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Friday, September 21, 2012

Eating yogurt may prevent high blood pressure

Eating Yogurt May Protect Against High Blood Pressure

21 Sep 2012   

A new study has suggested that adding low calorie yogurt to your diet may help lower your risk of high blood pressure.

The new information presented at the American Heart Association's High Blood Pressure Research 2012 Scientific Sessions, has found that long-term yogurt eaters had a lower systolic blood pressure, as well as a diminished risk of developing high blood pressure.

Systolic blood pressure is the measure of how powerful the blood is against the walls of your arteries when your heart is beating. It is the top number in a blood pressure reading.

Hypertension can be a commonly misunderstood condition. According to the American Heart Association,untreated high blood pressure damages and scars your arteries. Tears and scars in the arteries can act like a net catching debris traveling through the bloodstream, such as cholesterol and plaque, which can then lead to build ups or blockages. It is important to be aware of blood pressure measurements, because symptoms are many times non-existent.

Past studies have established various health benefits of yogurt. Frequent consumption has been associated with healthier body weight and lower body mass index.

Low fat yoghurts with berries
Adding a low calorie yogurt to your daily diet may reduce your risk of high blood pressure.
Yogurt contains calcium, many needed daily nutrients and is easy to add to a meal or have as a snack. A great source of protein, yogurt keeps you feeling full slightly longer and also has liquid that provides hydration.

These researchers conducted a study lasting 15 years following more than 2,000 volunteers who did not have high blood pressure at the beginning of the study. Over the study period, participants filled out questionnaires three different times to measure yogurt intake.

Results showed that 31 percent of volunteers were less likely to develop high blood pressure when at least 2 percent of their daily caloric intake was yogurt, equivalent to at least one six-ounce cup of low-fat yogurt every three days. Their systolic blood pressure also increased significantly less than those who did not eat yogurt. These findings support a common belief that low-fat dairy products reduce blood pressure.

A healthy diet including low-fat yogurt, paired with physical activity, can help prevent chronic diseases such as hypertension and manage your health.

It should be noted that this study was presented at a conference and published as an abstract. It has not yet been published in a peer-reviewed journal.

Written by Kelly Fitzgerald
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

American Heart Association


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Sugary drinks and obesity: the link is real

Studies strengthen the case against sugary drinks as culprits in obesity epidemic

By Associated Press,  Published: FRIDAY, SEPTEMBER 21, 6:01 PM ET


New research powerfully strengthens the case against soda and other sugary drinks as culprits in the obesity epidemic.

A huge, decades-long study involving more than 33,000 Americans has yielded the first clear proof that drinking sugary beverages interacts with genes that affect weight, amplifying a person's risk of obesity beyond what it would be from heredity alone.

This means that such drinks are especially harmful to people with genes that predispose them to weight gain. And most of us have at least some of these genes.

In addition, two other major experiments have found that giving children and teens calorie-free alternatives to the sugary drinks they usually consume leads to less weight gain.

Collectively, the results strongly suggest that sugary drinks cause people to pack on the pounds, independent of other unhealthy behavior such as overeating and getting too little exercise, scientists say.

That adds weight to the push for taxes, portion limits like the one just adopted in New York City, and other policies to curb consumption of soda, juice drinks and sports beverages sweetened with sugar.

Soda lovers do get some good news: Sugar-free drinks did not raise the risk of obesity in these studies.

"You may be able to fool the taste" and satisfy a sweet tooth without paying a price in weight, said an obesity researcher with no role in the studies, Rudy Leibel of Columbia University.

The studies were being presented Friday at an obesity conference in San Antonio and were published online by the New England Journal of Medicine.

The gene research in particular fills a major gap in what we know about obesity. It was a huge undertaking, involving three long-running studies that separately and collectively reached the same conclusions. It shows how behavior combines with heredity to affect how fat we become.

Having many of these genes does not guarantee people will become obese, but if they drink a lot of sugary beverages, "they fulfill that fate," said an expert with no role in the research, Jules Hirsch of Rockefeller University in New York. "The sweet drinking and the fatness are going together, and it's more evident in the genetic predisposition people."

Sugary drinks are the single biggest source of calories in the American diet, and they are increasingly blamed for the fact that a third of U.S. children and teens and more than two-thirds of adults are obese or overweight.

Consumption of sugary drinks and obesity rates have risen in tandem — both have more than doubled since the 1970s in the U.S.

But that doesn't prove that these drinks cause obesity. Genes, inactivity and eating fatty foods or just too much food also play a role. Also, diet research on children is especially tough because kids are growing and naturally gaining weight.

Until now, high-quality experiments have not conclusively shown that reducing sugary beverages would lower weight or body fat, said David Allison, a biostatistician who has done beverage research at the University of Alabama at Birmingham, some of it with industry support.

He said the new studies on children changed his mind and convinced him that limiting sweet drinks can make a difference.

In one study, researchers randomly assigned 224 overweight or obese high schoolers in the Boston area to receive shipments every two weeks of either the sugary drinks they usually consumed or sugar-free alternatives, including bottled water. No efforts were made to change the youngsters' exercise habits or give nutrition advice, and the kids knew what type of beverages they were getting.

After one year, the sugar-free group weighed more than 4 pounds less on average than those who kept drinking sugary beverages.

"I know of no other single food product whose elimination can produce this degree of weight change," said the study's leader, Dr. David Ludwig of Boston Children's Hospital and the Harvard School of Public Health.

The weight difference between the two groups narrowed to 2 pounds in the second year of the study, when drinks were no longer being provided. That showed at least some lasting beneficial effect on kids' habits. The study was funded mostly by government grants.

A second study involved 641 normal-weight children ages 4 to 12 in the Netherlands who regularly drank sugar-sweetened beverages. They were randomly assigned to get either a sugary drink or a sugar-free one during morning break at their schools, and were not told what kind they were given.

After 18 months, the sugary-drink group weighed 2 pounds more on average than the other group.

The studies "provide strong impetus" for policies urged by the Institute of Medicine, the American Heart Association and others to limit sugary drink consumption, Dr. Sonia Caprino of the Yale School of Medicine wrote in an editorial in the journal.

The American Beverage Association disagreed.

"Obesity is not uniquely caused by any single food or beverage," it said in a statement. "Studies and opinion pieces that focus solely on sugar-sweetened beverages, or any other single source of calories, do nothing meaningful to help address this serious issue."

The genetic research was part of a much larger set of health studies that have gone on for decades across the U.S., led by the Harvard School of Public Health.

Researchers checked for 32 gene variants that have previously been tied to weight. Because we inherit two copies of each gene, everyone has 64 opportunities for these risk genes. The study participants had 29 on average.

Every four years, these people answered detailed surveys about their eating and drinking habits as well as things like smoking and exercise. Researchers analyzed these over several decades.

A clear pattern emerged: The more sugary drinks someone consumed, the greater the impact of the genes on the person's weight and risk of becoming obese.

For every 10 risk genes someone had, the risk of obesity rose in proportion to how many sweet drinks the person regularly consumed. Overall calorie intake and lifestyle factors such as exercise did not account for the differences researchers saw.

