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Tag: cardiovascular disease

The Co-Occurrence of Diabetes & Heart Disease

The number of people living with diabetes has tripled since 2000, leading to enormous financial ramifications: the global cost of the disease is $850 billion each year. The latest estimates from the International Diabetes Federation indicate that one in 11 adults worldwide have diabetes; most have type 2 diabetes, which is strongly linked to obesity and lack of exercise. There is a strong link between type 2 diabetes and cardiovascular disease, as people with diabetes are more than twice as likely to develop cardiovascular disease and lower life expectancy.

According to a study presented at the American Heart Association’s Scientific Sessions last week, data indicates that children and young adults with diabetes mellitus have a fivefold increased risk of all-cause mortality, and a sevenfold increased risk of sudden cardiac death, compared with age-matched individuals without diabetes. The findings highlight the critical need for continuous cardiovascular risk monitoring and management in young people with DM.

Less than half of those diagnosed with diabetes are aware that the diseases places them at a much higher risk for cardiovascular disease complications; the lack of awareness prevents addressing risks and improving health–often leading to preventable deaths. Ken Thorpe, Chairman of the Partnership to Fight Chronic Disease, urges education and the power of prevention. “We must do better to diagnose, treat, and prevent chronic conditions like diabetes and cardiovascular diseases, and one of the first and most important actions we can take is to raise awareness among patients, providers, and policymakers of the alarming co-existence of these two debilitating conditions, and what can be done to avoid them in the first place.”

The total number of diabetes worldwide is now 451 million, and is expected to reach 693 million by 2045 if current trends continue.

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African-Americans More Likely to Die from Cardiovascular Disease

According to the American Heart Association, African Americans experience significantly worsened cardiovascular health, and thus face greater mortality rates from heart disease. African Americans die an average of 3.4 years before white Americans, a gap largely attributable to prevalent cardiovascular disease and risk factors. Recent publication of a scientific statement from the organization reads: “The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites.”

Dr. Mercedes R. Carnethon from Northwestern University Preventive Medicine in Chicago states that traditional cardiovascular risk factors—including high blood pressure, diabetes, obesity, and atherosclerosis—are not only more common among African Americans, but also manifest at relatively young ages. Data indicates that high blood pressure is diagnosed in 13.8 percent of black children, compared to 8.5 percent in white children. The risk of persisting hypertension in black adults, throughout adulthood, is 1.5 times higher than in whites. “Interrupting this process by preventing the early onset of cardiovascular diseases is one strategy to reduce disparities in cardiovascular disease mortality,” Dr. Carnethon writes.

The research team at the American Heart Association notes that circumstances have remained fairly stagnant since 2005; relatively little has changed since 2005, when the same journal pointed to disparities in the rates of cardiovascular disease, disease management, and outcomes for African Americans. While genetic differences between African Americans and other groups do not account for the disparities in cardiovascular disease rates and outcomes, many of the variances arise from “unhealthy behaviors, lower implementation of guidelines shown to improve cardiovascular health, ingrained cultural preferences and attitudes, and lack of persistence in following lifestyle changes that need to be lifelong.”

While Dr. Carnethon’s team notes that cardiovascular disease is often preventable through the implementation and continued practice of a healthy, nutritious lifestyle, she discusses the difficulties faced by many African Americans—particularly those in lower income groups—in accessing the necessary resources to lead healthy lifestyles: specifically, access to healthful foods, safe spaces for physical activity and exercise, and homes that allow for restorative sleep. Moreover, she argues that despite the strides our country has made in broadening access to healthcare, many African-Americans are still unable to afford and prioritize preventive care visits.

Dr. LaPrincess Brewer from the Mayo Clinic in Rochester, Minnesota has continuously worked to promote cardiovascular health in African-American communities, promotes “culturally relevant, community-based cardiovascular health interventions that focus more on positive motivation towards promoting cardiovascular health rather than the negative impact of cardiovascular disease.” Through increased awareness, and a collective, collaborative effort on the part of clinicians, public health workers, researchers, social services, and community stakeholders, the high burden of traditional risk factors among African Americans can be addressed—in tandem with the inherent social and environmental contextual barriers faced by this specific population.

