Finally, a long-promised revolution may be unfolding, based on a series of recent studies. Cell therapy (typically using a patient’s own stem cells) has finally started to show benefit in patients with crippling heart pain (known as angina) who literally have no other treatment option. As for gene therapy, remember the movie “Lorenzo’s Oil?” The disease featured in that story is now responding to gene therapy. In another study, kids have had their sight restored, while a third has used gene therapy to correct a rare immunological disorder.
Like all revolutions, battles are won and lost along the way. The bruising battle for cell-based therapies to treat disease was evident a few years ago when the Journal of the American College of Cardiology published several studies in a special section. One study used patient’s own bone marrow cells to successfully regenerate cardiac tissue from 5 months to 8.5 years after a heart attack. This is long after any intervention is expected to reverse major damage done to heart tissue. Two other studies in the same issue of JACC reported the effects of using two types of widely available growth factor therapies to promote new coronary vascularization. Both studies were stopped early because of ominous results.
Recently, I talked to Dr. Douglas Losordo, Northwestern University Medical School, Chicago. In a randomized trial of “no option” patients with chronic angina, use of patients’ own stem cells plus growth factor therapy led to significant improvements that the patients themselves could recognize. (Sometimes, “significant” benefit is technically achieved but the differences are so small that they are not relevant to the patient’s day-to-day life.)
Dr. Losordo said, “The good news here is that you're talking about a reduction in approximately 14 episodes of angina per week and the patients will tell you, ‘Gee, I can do stuff now that I really couldn't do before.’ It’s really a quality of life change for the patients.”
As an investigator long involved in such research, he said many previous studies “completely failed.” Thus, Dr. Losordo added, “It's refreshing to finally have something that looks like a possible win. It's phase II, so we can't say for sure that this is a therapy that will move forward, but this is a large population of patients that is disabled with symptoms. If we could offer something beyond what we currently have I think that would be a very positive thing.”
Gene Therapy
Gene therapy requires that scientists match a disease, condition, or disorder with a gene mutation and then, find the mutation within an individual patient and insert a gene that corrects the problem. There has been remarkable progress in sequencing the human genome, as well as identifying some links among gene mutations or irregularities and specific diseases, disorders, and conditions. However, using these discoveries to treat patients remains highly experimental.
The good news is that researchers may be reversing the tide of disappointing data in recent years. Just before Thanksgiving (how appropriate!), Rob Logan, PhD, senior staff at the National Library of Medicine, cited three recent reports suggesting impressive progress in gene therapy.
In a study published in Science, investigators arrested the development of adrenoleukodystropy (ALD), in two children. ALD causes a degeneration of the fatty insulation of nerve cells, which results in progressive brain damage. The impact of the disease on patients and caregivers was the focus of the 1992 movie, 'Lorenzo's Oil.'
In a second study, reported by The Lancet in October, gene therapy restored the sight of five children and several adults with a rare, congenital eye disease. All patients had a gene mutation that prevented them from making a retina protein. An added gene (that remained in the body of each patient's cells) stimulated the development of the missing protein, which helped partially restore their vision.
A third study, reported in the New England Journal of Medicine, described how gene therapy overcame a rare immunological disorder in eight of 10 patients.
Dr. Logan said, “Now normally, we would not highlight three studies about experimental treatments for a different disease that provide preliminary results based on a few patients. However, the announcement of the successful ALD intervention in Science by itself resulted in an accompanying editorial titled 'A Comeback for Gene Therapy.'”
None of these therapies are ready for prime time yet, but it is very encouraging to finally be able to say that this revolution appears to be coming – this time, sooner as opposed to later.
You can read more about the progress being made to move from genes to personalized medicine here: http://bit.ly/697dwP
Wednesday, November 25, 2009
Wednesday, November 18, 2009
Want to be Really Young at Heart? Exercise.
We know being sedentary hurts the heart and it’s clear that being a Master’s athlete creates what can best be described as a youthful heart regardless of age. Is there any happy medium? I mean, 6-7 Master-level training sessions per week throughout life is probably a little beyond most people.
A new study suggests a lower level of lifelong exercise has major benefits. The researchers studied healthy people older than 65 years, who were without chronic diseases, such as high blood pressure or diabetes. The participants were recruited from another study (the Aerobics Center Longitudinal Study), in which they had been reporting their weekly activity for about the last 15 to 25 years.
For the study, participants had cardiopulmonary stress tests, ultrasounds of the heart and vessels, as well as a simultaneous heart catheterization and ultrasound (an echocardiogram) of the heart to determine the heart’s compliance and distensibility. (Essentially, how pliable is it? Does it keep its shape or start to lose it over time? A lifetime of living usually hardens the heart a bit, making it less compliant and more difficult to pump blood throughout the body. Heart failure is one common result to these kinds of changes to the structure of the heart.)
The greater the amount of lifelong exercise training — measured by the number of days per week exercised — the more likely individuals preserve the youthful compliance and distensibility of their heart. Specifically, for each increase in the number of exercise sessions per week, the benefits increase.
People who exercised six to seven times a week for 15 to 25 years (Masters athletes) retained 100% of their hearts’ youthful compliance and distensibility, leaving them with hearts similar to those of 30-year-olds. Those people able to exercise four to five times a week earned about 54% of the benefit observed in Master athletes, while two to three times a week achieved 42% of the benefit.
Overall, there appears to be a dose-response effect with exercise; exercise more and earn more heart health; do less, and you see less benefit – and you see it quite literally in terms of the measurable structure of your heart.
A new study suggests a lower level of lifelong exercise has major benefits. The researchers studied healthy people older than 65 years, who were without chronic diseases, such as high blood pressure or diabetes. The participants were recruited from another study (the Aerobics Center Longitudinal Study), in which they had been reporting their weekly activity for about the last 15 to 25 years.
For the study, participants had cardiopulmonary stress tests, ultrasounds of the heart and vessels, as well as a simultaneous heart catheterization and ultrasound (an echocardiogram) of the heart to determine the heart’s compliance and distensibility. (Essentially, how pliable is it? Does it keep its shape or start to lose it over time? A lifetime of living usually hardens the heart a bit, making it less compliant and more difficult to pump blood throughout the body. Heart failure is one common result to these kinds of changes to the structure of the heart.)
The greater the amount of lifelong exercise training — measured by the number of days per week exercised — the more likely individuals preserve the youthful compliance and distensibility of their heart. Specifically, for each increase in the number of exercise sessions per week, the benefits increase.
People who exercised six to seven times a week for 15 to 25 years (Masters athletes) retained 100% of their hearts’ youthful compliance and distensibility, leaving them with hearts similar to those of 30-year-olds. Those people able to exercise four to five times a week earned about 54% of the benefit observed in Master athletes, while two to three times a week achieved 42% of the benefit.
Overall, there appears to be a dose-response effect with exercise; exercise more and earn more heart health; do less, and you see less benefit – and you see it quite literally in terms of the measurable structure of your heart.
Brain Food: Vegetables Improve Mental Function
Here’s the headline from the AHA press release: Vegetables, fruits decrease heart disease risk, all cause mortality, and improve mental function in seniors.
Disclaimer: OK, for this story I should note I have been a vegetarian for more than 25 years. (I eat eggs and dairy products, no meat or fish.) It’s not a conflict of interest because I don’t proselytize; many people who have known me for some time don’t know about my food preferences. So, it really doesn’t impact my reporting, but journalistic integrity says I should mention it.
Here are the study results in brief:
Researchers analyzed data from the largest national study of community-dwelling adults aged 70 years or older at the time they joined the study (1994-1996). Detailed assessment of participants dietary habits were analyzed as was global mental function.
All of this was done prospectively to examine risk of mortality in the national Longitudinal Study of Aging, involving 4,879 people. Participants were followed for an average of 7 years. The important finding: these older people did not have to consume truckloads of produce to see a benefit.
• People who ate 3 or more servings of vegetables per day had a 30% lower risk of death from heart disease, and a 15% lower risk of death due to any cause than those with less than 3 servings of vegetables per day. The difference was highly significant (p<0.001).
• Increased servings of vegetables and fruits meant a significantly lower risk of cognitive impairment. (In other words, less risk of memory loss, deteriorating visual processing, etc.)
• Fruit intake influenced risk of dying, too, but this affect was not as strong after adjusting for vegetable intake. So, at least for older individuals, it’s really the vegetables that made a big difference.
This time my comment is simply: No comment.
Disclaimer: OK, for this story I should note I have been a vegetarian for more than 25 years. (I eat eggs and dairy products, no meat or fish.) It’s not a conflict of interest because I don’t proselytize; many people who have known me for some time don’t know about my food preferences. So, it really doesn’t impact my reporting, but journalistic integrity says I should mention it.