This means that people with genes that predispose them to be obese are more susceptible to the harmful effects of sugary drinks on their weight, said one of the study leaders, Harvard's Dr. Frank Hu. The opposite also was true — avoiding these drinks can minimize the effect of obesity genes.

"Two bad things can act together and their combined effects are even greater than either effect alone," Hu said. "The flip side of this is everyone has some genetic risk of obesity, but the genetic effects can be offset by healthier beverage choices. It's certainly not our destiny" to be fat, even if we carry genes that raise this risk.

The study was funded mostly by federal grants, with support from two drug companies for the genetic analysis.



Obesity info: http://www.cdc.gov/obesity/data/trends.html

BMI calculator: http://www.nhlbisupport.com/bmi/bminojs.htm

New England Journal: http://www.nejm.org


Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Tuesday, September 18, 2012

Gastric bypass reduced cardiovascular, metabolic risks in severely obese | Cardiology

Gastric bypass reduced cardiovascular, metabolic risks in severely obese

Severely obese patients who underwent gastric bypass surgery had greater diabetes remission rates and were less likely to experience cardiovascular events than controls in a recent study.

In a prospective study, researchers evaluated 1,156 patients with a BMI of 35 or more who underwent Roux-en-Y gastric bypass surgery (n=418) (RYGB), sought weight loss surgery but did not undergo it (n=417, control group 1) or did not seek surgery (n=321, control group 2) between July 2000 and June 2011 in Utah.

Among evaluable participants, those who underwent bypass lost 27.7% of their initial weight, compared with 0.2% of control group 1 and 0% of control group 2. More than 20% of lost weight was maintained by the RYGB group in 94% of cases after 2 years and in 76% after 6 years.

Incidence rates for diabetes were lower in the RYGB group (2% compared with 17% in control group 1, OR=0.11, 0.04-0.34, and 15% in control group 2, OR=0.21, 0.06-0.67). Remission rates for diabetes after 6 years also were significantly greater in the bypass group (62% compared with 8% in control group 1, OR=16.5, 4.7-57.6, and 6% in control group 2, OR=21.5, 5.4-85.6) (95% CI for all).

Hypertension remission rates also improved for RYGB patients compared with control groups (42% vs. 18% in control group 1, OR=2.9, 1.4-6.0 and with 9% in control group 2, OR=5.0, 2.1-11.9). Remission rates for low high-density lipoprotein cholesterol levels saw gains in more bypass patients (67% of patients compared with 34% in control group 1, OR=3.8, 2.0-7.2 and with 18% in control group 2, OR=6.2, 2.7-14.1) (95% CI for all).

"Our study reports significant weight loss and 6-year improvements in major cardiovascular and metabolic risk factors in patients receiving RYGB surgery compared with severely obese control participants," the researchers wrote. "In contrast, cardiovascular and metabolic status of several obese control participants generally worsened. These findings are important considering the rapid increase in total numbers of bariatric surgical operations performed in the United States and worldwide, and may have significant ramifications for the projected 31 million US individuals meeting criteria for bariatric surgery."

Disclosure: See the study for a full list of relevant disclosures.

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Heart Disease and Firefighters: How and Why? - Fire Engineering

Heart Disease and Firefighters: How and Why?

By John Hofman

It has been well documented that the #1 killer of firefighters is heart disease. Intervention strategies within a comprehensive health and wellness program have helped to reduce these numbers over the years, but there is still an alarming rate of firefighters who suffer from heart attacks each year.

Researchers at Iowa State University discovered that 86 percent of volunteer firefighters did not know their blood lipid and 47 percent did not know their blood pressure (1). Within the U.S. alone, more than 1 million people will suffer a heart attack within the next year, and it does not just affect the elderly. We are now seeing individuals as young as 21 suffer from heart disease. So why are firefighters at a more increased risk than the average population?

Simple: It's the job! But let's take a closer look at some of the things that lead to an increase in heart attacks.

Sleep plays an important role in helping our bodies to recover from stress, illness, and fatigue. If we do not get quality sleep, our resting metabolic rate will decrease, causing weight gain. A firefighter's "internal biological clock" is often disrupted throughout a shift, affecting the body's ability to regulate the sleep-wake system. Researchers at the Brigham and Women's hospital showed that prolonged sleep restriction with simultaneous circadian disruption decreased the individual's metabolic rate, thereby increasing over time the risk for diabetes. (2)

The University of Chicago went even further and showed there is a direct link between sleeping and an increased risk of stroke, heart attack, and congestive heart failure. (3) Their findings showed how an individual who sleeps more than eight hours and fewer than six hours had a significantly higher chance of experiencing chest pain or angina and coronary heart disease. Therefore, it is important to control the duration of restful sleep in a completely dark room to help reduce the chances of heart disease and other related illnesses.

Abdominal fat, also known as visceral fat, is generally associated with diabetes. However, there have been links to an increase of strokes through the hardening of the arteries. Increased visceral fat could lead to diabetes, which creates a change in blood vessels that reduce blood flow to the brain. Based on the findings at Iowa State University, 41 percent of volunteer firefighters were classified as obese and 35 percent as overweight. Therefore, it is recommended that a firefighter participate in physical activity and proper nutrition programs to reverse the side effects associated with belly fat.

Firefighters are often exposed to traumatic stress. Over a 30-year career, things tend to affect them both mentally and physically. According to researchers at the University of California - San Francisco, these exposures over a lifetime or career will boost inflammation in the body, even if they do not lead to post-traumatic stress disorder. (4) It was discovered that the greater the traumatic stress, the higher levels of inflammation within the body. Individuals with higher levels of inflammation within their body tend to have an increased risk of having a heart attack. Even if the firefighter adjusted to these traumatic events, the inflammation remained constant over a period of time. So the stress of the job can impact your health even if you don't have certain mental or physical symptoms. Intervention strategies to help combat stress, such as exercise, yoga, and other health-related activities, should be integrated at the start of a firefighter's career.

Firefighting itself is physically demanding and will eventually break the body down. According to a study performed at the Illinois Fire Service Institute (5), three hours of prolonged firefighting stiffens arteries and impairs heart function in young, healthy male firefighters. The same is seen within heavy powerlifters and ultra-marathon runners. This could affect those firefighters who do not value the importance of fitness and, therefore, exhibit several of the risk factors for cardiovascular disease, including being overweight and having elevated blood pressure and/or cholesterol.

Finally, your lungs. Breathing in toxic fumes and particles during overhaul, exhaust pollution from the apparatus bay, and exposures during most regular calls can adversely affect lung function. Lung function and obstructive airway diseases are strongly and independently associated with increased risk of heart failure. These results were not limited to smokers, but also to nonsmokers.

So what can you do?

1.  Get an annual physical with a complete blood panel. In addition to the normal blood work, ask your physician to include the following:

a.  C-Reactive Protein (CRP) is elevated in the blood when there is widespread inflammation somewhere in the body. The evidence now available indicates that inflammation and molecules such as CRP associated with inflammation may be as important as cholesterol in determining the development of atherosclerosis (hardening of the arteries) and heart disease.

i.   You are at low risk of developing cardiovascular disease if your high sensitivity (hs)-CRP level is lower than 1.0mg/L.

ii.  You are at average risk of developing cardiovascular disease if it is between 1.0 and 3.0 mg/L.

iii. You are at high risk for cardiovascular disease if your hs-CRP level is higher than 3.0 mg/L.

