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Tag: cardiovascular disease

Simple & Preventive Changes to Combat CVD

Cardiovascular disease has the highest mortality rate in the United States, and billions of dollars are given to pharmaceutical industries each year in order to combat and reduce risks.

Yet recent research on cardiovascular risk factors offers renewed hope and optimism regarding heart disease, demonstrating a number of simple life changes to implement in order to prevent the onset of cardiovascular disease. Changing behavior can significantly lower risks, even for those genetically predisposed to heart disease—though it has long been thought that these factors were outside one’s control.

Data gathered from four large prospective cohort studies, all of which tracked thousands of people for years, analyzed and assessed the relationships between various risk factors and heart disease. Researchers examined the ways in which lifestyle factors were associated with outcomes, including not smoking cigarettes, not being obese, engaging in weekly physical activity, and following a healthy diet. The final criterion was based upon recommendations including eating more fruits, nuts, vegetables, whole grains, and not eating sugar-sweetened beverages, processed foods, etc.

The cumulative lifestyle factors were all associated with a significantly decreased risk of coronary events, and those who followed all of them had a favorable lifestyle. The reduction in heart attacks, bypass procedures, and deaths from cardiovascular causes was 45%: a 47% reduction even among those with genetic risks.

These numbers are substantial; the risk of a coronary event in a decade was halved. The data demonstrated that lifestyle changes were as powerful, if not more powerful, than many drugs and pharmaceuticals that are recommended. While there were caveats, including the sample size and population’s race and ethnicity, the lessons imparted must encourage us to understand and internalize that genetics do not necessarily determine overall health.

Changes in lifestyle can ultimately overcome many of the hurdles and challenges posed by DNA and genetics. These alternations will also reduce risks of other diseases like cancer, and a healthier lifestyle can have enormous implications for many more people across the globe.

Interested in learning about the latest updates in hypertension, heart failure, diabetes, lifestyle management, and cardiovascular health? Attend CMHC West, and listen to the nation’s top experts in cardiometabolic health while networking with hundreds of other healthcare professionals and practitioners. 

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Cardiovascular Morbidity and Mortality in Pregnancy

More than one fifth of all pregnancy-associated deaths during a 10-year period in Illinois were the result of cardiovascular causes, and the mortality rate resulting from cardiac causes rose with maternal age, new data study show.

Further, of the cardiac-associated deaths, 28.1% of them were potentially preventable, Joan Briller, MD, from the Division of Cardiology, Department of Medicine, and the Center for Research on Women and Gender at the University of Illinois at Chicago, and colleagues report in an article published online April 4 in Obstetrics & Gynecology.

Recent research has shown that the maternal mortality rate in the United States has risen substantially in recent years, with one study of national trends reported by Medscape Medical News indicating a relative increase of more than 25% between 2000 and 2014.

Because cardiovascular disease is recognized as a leading contributor to US maternal mortality, Dr Briller and colleagues sought to identify the most common etiologies of maternal cardiac death in Illinois and to assess their potential preventability.

The investigators reviewed data on pregnancy-associated cardiovascular deaths in the state from 2002 to 2011. Data were collected by a network of regional perinatal centers and recorded in the Illinois Department of Public Health maternal mortality review database. Illinois requires the reporting and review of all deaths to women within a year of pregnancy.

During the period of study, there were 636 deaths in women who were pregnant or within 1 year of pregnancy, reflecting an overall death rate of 37.1 per 100,000 live births. Of the deaths, 140 (22.0%) were cardiac-related, predominantly (97.1%) resulting from acquired heart disease. The most common etiology was cardiomyopathy (27.9%), followed by stroke (22.9%), hypertension-related death (12.9%), arrhythmias (10.7%), and coronary artery disease (9.3%). Of the 39 women who died of cardiomyopathy, 30.8% (n = 12) developed the condition during the peripartum period.

Of the cardiovascular deaths, those attributed to cardiomyopathy “were significantly more likely to be considered directly related to pregnancy (P<.01) than other cardiac etiologies,” the authors write, and women with cardiomyopathy “were more likely to be younger than women who died of other cardiovascular causes,” they observe. The cardiomyopathy mortality rate in women younger than 20 years was nearly three times that of women aged 20 to 29 years (rate ratio [RR], 3.38; 95% confidence interval [CI], 1.38 – 8.27).

More than half of the cardiovascular deaths in this patient population occurred during the first 6 weeks postpartum compared with deaths from noncardiac causes (56.7% vs 49.2%; P < .01). This suggests that women with hypertension, preeclampsia, or other cardiac risk factors or symptoms should receive more extensive postpartum care, the authors write.

“[T]he preponderance of cardiovascular deaths in the older population is especially striking given that only 40.1% of births occurred in women older than age 30 years of age,” the authors write. “Increasing cardiovascular death as women aged is partly explained by the rising prevalence of cardiovascular disease in the older population,” they explain.