Here are the study results in brief:
Researchers analyzed data from the largest national study of community-dwelling adults aged 70 years or older at the time they joined the study (1994-1996). Detailed assessment of participants dietary habits were analyzed as was global mental function.
All of this was done prospectively to examine risk of mortality in the national Longitudinal Study of Aging, involving 4,879 people. Participants were followed for an average of 7 years. The important finding: these older people did not have to consume truckloads of produce to see a benefit.
• People who ate 3 or more servings of vegetables per day had a 30% lower risk of death from heart disease, and a 15% lower risk of death due to any cause than those with less than 3 servings of vegetables per day. The difference was highly significant (p<0.001).
• Increased servings of vegetables and fruits meant a significantly lower risk of cognitive impairment. (In other words, less risk of memory loss, deteriorating visual processing, etc.)
• Fruit intake influenced risk of dying, too, but this affect was not as strong after adjusting for vegetable intake. So, at least for older individuals, it’s really the vegetables that made a big difference.
This time my comment is simply: No comment.
Is the Glass Half Full? Or are You at Higher Risk of Heart Attack?
Do emotions and optimism really matter in relation to heart health? Two new studies provide some of the strongest evidence yet that both positive emotions and an optimistic attitude significantly reduce one’s risk of heart disease.
Researchers at Columbia University studied more than 1,600 healthy men and women who were enrolled in a long-term Canadian health study. The subjects were evaluated using standard scales to measure anxiety, hostility, and depression. Then researchers watched videotaped interviews to measure the positive emotions expressed by the study participants. A lot of other data were collected, too, including blood pressure, cholesterol levels, smoking status, and whether or not the participants had diabetes.
During the 10 years the study subjects were followed, 129 heart disease incidents occurred (121 nonfatal and 8 fatal). Of these 8% of study subjects who developed heart problems, those who expressed positive emotions more often were less likely to have a cardiac event, and those who experienced depression were more likely to have an event. This was true even after adjusting for various factors (such as age, sex, and standard risk factors). Hostility and anxiety did not predict coronary heart disease events.
The second study involved an even larger group of randomly selected men and women (2,380) and assessed individual levels of optimism. (It’s surprising how many tools are available to measure emotions and traits such as optimism.)
None of the study participants had coronary heart disease at baseline and, again, they were followed for 10 years, during which time 274 coronary events occurred, representing 11.5% of subjects. Those participants considered highly optimistic were less likely to have a coronary heart disease event during the study period compared to those with average and low levels of optimism. Again, after adjusting for important variables that could influence the outcome, level of optimism remained a significant factor influencing cardiac risk. There was a consistent effect, too, with low optimism showing the highest risk, average optimism showing average risk, and the most optimistic showing the least risk of a coronary heart disease event.
Most people interested in medicine want to know the mechanism; in this case, what explains the protective effect of positive emotions and optimism? There could be direct influences on physiology. For example, depression is known to have a variety of bad effects on the heart and vascular system. Or the explanation could be indirect via the influencing of health behavior, such as smoking. Maybe optimists just don’t feel the need to ever pick up a cigarette.
Whatever the explanation, it is good to see two studies with long-term follow-up in good-sized populations of patients. Many of the previously reported trials have gotten a lot of attention with far fewer people over much shorter periods of time. So, let me ask you: are optimistic about these results?
Researchers at Columbia University studied more than 1,600 healthy men and women who were enrolled in a long-term Canadian health study. The subjects were evaluated using standard scales to measure anxiety, hostility, and depression. Then researchers watched videotaped interviews to measure the positive emotions expressed by the study participants. A lot of other data were collected, too, including blood pressure, cholesterol levels, smoking status, and whether or not the participants had diabetes.
During the 10 years the study subjects were followed, 129 heart disease incidents occurred (121 nonfatal and 8 fatal). Of these 8% of study subjects who developed heart problems, those who expressed positive emotions more often were less likely to have a cardiac event, and those who experienced depression were more likely to have an event. This was true even after adjusting for various factors (such as age, sex, and standard risk factors). Hostility and anxiety did not predict coronary heart disease events.
The second study involved an even larger group of randomly selected men and women (2,380) and assessed individual levels of optimism. (It’s surprising how many tools are available to measure emotions and traits such as optimism.)
None of the study participants had coronary heart disease at baseline and, again, they were followed for 10 years, during which time 274 coronary events occurred, representing 11.5% of subjects. Those participants considered highly optimistic were less likely to have a coronary heart disease event during the study period compared to those with average and low levels of optimism. Again, after adjusting for important variables that could influence the outcome, level of optimism remained a significant factor influencing cardiac risk. There was a consistent effect, too, with low optimism showing the highest risk, average optimism showing average risk, and the most optimistic showing the least risk of a coronary heart disease event.
Most people interested in medicine want to know the mechanism; in this case, what explains the protective effect of positive emotions and optimism? There could be direct influences on physiology. For example, depression is known to have a variety of bad effects on the heart and vascular system. Or the explanation could be indirect via the influencing of health behavior, such as smoking. Maybe optimists just don’t feel the need to ever pick up a cigarette.
Whatever the explanation, it is good to see two studies with long-term follow-up in good-sized populations of patients. Many of the previously reported trials have gotten a lot of attention with far fewer people over much shorter periods of time. So, let me ask you: are optimistic about these results?
Tuesday, November 17, 2009
Heart Healthy Fish? Not if You Don't Cook it RIght
Eating fish for your heart? How you cook it is very important.
If you eat fish to gain the heart-health benefits of its omega-3 fatty acids, how you prepare it matters a lot.
“It appears that boiling or baking fish with low-sodium soy sauce (shoyu) and tofu is beneficial, while eating fried, salted or dried fish is not,” said Lixin Meng, M.S., lead researcher of the study and Ph.D. candidate at the University of Hawaii at Manoa. In fact, she added, eating fried, salted or dried fish may contribute to your risk. We did not directly compare boiled or baked fish vs. fried fish, but one can tell from the (risk) ratios, boiled or baked fish is in the protective direction but not fried fish.”
The findings also suggest that the cardioprotective benefits of fish vary by gender and ethnicity — perhaps because of the preparation methods, genetic susceptibility or hormonal factors.
In this study, researchers examined the source, type, amount and frequency of dietary omega-3 ingestion among gender and ethnic groups. Participants were part of the Multiethnic Cohort living in Hawaii and Los Angeles County when they were recruited between 1993 and 1996. The group consisted of 82,243 men and 103,884 women of African-American, Caucasian, Japanese, Native Hawaiian and Latino descent ages 45 to 75 years old with no history of heart disease.
Overall, men who ate about 3.3 grams per day of omega-3 fatty acids had a 23% lower risk of cardiac death compared to those who ate 0.8 grams daily. “Clearly, we are seeing that the higher the dietary omega-3 intake, the lower the risk of dying from heart disease among men,” Meng said. Interestingly, for women, the omega-3 effect was cardioprotective at each level of consumption.
However, eating salted and dried fish was a risk factor in women. In contrast, adding less than 1.1 gram/day shoyu and teriyaki sauce at the dinner table was protective for men. But more was not better: adding more than 1.1 gram/day of such sauce was not beneficial. For women, shoyu use showed a clear inverse relationship to death from heart disease. Shoyu high in sodium can raise blood pressure, so she stressed low-sodium products. Eating tofu also had a cardioprotective effect in all ethnic groups.
“My guess is that, for women, eating omega-3s from shoyu and tofu that contain other active ingredients such as phytoestrogens, might have a stronger cardioprotective effect than eating just omega-3s,” said Meng, noting that further studies are needed to confirm the hypothesis.
Comment: There is good reason to tell your doctor about all supplements you take. For example, excessive intake of omega-3 fats tends to prevent blood from clotting and may cause excessive nose bleeding.
If you eat fish to gain the heart-health benefits of its omega-3 fatty acids, how you prepare it matters a lot.
“It appears that boiling or baking fish with low-sodium soy sauce (shoyu) and tofu is beneficial, while eating fried, salted or dried fish is not,” said Lixin Meng, M.S., lead researcher of the study and Ph.D. candidate at the University of Hawaii at Manoa. In fact, she added, eating fried, salted or dried fish may contribute to your risk. We did not directly compare boiled or baked fish vs. fried fish, but one can tell from the (risk) ratios, boiled or baked fish is in the protective direction but not fried fish.”
The findings also suggest that the cardioprotective benefits of fish vary by gender and ethnicity — perhaps because of the preparation methods, genetic susceptibility or hormonal factors.
