Tag Archive for: heart disease

Emerging CVD Risk Factors for Women

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The paper I referred to in Tuesday’s Memo provided a list of emerging risk factors for heart disease that apply only to women. But first, I wanted to define exactly what a risk factor is and what it means.

As defined by the World Health Organization, a risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury. The key word is likelihood. It does not mean cause and effect, and that includes genetic tendencies. Lifestyle contributes close to 80% when it comes to raising or lowering risk. You’re not doomed; you just have to be aware and take action.

There were several emerging risk factors for cardiovascular disease (CVD):

  • Gestational diabetes: your risk of getting type 2 diabetes increases four-fold later in life; type 2 diabetes is a risk factor for heart disease.
  • Hypertension during pregnancy: hypertension and preeclampsia increase the risk of heart disease three-fold.
  • Early menopause: women’s hormones are protective against heart disease. When they change during menopause, the risk of heart disease begins to increase; the earlier that happens, the sooner the risk rises.
  • Autoimmune disease: diseases such as rheumatoid arthritis and lupus increase the risk of heart disease. Autoimmune diseases increase inflammation, and that may partially explain this connection.

You can see why these emerging risk factors are primarily associated with women. While depression is also associated with an increased risk in women, it may be that women seek help more than men.

Keep in mind that these conditions don’t make heart disease a given, just a risk. But if that gives you the oomph you need to get to the gym today or skip that sweet roll, I’m okay with that.

What happens after a woman has heart disease or a heart attack? We’ll take a look at that on Saturday including one thing that stunned me and has to change.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2018;11:e004437.

 

It’s American Heart Month

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February was declared American Heart Month by President Lyndon Johnson in December 1963. As I’m searching the recent research in preparing to update the Women’s Heart Health audio, I’ve found new research on women’s hearts. I’m not ignoring men, but the research on women has lagged behind what we know about the risk of heart disease in men, because women’s bodies react differently to heart issues. Now we’re starting to catch up on women’s hearts.

Let’s look at the same risk factors for heart disease and see the differences between men and women. In a paper published this month, researchers looked at the differences in how risk factors for heart disease are managed in women. Here’s what they found:

  • Blood lipids: after menopause, women are less likely to achieve goals in reducing triglycerides and LDL-cholesterol and increasing HDL-cholesterol.
  • Blood pressure: as women get older, those with hypertension are less likely to lower blood pressure; only 29% achieve healthy blood pressures.
  • Exercise: 25% of all women get no regular exercise.
  • Obesity: carrying extra weight impacts the risk of heart disease more in women than men—64% compared to 46%.

There are more risk factors, but what makes these four important is that they can be improved through changes in lifestyle. Eating less. Eating better. Moving more. Even a 10% change can help reduce a women’s risk of getting heart disease.

Some new risk factors are emerging that are unique to women. I’ll cover those on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2018;11:e004437.

 

The Bottom Line on Veggies and Carbs

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Go ahead and finish your oatmeal and drink your protein-kale smoothie—you do need those veggies. Meanwhile I’ll put the PURE study in perspective.

This is a large study that looks at the economics of food as well as the health benefits. In a separate publication, the analysis of the data focused on the cost of fruit and vegetable intake as a percentage of monthly income. They specifically collected data from low-, middle-, and high-income communities from 18 different countries. Researchers actually went to grocery markets in those countries to collect the cost data. As you might expect, the lower the income, the higher the percentage of monthly revenue spent on vegetables and fruits.

I think that explains part of the reason the second study on vegetable intake and mortality said there was no additional benefit beyond three or four servings per day: if people can’t afford more, it’s wrong to teach them that more is better if it might not be. But that doesn’t justify the headlines because the message that Americans hear is “I don’t have to eat those darn vegetables!”

Yes, you do. Here are the issues with each of the studies.

 

Do Carbs Kill?

In the first study on carbohydrate intake and mortality, researchers used a simple percentage of caloric intake in their analysis. Basically we have a math problem: if someone in a poor country eats 80% of their diet as carbohydrates from root vegetables but they only get 1,000 calories per day that’s a completely different situation from a person who eats 3,000 calories per day but 50% of their calories are from refined carbohydrates and sugars.