2.  Testosterone: Lower testosterone levels have been shown to be an independent risk factor for worse outcomes among men and women with heart failure. It also has been associated with decreased survival for men with coronary artery disease.

3.  forget about diets and low fat! eat a more healthful diet. There is no magic pill! Although there are some benefits to taking omega -3 (usually taken in a fish oil supplement), some studies have suggested otherwise. In an analysis of past studies, there was no difference in the number of heart attacks, strokes, or deaths among more than 20,000 people with heart disease who were randomly assigned to take either fish oil supplements or fish oil-free placebo pills. So eat better.

•         Eat more fruits and vegetables, which are high in antioxidants. Good heart health depends on open, flexible arteries that can deliver blood efficiently throughout the body. Dark chocolate and cocoa, as well as plant-based compounds found in red wine and green tea, are high in antioxidants, which help fight cell damage from free radicals in the bloodstream that can cause fatty plaque to build up on artery walls

•         eat more fiber: Aim for 35 to 40 grams of dietary fiber per day. Fiber helps to lower cholesterol by binding with it and pulling it out of the system.

•         spice it up: Numerous studies have shown that spices can help improve cardiovascular health. Cayenne pepper is known to strengthen the heart, arteries, and capillaries and to lower the cholesterol level. Garlic is known to help lower blood cholesterol, and ginger is a natural blood thinner and anti-inflammatory agent.

4.  Exercise, exercise, exercise. 30 minutes of aerobic activity is associated with a 70-percent reduction in heart attack risk over a year. Researchers from the Mayo Clinic analyzed its data and noticed that a brisk 10-minute walk a day results in a nearly 50-percent reduction in heart attacks versus doing nothing. (7)

5.  Stay happy; be optimistic. It could save your life. A Duke University study of 255 doctors from several years ago found that 14 percent of those rated above average for hostility based on a personality test had died 25 years later--most from heart disease--compared with 2 percent of those who tested below the average. (8)


(1)  Yoo, HL, Franke, WD. "Prevalence of cardiovascular disease risk factors in volunteer firefighters." Department of Kinesiology, Iowa State University. J Occup Environ Med. Aug 2009; 51(8):958-62.

(2)  O M Buxton, SW Cain, SP O'Connor, JH Porter, JF Duffy, W Wang, CA Czeisler, SA Shea. "Adverse Metabolic Consequences in Humans of Prolonged Sleep Restriction Combined with Circadian Disruption." Science Translational Medicine, 2012; 4 (129):

(3)  American College of Cardiology (2012, March 26). "Sleeping too much or too little can be bad for your heart." ScienceDaily. Retrieved April 21, 2012.

(4)  O'Donovan A, Neylan TC, Metzler T, Cohen BE. Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the Heart and Soul Study. Brain Behav Immun. 2012 May; 26(4):642-9. Epub 2012 Feb 15.

(5)  Fahs, Christopher A, Huimin Yan, Ranadive, Sushant, Rossow, et al. "Acute effects of firefighting on arterial stiffness and blood flow." Vasc Med; April 2011 16: 113-118

(6)  Grace Rattue. "Lower Lung Function and Airflow Obstruction Raise Heart Failure Risk." Medical News Today. MediLexicon, Intl., 26 Feb. 2012. Web. 21 Apr. 2012.

(7)  MayoClinic.com: Walking for Fitness: How to Trim Your Waistline, Improve Your Health.

(8)  Barefoot JC, Brummett BH, Williams RB, et al. "Recovery expectations and long-term prognosis of patients with coronary heart disease." Arch Intern Med; 2011; DOI:10.1001/archinternmed.2011.41

John HofmanJohn Hofman is the strength and conditioning coach for the Sacramento (CA) Fire Department, He oversees the Wellness Center; coordinates the department's medical and fitness assessments; develops recruit fitness training, pre-employment medical and fitness evaluations; and assists the department's 20 certified Peer Fitness Trainers. In addition, he is the strength and conditioning coach for the California Regional Fire Academy, Sierra Fire Technology Program, Rocklin Fire Department, and South Placer Fire District. He also consults with the Fire Agency Self-Insurance System of California.

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Monday, September 17, 2012

Cancer passes heart disease as top killer of Hispanics

Cancer passes heart disease as top killer of Hispanics

Cancer is the leading cause of death among U.S. Hispanics, surpassing heart disease, American Cancer Society researchers report.

And although heart disease remains the No. 1 killer of non-Hispanic whites and African Americans, cancer is expected to assume the top spot within 10 years as prevention and treatment reduce heart disease deaths. Overall, death rates for both illnesses declined between 2000 and 2009.

"The overall message is positive," said Dr. Paulo Pinheiro, an epidemiologist at the University of Nevada not involved with the report, told the Los Angeles Times.

Using the most recent data available, the researchers report that 29,935 Hispanics died of cancer in 2009 and 29,611 from heart disease. Among all Americans in 2009, 599,413 died from heart disease and 567,628 from cancer, the U.S. Centers for Disease Control and Prevention.

Compared with other whites, Hispanics have higher incidences of and mortality rates for cancers of the stomach, liver, uterus, cervix and gallbladder, the cancer society says. For all cancers and for the four most common -- breast, prostate, lung and bronchus and colorectum -- Hispanics have incidence and mortality rates that are lower than other whites.

Hispanic women contract and die from cervical cancer at rates 50% to 70% higher than non-Hispanic whites.

The researchers said that higher rates reflected "greater exposure to cancer-causing infectious agents, lower rates of screening for cervical cancer, and possibly genetic factors," and that Hispanics "are diagnosed at an advanced stage of disease more often than non-Hispanic whites for most cancer sites."

Lung cancer rates for Hispanics, however, are about 50% less than other whites, because they are less likely to smoke tobacco.

Here's how the researchers summed up the cancer differences:

Much of the difference in the cancer burden among U.S. Hispanics results from their unique profile in terms of age distribution, socioeconomic status, and immigration history. Just one in ten U.S. Hispanics is 55 years or older, the age group among whom the majority of cancers are diagnosed, compared with almost one in three non-Hispanics. In 2010, more than one in four (26.6%) Hispanics lived in poverty and nearly one in three (30.7%) was uninsured, compared with 9.9% and 11.7%, respectively, of non-Hispanic whites.

Hispanics in the U.S. are an extremely diverse group because they originate from many different countries (e.g., Mexico, Central and South America, and Cuba). As a result, cancer patterns among Hispanic subpopulations vary substantially. For example, in Florida the cancer death rate among Cuban men is double that of Mexican men.

The finding appear in CA: A Cancer Journal for Clinicians.

Datos y Estadísticas sobre el Cáncer entre los Hispanos/Latinos 2009-2011.

Saturday, September 15, 2012

Restless legs, heart disease link still murky

Restless legs, heart disease link still murky

By Frederik Joelving

NEW YORK (Reuters Health) - Researchers have found a link between restless legs syndrome and future heart disease in women, suggesting people with the strange condition may want to be extra careful about protecting their tickers.

But the new findings contradict earlier studies, and one expert said it's too early to be alarmed.