In this study, researchers examined the source, type, amount and frequency of dietary omega-3 ingestion among gender and ethnic groups. Participants were part of the Multiethnic Cohort living in Hawaii and Los Angeles County when they were recruited between 1993 and 1996. The group consisted of 82,243 men and 103,884 women of African-American, Caucasian, Japanese, Native Hawaiian and Latino descent ages 45 to 75 years old with no history of heart disease.
Overall, men who ate about 3.3 grams per day of omega-3 fatty acids had a 23% lower risk of cardiac death compared to those who ate 0.8 grams daily. “Clearly, we are seeing that the higher the dietary omega-3 intake, the lower the risk of dying from heart disease among men,” Meng said. Interestingly, for women, the omega-3 effect was cardioprotective at each level of consumption.
However, eating salted and dried fish was a risk factor in women. In contrast, adding less than 1.1 gram/day shoyu and teriyaki sauce at the dinner table was protective for men. But more was not better: adding more than 1.1 gram/day of such sauce was not beneficial. For women, shoyu use showed a clear inverse relationship to death from heart disease. Shoyu high in sodium can raise blood pressure, so she stressed low-sodium products. Eating tofu also had a cardioprotective effect in all ethnic groups.
“My guess is that, for women, eating omega-3s from shoyu and tofu that contain other active ingredients such as phytoestrogens, might have a stronger cardioprotective effect than eating just omega-3s,” said Meng, noting that further studies are needed to confirm the hypothesis.
Comment: There is good reason to tell your doctor about all supplements you take. For example, excessive intake of omega-3 fats tends to prevent blood from clotting and may cause excessive nose bleeding.
Hmmm: Getting Away from Men Reduces Depression in Women.
In a world where just about everything is co-ed, maybe there’s room for occasional gender separation. A new study shows that depressive symptoms improved among women with coronary heart disease who participated in a cardiac rehabilitation program exclusively for women.
Depression is common in people with heart disease and is more evident in women. There are reported physiological effects that could make heart disease worse, but there are psychological and practical issues, too. Being depressed interferes with adherence to lifestyle modifications and the willingness to attend rehab, which makes it harder for people to recover.
“Women often don’t have the motivation to attend cardiac rehab particularly if they’re depressed,” said Theresa Beckie, Ph.D., lead investigator and author of the study and professor at the University of South Florida’s College of Nursing in Tampa, Florida. “Historically women have not been socialized to exercise and their attendance in cardiac rehabilitation programs has been consistently poor over the last several decades. This poor attendance may be partly due to mismatches in stages of readiness for behavior change with the health professional approaching from an action-oriented perspective and the women merely contemplating change – this is destined to evoke resistance.”
Cardiac rehabilitation programs tailored to the needs of women and to their current level of readiness to change may improve adherence to such programs and potentially improve outcomes for women, she said.
The primary goals of the 5-year randomized clinical trial were to compare multiple physiological and psychosocial outcomes of women who participated in a 12-week stage-of-change matched, motivationally enhanced, gender-tailored cardiac rehabilitation program exclusively for women compared to women attending a 12-week traditional cardiac rehabilitation program comprised of education and exercise.
“We didn’t push them if they weren’t ready to make the changes,” Beckie said. “We have found that if some patients receive long lists of behaviors they are expected to change immediately — such as quitting smoking, eating healthier, exercising regularly — they are overwhelmed. Pushing such patients who are not ready can lead them to tune out or drop out. Instead, for these women, we acknowledged their ambivalence about change and gave them strategies to move toward being ready by reinforcing their own motivations for changing. It’s unrealistic to expect all patients to change their lifestyle all at once, right now in front of you.”
The woman-centered program was a more individualized approach to rehabilitation, she said, adding, “You can’t treat everyone the same when it comes to changing health behaviors.”
Depression is common in people with heart disease and is more evident in women. There are reported physiological effects that could make heart disease worse, but there are psychological and practical issues, too. Being depressed interferes with adherence to lifestyle modifications and the willingness to attend rehab, which makes it harder for people to recover.
“Women often don’t have the motivation to attend cardiac rehab particularly if they’re depressed,” said Theresa Beckie, Ph.D., lead investigator and author of the study and professor at the University of South Florida’s College of Nursing in Tampa, Florida. “Historically women have not been socialized to exercise and their attendance in cardiac rehabilitation programs has been consistently poor over the last several decades. This poor attendance may be partly due to mismatches in stages of readiness for behavior change with the health professional approaching from an action-oriented perspective and the women merely contemplating change – this is destined to evoke resistance.”
Cardiac rehabilitation programs tailored to the needs of women and to their current level of readiness to change may improve adherence to such programs and potentially improve outcomes for women, she said.
The primary goals of the 5-year randomized clinical trial were to compare multiple physiological and psychosocial outcomes of women who participated in a 12-week stage-of-change matched, motivationally enhanced, gender-tailored cardiac rehabilitation program exclusively for women compared to women attending a 12-week traditional cardiac rehabilitation program comprised of education and exercise.
“We didn’t push them if they weren’t ready to make the changes,” Beckie said. “We have found that if some patients receive long lists of behaviors they are expected to change immediately — such as quitting smoking, eating healthier, exercising regularly — they are overwhelmed. Pushing such patients who are not ready can lead them to tune out or drop out. Instead, for these women, we acknowledged their ambivalence about change and gave them strategies to move toward being ready by reinforcing their own motivations for changing. It’s unrealistic to expect all patients to change their lifestyle all at once, right now in front of you.”
The woman-centered program was a more individualized approach to rehabilitation, she said, adding, “You can’t treat everyone the same when it comes to changing health behaviors.”
Heart Disease for Mummies
Civilization causes heart disease. That’s one way to look at data from researchers who found hardening of the arteries in 3,500-year-old mummies. The lesson is we may have to look beyond modern risk factors to fully understand heart disease.
We have an idealized image of living in ancient societies: fruits, nuts, berries, and the occasional wild animal meat. At the other end of the time warp, we look around us today and ascribe artery-clogging cardiovascular disease to modern risk factors. But now we have evidence from ancient Egyptian mummies that ancient societies suffered heart attacks and strokes, too.
The study, presented by Randall C. Thompson, M.D., professor of medicine at the Mid America Heart Institute in Kansas City, was conducted by a unique collaboration of imaging experts, Egyptologists and preservationists who sought the most direct evidence possible. Using six-slice computed X-ray tomography (CT) scans, they examined 20 mummies housed in the Museum of Antiquities in Cairo, Egypt to see if heart and blood vessel tissue was present and to learn its condition.
Definite atherosclerosis, in other words a build-up of fat, cholesterol, calcium and other substances in the inner walls of blood vessels, was present in three mummies and probable atherosclerosis was apparent in another three. Calcification was significantly more common in the mummies estimated to be 45 years or older at the time of death. Men and women were similarly affected.
Thus, clogged arteries is not only a disease of modern man, but was not unusual in humans living 3000 years ago.
Why? That’s unclear, but one researcher (L. Samuel Wann, MD) told me that once civilizations were established, farming took off and food stocks became more abundant and reliable. Perhaps, people ate more and gained weight – and the rest, as they say, is history.
We have an idealized image of living in ancient societies: fruits, nuts, berries, and the occasional wild animal meat. At the other end of the time warp, we look around us today and ascribe artery-clogging cardiovascular disease to modern risk factors. But now we have evidence from ancient Egyptian mummies that ancient societies suffered heart attacks and strokes, too.
The study, presented by Randall C. Thompson, M.D., professor of medicine at the Mid America Heart Institute in Kansas City, was conducted by a unique collaboration of imaging experts, Egyptologists and preservationists who sought the most direct evidence possible. Using six-slice computed X-ray tomography (CT) scans, they examined 20 mummies housed in the Museum of Antiquities in Cairo, Egypt to see if heart and blood vessel tissue was present and to learn its condition.
Definite atherosclerosis, in other words a build-up of fat, cholesterol, calcium and other substances in the inner walls of blood vessels, was present in three mummies and probable atherosclerosis was apparent in another three. Calcification was significantly more common in the mummies estimated to be 45 years or older at the time of death. Men and women were similarly affected.
Thus, clogged arteries is not only a disease of modern man, but was not unusual in humans living 3000 years ago.
Why? That’s unclear, but one researcher (L. Samuel Wann, MD) told me that once civilizations were established, farming took off and food stocks became more abundant and reliable. Perhaps, people ate more and gained weight – and the rest, as they say, is history.
In one generation, overweight and obesity triples in kids,making for higher risk of heart disease as adults.
