With many of us contemplating marathons or other prolonged endurance events in 2016, we, our spouses and other family members most likely have wondered whether such strenuous training could be harmful to our hearts. Could any of us, in making ambitious resolutions, exercise too much?
A newly published scientific review offers both reassurance and some caution. It found that while most athletes' hearts can withstand most exercise, there are exceptions. For some people in seemingly good health, heavy loads of exercise might be problematic. That's why all of us who work out should be as informed as possible about our family's cardiac history and our own potential genetic risks.
Exercise, of course, is in general extremely beneficial for heart health. Dozens of large-scale epidemiological studies have found that people who exercise in any amount, whether five minutes a day or two hours a day or more, are much less likely to develop or die from heart disease than people who are sedentary.
But these studies, while encouraging, contain a disquieting subtext. Their plotted data typically shows some type of bell curve to the heart benefits from exercise, meaning that the more people work out, the less they are at risk of cardiac problems — up to a point, and then the benefits plateau or decline.
To some scientists, that finding made little intuitive sense. If a little exercise is good for the heart, why shouldn't more be continually better?
Dr. Paul Thompson, the chief of cardiology at Hartford Hospital in Connecticut and for years a dedicated marathon runner, was particularly drawn to that issue. He and his colleagues at Hartford Hospital, along with scientists at the Radboud University Medical Center in Nijmegen, the Netherlands, recently decided to delve more comprehensively than had yet been done into the available data on the topic.
Many past studies have looked at individual aspects of prolonged exercise and heart health. But no past review had comprehensively examined all of the ways in which prolonged endurance exercise might affect the heart and whether, on aggregate, those studies indicated that we should — or should not — worry about the effects of heavy training.
So for the new study, being published next month in Physiological Reviews, Dr. Thompson and his collaborators gathered all of the studies they could find from the past 30 or more years related to exercise and heart health, and parsed their findings both singly and collectively.
Their findings should reassure most of us and our concerned loved ones.
"There is no evidence that there is a level of exercise that is dangerous or too much for a normal, healthy person," Dr. Thompson told me.
At the same time, those of us who work out should understand that frequent exercise training causes "profound changes in cardiac physiology and structure," as Dr. Thompson and his colleagues write in their review.
In the short term, these changes can mimic heart damage, they point out, with cardiac cells often becoming "leaky" after strenuous workouts or events, releasing proteins into the bloodstream that, in other circumstances, could indicate a heart attack. These proteins usually disappear within a few days, and the heart seems to recover fully, Dr. Thompson said.
But in the process, the heart adapts and changes. Its left and right ventricles enlarge. It begins to look quite different than a non-athlete's heart.
For most people, these changes are beneficial and also necessary for successful athletic performance. But, as Dr. Thompson and his colleagues write, their review of the studies indicates that there are outliers, seemingly healthy people for whom strenuous exercise holds unexpected dangers.
Perhaps most surprising, older marathon runners can be just as susceptible as their sedentary counterparts to atherosclerosis, or the buildup of dangerous plaques in the arteries, the studies show. Strenuous exercise does not prevent these plaques in people who are predisposed by heredity or lifestyle to the condition.
The act of exercising, however, may increase the risk that the plaques will rupture, precipitating a heart attack. Someone with atherosclerosis is more likely, studies show, to have a heart attack while running than while sitting quietly.
But many older athletes with atherosclerosis have no idea they suffer from the condition, which often causes few symptoms.
Similarly, according to the new review, people with certain inherited heart abnormalities, such as cardiomyopathy (an enlarged heart) or long QT syndrome, a disorder of the heart's electrical activity, may exacerbate their conditions with strenuous exercise. The cardiac remodeling that is beneficial for most exercisers, the reviewers write, is undesirable for them and could lead to premature death, possibly contributing to the statistical downturn in health benefits from extreme exercise seen in some studies.