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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.

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Sitting at Work? Exercise to Reduce Cardiometabolic Risk

Regular exercise outside of work can reduce the risk of metabolic syndrome in people whose jobs have them sitting most of the time, according to a small study from Brazil.

“If you have a sedentary occupation, especially in a sitting position for hours, you should move yourself out of work at least 150 minutes per week in a moderate intensity to mitigate the detrimental effects of sedentary behavior at work,” Eduardo Caldas Costa from Federal University of Rio Grande do Norte in Natal reported.

Sedentary behavior has been associated with an increased risk for metabolic syndrome – a cluster of unfavorable markers including abdominal obesity, high blood pressure and low HDL “good” cholesterol – which, in turn, is associated with an increased risk of developing heart disease and type 2 diabetes.

The researchers investigated whether Navy workers who spent about eight hours daily seated, mostly in administrative duties, had different risks for metabolic syndrome based on their activity levels outside of work.

All the workers were men, ranging in age from 26 to 42. Out of 502 workers included in the final analysis, 201, or 40 percent, did not achieve at least 150 minutes per week of moderate-vigorous activity. Nearly half, 48 percent, were overweight and almost 19 percent were obese.

After adjusting for age, time in the job, body mass index (BMI) and tobacco use, researchers found the sedentary workers who met the physical activity recommendations were only about half as likely to have metabolic syndrome, compared to those with lower activity levels.

Workers with higher activity levels were also less likely to have abdominal obesity, high blood pressure and low HDL.

Even those who increased their activity slightly (the “insufficiently active” group) had lower blood pressure than workers who remained sedentary off the job, researchers reported in the Journal of Occupational and Environmental Medicine.

“Sedentary occupation workers should break up prolonged sitting time at work as much as they can in order to reduce the risk for cardiovascular and metabolic diseases,” Caldas Costa said by email. “Be involved in regular physical activity out of work, including leisure time, domestic activities, and active transportation (i.e., walking and/or cycling).”

Only the physically active group, he added, and not the insufficiently active group, had a reduced risk for metabolic syndrome compared to the sedentary group. “Therefore,” he said, “it seems that probably there is a minimum quantity of physical activity that can mitigate the detrimental effects of sedentary behavior at work.”

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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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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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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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Happy Hour: Good for the Heart?

A recent large-scale study indicates that alcohol, in moderation, is healthy for the heart. New research published in the British Medical Journal adds further evidence linking alcohol consumption with lower risks of heart attack, stroke, and cardiovascular disease. While the new study is consistent with earlier results that have shown potential heart health benefits from occasional drinking, it amplifies the message due to its large sample population.

Drinking about a glass of wine for women per day, and two glasses of wine for men, showed benefits for heart health in a large group of U.K. adults; of the near 2 million subjects, none had cardiovascular disease when the study began. People who did not drink showed increased risk for eight of the heart ailments, ranging from 12% to 56%, compared to those who drank in moderation; the eight conditions included the most common heart events—such as heart attack and stroke. Non-drinkers had a 33% higher risk of unstable angina, a condition in which the heart does not receive sufficient blood flow, and a 56% higher risk of dying unexpectedly from cardiovascular disease—compared to those people who drank a glass or two of alcohol each day.

There are several potential ways that casual drinking might benefit heart health, although none have been directly proven. Alcohol consumption has been linked to increases in ‘good’ HDL cholesterol, and properties in the blood that reduce clotting. It is also possible that moderate drinking helps reduce stress levels.

Yet alcohol does not provide protection against four less common heart problems, including certain types of mild strokes. It is not clear from the current study why alcohol lowers the risk of some heart conditions and not others, but the results should reassure people who drink a few glasses of alcohol each week. Moreover, while casual drinking shows potential benefit, drinking to excess can increase risks for a variety of heart problems.

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Move — and Move Often!