Between the mid-1980s and 2008 – the span of just one generation – the prevalence of overweight and obese children has tripled. According to the American Heart Association and the Centers for Disease Control and Prevention (CDC), an estimated 31.9% of U.S. children and adolescents are now overweight or obese. (About 16% of all children and teens in the U.S. have zoomed beyond just being overweight and are officially obese.) As the AHA puts it, “The cardiovascular fallout from this epidemic in the decades ahead will challenge the healthcare system.”
Two pieces of good news:
• Children’s Hospital, Denver: Heart function improves quickly after morbidly obese teens undergo bariatric surgery, and continues to improve for at least 2 years.
• University of Leipzig Heart Center, Germany: Regular exercise narrows the fitness gap between students from different backgrounds. Specifically, adding an exercise program to a high school curriculum dramatically improves physical fitness levels in teens from lower socio-economic backgrounds. (These kids started out with significantly higher body mass index and lower lean body mass, as well as poorer results in cardio-respiratory fitness testing compared to kids from higher income areas. This gap was reduced with the addition of an exercise program to school curriculums.)
Between the mid-1980s and 2008 – the span of just one generation – the prevalence of overweight and obese children has tripled. According to the American Heart Association and the Centers for Disease Control and Prevention (CDC), an estimated 31.9% of U.S. children and adolescents are now overweight or obese. (About 16% of all children and teens in the U.S. have zoomed beyond just being overweight and are officially obese.) As the AHA puts it, “The cardiovascular fallout from this epidemic in the decades ahead will challenge the healthcare system.”
Two pieces of good news:
• Children’s Hospital, Denver: Heart function improves quickly after morbidly obese teens undergo bariatric surgery, and continues to improve for at least 2 years.
• University of Leipzig Heart Center, Germany: Regular exercise narrows the fitness gap between students from different backgrounds. Specifically, adding an exercise program to a high school curriculum dramatically improves physical fitness levels in teens from lower socio-economic backgrounds. (These kids started out with significantly higher body mass index and lower lean body mass, as well as poorer results in cardio-respiratory fitness testing compared to kids from higher income areas. This gap was reduced with the addition of an exercise program to school curriculums.)
Talk about a teachable moment: Watch yourself having a heart attack!
Oh wad some power the giftie gie us
To see oursel’s as others see us!
The poet Robert Burns would have enjoyed this: Smokers who watch simulated videos of themselves having a heart attack are more likely to be more successful in stopping smoking. Talk about a teachable moment!
Researchers inserted photographs of 13 smokers (average age 45) with no related illness, their nonsmoking partner and family members into a video depicting the smoker having a heart attack — with all the potential personal and family consequences.
Seven participants had observable responses to the video including looking uncomfortable, red eyes and difficulty speaking. Self reports included “awareness of the important things” and “feeling it was very real.”
Researchers evaluated carbon monoxide levels and smoking status at baseline, 1 week, 3 months and 6 months. At week one, they found that: Seven smokers reported they had stopped smoking (four people also used quitting aids). The daily average cigarette consumption fell from 17.3 to 2.7 cigarettes. Carbon monoxide levels decreased from 15.7 to 3.1 ppm (parts per million).
At 6 months, seven of the 13 participants still weren’t smoking. (And no, it was not just those who ad emotional reactions to the video simulation)
There was 3 months of face-to-face counseling, too, for the participants, so it's hard to determine how much of the response seen in this study was due to just the video. But it certainly is promising.
One suggestion for upping smoking cessation rates even further: After the video, have a lawyer present offering discounted will preparation services.
Oh wad some power the giftie gie us
To see oursel’s as others see us!
The poet Robert Burns would have enjoyed this: Smokers who watch simulated videos of themselves having a heart attack are more likely to be more successful in stopping smoking. Talk about a teachable moment!
Researchers inserted photographs of 13 smokers (average age 45) with no related illness, their nonsmoking partner and family members into a video depicting the smoker having a heart attack — with all the potential personal and family consequences.
Seven participants had observable responses to the video including looking uncomfortable, red eyes and difficulty speaking. Self reports included “awareness of the important things” and “feeling it was very real.”
Researchers evaluated carbon monoxide levels and smoking status at baseline, 1 week, 3 months and 6 months. At week one, they found that: Seven smokers reported they had stopped smoking (four people also used quitting aids). The daily average cigarette consumption fell from 17.3 to 2.7 cigarettes. Carbon monoxide levels decreased from 15.7 to 3.1 ppm (parts per million).
At 6 months, seven of the 13 participants still weren’t smoking. (And no, it was not just those who ad emotional reactions to the video simulation)
There was 3 months of face-to-face counseling, too, for the participants, so it's hard to determine how much of the response seen in this study was due to just the video. But it certainly is promising.
One suggestion for upping smoking cessation rates even further: After the video, have a lawyer present offering discounted will preparation services.
Monday, November 16, 2009
Little things mean a lot: Extra serving of fruit/vegetables each day reduces inflammation and cardiovascular disease risk.
Speaking of omega-3 fatty acids (as we were very recently!), increased fruit and vegetable intake plus additional omega-3 fatty acid intake decreases levels of inflammation and blood cholesterol linked to cardiovascular disease (CVD) in family members of CVD patients.
The study involved family members of patients enrolled in a National Heart Lung and Blood Institute-sponsored trial. At baseline and at 1 year, the 501 people in the study underwent diet assessment via questionnaire and measurement of blood fats and biomarkers of inflammation, including high sensitivity C-reactive protein (hsCRP). Inflammation has been linked to CVD; in general, the higher the hsCRP the higher the risk and the lower the hsCRP the lower the risk of CVD.
After adjusting for age, race, gender, smoking, family history of CVD, physical activity and other factors, investigators found that a one-serving increase in daily fruit/vegetable consumption and a 1 gram per day increase in omega-3 fatty acids were each associated with significant reductions in hsCRP. Also, 1 gram per day reductions in saturated fat and trans fat were associated with reductions in total and LDL cholesterol.
Comment: The message from this study should be put in neon and hung in everyone’s kitchen: even small diet changes can have big consequences. Think about it: Here is a group of people who are family members of patients with CVD, so these study participants were themselves at increased CVD risk due to the genes and lifestyle habits they share with the CVD patient. What a great group of people to study! Let's hope they all get a copy of the results.
Speaking of omega-3 fatty acids (as we were very recently!), increased fruit and vegetable intake plus additional omega-3 fatty acid intake decreases levels of inflammation and blood cholesterol linked to cardiovascular disease (CVD) in family members of CVD patients.
The study involved family members of patients enrolled in a National Heart Lung and Blood Institute-sponsored trial. At baseline and at 1 year, the 501 people in the study underwent diet assessment via questionnaire and measurement of blood fats and biomarkers of inflammation, including high sensitivity C-reactive protein (hsCRP). Inflammation has been linked to CVD; in general, the higher the hsCRP the higher the risk and the lower the hsCRP the lower the risk of CVD.
After adjusting for age, race, gender, smoking, family history of CVD, physical activity and other factors, investigators found that a one-serving increase in daily fruit/vegetable consumption and a 1 gram per day increase in omega-3 fatty acids were each associated with significant reductions in hsCRP. Also, 1 gram per day reductions in saturated fat and trans fat were associated with reductions in total and LDL cholesterol.
Comment: The message from this study should be put in neon and hung in everyone’s kitchen: even small diet changes can have big consequences. Think about it: Here is a group of people who are family members of patients with CVD, so these study participants were themselves at increased CVD risk due to the genes and lifestyle habits they share with the CVD patient. What a great group of people to study! Let's hope they all get a copy of the results.
Soy what? A modified soybean oil may be as effective as fish oil in preventing heart attacks.
The American Heart Association recommends eating two servings per week of fatty fish which is high in EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), like mackerel, lake trout, herring, sardines, albacore tuna, and salmon. Eating these fish, which have high levels of omega-3 fatty acids, has been associated with a decreased risk of cardiovascular disease. However, many Americans don’t like eating fish because of the taste, preparation, and/or concern that it may be contaminated by mercury or other pollutants.
Here at the AHA meeting, investigators evaluated a new type of oil from soybeans that have been modified through biotechnology to produce increased levels of omega-3 EPA in red blood cells. “This soybean oil could be an effective alternative to fish oil as a source of heart-healthy omega-3 fatty acids,” said William Harris, Ph.D., lead author of the study and chief of cardiovascular health research at Sanford Research/USD and professor of medicine at Sanford School of Medicine at the University of South Dakota in Sioux Falls. “We know that giving pure EPA to people reduces their risk for heart disease. “Presumably, if you gave this special soybean oil to people, you’d do the same thing — reduce heart attacks.”