Of the cardiac deaths, 28.1% were determined to be potentially preventable and point to aspects of care that are “amenable to change such as monitoring patients at risk for several weeks postpartum,” the authors write.

The Illinois findings “add to our understanding of cardiovascular disease as a leading contributor to maternal mortality by addressing risk factors to be assessed and that a large proportion of maternal mortality is potentially preventable by addressing issues such as the importance of monitoring patients at risk for several weeks postpartum while hemodynamic changes are still in flux,” the authors conclude. “Our data support the need for more investigations into cardiovascular maternal mortality, organized communication between obstetricians and cardiologists, and the need for systems designed to better educate and communicate cardiovascular risk factors and warning signs to pregnant women and medical care providers.”

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Higher Risk Factors for Women

Fewer women who suffer a heart attack each year in the UK would die if they were simply given the same treatments as men, according to new research.

Scientists at the University of Leeds and the Karolinska Institute in Sweden used data from Sweden’s extensive online cardiac registry, SWEDEHEART, to analyze the outcomes of 180,368 patients who suffered a heart attack over a 10 year period to December 2013.

After accounting for the expected number of deaths seen in the average population, the researchers found that women had an excess mortality up to three times higher than men’s in the year after having a heart attack.

While the analysis uses Swedish data, the researchers believe that the situation for women in the UK is likely to be worse than in Sweden, which has one of the lowest mortality rates from heart attacks anywhere in the world. The study, published yesterday in the Journal of the American Heart Association, was co-funded by the British Heart Foundation.

Professor Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds, who co-authored the study, said: “We need to work harder to shift the perception that heart attacks only affect a certain type of person. Typically, when we think of a heart attack patient, we see a middle-aged man who is overweight, has diabetes and smokes. This is not always the case: heart attacks affect the wider spectrum of the population, including women. Sweden is a leader in healthcare, with one of the lowest mortality rates from heart attacks, yet we still see this disparity in treatment and outcomes between men and women. In all likelihood, the situation for women in the UK may be worse.”

Analysis of the Swedish data found that women who had a heart attack resulting from a blockage in the coronary artery were 34 per cent less likely than men to receive procedures which clear blocked arteries and restore blood flow to the heart, including bypass surgery and stents.

The paper reported that women were also 24 per cent less likely to be prescribed statins, which help to prevent a second heart attack, and 16 per cent less likely to be given aspirin, which helps to prevent blood clots. Critically, when women received all of the treatments recommended for patients who have suffered a heart attack, the gap in excess mortality between the sexes decreased dramatically.

Professor Gale, from the Leeds Institute of Cardiovascular and Metabolic Medicine, added: “The findings from this study suggest that there are clear and simple ways to improve the outcomes for women who have a heart attack – we must ensure equal provision of evidence-based treatments for women.”

Previous British Heart Foundation research has shown that women are 50 percent more likely than men to receive the wrong initial diagnosis and are less likely to get a pre-hospital Electrocardiogram (ECG) which is essential for swift diagnosis and treatment.

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “Heart attacks are often seen as a male health issue, but more women die from coronary heart disease than breast cancer in the UK. The findings from this research are concerning – women are dying because they are not receiving proven treatments to save lives after a heart attack.”

This year, attend our 13th Annual CMHC conference, taking place from October 24-27 in the heart of downtown Boston. We are hosting our first pre-conference Women’s Health Summit on October 24th: highlighting the latest research unique to women’s healthcare. Expand your therapeutic options to enhance and optimize your female patients’ health, while learning tangible solutions to complex medical problems. This day is designed for you to become well-versed in integrative practices and protocols, and understand the unique challenges faced by women.

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Live Longer By Saying “I Do”

In a new study published last week in the Journal of the American Heart Association, researchers at Emory University in Atlanta found that people with cardiovascular disease who were not married –- including those who were divorced, separated, widowed or never married –- had 24 percent higher rates of death from any cause during the study period, compared to those who were married. 

Specifically, not being married was associated with a higher risk of death from cardiovascular causes, like heart attacks and strokes, for the more than 6,000 Emory Healthcare patients in this study. Divorced and separated people had a 41 percent increased risk of death; widowed people had nearly double that risk.

“I was somewhat surprised at the impact,” Dr. Arshed Quyyumi, the study’s lead researcher and co-director of Emory Clinical Cardiovascular Research Institute, told ABC News. “But we suspected there might be something, since there have been studies that signal that marital status affects how well people do.”

This was a large study conducted between 2003 and 2015 that included 50 to 70 year old participants, from diverse racial groups, who had cardiovascular disease — including coronary artery disease, heart failure and previous heart attacks. Each participant was followed for an average of 3.7 years.