"The evidence to date is not really convincing enough to go out to the public and say, 'If you have restless legs, you should be concerned about heart disease,'" said Dr. Tobias Kurth, a director of research at the French National Institute of Health and Medical Research in Bordeaux.

Restless legs syndrome, or RLS, refers to unpleasant sensations in the legs that trigger an uncontrollable urge to move.

It is a recognized neurological disorder, but because the symptoms are so vague and may be fleeting, it is unclear when it should be considered a disease. As a result, estimates of how common the condition is have ranged widely - from just a few percent to nearly a quarter of all people.

The new findings, published in the American Heart Association's journal Circulation, are based on data from the massive Nurses' Health Study. Researchers tracked more than 70,000 women from 2002, when none of them had heart disease, until 2008.

Overall, there was no link between RLS and heart disease. But women who had been diagnosed with the disorder at least three years before the study began were at higher risk.

The rate of death from heart disease was 3.5 percent per decade among this group, compared to 1.7 percent per decade among women without RLS. They were also more likely to have non-fatal heart attacks.

Dr. Xiang Gao, who led the work, said the study doesn't prove that RLS causes heart disease, even though he and his colleagues tried to rule out several possible explanations, such as differences in sleep duration and physical activity.

"Because this an observational study there are still some unknown factors that could affect the association," cautioned Gao, a researcher at Brigham and Women's Hospital in Boston.

Gao said it is too early to recommend taking medicine for RLS, which comes with side effects and limited benefits, in hopes of staving off future heart problems.

But he advised people with RLS to have their heart health checked regularly by a doctor and to have a healthy lifestyle to cut their risk of heart disease.

Previous research has supported the link between RLS and heart disease, but it hasn't been able to tease out which came first. The only two studies that have taken a stab at that did not find any association between the neurological problem and later heart problems, although they didn't consider the duration of RLS.

"Overall to me that means there is no consistent evidence that restless legs per se should be considered as a risk factor for coronary heart disease," said Kurth, who led one of those studies.

While he acknowledged that some people can have severe RLS that warrants treatment, he said that in other cases the problem may be mild or go away on its own.

"Is this syndrome a disease in everybody? That is the question for me that is still unclear," Kurth told Reuters Health.

SOURCE: http://bit.ly/Q8J7w8 Circulation, online September 11, 2012.

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Friday, September 14, 2012

Meta-Analysis Links Stress At Work And Heart Disease | CardioBrief

Meta-Analysis Links Stress At Work And Heart Disease

A new study published in the Lancet provides the best evidence yet that work-related stress and, in particular, job strain– "the combination of high job demands and low control at work"– plays a small but important role in causing heart disease. In order to address the limitations of previous studies on this topic, including a publication bias which might exaggerate the effect, European investigators performed a large collaborative meta-analysis of published and unpublished studies.

The IPD-Work (individual-participant-data meta-analysis in working populations) consortium found that 15% of nearly 200,000 participants in the analysis reported having job strain. With a mean followup of 7.5 years, job strain was significantly associated with heart disease. The effect was higher in published studies, though it still achieved significance in the unpublished studies:

  • Overall hazard ratio (HR) for job strain: 1.23,CI 1.10–1.37
  • HR in published studies: 1.43, CI 1.15−1.77
  • HR in unpublished studies: 1.16, CI 1.02−1.32

The investigators calculated that the population attributable risk for job strain was 3.4%, which, they noted, was substantially lower than the major risk factors of smoking, obesity, and physical inactivity.

"Our findings suggest that job strain is associated with a small, but consistent, increased risk of an incident event of cardiovascular heart disease," they concluded.

In an accompanying comment, Bo Netterstrøm writes that "job strain is a measure of only part of a psychosocially damaging work environment, which implies that prevention of workplace stress could reduce incidence of coronary heart disease to a greater extent than stated in the authors' interpretation of the calculated population-attributable risk for job strain."

Here is the Lancet press release:

Large Europe-wide study confirms work stress linked to greater risk of heart disease

People who have highly demanding jobs and little freedom to make decisions are 23% more likely to experience a heart attack compared with their counterparts without such work stress, according to a study of nearly 200 000 people from seven European countries, published Online First in The Lancet.

"The pooling of published and unpublished studies allowed us to investigate the association between coronary heart disease (CHD) and exposure to job strain [defined by high work demands and low decision control] with greater precision than has been previously possible", explains Mika Kivimäki from University College London who led the research. "Our findings indicate that job strain is associated with a small, but consistent, increased risk of experiencing a first CHD event such as a heart attack."*

Previous studies examining the impact of job strain on CHD have been inconsistent in their findings, limited in scope, and plagued by methodological shortcomings including publication bias and reverse causation bias.

In this collaborative meta-analysis, Kivimäki and colleagues analysed job strain in employees without CHD who participated in 13 European national cohorts conducted in Belgium, Denmark, Finland, France, Netherlands, Sweden, and the UK between 1985 and 2006. All participants completed questionnaires at the start of the studies to assess job demands, excessive workload, the level of time-pressure demands, and freedom to make decisions.

The researchers recorded 2356 events of incident CHD (first non-fatal heart attack or coronary death) during the average 7.5 year course of follow-up.

The 23% higher risks for people who reported job strain remained the same even after taking into account factors such as lifestyle, age, gender, and socioeconomic status.

What is more says Kivimäki, "The overall population attributable risk (PAR) for CHD events was around 3.4%, suggesting that if the association were causal, then job strain would account for a notable proportion of CHD events in working populations. As such, reducing workplace stress might decrease disease incidence. However, this strategy would have a much smaller effect than tackling standard risk factors such as smoking (PAR 36%) and physical inactivity (PAR 12%)."*

In a linked Comment Bo Netterstrøm from Bispebjerg Hospital, Copehagen, Denmark notes, "Job strain is a measure of only part of a psychosocially damaging work environment, which implies that prevention of workplace stress could reduce incidence of coronary heart disease to a greater extent than stated in the authors' interpretation of the calculated population-attributable risk for job strain."

He adds, "Exposures such as job insecurity and factors related to social capital and emotions, are likely to be of major importance in the future. The present economic crisis will almost certainly increase this importance."

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Wednesday, September 12, 2012

Study Predicts Renal Denervation Will Be Cost Effective In Resistant Hypertension - Forbes

Study Predicts Renal Denervation Will Be Cost Effective In Resistant Hypertension

Renal denervation (RDN) for resistant hypertension may be cost-effective and may provide long-term clinical benefits, according to a new analysis published in the Journal of the American College of Cardiology.

Benjamin Geisler and colleagues developed a model to predict the impact of the Medtronic Symplicity RDN system in patients with resistant hypertension. Over 10 years, according to the model, RDN treatment resulted in large differences in outcomes, though the benefits were less pronounced when projected over a lifetime.