Harris and his colleagues recruited healthy volunteers in Cincinnati, Sioux Falls and Chicago into the double-blind study. “Our goal was to see if the oil from the genetically engineered soybean would raise red blood cell levels of EPA,” he said.
EPA levels rose 17.7% in the individuals given the enriched soybean oil and 19.7% in a group receiving pure EPA plus regular soybean oil. Regular soybean oil, like you’d buy at the grocery store, did not raise cellular EPA levels at all.
Dr. Harris said, “This oil could make a major contribution to our national omega-3 intake. The supply could be virtually endless, and it would provide omega-3s without putting additional pressure on fish stocks. What’s more, it will be free of contamination from mercury, PCBs or dioxins, the harmful things that can get into some types of fish,” he said. “Our next step is to formulate this SDA soybean oil into food products such as breakfast bars, yogurts and salad dressings, and then do a study to see if it is absorbed by the body and converted to EPA.”
The American Heart Association recommends eating two servings per week of fatty fish which is high in EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), like mackerel, lake trout, herring, sardines, albacore tuna, and salmon. Eating these fish, which have high levels of omega-3 fatty acids, has been associated with a decreased risk of cardiovascular disease. However, many Americans don’t like eating fish because of the taste, preparation, and/or concern that it may be contaminated by mercury or other pollutants.
Here at the AHA meeting, investigators evaluated a new type of oil from soybeans that have been modified through biotechnology to produce increased levels of omega-3 EPA in red blood cells. “This soybean oil could be an effective alternative to fish oil as a source of heart-healthy omega-3 fatty acids,” said William Harris, Ph.D., lead author of the study and chief of cardiovascular health research at Sanford Research/USD and professor of medicine at Sanford School of Medicine at the University of South Dakota in Sioux Falls. “We know that giving pure EPA to people reduces their risk for heart disease. “Presumably, if you gave this special soybean oil to people, you’d do the same thing — reduce heart attacks.”
Harris and his colleagues recruited healthy volunteers in Cincinnati, Sioux Falls and Chicago into the double-blind study. “Our goal was to see if the oil from the genetically engineered soybean would raise red blood cell levels of EPA,” he said.
EPA levels rose 17.7% in the individuals given the enriched soybean oil and 19.7% in a group receiving pure EPA plus regular soybean oil. Regular soybean oil, like you’d buy at the grocery store, did not raise cellular EPA levels at all.
Dr. Harris said, “This oil could make a major contribution to our national omega-3 intake. The supply could be virtually endless, and it would provide omega-3s without putting additional pressure on fish stocks. What’s more, it will be free of contamination from mercury, PCBs or dioxins, the harmful things that can get into some types of fish,” he said. “Our next step is to formulate this SDA soybean oil into food products such as breakfast bars, yogurts and salad dressings, and then do a study to see if it is absorbed by the body and converted to EPA.”
Let the sunshine in: Heart disease plus too little vitamin D = depression.
In recent weeks, there have been a number of interesting reports on vitamin D in the news. For example, our attempts to limit sun exposure to reduce skin cancer may have an unexpected affect on our brains. http://bit.ly/1Lae1V Small-scale studies have documented low vitamin D levels in children and adolescents, even as evidence mounts about the critical role of this vitamin in maintaining health and preventing disease. In one large study of 6,000 kids in the United States, 7 of 10 had low levels of vitamin D, raising their risk of bone and heart disease. http://bit.ly/1600pT
In a report to be presented later today at the American Heart Association Scientific Sessions (the embargo has been lifted, that’s why I can tell you about it), investigators evaluated about 9,000 people with cardiovascular disease. Very low levels of vitamin D were associated with depression; this was particularly evident among those with no prior incidence of depression.
And yes, winter (when many people see little sun for days on end), enhanced the association overall and was even a factor in those people who had never before had a diagnosis of depression.
Comment: Another recent report found that too little vitamin D nearly doubles heart disease risk in diabetics. Clearly vitamin D is important. http://bit.ly/3Jn70G If you’re concerned about skin cancer, maybe you should try to consume more dairy products; even low-fat and skim milk is rich in vitamin D. Another option is to take vitamin supplements, although I prefer not to make blanket recommendations that we all need to be popping vitamin pills every day. A multi-vitamin with vitamin D might be valuable (and not JUST for the vitamin D). Clearly, the weight of the evidence suggests many of us are getting far too little of this critical vitamin, so taking personal steps to up our intake a little might be very beneficial.
In recent weeks, there have been a number of interesting reports on vitamin D in the news. For example, our attempts to limit sun exposure to reduce skin cancer may have an unexpected affect on our brains. http://bit.ly/1Lae1V Small-scale studies have documented low vitamin D levels in children and adolescents, even as evidence mounts about the critical role of this vitamin in maintaining health and preventing disease. In one large study of 6,000 kids in the United States, 7 of 10 had low levels of vitamin D, raising their risk of bone and heart disease. http://bit.ly/1600pT
In a report to be presented later today at the American Heart Association Scientific Sessions (the embargo has been lifted, that’s why I can tell you about it), investigators evaluated about 9,000 people with cardiovascular disease. Very low levels of vitamin D were associated with depression; this was particularly evident among those with no prior incidence of depression.
And yes, winter (when many people see little sun for days on end), enhanced the association overall and was even a factor in those people who had never before had a diagnosis of depression.
Comment: Another recent report found that too little vitamin D nearly doubles heart disease risk in diabetics. Clearly vitamin D is important. http://bit.ly/3Jn70G If you’re concerned about skin cancer, maybe you should try to consume more dairy products; even low-fat and skim milk is rich in vitamin D. Another option is to take vitamin supplements, although I prefer not to make blanket recommendations that we all need to be popping vitamin pills every day. A multi-vitamin with vitamin D might be valuable (and not JUST for the vitamin D). Clearly, the weight of the evidence suggests many of us are getting far too little of this critical vitamin, so taking personal steps to up our intake a little might be very beneficial.
Some Wii programs produce the equivalent of moderate-intensity exercise. #SS09
OK, so maybe your kid – the one who can’t be ripped from his (or her) video games – may actually find a job after all that involves their passion (obsession?). A number of new approaches to health rely on Wii technology. Although I can't confirm it, I suspect a number of these new program developers were video game players when they were younger and may have even been in that hard core group referred to derisively as vidiots. Parents, if you are stressed about your kids' obsessive game playing, you might want to relax a little. Maybe all this obsessive playing could lead to a research career.
For example, the Nintendo system could save lives. This was the conclusion of some experts after a group of students developed a program to teach CPR using a Wii. http://bit.ly/nDFcu Older adults are benefiting when they use Wii because it turns the games enhance physical movement, thereby helping build coordination and agility while playing virtual tennis, bowling, or darts on a Wii system. Also, a number of studies are now or will soon be underway to evaluate video games for their ability to boost thinking skills among the elderly. http://bit.ly/4BBJDL Even the Mayo Clinic recently summarized the work in this field by noting that interactive video games have a role in good health. http://bit.ly/2cia0y
In this latest report, presented at the 2009 American Heart Association Scientific Sessions, researchers found that some Wii sports and Wii fit activities can increase adults’ energy expenditure as much as moderately intense exercise. The study was done under the auspices of the National Institute of Health and Nutrition in Tokyo, Japan, and funded by Nintendo. The investigators found that “the range of energy expenditure in these active games is sufficient to prevent or to improve obesity and lifestyle-related disease, from heart disease and diabetes to metabolic diseases.”
Of the games studied, boxing was the most effective for increasing energy expenditure, with golf, bowling, tennis and baseball associated with more moderate exercise levels. The most effective Wii fit exercise was the single-arm stand, which involves standing up and lying down. The intensities of yoga and balance exercise (using the Wii system) were significantly lower than those of resistance and aerobic exercise, but these exercises still could improve flexibility and help in fall prevention.
Motohiko Miyachi, Ph.D., lead author of the study, plays active video games himself and recommends these active games rather than sedentary video games. The study’s findings about energy expenditure, he said, apply to Americans as well as Japanese and to younger and older people.
OK, so maybe your kid – the one who can’t be ripped from his (or her) video games – may actually find a job after all that involves their passion (obsession?). A number of new approaches to health rely on Wii technology. Although I can't confirm it, I suspect a number of these new program developers were video game players when they were younger and may have even been in that hard core group referred to derisively as vidiots. Parents, if you are stressed about your kids' obsessive game playing, you might want to relax a little. Maybe all this obsessive playing could lead to a research career.
