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Heart Saving Headlines

May 23, 2011 Written by JP       [Font too small?]

An important lesson cardiologists have learned over the past few decades is that patients don’t necessarily need to be overweight or out of shape to be at risk for heart attacks and strokes. Even more surprising to some is that the processes that underlie heart disease often begin very early in life. Fatty deposits in arteries or atherosclerosis is no longer considered the exclusive domain of adults. These undeniable facts provide justification for a steady stream of new information about how to best manage the current and ever growing cardiovascular crisis.

Patients and physicians need to be on the cutting edge when it comes to diagnostic testing, diet and medications that may help protect against various insults to the cardiovascular system. This past month alone has revealed some very interesting insights that can assist both interested parties.

Heart Headline #1 - Sometimes Older Physicians Are Best

If you’re under the impression that younger doctors are more open to the idea of using natural approaches to reduce heart risk, think again. A new review in the June 2011 issue of the International Journal of Clinical Practice reports that doctors under the age of 45 are actually more likely to prescribe antidiabetic, antiplatelet, blood pressure and cholesterol lowering drugs than older physicians. According to this investigation, physicians falling in the “46 to 55″ and “over 55″ age brackets suggest diet and lifestyle modification to a greater extent than their younger colleagues. What’s more, older doctors were more accurate when recording clinical data about patients. Such accuracy has previously been linked to a better cardiovascular (CV) outlook for patients. These findings become all the more relevant when you consider that recent studies have found that: a) common heart medications (aspirin and simvastatin) are ineffective in treating pulmonary arterial hypertension and; b) even short term use of pain relievers (NSAIDs or non-steroidal anti-inflammatory drugs) are associated with an increased risk of heart attacks in patients with cardiovascular disease. (1,2,3,4,5)

Heart Headline #2 - Use Fitness to Help Predict Heart Attack and Stroke Risk

There are a great many diagnostic tools that cardiologists can employ to determine your short term (10 years or less) and long term (25 years or more) heart risk. A simple treadmill test may soon be added to the recommended list. Researchers at the UT Southwestern Medical Center are the latest to confirm the importance of exercise capacity and rate as predictors of lifetime heart attack and stroke incidence. To illustrate their findings, the authors offered the following examples:

  • “A 55-year-old man who needs 15 minutes to run a mile has a 30% lifetime risk of developing heart disease.”
  • “A 55-year-old woman who can run a mile in 8 minutes has a lifetime risk of less than 10%.”

Also of significance is that exercise appears to offer protection even to those with established risk factors such as diabetes, elevated lipid panels and high blood pressure. The take home message is that a basic treadmill test could and should be included to conventional CV risk assessment as a complementary diagnostic tool. (6,7,8)

Heart Headline #3 - Nonpharmacological Strategies Can Be Lifesavers

Angioplasty is a procedure that inflates a small balloon inside an artery in order to press plaque against the vessel wall. The idea is to allow for more space for blood to freely flow. A stent is then typically placed in the affected area to ensure that the artery remains open. A 14 year analysis in a group of 2,395 angioplasty patients found that those who took part in cardiac rehabilitation (CR) experienced a 46% reduction in mortality as compared to those who did not. CR is a form of follow-up care that involves dietary counseling, exercise training, support with smoking cessation and weight loss therapy. Cardiac rehabilitation isn’t considered an alternative treatment. However, it’s estimated that only about a quarter of all eligible patients receive this type of guidance and monitoring. Most insurance plans cover this therapeutic modality and it should be insisted upon when not offered by a treating physician. (9,10)

Heart Headline #4 - Dairy Doesn’t Increase Cardiovascular Disease Incidence or Mortality

You want to follow a heart healthy diet but you’re having a hard time giving up cheese, milk and yogurt. Take heart: a new study appearing in the journal Nutrition, Metabolism and Cardiovascular Diseases set out to find a link between dairy consumption and cardiovascular risk in a group of 3,630 middle-aged men and women and discovered no such connection. The authors of the paper in question from Brown University theorize that there may be certain protective elements in dairy (calcium, CLA or conjugated linoleic acid, magnesium, potassium, Vitamin D, etc.) that offset any potential consequences relating to dairy’s saturated fat content. This finding is supported by several other recent publications that tend to show a net beneficial or neutral affect with relation to dairy intake and cardiovascular disease incidence and/or mortality. (11,12,13,14,15,16)

High Dairy Diets Decrease Intracellular Calcium and May Lower Blood Pressure

Source: J Am Coll Nutr. 2009 Feb;28 Suppl 1:103S-19S. (link)

Heart Headline #5 - See Red: Eat Tomatoes and/or Supplement with Lycopene

There’s more good news on the nutrition front. Dr. Karin Ried of the University of Adelaide suggests including more tomatoes in your diet as a natural means of controlling cardiovascular risk. According to Dr. Ried, a daily dosage of 25 mg/day of lycopene, an antioxidant carotenoid found in tomatoes, “can reduce LDL-cholesterol by up to 10%”. She goes on to say, “that’s comparable to the effect of low doses of medication commonly prescribed for people with slightly elevated cholesterol, but without the side effects of these drugs, which can include muscle pain and weakness and nerve damage.” And that’s only part of the story. In recent months, publications in the the journal Atherosclerosis, the Journal of Internal Medicine and the Journal of Nutrition confirm that lycopene: a) supports cardiovascular health by protecting arteries from hardening and plaque build up; b) reduces oxidative stress and subsequent endothelial dysfunction; c) inhibits systemic inflammation and pro-thrombotic factors which contribute to abnormal clotting. (17,18,19,20,21)

Of the five headlines presented today, the first three are directly associated with the type of medicine you’ll likely receive from conventional, Western-style physicians. Diagnostic testing, follow-up interventions and medication are familiar components of standard patient care. But you can influence how these modalities are administered by sharing pertinent information and voicing your preference for testing and treatment options. When you combine this proactive approach with the latest data pertaining to diet and self care you’ll establish a powerful and uncommon treatment and wellness alliance.