The best response to this information is not, however, to panic and avoid strenuous exercise, Dr. Thompson said. The best response is "to know your family history of sudden death," he said. If a close family member has died unexpectedly of heart problems, talk to your doctor about whether you need to be tested for conditions such as atherosclerosis or cardiomyopathy.
The rest of us should pay attention to symptoms such as unusual fatigue, shortness of breath or chest pain during exercise, he said, but are much more likely to strengthen our hearts with exercise than harm them.
(Reuters Health) -- In a 10-year U.S. study, people who drank coffee regularly were less likely to die of many causes, including heart disease and diabetes, than those who didn't drink coffee at all.
The more coffee study participants consumed, the lower their risk of dying, and decaf drinkers showed a similar pattern.
"Coffee contains numerous biologically active compounds, including phenolic acids, potassium, and caffeine," said lead author Dr. Erikka Loftfield of the National Cancer Institute in Rockville, Maryland.
Many studies have found that coffee consumption is associated with lower risk of overall and heart-related mortality, Loftfield told Reuters Health by email.
The researchers used data from a previous study on 90,317 adults without cancer or history of cardiovascular disease who were followed from 1998 through 2009. They had reported their coffee intake, along with other dietary and health details, at the start of the study.
By 2009, about 8,700 people had died. After accounting for other factors like smoking, the researchers found that coffee drinkers were less likely to have died during the study than nondrinkers.
The risk of death was lowest for those who drank four to five cups of coffee per day. A similar association was seen among drinkers of decaffeinated coffee as well, according to the results online now in American Journal of Epidemiology.
Coffee drinkers had a reduced risk of death from heart disease, chronic respiratory diseases, diabetes, pneumonia and influenza, and suicide, but not cancer, the researchers found.
"Although coffee drinking has also been inversely associated with incidence of certain cancers, like liver, in epidemiological studies, we did not observe an association between coffee and overall cancer mortality," Loftfield said. "This may be because coffee reduces mortality risk for some cancers but not others."
People who consumed two to three cups of coffee per day had approximately an 18% lower risk death during follow-up compared to those who reported drinking no coffee, she said. Drinking up to five cups per day, or 400 mg of caffeine per day, is not associated with any long-term health risks, Loftfield added.
Moderate caffeine intake, up to 200 mg per day, is even safe for pregnant women, according to a statement by the American College of Obstetricians and Gynecologists.
"There is an accumulating number of studies of very high quality that show that people who drink more coffee tend to have better health outcomes," said Dr. Marc J. Gunter of Imperial College London, who was not part of the new study.
"Coffee drinking is correlated with other health behaviors," and those who drink it regularly may have other healthy habits, like exercising and keeping to a healthier diet, though the researchers tried to account for those other factors, Gunter told Reuters Health.
The study doesn't prove that coffee extends life.
"You could argue that people who are already sick might not be drinking as much coffee," Gunter said. But coffee may also have a direct effect on inflammation or cardiovascular health, he said. "It doesn't seem to do you any harm, if you like drinking coffee then carry on," Gunter said.
Coffee can be part of a healthy, balanced lifestyle, and it may even do some good, though we can't yet recommend than nondrinkers adopt the habit for health reasons, he said.
Only half who should are using medications to help prevent heart disease
WebMD News from HealthDay
By Robert Preidt
HealthDay Reporter
THURSDAY, Dec. 3, 2015 (HealthDay News) -- Nearly half of American adults who should be taking cholesterol-lowering drugs don't, federal government researchers report.
They also found that blacks and Hispanics were less likely than whites to take medications that lower levels of "bad" LDL cholesterol.
"Nearly 800,000 people die in the U.S. each year from cardiovascular diseases -- that's one in every three deaths -- and high cholesterol continues to be a major risk factor," said Carla Mercado, a scientist in the division for heart disease and stroke prevention at the U.S. Centers for Disease Control and Prevention.
"This study reveals opportunities to reduce existing [racial] disparities through targeted patient education and cholesterol management programs," she said in a CDC news release.