For example, the Nintendo system could save lives. This was the conclusion of some experts after a group of students developed a program to teach CPR using a Wii. http://bit.ly/nDFcu Older adults are benefiting when they use Wii because it turns the games enhance physical movement, thereby helping build coordination and agility while playing virtual tennis, bowling, or darts on a Wii system. Also, a number of studies are now or will soon be underway to evaluate video games for their ability to boost thinking skills among the elderly. http://bit.ly/4BBJDL Even the Mayo Clinic recently summarized the work in this field by noting that interactive video games have a role in good health. http://bit.ly/2cia0y
In this latest report, presented at the 2009 American Heart Association Scientific Sessions, researchers found that some Wii sports and Wii fit activities can increase adults’ energy expenditure as much as moderately intense exercise. The study was done under the auspices of the National Institute of Health and Nutrition in Tokyo, Japan, and funded by Nintendo. The investigators found that “the range of energy expenditure in these active games is sufficient to prevent or to improve obesity and lifestyle-related disease, from heart disease and diabetes to metabolic diseases.”
Of the games studied, boxing was the most effective for increasing energy expenditure, with golf, bowling, tennis and baseball associated with more moderate exercise levels. The most effective Wii fit exercise was the single-arm stand, which involves standing up and lying down. The intensities of yoga and balance exercise (using the Wii system) were significantly lower than those of resistance and aerobic exercise, but these exercises still could improve flexibility and help in fall prevention.
Motohiko Miyachi, Ph.D., lead author of the study, plays active video games himself and recommends these active games rather than sedentary video games. The study’s findings about energy expenditure, he said, apply to Americans as well as Japanese and to younger and older people.
Too little fat? For people with the cluster of problems known as metabolic syndrome, moderate- beats low-fat diet.
A moderate-fat diet (40% fat/45% carbohydrates/15% protein) more effectively reduces cardiovascular risk than a low-fat diet of (20% fat/65% carbs/15% protein) in patients with the cluster of problems known as metabolic syndrome (or MetS). Think of MetS as an unwelcome group of dangerous house guests: obesity, high triglycerides, low levels of good cholesterol (called high density lipoprotein or HDL), elevated fasting glucose, and high blood pressure. None of these do you (and your heart) any favors, but when they gang up on you in your body, the outcome is not pretty (heart attack, premature death, maybe stroke).
In this small study of 64 men and women, participants underwent different diets for 4 weeks. In this first comparison of low-fat vs. moderate-fat diets in people with MetS, moderate-fat compared to low-fat diet did a better job of reducing cardiovascular disease risk. Why? The low-fat diet had more carbs, which could have been deleterious depending on the types of carbohydrates eaten.
Comment: For most Americans, a low-fat diet is very hard to maintain. For the huge number of Americans with the galaxy of problems known as metabolic syndrome, the good news from this study is you don’t have to eat a diet that makes you think your taste buds have died. Moderation in everything and, at least in these particularly high-risk people, that means a diet you can live with.
A moderate-fat diet (40% fat/45% carbohydrates/15% protein) more effectively reduces cardiovascular risk than a low-fat diet of (20% fat/65% carbs/15% protein) in patients with the cluster of problems known as metabolic syndrome (or MetS). Think of MetS as an unwelcome group of dangerous house guests: obesity, high triglycerides, low levels of good cholesterol (called high density lipoprotein or HDL), elevated fasting glucose, and high blood pressure. None of these do you (and your heart) any favors, but when they gang up on you in your body, the outcome is not pretty (heart attack, premature death, maybe stroke).
In this small study of 64 men and women, participants underwent different diets for 4 weeks. In this first comparison of low-fat vs. moderate-fat diets in people with MetS, moderate-fat compared to low-fat diet did a better job of reducing cardiovascular disease risk. Why? The low-fat diet had more carbs, which could have been deleterious depending on the types of carbohydrates eaten.
Comment: For most Americans, a low-fat diet is very hard to maintain. For the huge number of Americans with the galaxy of problems known as metabolic syndrome, the good news from this study is you don’t have to eat a diet that makes you think your taste buds have died. Moderation in everything and, at least in these particularly high-risk people, that means a diet you can live with.
Sunday, November 15, 2009
For high-risk heart disease, statin + niacin (a B vitamin) beats adding another drug (ezetimibe).
Twenty years ago, Robert E. Kowalski, PhD, drew widespread public attention to the value of niacin therapy for reducing heart disease. He pretty much made niacin a household word via his best selling book “The 8-Week Cholesterol Cure.” (The clinical use of niacin extends over 50 years, but Bob popularized the potential of this B vitamin when used in very high doses.) In the ensuing years, dozens of studies have established the heart healthy effects of niacin when used alone or when combined with a statin.
Bob was a good friend of mine and 20 years ago, based on his book and our long conversations, I decided to start myself on over-the-counter high-dose statin therapy. This seemed prudent given my family history of heart disease (from every side of my family!) and the fact I already had what today would be considered borderline high cholesterol. Today my LDL (bad cholesterol) is 28 and my HDL (good cholesterol) is 86. Is that good? My own doctor said I have a higher risk of being hit by a semi than having a heart attack. A cardiology friend put it more colorfully when he suggested that if my wife is waiting for me to drop dead she’s going to have to get a gun.
Clearly, I am biased in favor of niacin. With that disclaimer in full view, a new study reported at the 2009 American Heart Association Scientific Sessions is an important addition to the clinical literature on how to best treat people already on statin therapy but still not at their target cholesterol levels. Two approaches were evaluated in the ARBITER 6-HALTS study: adding extended-release niacin (Niaspan) to increase HDL levels or a different kind of LDL cholesterol-lowering drug called ezetimibe (known as Zetia). Not only did combining niacin with statin therapy produce superior outcomes, it appeared to cause disease regression as opposed to the niacin/ezetimibe combination which only halted the progression of cardiovascular disease.
In an editorial that accompanied the publication of the study in the New England Journal of Medicine, the authors (who were not part of the study) summarized the importance of ARBITER 6-HALTS. They said the findings provide “…support for the concept that the use of statins to reduce LDL cholesterol to target levels with the subsequent addition of a drug to raise HDL cholesterol levels (niacin), rather than a drug to lower LDL cholesterol levels (ezetimibe), is a more effective treatment for patients at high cardiovascular risk.” (Read the NEJM editorial here http://bit.ly/1T0Rru )
As much as I like not having to pay for a prescription drug, and telling myself that I am only taking a vitamin, I very much realize that at the levels of niacin required for effectiveness (in this trial, 2000 milligrams every day) this vitamin is powerful drug therapy. After all, the U.S. Recommended Daily Allowance for niacin is 20 milligrams per day! It’s hardly just a vitamin supplement when taken at 100 times the daily RDA every day for years (or decades!).
So, niacin is highly effective therapy, but remember: it is, for all intents and purposes, a drug and should be treated as such. Tell your doctor before you start taking it!
Twenty years ago, Robert E. Kowalski, PhD, drew widespread public attention to the value of niacin therapy for reducing heart disease. He pretty much made niacin a household word via his best selling book “The 8-Week Cholesterol Cure.” (The clinical use of niacin extends over 50 years, but Bob popularized the potential of this B vitamin when used in very high doses.) In the ensuing years, dozens of studies have established the heart healthy effects of niacin when used alone or when combined with a statin.
Bob was a good friend of mine and 20 years ago, based on his book and our long conversations, I decided to start myself on over-the-counter high-dose statin therapy. This seemed prudent given my family history of heart disease (from every side of my family!) and the fact I already had what today would be considered borderline high cholesterol. Today my LDL (bad cholesterol) is 28 and my HDL (good cholesterol) is 86. Is that good? My own doctor said I have a higher risk of being hit by a semi than having a heart attack. A cardiology friend put it more colorfully when he suggested that if my wife is waiting for me to drop dead she’s going to have to get a gun.
Clearly, I am biased in favor of niacin. With that disclaimer in full view, a new study reported at the 2009 American Heart Association Scientific Sessions is an important addition to the clinical literature on how to best treat people already on statin therapy but still not at their target cholesterol levels. Two approaches were evaluated in the ARBITER 6-HALTS study: adding extended-release niacin (Niaspan) to increase HDL levels or a different kind of LDL cholesterol-lowering drug called ezetimibe (known as Zetia). Not only did combining niacin with statin therapy produce superior outcomes, it appeared to cause disease regression as opposed to the niacin/ezetimibe combination which only halted the progression of cardiovascular disease.
