thresholds, it makes sense to treat them earlier than in the past, said Jan, who was not involved in the new recommendations.

What she would tell parents is that “we’re not doing anything majorly different. We’re still going to check your child’s pressure when he or she comes for wellness child visits. That’s what we’ve done always in the past.” What’s new is that “we may be quicker to recommend that you and your family help your child engage in lifestyle changes if your child’s pressure is within a threshold that is lower than in the past. “Everyone’s loath to put kids on medicines if you don’t have to, but we may need to get there a little bit faster than we have traditionally in the past,” Jan said.

“As doctors, we recommend these lifestyle changes, yet in reality, it requires partnership with schools and public health agencies,” she said. “We in the pediatric community did not necessarily appreciate to what degree kids were starting to exhibit what is traditionally thought of as an adult condition. Kids can show early signs of organ damage and increased risk for cardiovascular disease despite the fact that they’re young.”

Risks of Poor Medication Adherence

A recent study published in the journal Diabetes Care indicates that poor medication adherence in adults diagnosed with type 2 diabetes is strongly associated with increased risks for “cardiovascular disease, all-cause mortality, and hospitalizations.” Conversely, when patients have good medication adherence, these risks are reduced.

The Leicester Diabetes Center at Leicester General Hospital, in conjunction with the Diabetes Research Centre at the University of Leicester in Southmead, United Kingdom, conducted a meta-analysis surrounding eight observational studies in order to determine the correlation between medication adherence and risk for cardiovascular disease (CVD)—in addition to hospitalization and mortality rates—among adults with type 2 diabetes.

The studies’ poor adherence statistics ranged from 25% to 91%, with a mean of 37.8%; one study demonstrated that there was a decrease in CVD with good medication adherence. Other studies reported that good adherence was further associated with benefits in reduced hospitalization rates. The researchers wrote: “In conjunction with previous studies, these data should encourage health care professionals to routinely assess adherence in clinical practice and make efforts to improve it where it falls below 80%…in addition, our findings should serve to reinforce to patients the importance of taking medications as prescribed, in order to avoid premature death and preventable admissions to the hospital.”

Numerous other studies confirm that poor medication adherence is particularly common among patients with cardiovascular disease, and results in serious adverse health consequences. The American Heart Association cites that medication nonadherence results in approximately 125,000 preventable deaths per year, in addition to dramatically increased risks of hospitalization and premature death. Moreover, medication adherence leads to increased health care costs for both individuals and the health care system.

In order to address the variety of potential reasons for poor medication adherence, in addition to an assessment of solutions that could close the adherence gap, the 12th Annual CMHC will host a pre-conference Business of Medicine day on Wednesday, October 4th, featuring an expert discussion hosted by Robert H. Eckel, MD, and William H. Polonsky, PhD, CDE: “The Psychology Behind Patient Adherence.” Register for the upcoming conference in Boston from October 4-7, and learn about the various methods of diagnosis, treatment, and prevention of cardiometabolic disease.