Even after accounting for known cardiac risk factors — such as diabetes and smoking, different types of heart disease, socioeconomic background, age, sex and appropriate treatment –- being unmarried still showed higher risk of death for these patients.
One expert not involved with the research agreed that the findings offer additional clues to the importance of relationships when it comes to health.

“This study adds to this line of research,” Dr. Matthew Dupre, an associate professor at Duke University who has done extensive research on social factors and heart outcomes, told ABC News. “There is now a growing body of work showing how our social relationships, particularly the disruption of these relationships through divorce or widowhood, can get under our skin and have immediate and lasting consequences for our cardiovascular health.”

For this study, the researchers did not specifically look for why these differences exist. But the research team, as well as Dupre, note that previous research suggests less social support, stress from divorce or a spouse passing and less motivation to have a healthy lifestyle, or to stick to medical treatment, may play a role.

“All these things can be put under the basket of social support,” study author Quyyumi said. “Cardiovascular disease, even though we consider diabetes and high cholesterol to be high risk factors, it is sizably impacted by psychosocial status –- how stressed you are, how depressed you are. Being alone, lonely, etc. may well do the same.”

For people who are widowed or getting divorced, there may be other stressors that can lead to worse heart health. “After the depression and grieving, be alerted to the fact that your life is altered and don’t fall into high risk behaviors. Perhaps, create a social network,” Quyyumi said. “All those things become important.”

The researchers did not account for people who changed their marriage status during the study, but Quyyumi explained that would not likely affect the results because only a small amount of people in their sixties change marital status over the course of two to seven years. The study also did not specifically account for people who have partners, but are not married.

“I wouldn’t say that if you have heart disease, you have to get married. I’m not sure anyone has prescribed getting married to prevent getting sicker,” Quyyumi said. “But I think doctors and even family and friends can pay more attention when life events occur –- perhaps these people need extra care and attention to compensate for things they are now missing.”

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Cheese: A Heart Healthy Snack?

Cheese is typically considered more of an indulgence than a health food, but a new review of research suggests that it may not be as bad for you as once thought. In fact, people in the analysis who ate a little bit of cheese every day were less likely to develop heart disease or have a stroke, compared to those who rarely or never ate cheese.

Cheese, like other dairy products, contains high levels of saturated fat—which has been linked to high cholesterol, atherosclerosis and an increased risk of heart disease. (Recently, however, some nutrition experts believe that saturated fat is more benign.) But cheese also contains potentially beneficial ingredients like calcium, protein and probiotics, wrote the authors of the new paper, published in the European Journal of Nutrition.

To learn more about how long-term cheese consumption affects a person’s risk for cardiovascular disease, researchers from China and the Netherlands combined and analyzed data from 15 observational studies including more than 200,000 people. All but one of the studies excluded people with existing heart disease, and all but two tracked people for 10 years or more.

The researchers’ findings were “certainly different from what people might expect,” says Dr. Allan Stewart, director of aortic surgery at Ichan School of Medicine at Mount Sinai Medical Center, who was not involved in the new analysis. Overall, people who consumed high levels of cheese had a 14% lower risk of developing coronary heart disease and were 10% less likely to have a stroke than those who rarely or never ate cheese.

The relationship, however, was U-shaped rather than linear—meaning that higher quantities of cheese were not necessarily better. The people who had the lowest risks for heart disease and stroke were those who consumed, on average, about 40 grams a day—about the size of a matchbook. (According to the review, the average American eats about 42.5 grams a day.)

“This is not the same as eating a big slice of cheesy pizza every day,” says Stewart. He also cautions against reading too much into data that’s self-reported—as much of the data was—because people tend to over- or under-estimate their consumption of specific foods.

Stewart points out that the study was only able to find an association between cheese consumption and decreased risk of heart disease, rather than a cause-and-effect relationship. It could be that people who eat cheese on a daily basis are healthier overall, or have more disposable income and higher socioeconomic statuses.

But it’s also possible that cheese has beneficial qualities that offset the negative impact of its high saturated fat content, says Stewart. “Cheese can be high in probiotics, which tend to put you in less of an inflammatory state,” he says. Cheese also contains conjugated linoleic acid (CLA), an unsaturated fatty acid that may increase the amount of of HDL “good” cholesterol and decrease “bad” LDL levels.

“There is some evidence that cheese—as a substitute for milk, for example—may actually have a protective effect on the heart,” says Stewart. “No one’s saying you should definitely go out and eat 40 grams of cheese a day. But on the upside, a bit of cheese on a cracker doesn’t sound unreasonable.”

The study did not look at different types of cheeses, and Stewart says more research is needed to know whether certain varieties hold more health benefits (or risks) than others. Overall, though, the news is good for cheese lovers.

“We’re always are searching for ways to minimize heart disease and reduce atherosclerosis,” he says. “It’s promising to find that something that actually tastes good—and pairs well with a nice glass of red wine—may offer some protection, as well.”

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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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