Be well!

JP

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6 Comments & Updates to “Heart Saving Headlines”

  1. Liverock Says:

    JP

    Thanks for a timely reminder about the ‘calcium paradox’.

    Cutting back on calcium seems to in vogue at the moment due to heart attack scares about calcium build up in arteries.

    In fact cutting intake too low can actually cause calcium buildup in the arteries, due to calcium having to be leeched from the bones by parathyroid hormone when intake is too low. Parathyroid Hormone favors depositing this calcium in the arteries causing intracellular calcium build up in tissues and arteries.

    As in most minerals balance is the key.

  2. JP Says:

    Thank you, Liverock. Agreed!

    Be well!

    JP

  3. Paul F. Says:

    Hi JP,

    Another ten points on keeping us informed and open minded!

    Keep it up! I am happy we can indulge in moderation some dairy treats provided our individual genetic history allows us to do so!

    We must listen to our body feed back, right?

    I am always anxious to read what your new article will reveal!

    Paul

  4. JP Says:

    Many thanks, Paul!

    Absolutely. Staying in tune with your body provides information that is often otherwise missed. It’s invaluable.

    Be well!

    JP

  5. JP Says:

    Update: A recent, scientific review about the safety of calcium supplementation in older women …

    http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2311/full

    The Effects of Calcium Supplementation on Verified Coronary Heart Disease Hospitalization and Death in Postmenopausal Women: A Collaborative Meta-Analysis of Randomized Controlled Trials

    Calcium supplementation, particularly with vitamin D, has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta-analyses suggesting that calcium supplementation with or without vitamin D increases myocardial infarction (MI) risk; however, concern has been raised over the design of these meta-analyses. We, therefore, undertook a meta-analysis of randomized controlled trials with placebo or no-treatment control groups to determine if these supplements increase all-cause mortality and coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record, or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966, to May 24, 2013, for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional unpublished data were required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3390 CHD events and 4157 deaths. Two authors extracted the data independently with trial data combined using random-effects meta-analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95% confidence interval [CI], 0.96–1.09; p = 0.51). Seventeen trials contributed all-cause mortality data with pooled RR of 0.96 (95% CI, 0.91–1.02; p = 0.18). Heterogeneity among the trials was low for both primary outcomes (I2 = 0%). For secondary outcomes, the RR for MI was 1.08 (95% CI, 0.92–1.26; p = 0.32), angina pectoris and acute coronary syndrome 1.09 (95% CI, 0.95–1.24; p = 0.22) and chronic CHD 0.92 (95% CI, 0.73–1.15; p = 0.46). In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all-cause mortality risk in elderly women.

    More info: http://www.nutraingredients-usa.com/Research/Meta-analysis-rejects-safety-concerns-over-calcium-supplementation-for-increasing-coronary-heart-disease-risk

    Be well!

    JP

  6. JP Says:

    Update: Higher intake of dietary calcium may lower cardiovascular and all-cause mortality risk in older adults …

    http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2515/abstract

    J Bone Miner Res. 2015 Mar 31.

    Higher Dietary Calcium Intakes are Associated With Reduced Risks of Fractures, Cardiovascular Events and Mortality: A Prospective Cohort Study of Older Men and Women.

    The aim of this population-based, prospective cohort study was to investigate long-term associations between dietary calcium intake and fractures, non-fatal cardiovascular disease (CVD), and death from all causes. Participants were from the Melbourne Collaborative Cohort Study which was established in 1990-1994. A total of 41,514 men and women (∼99% aged 40-69 years at baseline) were followed-up for a mean (SD) of 12 (1.5) years. Primary outcome measures were time to death from all causes (n = 2,855), CVD-related deaths (n = 557), cerebrovascular disease-related deaths (n = 139), incident non-fatal CVD (n = 1,827), incident stroke events (n = 537) and incident fractures (n = 788). 12,097 participants (aged ≥50 years) were eligible for fracture analysis and 34,468 for non-fatal CVD and mortality analyses. Mortality was ascertained by record linkage to registries. Fractures and CVD were ascertained from interview ∼13 years after baseline. Quartiles of baseline energy-adjusted calcium intake from food were estimated using a food frequency questionnaire. Hazard ratios (HR) and odds ratios (OR) were calculated for quartiles of dietary calcium intake. Highest and lowest quartiles of energy-adjusted dietary calcium intakes represented unadjusted means (SD) of 1,348 (316) mg/d and 473 (91) mg/d, respectively. Overall there were 788 (10.3%) incident fractures, 1,827 (9.0%) incident CVD; and 2,855 people (8.6%) died. Comparing the highest with the lowest quartile of calcium intake, for all-cause mortality, the HR was 0.86 (95%CI; 0.76 to 0.98, Ptrend  = 0.01);for non-fatal CVD and stroke, the OR was 0.84 (95%CI; 0.70 to 0.99, Ptrend  = 0.04) and 0.69 (95%CI; 0.51 to 0.93, Ptrend  = 0.02), respectively, and the OR for fracture was 0.70 (95%CI; 0.54 to 0.92, Ptrend  = 0.004). In summary, for older men and women, calcium intakes of up to 1,348 (316) mg/d from food were associated with decreased risks for fracture, non-fatal CVD, stroke and all-cause mortality.

    Be well!

    JP

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