Projected 10 year Relative Risk:

  • Stroke: 0.70 (reduced from 11.6% in the control group to 8.2% in the RDN group)
  • MI: 0.68 (reduced from 9.6% to 6.5%)
  • CHD: 0.78 (reduced from 24.8% to 19.4%)
  • HF: 0.79 (reduced from 5.4% to 4.3%)
  • ESRD: 0.72 (reduced from 2.9% to 2.1%
  • CV mortality: 0.70 (reduced from 12.5% to 8.7%)
  • All-cause mortality: 0.85 (reduced from 23.0% to 19.5%)

Median survival was lengthened from 17.07 years to 18.37 years. The authors calculated an increase in quality-adjusted life-years (QALY) from 12.07 to 13.17 years, resulting in a discounted incremental cost-effectiveness ratio of $3,071/QALY. Cost-effectiveness was "markedly below the commonly accepted threshold of $50,000 per QALY [quality-adjusted life-year]," and might even be cost-saving, according to the authors.

The model assumes that RDN causes a long term reduction in blood pressure, though current data from the Symplicity HTN-2 trial only extends to 36 months. However, the authors reported that RDN remained "cost-effective across a wide range of assumptions."

Republished with permission from CardioExchange, a NEJM group publication.

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Omega-3 Fish Oil Supplements May Not Offer Heart Benefits After All

Omega-3 Fish Oil Supplements May Not Offer Heart Benefits After All

Featured Article
Academic Journal
Main Category: Cardiovascular / Cardiology
Also Included In: Nutrition / Diet
Article Date: 12 Sep 2012 - 4:00 PDT

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Omega-3 Fish Oil Supplements May Not Offer Heart Benefits After All

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A review of 20 studies covering nearly 70,000 participants finds no statistically significant evidence that supplementation with omega-3 polyunsaturated fatty acids (PUFAs), commonly referred to as fish oil supplements, is linked to a lower risk of heart attack, stroke, or premature death.

However, in their attempt to clarify the recent controversy surrounding the use of omega-3 supplements, the authors do not rule out the possibility that certain groups may benefit, and call for future studies to look more closely at this.

Evangelos Rizos, of the University Hospital of Ioannina, Ioannina, Greece, and colleagues write about their findings in the 12 September issue of JAMA.

Omega-3 PUFAs are considered essential for healthy development of the heart and other parts of the body, and food sources rich in these include nuts and seeds, and oily fish such as salmon, mackerel, herring and sardines. As supplements they are typically given in the form of fish oil.

Although it is not clear how they help the heart and circulation, there are suggestions omega-3 PUFAs lower triglyceride levels, prevent serious arrythmias, reduce the clumping of platelets, and lower blood pressure.

However, the authors write that:

"Considerable controversy exists regarding the association of omega-3 polyunsaturated fatty acids (PUFAs) and major cardiovascular end points."

Omega 3 fish oils
For years, omega 3 fish oils have been recommended by health organisations to help reduce heart disease. However, a review of recent studies has questioned this.
Although some randomized studies suggest omega-3 PUFAs prevent heart disease, others refute this, they explain, noting also that many medical and health societies support their use for patients after heart attack (MI, myocardial infarction), either as supplements or through dietary advice.

Regulatory authorities also appear to have different views. The US Food and Drug Administration (FDA) has approved the use of omega-3 PUFAs only for lowering triglycerides in patients with overt hypertriglyceridemia, while some, but not all, European regulators have approved them for reducing cardiovascular risk.

"The controversy stemming from the varying labeling indications causes confusion in everyday clinical practice about whether to use these agents for cardiovascular protection," write Rizos and colleagues.

Thus, in an attempt to clarify the situation, they carried out a large-scale statistical review of the available evidence from randomized controlled studies, looking at the link between omega-3 PUFAs and major cardiovascular outcomes such as stroke and heart attacks, and also premature death.

From a search of the well-known databases, they found 3,635 studies, from which 20 matched their criteria. These provided data for a pooled analysis on 68,680 randomized patients, and events that included 7,044 deaths, 3,993 cardiac deaths, 1,150 sudden deaths, 1,837 heart attacks, and 1,490 strokes.

Taking all the included supplement studies together, the researchers found no significant association between use of omega-3 PUFAs and all-cause mortality, cardiac death, sudden death, heart attack (MI), and stroke.

They conclude:

"... omega-3 PUFAs are not statistically significantly associated with major cardiovascular outcomes across various patient populations."

They suggest their findings "do not justify the use of omega-3 as a structured intervention in everyday clinical practice or guidelines supporting dietary omega-3 PUFA administration."

However, they also note that as scientists continue to do more randomized studies in this field, it would be useful to do some that look more closely at how these supplements might benefit individual risk groups, and use more refined measures such as dose, adherence and baseline intake.

In other words, while looking at all the evidence as a whole does not appear to support the idea that omega-3 PUFA supplements benefit the heart, this broad-brush picture could be missing details: there may be certain groups that do benefit, and this may also depend on factors such as the supplement dose and how long they take it for.

Other studies on fish oils

Some other recent individual studies, published in Medical News Today, have also concluded that fish oils do not appear to provide some of the benefits people had previously taken for granted. Researchers from the London School of Hygiene & Tropical Medicine found that taking omega-3 fish oil supplements appears not to protect older people from cognitive decline.

In contrast, a study published on September 10th found that DHA intake may help improve reading and behavior in healthy but underperforming children. DHA is an omega-3 fatty acid. You can look up other studies related to omega-3 fish oils in our archive.

Written by Catharine Paddock PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Fish Oils And Algae Oils

posted by PaulC on 12 Sep 2012 at 8:40 am

Fish oil is often contaminated with mercury, PCB's and dioxins which may negate their benefit. Molecularity distilled fish oil only removes the most volatile contaminants and requires that the omega-3 acids be first converted into an ethyl-ester form which is not particularly absorbable by the body. Algae n-3 oils, on the other hand are virtually free of contaminants and do not require molecular distillation. Perhaps the results of this meta-study would have been different had algae oil results been analyzed.

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Does It Work or Not?

posted by T. Marks on 12 Sep 2012 at 5:29 am

This comment of frustration is NOT directed towards JAMA or the doctor(s) doing the fish-oil study.

I am SO TIRED of hearing on one day how supplements like fish oil, olive oil, red wine, caffeine, etc provide amazing health benefits; then the next thing I hear is that the supplements don't provide these benefits.

I have confidence study results from JAMA and some other professional organizations. As for the other pseudo-doctors and "medical/health" organizations who hap-hazardly publish their "scientific study results": should be prosecuted for perpetrating a hoax on the public.

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Pregnancy Safe for Most Heart Disease Patients

Pregnancy Safe for Most Heart Disease Patients

By Todd Neale, Senior Staff Writer, MedPage Today
Published: September 12, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania

Women with heart disease are at greater risk than other women when going through a pregnancy, but most still have positive outcomes, a registry showed.

Compared with healthy pregnant women, those with structural or ischemic heart disease had higher rates of preterm birth (15% versus 8%), fetal death (1.7% versus 0.35%), and maternal mortality (1% versus 0.007%), but absolute rates remained relatively low, according to Jolien Roos-Hesselink, MD, of Erasmus Medical Center in Rotterdam, and colleagues.

The risks conferred by heart disease were magnified in women with cardiomyopathies and in those living in developing countries, the researchers reported online in the European Heart Journal.

However, they wrote, "most patients with adequate counseling and optimal care should not be discouraged and can go safely through pregnancy."

Because of a limited amount of data detailing the effects of heart disease on pregnancy outcomes, the European Society of Cardiology started the European Registry on Pregnancy and Heart Disease in 2007. The ongoing registry enrolls pregnant women who have valvular heart disease, congenital heart disease, ischemic heart disease, or cardiomyopathies.