While most physicians and nutritionists agree that low to moderate levels of weekly physical activity is often insufficient to significantly reduce body weight, studies indicate that those who transition from little to no daily physical activity to moderate levels have clinically meaningful reductions in cardiometabolic risk.

Scores of controlled trials over the last decade demonstrate that physical activity helps mitigate and reduce cardiometabolic risk via biologic mechanisms, which are not entirely dependent upon body weight or BMI reduction. Research increasingly supports that those who have prediabetes should consistently increase physical activity levels, despite little to no weight loss.

According to research published in the European Journal of Preventive Cardiology, the benefits of physical activity may outweigh the impact of being overweight and/or obese in middle-aged and elderly people. The observational study, conducted with a sample size of over 5,000 people aged 55 years and older, followed up with participants for 15 years. While overweightness and obesity is associated with a higher risk of cardiovascular disease, and weight loss is recommended, it is slightly different with the elderly population: weight loss, especially unintentional, is often associated with muscle loss and death.

Regardless of age, physical activity is associated with a lower risk of cardiovascular disease. Studies have further demonstrated that physical activity is protective for cardiovascular risk, playing a crucial role in the health of middle-aged and elderly people. Without adequate physical activity, those who are overweight and obese are at a significantly higher risk of developing cardiovascular disease.

The harmful effects of overweightness and obesity occur through adipose tissue, which accelerates the atherosclerotic process, thereby increasing cardiovascular risk. Exercise and physical activity lowers the harmful effects of atherosclerosis by reducing the stabilization of plagues on blood vessels, ultimately reducing the heart’s oxygen demand. Engaging in high levels of physical activity protects people from the harmful effects of adipose tissue on cardiovascular disease. The idea: move—and move often!

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Unscrambling Eggs: Nutrition Science

A recent article published through National Public Radio analyzes and assesses one of humankind’s most reliable source of calories: eggs, which have historically been obtained “with minimal exertion and zero horticulture skills.”

In the late 1970s, specifically, the appreciation of eggs was at an all-time high, as physicians began to realize that excess cholesterol is a strong predictor for a higher risk of cardiovascular disease. Subsequently, many doctors assumed that eating high-cholesterol foods like meat, butter, and eggs would likely have a negative impact on health, and should thus be avoided.

Yet the nutritional science behind eggs, and foods generally high in cholesterol, is more nuance and complex. While cholesterol objectively can contribute to heart disease by literally blocking the body’s blood vessels, and eating foods high in cholesterol can raise its levels in the blood, an emerging and growing body of research has shown that the consumption of sugar, transfats, and excessive saturated fat is far more harmful to cholesterol levels than actual dietary cholesterol.

Studies and scientific research have gradually come to the consensus that some degree of cholesterol consumption is harmless—if not outright healthy—and that eggs should not be feared and avoided at all costs. Conversely, experts worry that if science is ‘misinterpreted and spun by the media,’ both the egg industry and opportunistic doctors will spin through the perpetual cycle of self-help revenue that is the foundation of diet science.

Dr. Walter Willett, chair of the Harvard T.H. Chan School of Public Health’s Nutrition Department, was one of the first U.S. physicians to determine that while previous findings have demonstrated that cholesterol in the blood has a correlation with a higher risk of heart disease, no studies had indicated that cholesterol consumption actually increases blood levels. Remember: correlation does not necessarily indicate causation.

Willett and his colleagues have since studied thousands of patients for years, and have found no evidence that moderate dietary cholesterol or egg consumption increases the risk for heart disease and stroke—except in people with a particularly strong genetic risk for high cholesterol. These findings reiterate and reaffirm those from a 2013 published study, which report that eating one egg per day is not associated with impaired heart health.

Further complicating this, however, is an abundance of studies funded by the egg industry that support egg consumption, which loosely interpret scientific data in the interest of profit. While there is no strong data upon which to base a specific numerical limit to a dietary cholesterol intake, guidelines continue to recommend that cholesterol intake should be as low as possible, and part of a generally healthy diet that is primarily rooted in fruits, vegetables, nuts, and whole grains—all thought to lower blood cholesterol and the risk of cardiovascular disease.

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