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.
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