In an editorial that accompanied the publication of the study in the New England Journal of Medicine, the authors (who were not part of the study) summarized the importance of ARBITER 6-HALTS. They said the findings provide “…support for the concept that the use of statins to reduce LDL cholesterol to target levels with the subsequent addition of a drug to raise HDL cholesterol levels (niacin), rather than a drug to lower LDL cholesterol levels (ezetimibe), is a more effective treatment for patients at high cardiovascular risk.” (Read the NEJM editorial here http://bit.ly/1T0Rru )
As much as I like not having to pay for a prescription drug, and telling myself that I am only taking a vitamin, I very much realize that at the levels of niacin required for effectiveness (in this trial, 2000 milligrams every day) this vitamin is powerful drug therapy. After all, the U.S. Recommended Daily Allowance for niacin is 20 milligrams per day! It’s hardly just a vitamin supplement when taken at 100 times the daily RDA every day for years (or decades!).
So, niacin is highly effective therapy, but remember: it is, for all intents and purposes, a drug and should be treated as such. Tell your doctor before you start taking it!
Cool! Chilling the brain with nasal cooling device during CPR may be a simple way to increase survival after cardiac arrest.
Recently, people hospitalized after cardiac arrest have been cooled to reduce injury to the brain and other tissues. Evidence suggests that this procedure, known as “therapeutic hypothermia,” reduces damage that occurs when the blood supply returns after being temporarily halted during cardiac arrest.
However, standard body cooling may not cool the brain soon enough or well enough to prevent neurological damage. (Saving your heart but not your brain is NOT a desirable outcome!) One problem has to do with the simple biophysics of cardiac arrest. Body cooling works if there is blood that travels to the brain leading to protective lower brain temperatures. Without blood circulation (as in cardiac arrest) or less than optimal blood flow (which may occur with prolonged CPR) it’s hard to quickly lower brain temperature. Also, waiting until a patient arrives at the hospital may delay neuroprotective cooling by an hour or more.
Now, in the PRINCE (Pre-Resuscitation Intra-Nasal Cooling Effectiveness) study, investigators at 15 centers across Europe used a new tool, RhinoChill, that cools the brain during ongoing cardiopulmonary resuscitation (CPR). (The name has nothing to do with the animal; “rhinos” is Greek for nose.) RhinoChill is a non-invasive device that introduces coolant through nasal prongs. The system is battery-powered, simple to operate, and requires no refrigeration, making it highly suitable for use by emergency medical technicians while delivering CPR and other necessary out-of-hospital emergency treatment.
In this randomized study, 46.7% of those cooled survived to hospital discharge, compared with 31% who receiving standard care. Those who received treatment fastest (under 10 minutes) had the best outcomes.
This technology will likely be available in Europe in early 2010, with studies continuing here in the United States.
Recently, people hospitalized after cardiac arrest have been cooled to reduce injury to the brain and other tissues. Evidence suggests that this procedure, known as “therapeutic hypothermia,” reduces damage that occurs when the blood supply returns after being temporarily halted during cardiac arrest.
However, standard body cooling may not cool the brain soon enough or well enough to prevent neurological damage. (Saving your heart but not your brain is NOT a desirable outcome!) One problem has to do with the simple biophysics of cardiac arrest. Body cooling works if there is blood that travels to the brain leading to protective lower brain temperatures. Without blood circulation (as in cardiac arrest) or less than optimal blood flow (which may occur with prolonged CPR) it’s hard to quickly lower brain temperature. Also, waiting until a patient arrives at the hospital may delay neuroprotective cooling by an hour or more.
Now, in the PRINCE (Pre-Resuscitation Intra-Nasal Cooling Effectiveness) study, investigators at 15 centers across Europe used a new tool, RhinoChill, that cools the brain during ongoing cardiopulmonary resuscitation (CPR). (The name has nothing to do with the animal; “rhinos” is Greek for nose.) RhinoChill is a non-invasive device that introduces coolant through nasal prongs. The system is battery-powered, simple to operate, and requires no refrigeration, making it highly suitable for use by emergency medical technicians while delivering CPR and other necessary out-of-hospital emergency treatment.
In this randomized study, 46.7% of those cooled survived to hospital discharge, compared with 31% who receiving standard care. Those who received treatment fastest (under 10 minutes) had the best outcomes.
This technology will likely be available in Europe in early 2010, with studies continuing here in the United States.
Incidence of sudden cardiac death three times higher for men; African-American heritage also increases risk. #SS09
Sudden cardiac death (SCD) occurs from an abrupt loss of heart function, and victims are often unaware that they are at risk. Coronary heart disease due to blocked arteries is a common underlying cause of SCD. Another common cause are heart rhythm disorders; sometimes the heart beats rapidly (ventricular tachycardia) or chaotically (ventricular fibrillation) or both.
Researchers examined SCD data from three famous studies: Framingham Heart Study (FHS), the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study. Lifetime risk was associated with three different variables: cardiac risk factors (of course), male gender, and African-American heritage. For example, the lifetime risk of SCD was one in eight for men and one in 24 for women.
Less sudden than thought? About two-thirds of cardiac arrests are preceded by symptoms. Good news IF you recognize symptoms.
A team of researchers in Japan report that about two-thirds (61%) of sudden cardiac arrests were preceded by well-known cardiac symptoms. The most frequent symptoms included shortness of breath, chest pain and/or fainting – 59.8% a few minutes before arrest and 25% within an hour before.
Comment: In the first report, its importance derives from the studies analyzed. Individually, these are three of the largest cardiac and health data sets in the United States, so using these studies to evaluate a specific question provides insights likely to be very reliable.
As for the second study, this is critically important. Previous data suggested that for about half of all people with SCD the first symptom is sudden death. How do you like that for a first symptom? This study, however, says that in many cases there are symptoms that something’s wrong. Unfortunately people (yeah, mostly men) don’t want to think of symptoms as being a heart attack. A doctor even told me once of getting a call from a cardiology colleague who said he wasn’t feeling well and described the symptoms of a heart attack! Even trained cardiologists (again, in this case, a man) may want to think it’s that pepperoni pizza they just ate that’s the problem and not a heart attack.
Please: Learn more about heart attacks. We wrote this for the American College of Cardiology’s patient website known as CardioSmart. http://bit.ly/2Pn5E0 And if you’re alone when these symptoms strike, and you’re too stubborn to call 911, call a friend or go somewhere with plenty of people. At least then, when your heart stops, there is a chance someone will call 911 for you and maybe perform CPR so you can live again – when you hopefully will take better care of yourself.
Sudden cardiac death (SCD) occurs from an abrupt loss of heart function, and victims are often unaware that they are at risk. Coronary heart disease due to blocked arteries is a common underlying cause of SCD. Another common cause are heart rhythm disorders; sometimes the heart beats rapidly (ventricular tachycardia) or chaotically (ventricular fibrillation) or both.
Researchers examined SCD data from three famous studies: Framingham Heart Study (FHS), the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study. Lifetime risk was associated with three different variables: cardiac risk factors (of course), male gender, and African-American heritage. For example, the lifetime risk of SCD was one in eight for men and one in 24 for women.
Less sudden than thought? About two-thirds of cardiac arrests are preceded by symptoms. Good news IF you recognize symptoms.
A team of researchers in Japan report that about two-thirds (61%) of sudden cardiac arrests were preceded by well-known cardiac symptoms. The most frequent symptoms included shortness of breath, chest pain and/or fainting – 59.8% a few minutes before arrest and 25% within an hour before.
Comment: In the first report, its importance derives from the studies analyzed. Individually, these are three of the largest cardiac and health data sets in the United States, so using these studies to evaluate a specific question provides insights likely to be very reliable.
As for the second study, this is critically important. Previous data suggested that for about half of all people with SCD the first symptom is sudden death. How do you like that for a first symptom? This study, however, says that in many cases there are symptoms that something’s wrong. Unfortunately people (yeah, mostly men) don’t want to think of symptoms as being a heart attack. A doctor even told me once of getting a call from a cardiology colleague who said he wasn’t feeling well and described the symptoms of a heart attack! Even trained cardiologists (again, in this case, a man) may want to think it’s that pepperoni pizza they just ate that’s the problem and not a heart attack.
Please: Learn more about heart attacks. We wrote this for the American College of Cardiology’s patient website known as CardioSmart. http://bit.ly/2Pn5E0 And if you’re alone when these symptoms strike, and you’re too stubborn to call 911, call a friend or go somewhere with plenty of people. At least then, when your heart stops, there is a chance someone will call 911 for you and maybe perform CPR so you can live again – when you hopefully will take better care of yourself.
Athletic trainers use a novel cost-effective screening method to ID athletes who may be at risk of sudden death.