As I’ve said many times, while we should eat fewer refined carbohydrates, carbohydrates are not inherently bad; it is the overconsumption that’s the problem. If researchers didn’t analyze the total caloric intake from carbohydrates, protein, and fats, we don’t have the complete answer. The PURE study used a food frequency questionnaire. I’ll leave it at that because I rant too much about the FFQs.

Finally, the researchers simply jumped the gun by recommending that health education should now focus on increasing fat intake while reducing carbohydrates. All types of vegetables and fruits are carbohydrates. Because researchers did not parse out different sources of carbohydrates in their analysis, their recommendations are meaningless.

 

Don’t Bother with More Veggies?

PURE is an observational study; it cannot determine cause and effect. Also it can tell you a lot about a large group of people but nothing about an individual.

The lead researcher actually provided the perspective on vegetables and fruit during an interview: if the research shows that the benefit of eating more plant-based food is a 20% reduction in mortality, and the mortality rate of the population is just 1%, that means the reduction goes from 10 out of 1,000 to 8 out of 1,000. It’s virtually meaningless to an individual.

The researchers hesitated to tell people with very low incomes to spend more on additional servings of plant-based food if there was not a meaningful benefit. But for most of you, the cost of fruit and vegetables is not a hardship, so buy ’em and eat ’em.

 

The Bottom Line

These will not be the last headlines we hear from the PURE study because the data continues to be analyzed. One issue for me is that there’s no data from the U.S. included so the ability to generalize to the U.S. population is very limited. We lead the world in obesity and overweight and our food consumption patterns are different even from other Westernized countries.

One thing remains clear to me: we should all eat more vegetables and fruit and reduce refined carbohydrates. The recommendation never changes: eat less, eat better, move more.

What are you prepared to do today?

Dr. Chet

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References:
1. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32252-3.
2. DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8.

 

PURE Headline 2: Don’t Bother with More Veggies?

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Using the same data base of subjects in the PURE Study, researchers examined the vegetable, fruit, and legume intake on total mortality, mortality, and major cardiac events such as heart attacks.

The most important finding was that higher vegetable, fruit, and legume intake was associated with a reduced risk of mortality and morbidity. Simply put, the more plant-based the diet, the better off you are from an overall health perspective.

But that’s not what the headline messages said. They focused on the part of the study that said there appeared to be no additional benefits if subjects ate more than a few servings of vegetables, fruits, and legumes. That seems to fly in the face of the “more is better” results that previous research has shown.

Have all the prior studies been wrong? Have you been eating kale for no good reason? No, and I’ll explain why the headlines are wrong on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI: http://dx.doi.org/10.1016/S0140-6736(17)32253-5.

 

PURE Headline 1: Do Carbs Kill?

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Never a dull moment when it comes to health news: now they’re asking if you should choose fat rather than carbs.

The research study was called PURE: Prospective Urban Rural Epidemiology, and you’ll be hearing more about it. Over 150,000 people from five continents, 18 countries, and 613 different communities were included in the study. Researchers collected data on demographics, smoking habits, and health questionnaires including a semi-quantitative food frequency questionnaire (FFQ).

In the first paper, researchers examined the relationship between macronutrient intake, specifically fats and carbohydrates, and total mortality including cardiovascular events. Higher fat intake was associated with a decreased risk of total mortality while high carbohydrate intake was associated with a higher risk of mortality. There was no specific relationship between either macronutrient and heart disease.

Should you put down that rice? How about the bread? What about that cabbage and broccoli? Before you decide, let’s check out the second headline grabber on Thursday.

What are you prepared to do today?

Dr. Chet

Insider Update: The next Conference Call will be next Tuesday September 25 at 9 p.m. If you’re not an Insider yet, join now to participate in this information-packed call and get your questions answered.

 

Reference: DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8

 

How to Fix a Broken Heart

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What causes broken heart syndrome (BHS)? Most types of cardiomyopathy are idiopathic—no one really knows how it happens. In the case of BHS, there’s a severe stressor, good or bad, that precipitates the symptoms. But what is actually going on? I found two potential explanations.

First, an excess amount of catecholamines are released in response to the stress. The theory is that this stuns the heart muscle and temporarily causes the muscle weakness. The second theory involves an increase in sympathetic activity in the heart. In short, the nerves that stimulate the heart to beat faster keep firing. Between the two factors, the heart tissue gives the symptoms of BHS.

Another factor may be hormone levels; BHS mostly happens to post-menopausal women over 55 years old. More research is needed to find out whether this is truly a factor or not.