For the current analysis, the researchers looked at data on 1,321 pregnant women who were enrolled from 60 hospitals in 28 countries from 2007 to 2011. The median age was 30.

Most of the patients (72%) were in New York Heart Association class I, and only 0.3% were in NYHA class IV.

The most frequent diagnosis was congenital heart disease (66%), followed by valvular heart disease (25%), cardiomyopathy (7%), and ischemic heart disease (2%).

The median duration of pregnancy was 38 weeks, and the median birth weight was 3,010 grams (6 pounds 10 ounces).

Thirteen of the mothers died -- seven from cardiac causes, three from thromboembolic events, and three from sepsis. The highest mortality rate occurred in patients with cardiomyopathy, who also carried higher rates of heart failure and ventricular arrhythmias.

"Cardiomyopathy is uncommon during pregnancy, but it is difficult to manage a pregnancy in the context of left ventricular dysfunction or peripartum cardiomyopathy with a high risk of an adverse outcome for both the mother and the baby," the authors noted. "Our study shows that more attention needs to be paid to this group."

During pregnancy, 26% of the women were hospitalized, a much higher rate than seen in healthy pregnant women (2%). More than one-third of the admissions (39%) were for heart failure; 31% were for obstetric reasons, including pregnancy-induced hypertension, vaginal bleeding, pregnancy-induced diabetes, and abortion/missed abortion; 21% were for cardiac reasons other than heart failure; and 9% were for other reasons.

The rate of cesarean delivery was significantly higher among the women with heart disease than has previously been seen in healthy pregnant women (41% versus 23%, P<0.001).

Fetal mortality beyond 22 weeks of gestation or when the fetus was greater than 500 grams (1 pound 2 ounces) occurred at a higher rate in the women with heart disease. Most of those cases (62%) were listed as intrauterine fetal death without any further information, 21% were attributed definitely to the mother's condition, and 17% were related to structural fetal abnormalities.

Neonatal mortality (within the first 30 days of life) occurred in 0.6%, a rate that was not significantly higher compared with historical controls (0.4%, P=0.27).

Women living in developing countries (185 of the registry patients) carried greater risks of both maternal mortality (3.9% versus 0.6%, P<0.001) and fetal mortality (6.5% versus 0.9%, P<0.001).

The authors noted that developed countries have much greater access than developing countries to optimal prenatal care and preconception counseling, even if it isn't used in all cases.

"This is a very complex issue, but if achievable, pre-conception counseling focusing on the severity of the heart disease with a clear statement of the consequences of pregnancy may save lives," they wrote.

The researchers acknowledged some limitations of the study, including the inability to perform extensive subgroup analyses because of small patient numbers, the fact that the input and quality of data was checked in only 5% to 10% of cases, and uncertainty about how representative the patient population is, considering the voluntary participation in the registry.

This work was supported by the European Society of Cardiology.

The authors reported that they had no financial disclosures.

From the American Heart Association:

Todd Neale

Senior Staff Writer

Todd Neale, MedPage Today Staff Writer, got his start in journalism at Audubon Magazine and made a stop in directory publishing before landing at MedPage Today. He received a B.S. in biology from the University of Massachusetts Amherst and an M.A. in journalism from the Science, Health, and Environmental Reporting program at New York University. He is based at MedPage Today headquarters in Little Falls, N.J.

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Tuesday, September 11, 2012

Type A personality and stress linked to high risk for stroke

Type A personality and stress linked to high risk for stroke

Type A personality traits and chronic stress were associated with high risk for stroke, according to recent study results published in the Journal of Neurology, Neurosurgery & Psychiatry.

"Several studies highlight stress as an independent risk factor in cardiovascular diseases, but there is a dearth of in-depth studies evaluating the psycho-physical bases of stress and stroke," the researchers wrote.

Jose Antonio Egido, MD, of the stroke unit at the Hospital Clinico Universitario San Carlos in Madrid, and colleagues compared 150 patients aged 18 to 65 years who were admitted to the stroke unit with a diagnosis of stroke with 300 healthy adults who were matched for age and resided in the same neighborhood as the stroke patients.

The researchers measured psychophysical stress based on four assessments: stressful experiences over the previous year; psychosocial problems, including distress, anxiety, social dysfunction and depression; quality of life; and type A behavior patterns.

Type A behaviors included competitiveness, hostility, aggression, impatience and quick temper. Participants were assessed for diabetes, hypertension, hypercholesterolaemia, history of alterations in cardiac rhythm and atrial fibrillation. Egido and colleagues also looked at lifestyle factors, including smoking and the use of recreational drugs, caffeine, alcohol and energy drinks.

Results showed that risk for stroke was almost four times higher among participants who had experienced a stressful life event in the past year (OR=3.84; 95% CI, 1.91-7.70). Those who exhibited greater type A personality behaviors were at more than twice the risk for stroke (OR=2.23; 95% CI, 1.19-4.18).

Other factors independently associated with a greater risk for stroke included smoking (OR=2.08; 95% CI, 1.01-4.27), male gender (OR=9.33; 95% CI, 4.53-19.22), cardiac arrhythmia (OR=3.18; 95% CI, 1.19-8.15) and high consumption of energy drinks (OR=2.63; 95% CI, 1.30-5.31).

"Addressing the influence of psychophysical factors on stroke could constitute an additional therapeutic line in the primary prevention of stroke in the at-risk population and, as such, warrants further investigation," the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

Monday, September 10, 2012

Study: Placebo or not, acupuncture helps with pain

Study: Placebo or not, acupuncture helps with pain

CHICAGO (AP) — Acupuncture gets a thumbs-up for helping relieve pain from chronic headaches, backaches and arthritis in a review of more than two dozen studies — the latest analysis of an often-studied therapy that has as many fans as critics.

Some believe its only powers are a psychological, placebo effect. But some doctors believe even if that's the explanation for acupuncture's effectiveness, there's no reason not to offer it if it makes people feel better.

The new analysis examined 29 studies involving almost 18,000 adults. The researchers concluded that the needle remedy worked better than usual pain treatment and slightly better than fake acupuncture. That kind of analysis is not the strongest type of research, but the authors took extra steps including examining raw data from the original studies.

The results "provide the most robust evidence to date that acupuncture is a reasonable referral option," wrote the authors, who include researchers with Memorial Sloan-Kettering Cancer Center in New York and several universities in England and Germany.

Their study isn't proof, but it adds to evidence that acupuncture may benefit a range of conditions.

The new analysis was published online Monday in Archives of Internal Medicine. The federal government's National Center for Complementary and Alternative Medicine paid for most of the study, along with a small grant from the Samueli Institute, a nonprofit group that supports research on alternative healing.

Acupuncture's use has become more mainstream. The military has used it to help treat pain from war wounds, and California recently passed legislation that would include acupuncture among treatments recommended for coverage under provisions of the nation's new health care law. That law requires insurance plans to cover certain categories of benefits starting in 2014. Deciding specifics is being left up to the states.

Some private insurance plans already cover acupuncture; Medicare does not.