The CDC study team analyzed national data from 2005 to 2014 and found that nearly 37 percent of U.S. adults -- more than 78 million people aged 21 and older -- were eligible to take cholesterol-lowering medications or were already taking them.
Among these people, 55.5 percent were taking cholesterol-lowering medication, almost 47 percent were making lifestyle changes to lower cholesterol, 37 percent were taking medication and making lifestyle changes, and 35.5 percent were doing neither.
The study included all types of cholesterol-lowering drugs, but nearly 90 percent of those on medication were taking a statin, the researchers noted.
Of the almost 41 percent of men eligible for or already on cholesterol medication, close to 53 percent were taking them. Among women, the figures were almost 33 percent and more than 58 percent, respectively.
Of the roughly 24 percent of Mexican-Americans eligible for or already on cholesterol medication, 47 percent were taking medications. The figures were 39.5 percent and 46 percent, respectively, among blacks, and more than 38 percent and 58 percent, respectively, among whites.
The lowest rate of taking recommended cholesterol medication (close to 6 percent) was among blacks who did not have a regular place for health care. The highest rate (80 percent) was among people who said they already adopted a heart-healthy lifestyle.
The study appears in the Dec. 4 issue of the CDC's Morbidity and Mortality Weekly Report.
Walnuts significantly improved diet quality, endothelial function, and cholesterol without negatively affecting blood pressure or glucose levels in a new study.
In a randomized trial of 112 participants who either spent 6 months eating walnuts followed by 6 months on a diet with no walnuts, or vice versa, the walnut group had a significantly better diet both with dietary counseling (9.14±17.71 versus 0.40±15.13 on the 2010 Health Eating Index; P=0.02) and without it (7.02±15.89 versus −5.92±21.84; P=0.001).
In addition, endothelial function and total and low-density lipoprotein (LDL) cholesterol improved from baseline with the walnut diet of about 56 g of walnuts per day -- about a handful -- though these measures didn't significantly vary when the two arms were directly compared, according to lead author David Katz, MD, at the Yale University School of Medicine.
"Walnuts are uniquely nutritious, so they likely confer benefits that other nuts do not," said Katz in an email to MedPage Today, though he added that research is limited. "In general, nut consumption has been associated with health benefit, including reduction in all-cause mortality, but few nuts have been studied in isolation -- mostly walnuts and almonds, and to a lesser extent, pistachios."
The walnut diets neither significantly improved or worsened body mass index, percent body fat, percent body water, or visceral fat (P>0.05) when the two arms were compared. But waist circumference improved in the walnut plus dietary counseling group.
The walnut diets also had no significant effect on blood pressure or fasting blood glucose.
"Our findings persisted after controlling for age, gender, caloric intake, fiber intake, monounsaturated fatty acid intake, polyunsaturated fatty acid intake, omega-3 intake, and physical activity level," wrote the authors.
"Compared with most other nuts, walnuts have a higher content of polyunsaturated fatty acids," wrote the authors. The benefits vary, according to previous research, from improved semen quality to better cardiovascular health.
But walnuts also have a high energy density, so there's the possibility that it contributes to a positive energy balance and to weight gain, wrote Katz and colleagues, though there was no evidence for that in this study.
The Nurses Health Study has found that increased nut consumption is associated with a lower risk of type 2 diabetes, but the authors of the present study found no evidence of an increased insulin response or a decrease in HbA1c levels. "This may relate to variations in study populations, study duration, or the treatment dose, among other potential explanations," wrote the authors.
There were no caloric restrictions on participants' diets aside from the walnuts provided each week. Thirty-one of the participants were men and all were recruited in Connecticut via flyers and newspaper advertisements. Ages ranged from 25 to 75, and all were nonsmokers with a high risk of diabetes as determined by waist circumference, fasting blood glucose, or metabolic syndrome.
Exclusion criteria included those who were allergic to walnuts or other nuts, those with a current eating disorder, those with restricted diets by their own choice, those receiving pharmacotherapy for obesity, those on supplements like fish or flaxseed oil, and those with diabetes or certain cardiovascular complications. Fifteen participants did not complete the study.