The most important thing to know is that the effects are temporary; the heart tissue is not permanently damaged and can recover. Here’s the important point: the person still needs to be treated in a hospital. Left untreated, the person can die. Typical treatments may be medications to slow down the heart rate and reduce blood pressure. While there may be no blockages, all those tests may show excessive plaque, so changes in diet and medications may be warranted. Typically the heart can recover in a month or two with no permanent damage.

Can you prevent BHS? After all, not everyone who has a severe stress event gets BHS. It’s hard to say with certainty, but there are three things that may help. First, have a strong heart to begin with; exercise is critical for that. Second, find a way to deal with stress on a regular basis: yoga, prayer, meditation, counseling, whatever works for you—do it. It can help with the stress response.

Finally, never, never, ever ignore chest pain. In this case, I’m talking to my women readers. I rant all the time about men who ignore chest pain. Don’t be like them! Women take on the role of caregivers, and that’s so important to our society, but this is a time when you have to take care of yourself first. When in doubt, check it out.

What are you prepared to do today?

Dr. Chet

 

Broken Hearts and Octopus Traps

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Broken heart syndrome (BHS) has several names, such as stress-induced cardiomyopathy. One you’ve probably never heard is takotsubo cardiomyopathy.

BHS is similar to other forms of cardiomyopathy in that the heart gets significantly weaker. If you view the appearance of the heart during echocardiography, the bottom of the heart, specifically the left ventricle, is weaker and balloons out more than normal when the heart contracts. Healthcare professionals in Japan thought it looked like the takotsubo, a pot used by Japanese fishermen for trapping octopus, thus the name.

The symptoms of BHS are severe pain deep in the chest along with shortness of breath. For some, there may be a build-up of fluid in the lungs that causes coughing and an inability to sleep lying down. It feels like a heart attack. Some of the changes in the EKG may look like a heart attack, but an angiogram will show no blockages causing a heart attack. Enzymes that rise during a heart attack will not follow the same pattern. The diagnosis can be confirmed by an echocardiogram which will show the ballooning effect.

On Saturday, I’ll finish up the treatment of BHS and what may help to prevent it.

What are you prepared to do today?

Dr. Chet

 

Broken Heart Syndrome

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This week’s focus is on American Heart Month and specifically heart disease in women. While heart disease is the leading cause of death in both men and women, there’s one type of heart disease that affects more women than men: broken heart syndrome. Can you die from a broken heart? Absolutely. We’ll find out how this week.

Cardiomyopathy is a weakening of the muscle tissue of the heart. There are four major forms of cardiomyopathy and several minor ones that can affect men, women, and even children. Cardiomyopathy affects up to one in five people and most don’t know that they have it until serious symptoms start to develop. Shortness of breath, fatigue, and swelling in the ankles are the first symptoms people may notice, and the symptoms get more severe as the heart continues to weaken. Treatment can range from medications to a heart transplant in severe cases.

Broken heart syndrome is a special type of cardiomyopathy. The primary cause is severe stress such as the death of a loved one, hence the name. It’s not limited to extreme bad news; extreme good news can initiate the process as well. I’ll explain what happens to the heart in Thursday’s post. Until then, give your loved ones extra hugs and kisses today. More than anything, give them the most important thing above all else: time.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2kWCbsT

 

Do You Make Enough Coenzyme Q10?

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There’s one major difference between coQ10 and other vitamins, minerals, and nutrients such as omega-3s: we can produce coQ10 ourselves. The problem is that we may not produce all the coQ10 we need, especially as we get older.

CoQ10 is used in the production of energy from both carbohydrates and fat in the mitochondria of the cells. You remember mitochondria from science class; they’re often called the powerhouse of the cells. And coQ10 is the substance that’s used to produce that power. It’s critical in the steps where oxygen is used to produce ATP, the . . .

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What You Need to Know About Omega-3s

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This week I’m covering basic information about three supplements.  One of my favorites and one I don’t ever leave home without is omega-3 fatty acids.

There are three basic forms of omega-3 fatty acids: eicosapentanoic acid or EPA, docosahexaenoic acid or DHA, and alpha-linolenic acid or ALA. The body cannot make omega-3 fatty acids, so they have to come from food and supplements. ALA is an essential fatty acid—the body can make EPA and DHA from it but not very well—so getting EPA and DHA from diet and supplements is critical.

EPA . . .

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