In traditional Chinese medicine, acupuncture involves inserting long, very thin needles just beneath the skin's surface at specific points on the body to control pain or stress. Several weekly sessions are usually involved, typically costing about $60 to $100 per session. Fake acupuncture studied in research sometimes also uses needles, but on different areas of the body.

Scientists aren't sure what biological mechanism could explain how acupuncture might relieve pain, but the authors of the new study say the results suggest there's more involved than just a placebo effect.

Acupuncture skeptic Dr. Stephen Barrett said the study results are dubious. The retired psychiatrist runs Quackwatch, a Web site on medical scams, and says studies of acupuncture often involve strict research conditions that don't mirror how the procedure is used in the real world.

The new analysis combined results from studies of patients with common types of chronic pain — recurring headaches, arthritis or back, neck and shoulder. The studies had randomly assigned patients to acupuncture and either fake acupuncture or standard pain treatment including medication or physical therapy.

The authors explained their statistical findings by using a pain scale of 0 to 100: The patients' average baseline pain measured 60; it dropped to 30 on average in those who got acupuncture, 35 in those who got fake acupuncture, and 43 in the usual treatment group.

While the difference in results for real versus fake acupuncture was small, it suggests acupuncture could have more than a psychological effect, said lead author Andrew Vickers, a cancer researcher at Memorial Sloan-Kettering. The center offers acupuncture and other alternative therapies for cancer patients with hard-to-treat pain.

The analysis was more rigorous than most research based on pooling previous studies' results, because the authors obtained original data from each study. That makes the conclusion more robust, said Dr. Andrew Avins, author of an Archives commentary and a physician and researcher with the University of California at San Francisco and Kaiser-Permanente.

Acupuncture is relatively safe and uncertainty over how it works shouldn't stop doctors from offering it as an option for patients struggling with pain, Avins said.

"Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing," he wrote.



Archives: http://www.archinternmed.com

Acupuncture at NIH: 1.usa.gov/igK6l

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Sunday, September 9, 2012

Outdoor Cardio Exercise


Your cardio routine is like your razor: After a few weeks of constant use, it becomes increasingly dull and ineffective. That's when you need to find a new challenge, says Patrick Ward, C.S.C.S., founder of Optimum Sports Performance in Tempe, Arizona. Here are five finely honed workouts for wherever your summer takes you. (And for more great exercises for throughout the year, check out The Men's Health Big Book of Exercises.)


Do This: Draw a line in the sand near the water, but not where it will wash away. Draw another one 75 yards down the beach. (One long stride is roughly equal to a yard.) Run from one line to the other 16 times at 70 percent of your maximum effort—in other words, slightly faster than a conversational pace. Each time you reach a line, do one of the following exercises and then rest for 30 seconds: plank (hold 20 seconds), lunge (10 reps), or pushup (10 reps). Pick a different exercise each time. "It will become harder as you progress," says Ward, "so pace yourself."

Why It Works: "All of your force dissipates into the sand, requiring you to work harder to cover the same distance," says Ward. The result: You'll burn more calories than you would pounding the pavement.


Do This: In a 25-yard pool, swim two laps (that's four lengths, or 100 yards) using a freestyle stroke. Rest for 20 seconds. Next, do two laps using a backstroke. Rest 20 seconds. That's one round. Do four more rounds, for a total of five rounds and 1,000 yards.

Why It Works: Swimming provides all the heart-healthy benefits of running without the joint-jarring impact. A recent French study of tri-athletes found that swimming accounted for just 7 percent of training injuries while running accounted for 73 percent. "The pool is ideal for cross-training," says Ted Knapp, an associate head coach of the NCAA's third-ranked Stanford University men's swim team. "You can rest the muscles you typically hit on long runs or bike rides without sacrificing your cardio burn." (Are you tough enough for any workout? If you have 15 minutes, we have The Shortest Total-Body Workout.)


Do This: Do the exercises described below as a superset (back-to-back), performing as many reps of each as you can in 30 seconds; rest for 30 seconds between them. Continue alternating back and forth until you complete 6 sets of both. "You want to move as much as possible during each of those active 30 seconds," says Craig Ballantyne, C.T.T., the author of Turbulence Training. "So crank up the intensity level as high as you can, and keep it that way for the duration of the workout."

Stand with your feet shoulder-width apart and your arms at your sides. Push your hips back, bend your knees, and lower your body as deep as you can into a squat. Place your hands on the ground in front of you and kick back into a pushup position. Do two pushups and then quickly bring your legs back into a squat. Now jump up. When you land, go immediately into your next rep.

Stand with your feet shoulder-width apart and put your hands behind your head, elbows back. Keeping your back straight, step forward with your right foot and slowly lower your body until your right knee is bent at least 90 degrees. Pause, and then push yourself back up to the starting position as quickly as you can. Repeat the movement, this time stepping forward with your left foot. That's 1 rep. Keep alternating back and forth.

Why It Works: These exercises focus on different muscle groups. "While one muscle group is active, the other rests," says Ballantyne. "That allows you to do more work with less fatigue in less time." In this case, you'll complete a total-body, metabolism revving workout in just 10 minutes.

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Romney says he would keep parts of Obama healthcare law

Romney says he would keep parts of Obama healthcare law

WASHINGTON (Reuters) - Republican presidential candidate Mitt Romney, who has called for scrapping President Barack Obama's 2010 U.S. healthcare law, said in remarks aired on Sunday that he likes key parts of "Obamacare" despite his party's loathing of it and wants to retain them.

Romney, who faces Obama in the November 6 election, has vowed throughout the campaign to repeal and replace the Obama healthcare law. But asked about the Obama healthcare law on NBC's "Meet the Press" program, Romney said, "Well, I'm not getting rid of all of healthcare reform."

"Of course, there are a number of things that I like in healthcare reform that I'm going to put in place," Romney added. "One is to make sure that those with pre-existing conditions can get coverage. Two is to assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they might like."

The Obama healthcare law, among other provisions, prevents insurance companies from denying medical coverage to people who already are suffering from a medical condition. It also allows parents to keep their young-adult children on their health insurance plans until age 26.

The law is Obama's signature domestic policy achievement.

Elements of the state healthcare reform plan that Romney put in place as governor of Massachusetts served as a model for the federal law passed by the U.S. Congress and signed by Obama in 2010 despite unified Republican opposition.

"I say we're going to replace Obamacare. And I'm replacing it with my own plan. And even in Massachusetts when I was governor, our plan there deals with pre-existing conditions and with young people," Romney told "Meet the Press."

On the day the Supreme Court upheld the Obama law in June, Romney said the American people must vote the president out of office in order to "get rid of Obamacare." The law is the most sweeping overhaul since the 1960s of the unwieldy U.S. healthcare system.

The Obama law was meant to bring coverage to more than 30 million of the roughly 50 million uninsured and slow soaring medical costs. Republicans say it meddles in the lives of individuals and in the business of the states.

On the divisive social issue of abortion, Romney said it "would be my preference" that the landmark 1973 Roe v. Wade ruling legalizing it be overturned by any justices who he would appoint to the U.S. Supreme Court if vacancies come up.

"Well, there are a number of things I think that need to be said about preserving and protecting the life of the unborn child. And I recognize there are two lives involved: the mom and the unborn child," Romney said.