In between the walnut stage and the no-walnut stage, participants had a 3 month washout phase. A dietitian customized diets to make room for walnuts in the diet, but participants were given freedom to determine how they consumed the walnuts, wrote the authors.
The Healthy Eating Index is based on the 2010 Dietary Guidelines for Americans and is used to look at how effective a nutritional intervention is.
Limitations of the study include the fact that most participants were white women, so the results may not be generalizable. The study was powered for the primary outcome, the Healthy Eating Index, and may have been underpowered for other reported measures. It relied on self-report of dietary intake -- which other studies have shown to be severely limited -- and participants were not given a restricted diet.
"Further investigation is warranted in a more diverse population to replicate these findings," concluded the authors.
Katz disclosed compensation from the California Walnut Commission for a public speech.
Heart Failure Patients Getting Too Little Exercise
By Robert Preidt
HealthDay Reporter
TUESDAY, Nov. 17, 2015 (HealthDay News) -- A number of obstacles prevent heart failure patients from getting enough exercise, a new study has found.
Supervised aerobic workouts benefit people with heart failure. But a lack of social support and barriers -- such as child care -- means that many patients don't get the recommended amount of exercise, researchers found.
They looked at more than 2,200 heart failure patients enrolled in a 36-session supervised exercise program for three months, followed by two years of home exercise.
Participants also answered questions that measured their perception of social support and assessed potential barriers, such as finances and weather, that could interfere with participation in an exercise program.
Those with the most social support averaged 118 minutes of exercise a week after 12 months, compared with an average of 92 minutes for those with the least social support. Those with the fewest barriers averaged 86 minutes a week, compared with 79 minutes for those with the most barriers.
The study was published Nov. 17 in the journal Circulation: Heart Failure.
"Patients, family members, and healthcare providers should work together to find solutions to the barriers preventing a patient from participating in structured exercise programs, because exercise programs can help patients manage their condition," lead author Dr. Lauren Cooper, a fellow in cardiovascular diseases at the Duke University School of Medicine, said in a journal news release.
Heart failure means the heart isn't pumping blood as well as it should, causing fluid to build up in the body.
Previous research found that heart failure patients who did moderate exercise had a lower risk of being hospitalized for heart failure or of dying from heart disease.
"Competing responsibilities and lack of support may prevent patients with heart failure from participating in exercise programs," Cooper said. "Assessing a patient's social support system and barriers that may interfere with their exercise program may help medical professionals to customize exercise programs that better fit individual patient"
WEDNESDAY, Nov. 4, 2015 (HealthDay News) -- Hispanic children are more likely to be obese if their parents have high levels of stress, a new study suggests.
Researchers compared obesity rates of Hispanic children in Chicago, Miami, New York City and San Diego with their parents' levels of stress at home and at work.
The children's obesity rates rose according to the amount of stress their parents faced -- from 20 percent among kids whose parents had no stress to 34 percent among those whose parents had three or more stress factors. Stress factors included difficulties at work or in a relationship, among others.
After adjusting for other factors such as age, gender, place of birth and neighborhood, the researchers concluded that parents with three or more chronic sources of stress were twice as likely to have obese children than those with no stress.
The findings are to be presented Friday at the Obesity Society's annual meeting in Los Angeles. Research presented at meetings is typically considered preliminary because it's not subject to the same level of scrutiny as studies published in journals.
"Obesity and chronic stress were both prevalent among this Latino population, with more than one-quarter (28 percent) of children ages 8 to 16 with obesity, and nearly one-third (29 percent) of their parents reporting high levels of stress," study leader Carmen Isasi said in a society news release. Isasi is an associate professor of epidemiology and population health at Albert Einstein College of Medicine in New York City.
Isasi said the study, one of the first to identify parental stress as a risk factor for child obesity among Hispanics, adds to the understanding of family influences on youngsters' weight.