Sudden cardiac death (SCD) occurs from an abrupt loss of heart function, and victims are often unaware that they are at risk. Coronary heart disease caused by blocked arteries is a common underlying cause of SCD. Cardiac rhythm disorders are also responsible for many of these deaths. These occur when electrical impulses in the heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation), or both. Such sudden deaths in younger persons are especially perplexing.
In an encouraging study, athletic trainers in 10 Houston high schools took part in a new screening method. Using a laptop computer, the trainers performed electrocardiograms (EKGs) on 2,057 student athletes and transmitted their results to a cardiologist. They discovered abnormal EKGs in 186 of these young people.
Comment: When a young athlete dies suddenly, the tragedy affects not only the family but usually an entire community, too. Unfortunately, this is such a rare occurrence that widespread screening to detect kids at risk is expensive and puts an additional burden on an already overworked health care system. What this study suggests is that athletic trainers, coaches, nurses and even students could perform the EKG. (Combining today’s computer power with amazing software is simplifying science to a degree that – well, no longer requires an advanced degree!) At the other end of this new screening tool, cardiology fellows could read the EKG. So, this could be a very economical way to screen for hidden heart disease in young athletes.
While no one suggests sudden cardiac death would be eliminated in young athletes, researchers said the discovery of significant heart problems in this study implies that the risk could be reduced. The model, with modifications, could be applicable to school districts nationwide.
Links: If you’re a doctor, what do you ask in a preparticipation medical screening? Some official recommendations here. http://bit.ly/3OLq3Y For more information, here is an article we prepared for the American College of Cardiology. http://bit.ly/1NDGMs
Expanding athlete program to a general population of young people may ID teens at risk of sudden death.
In this Italian study, screening 2,013 people (average age 18) with a health questionnaire and 12-lead (EKG) revealed 6.9% had a family history suggesting sudden cardiac death (SCD) or a family history of a condition (hereditary cardiomyopathy). Either of these family histories indicates that the student is at greater than normal risk of SCD. Another important finding: 10.4% of those studied had a 12-lead EKG abnormality warranting further investigation. (In other words, it might not have been a big problem, but something about the analysis of their heart suggested a need for further testing.)
Comment: Italian physicians have been way ahead of the rest of the world in screening young people (especially young athletes) for undetected cardiac disease. It’s been a huge debate. Widespread preparticipation screening, for example, is demanding, expensive, and requires commitment of the medical community, schools, and government. However, the experience in Italy is encouraging. Add in the Houston study above and soon we may see fewer of those terrible moments when we lose a young person suddenly from a problem that simply went unrecognized.
Sudden cardiac death (SCD) occurs from an abrupt loss of heart function, and victims are often unaware that they are at risk. Coronary heart disease caused by blocked arteries is a common underlying cause of SCD. Cardiac rhythm disorders are also responsible for many of these deaths. These occur when electrical impulses in the heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation), or both. Such sudden deaths in younger persons are especially perplexing.
In an encouraging study, athletic trainers in 10 Houston high schools took part in a new screening method. Using a laptop computer, the trainers performed electrocardiograms (EKGs) on 2,057 student athletes and transmitted their results to a cardiologist. They discovered abnormal EKGs in 186 of these young people.
Comment: When a young athlete dies suddenly, the tragedy affects not only the family but usually an entire community, too. Unfortunately, this is such a rare occurrence that widespread screening to detect kids at risk is expensive and puts an additional burden on an already overworked health care system. What this study suggests is that athletic trainers, coaches, nurses and even students could perform the EKG. (Combining today’s computer power with amazing software is simplifying science to a degree that – well, no longer requires an advanced degree!) At the other end of this new screening tool, cardiology fellows could read the EKG. So, this could be a very economical way to screen for hidden heart disease in young athletes.
While no one suggests sudden cardiac death would be eliminated in young athletes, researchers said the discovery of significant heart problems in this study implies that the risk could be reduced. The model, with modifications, could be applicable to school districts nationwide.
Links: If you’re a doctor, what do you ask in a preparticipation medical screening? Some official recommendations here. http://bit.ly/3OLq3Y For more information, here is an article we prepared for the American College of Cardiology. http://bit.ly/1NDGMs
Expanding athlete program to a general population of young people may ID teens at risk of sudden death.
In this Italian study, screening 2,013 people (average age 18) with a health questionnaire and 12-lead (EKG) revealed 6.9% had a family history suggesting sudden cardiac death (SCD) or a family history of a condition (hereditary cardiomyopathy). Either of these family histories indicates that the student is at greater than normal risk of SCD. Another important finding: 10.4% of those studied had a 12-lead EKG abnormality warranting further investigation. (In other words, it might not have been a big problem, but something about the analysis of their heart suggested a need for further testing.)
Comment: Italian physicians have been way ahead of the rest of the world in screening young people (especially young athletes) for undetected cardiac disease. It’s been a huge debate. Widespread preparticipation screening, for example, is demanding, expensive, and requires commitment of the medical community, schools, and government. However, the experience in Italy is encouraging. Add in the Houston study above and soon we may see fewer of those terrible moments when we lose a young person suddenly from a problem that simply went unrecognized.
Saturday, November 14, 2009
Valve Disease: Encouraging Reports on Less Invasive Procedures
Aortic valve replacement is the most common heart valve procedure. It’s usually due to a slowly narrowing of the valve due to a growing blockage or “stenosis.” It is a consistently progressive disease affecting from 2-7% of individuals older than 65 years in the U.S. As bad as that is, it will only get worse as the population ages.
Surgical valve replacement remains the gold standard for treating advanced aortic valve stenosis. However, up to one-third of patients with symptomatic aortic stenosis are not candidates for open surgery. Sometimes, they are simply too old or have other diseases that complicate any open surgical procedure.
For at least 5 years, I have been reporting on percutaneous valve repair or replacement. (If you’re a physician, check ACC’s Cardisource for much of our work on this topic. In particular, look for interviews by or features with Dr. Peter Block of Emory University. He was an early investigator and still one of the recognized U.S. authorities on this topic.) One of the world’s leading investigators is Dr. Helene Eltchaninoff, University of Rouen, France. Hers was the first session I attended this year at AHA and the results continue to be promising. I am scheduled to interview Dr. Eltchaninoff, so we’ll post more details later. (If you are a doctor, you might be interested in seeing Dr. Eltchaninoff's slides at http://bit.ly/2lctg5 )
For now, if you want to know more about valve disease, here is a good summary for patients that we wrote for CardioSmart, a website developed by the American College of Cardiology. http://bit.ly/2Nk1oZ
Surgical valve replacement remains the gold standard for treating advanced aortic valve stenosis. However, up to one-third of patients with symptomatic aortic stenosis are not candidates for open surgery. Sometimes, they are simply too old or have other diseases that complicate any open surgical procedure.
For at least 5 years, I have been reporting on percutaneous valve repair or replacement. (If you’re a physician, check ACC’s Cardisource for much of our work on this topic. In particular, look for interviews by or features with Dr. Peter Block of Emory University. He was an early investigator and still one of the recognized U.S. authorities on this topic.) One of the world’s leading investigators is Dr. Helene Eltchaninoff, University of Rouen, France. Hers was the first session I attended this year at AHA and the results continue to be promising. I am scheduled to interview Dr. Eltchaninoff, so we’ll post more details later. (If you are a doctor, you might be interested in seeing Dr. Eltchaninoff's slides at http://bit.ly/2lctg5 )
For now, if you want to know more about valve disease, here is a good summary for patients that we wrote for CardioSmart, a website developed by the American College of Cardiology. http://bit.ly/2Nk1oZ
The Heart of the Matter
For nearly 25 years, I have been covering the American Heart Association Scientific Sessions. I am in Orlando and, starting tomorrow, we'll be providing details and perspectives on dozens of the leading stories from this meeting.
Heart disease and stroke have such a huge impact on health worldwide and this meeting always provides new insights that change the prevention, detection, and management of cardiovascular disease.
We'll link you to additional sources, too, but I think you'll enjoy the opportunity to tap into this huge pipeline of information. (There are thousands of presentations; we'll try to narrow the focus down to the most interesting/influential work being presented here.)
Questions? Just ask, or send via Twitter: RickMcGuire1
Heart disease and stroke have such a huge impact on health worldwide and this meeting always provides new insights that change the prevention, detection, and management of cardiovascular disease.
We'll link you to additional sources, too, but I think you'll enjoy the opportunity to tap into this huge pipeline of information. (There are thousands of presentations; we'll try to narrow the focus down to the most interesting/influential work being presented here.)
Questions? Just ask, or send via Twitter: RickMcGuire1
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