"This research should encourage clinicians and health care practitioners to consider high stress levels as a warning sign for developing obesity not only in the adult patient, but also in the patient's entire family," Dr. Margarita Teran-Garcia, At-Large Mexico Council member for the Obesity Society, said in the news release.
The findings suggest "that special attention should be paid to adult patients who report experiencing high stress levels in this population, and providers are encouraged to consider behavioral counseling as one measure for obesity prevention and treatments," Teran-Garcia added.
Further research is needed to determine how parental stress increases a child's risk of obesity, to identify preventive measures, and to examine this link in other racial/ethnic groups, the researchers said.
WEDNESDAY, Oct. 28, 2015 (HealthDay News) -- Medical science has made tremendous progress in prolonging the lives of people with type 2 diabetes. But, the prognosis still remains poor for patients who don't keep their blood sugar levels under control, according to results from a large-scale Swedish study.
People with type 2 diabetes carry a 15 percent increased risk of premature death compared to healthy people, the researchers reported in the Oct. 29 issue of the New England Journal of Medicine.
Those odds aren't great, but they're much better than they were as recently as 15 years ago, said senior author Dr. Marcus Lind, a physician at the University of Gothenburg in Sweden.
"Up to the year 2000, the excess risk of mortality in individuals with type 2 diabetes was generally considered to be doubled compared to the general population, implying a doubled risk to die during the following years," Lind said.
Now, the overall death rate for diabetics has "dropped to historical low levels," he added.
However, the risk of death is much higher in people younger than 65, those who poorly control their blood sugar levels, and those who've suffered kidney damage from type 2 diabetes, the researchers found.
The upshot is this -- type 2 diabetics have to do their part in managing their condition if they want the benefits that medical advances have wrought, said Dr. Robert Ratner, chief scientific and medical officer for the American Diabetes Association.
"If you develop diabetes, there is good evidence that attention to glucose [blood sugar] control and other cardiovascular risk factors from the onset can reduce any individual's risk of death," Ratner said.
The new study used data from the Swedish National Diabetes Register to compare the death rate among just over 435,000 people with type 2 diabetes with that of a healthy control group of 2.1 million people.
Type 2 diabetes occurs when the body loses its ability to effectively use insulin, a hormone that helps process blood sugar into fuel for cells. Patients can wind up with high levels of glucose in their blood, which is damaging to many systems throughout the body.
Type 2 diabetics younger than 65 have a death risk substantially greater than that of older diabetics, according to the study findings. Excess risk of death was two to three times higher among those younger than 55, compared to between 30 percent and 40 percent higher for diabetics aged 65 to 75.
"What you begin to see is the increased risk of mortality in diabetes is highest the younger you are," Ratner said. "The significant impact is really in those individuals under the age of 75, and it gets progressively greater as you go younger."
The study authors speculated that the higher death rates seen among younger diabetics might owe, in part, to some gap in the care offered to these people.
Poor control of blood sugar levels can make that bad situation even worse for younger diabetics, the researchers found.
Anyone who didn't manage their diabetes through lifestyle changes, insulin or medication faced a greatly increased risk of death, said study co-author Dr. Mikhail Kosiborod. He is a cardiologist at Saint Luke's Mid America Heart Institute and a professor of medicine at the University of Missouri-Kansas City.
"If you look at the data, regardless of the age we look at, regardless of everything else, the worse the glycemic control the higher the mortality," Kosiborod said.
But diabetics under 55 with poorly controlled blood sugar had a more than fourfold increased risk of early death, compared to healthy people. That risk was 55 percent higher for diabetics 75 and older who didn't bother to manage their diabetes, the findings showed.
Finally, a patient's death risk skyrockets if poorly controlled diabetes results in damage to their kidneys, the researchers said.
Diabetics younger than 55 who've entered end-stage kidney disease are 14 times more likely to die than a healthy person, according to the study.
End-stage kidney disease also multiplies the death risk sevenfold for diabetics 55 to 64, and sixfold for diabetics 65 to 74, the investigators found.
"Renal [kidney] disease and worsened kidney function are huge risk factors for overall mortality, regardless of age group," Kosiborod said.
Kosiborod concluded that "the strong message from our data is that if you are a young patient, there's a lot you can do to protect your health."
But the best thing a person can do is try to avoid getting type 2 diabetes in the first place, Kosiborod added.
Type 2 diabetes prevention is possible, he said. "Clinical trials have shown that aggressive and intensive lifestyle interventions can prevent diabetes. You should do everything you possibly can to prevent this condition from occurring," Kosiborod said.
TUESDAY, Oct. 27, 2015 (HealthDay News) -- The food sitting out on your kitchen counter offers clues about your weight, a new study reveals.
Cornell University researchers photographed kitchen counters in more than 200 American homes and then checked the weight of the women living in those houses.
Women who had breakfast cereal sitting on the counter weighed 20 pounds more than women who didn't have cereal boxes on display. And women in homes with soft drinks sitting on the counter weighed 24 to 26 pounds more than those living in homes without soft drinks on the counter, the investigators found.
"It's your basic 'see-food diet' -- you eat what you see," lead author Brian Wansink, professor and director of Cornell's Food and Brand Lab, said in a university news release.
"As a cereal lover, that shocked me. Cereal has a health-halo, but if you eat a handful every time you walk by, it's not going to make you skinny," he explained.
On the flip side, women who had a stocked fruit bowl on their countertops weighed 13 pounds less than women without the easily accessible fruit.
Although this study found an association between what was on the counter and a person's weight, it wasn't designed to prove a cause-and-effect relationship.
The study was published online recently in the journal Health Education and Behavior.
"We've got a saying in our lab: 'If you want to be skinny, do what skinny people do.' If skinny people make their homes 'slim by design' by clearing the counters of everything but the fruit bowl, it won't hurt us to do the same," Wansink said.
There's no getting around it: America has a weight problem. Despite widespread efforts from a number of entities to encourage physical activity and promote healthier eating habits, obesity remains a serious and growing problem across the country.
Today, 35% of Americans are considered obese, a jarring figure that prompted the OECD to recently label the United States the most obese country in the world. Compounding the problem is that unhealthy lifestyle habits are imparted onto children at an early age. As a result, the percentage of obese children in the U.S. is greater than in any other country in the world.
Not too long ago, the non-profit organization Trust for America's Health put out an in-depth report covering the state of obesity in the United States for 2015. Underscoring the seriousness with which we need to take this growing health problem, the report boldly claims that "if we fail to change the course of the nation's obesity epidemic, the current generation of young people may be the first in American history to live shorter, less healthy lives than their parents."
The report in its entirety is well worth taking a look at, but there are a few data points we felt were worth sharing, especially pertaining to how obesity rates break down on a state by state basis.
According to the report, "22 states have adult obesity rates above 30 percent, 45 states have rates above 25 percent, and every state is above 20 percent." By way of contrast, no state back in 1980 had an obesity rate greater than 15%.
Breaking things down state by state, below are the states with the highest obesity rates.
Arkansas – 35.9% of population is obese
West Virginia – 35.7% of population is obese
Mississippi – 35.5% of population is obese
Louisiana – 34.9% of population is obese
Alabama – 33.5% of population is obese
Oklahoma – 33.0% of population is obese
Indiana – 32.7% of population is obese
Ohio – 32.6% of population is obese
North Dakota – 32.2% of population is obese
South Carolina – 32.1% of population is obese
And listed below are the states with the lowest obesity rates.
Fruit and Vegetable Intake and Coronary Calcium Prevalence - American College of Cardiology
"Is fruit and vegetable consumption during young adulthood associated with coronary atherosclerosis later in life?
...
Conclusions:
The authors concluded that higher intake of fruits and vegetables during young adulthood was associated with lower risk for CAC after 20 years of follow-up.
Perspective:
These data support the current recommendations for a diet high in fruits and vegetables, and reinforce the need for programs to promote healthy dietary patterns early in life."