"And I believe that people of good conscience have chosen different paths in this regard. But I am pro-life and will intend, if I'm president of the United States, to encourage pro-life policies," he added.

(Reporting by Will Dunham; Editing by Sandra Maler)

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Vitamin D Fails to Lower Cholesterol

MedPage Today Cardiovascular Vitamin D Fails to Lower Cholesterol

(MedPage Today) -- Among individuals with vitamin D deficiency, supplementation with the nutrient did not improve lipid profiles in the short term, a randomized, placebo-controlled trial showed.


Kidney Stent Safely Drops BP in Hypertension

MedPage Today Cardiovascular Kidney Stent Safely Drops BP in Hypertension (CME/CE)

(MedPage Today) -- Renal artery stenting appears to improve the outlook for patients with renal artery stenosis and hard-to-manage hypertension, the single-arm HERCULES trial showed.


Saturday, September 8, 2012

How We Treat Heart Disease Isn't Good Enough

How We Treat Heart Disease Isn't Good Enough - The Huffington Post

How We Treat Heart Disease Isn't Good Enough
Every year more than one million Americans find themselves in their local emergency room feeling like an elephant has plopped down on their chest. Heavy, suffocating chest pressure is one of the hallmark symptoms of coronary artery disease, our nation's number one killer, and so physicians take it seriously. If lab tests and history suggest there's a decent chance that the pachyderm in the room is coronary artery disease, you will be admitted to the hospital and treated aggressively.

Either sooner (within minutes in the case of a heart attack) or later, you will likely undergo a coronary angiogram, the gold standard test for cardiovascular disease. The procedure entails threading a small catheter into the opening of the coronary arteries, then injecting a chemical that makes the inside of the arteries appear white on X-ray. A healthy artery looks smooth and wide open. A diseased artery looks narrowed and beaded -- or in the most severe cases, completely blocked.

Unfortunately, as research published in January's The New England Journal of Medicine suggests, the gold standard test for detecting our country's most lethal health problem appears to behave more like tin.

Researchers followed nearly 700 patients who presented with a heart attack or a threatened heart attack. Each patient had an angiogram to identify the blockage that was causing the problem; the culprit blockage was then ballooned open (a procedure called angioplasty) and a small wire mesh device called a stent was inserted to keep the blockage from reoccurring. That's a typical angiogram procedure, but in this study, each patient also went on to be evaluated with a newer technology called "catheter-directed intravascular ultrasound." The idea was to use the more discerning eye of intravascular ultrasound to assess how many atherosclerotic blockages, a.k.a. "plaques," the angiogram may have missed.

It turns out that the standard angiogram misses a lot of plaques. In this study, conventional angiograms documented a total of about 1,800 of these blockages, whereas intravascular ultrasound found 3,100 -- despite the fact that ultrasound can't even "see" the last third of an artery the way an angiogram can. Not only did the angiogram miss a lot of blockages, but it often underestimated the severity of the blockages it did find. For example, angiograms found just 12 high-grade blockages; intravascular ultrasound found 283.

Over the following three years about 20 percent of the study patients returned to the hospital with more heart problems, and many of them had another angiogram to try to identify where the new blockage was. For about half of the returnees, the new problem was caused by the growth of a previously noted, but small (and therefore unstented) blockage. In the other half of cases, the chest pain occurred because a previously placed stent had closed off. That's a 50/50 split despite the fact that small unstented blockages outnumbered the larger stented blockages by more than two to one.

The researchers were also interested in whether there were any particular features on the initial ultrasound that could have predicted which blockages ended up causing problems in the follow up period. Coronary artery blockages aren't just a pile of cholesterol goo, stuck to the side of an artery. They are in essence a wound, fixed in place -- a mixture of different material and cell types going through cycles of healing and/or recurrent damage. But an angiogram can only document the severity of a blockage; it cannot peer inside this wound the way an ultrasound can.

It turned out that even when a particular blockage had all three of the most ominous ultrasound features the researchers could identify, there was only an 18 percent chance that that particular blockage would go on to cause an acute coronary problem. Call it "Whac-a-Mole Cardiology:" yes, an angiogram or ultrasound may identify a series of blockages, but we still can't predict which one will pop its head up out of the hole so we can bang it over the head with a stent.

Don't get me wrong: stents can save lives. In certain heart attack situations, angioplasty and stenting has dropped short-term mortality rates from 13 percent to 3-5 percent; in other situations, it can prevent "after-shock" heart attacks and readmissions for angina. But treating a heart attack in the here-and-now is different from preventing one in the future, which stents don't do very well. That's because, as this study showed, we're lousy at picking which blockages we should use them on, and also because stents don't always stay open: they can slowly scar shut, or quickly clot off. As a cardiologist colleague of mine says, "We've created a new disease -- the stent."

Of course we wish that stents worked better as preventive therapy for heart attacks. In fact, some interventional cardiologists wish so hard that they'll go ahead and place a stent anyway. This practice is so common that it's been given its own term, the "oculostenotic reflex," meaning that if an interventional cardiologist sees a stenosis (a higher grade blockage), he or she will reflexively stent it. In a 2006 focus group study of cardiologists in the San Francisco Bay area, one admitted, "We all agree that we don't know if we're doing the right thing, but if there's a lesion [blockage], we'll fix it."

In some cases, wishful thinking bows to greed, as angiograms are a lucrative procedure. With some regularity the multi-million-dollar exploits of stent cowboys like Baltimore cardiologist Dr. Mark Midei end up in a New York Times expose . It's unclear what percentage of stents (560,000 were placed in 2007) are unnecessary, but cardiologists will admit, at least privately, that it's a common practice. And it's clearly part of the sucking sound we hear coming from our health care premiums. Medicare alone spent $3.5 billion on stents in 2009; Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic told the New York Times, "We're spending a fortune as a country on procedures that we don't need."

The conclusion to this latest research might be "Oops, the best test we have to evaluate our country's most lethal health problem isn't all that good." If the conventional angiogram is moving down the podium, will there be a new gold standard? Many believe it will be either CT or MRI angiograms -- like intravascular ultrasound, these allow us to more accurately view the atherosclerotic scars that define coronary artery disease. Because stress tests can only detect severe disease (blockages of 70 percent or more), CT or MRI angiograms are also increasingly being used as a much more definitive screening test that can find coronary disease much earlier in its development.

In the meantime, if it took an angiogram and a stent to push that elephant off your chest, be grateful but not falsely reassured: you have been treated for coronary artery disease but not cured of it. The 90 percent blockage the cardiologist ballooned and stented may now be 100 percent open, but you'll need to be on medication to keep that stent open. And as this latest research shows, it's very likely that there are remaining smaller blockages that the angiogram either underestimated in size or didn't see at all. These could loom large in your future unless you aggressively treat the risk factors -- smoking, high blood pressure, bad cholesterol etc. -- that caused them to sprout up in the first place. Whenever possible, choose a smoke alarm over a fire engine.

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Vitamin D Supplements May Not...

I thought you would be interested in the following article:

Vitamin D Supplements May Not Improve Heart Health

Wednesday, September 5, 2012

Chocolate may protect the brain from stroke

Chocolate might not be the healthiest thing for your waistline - but research suggests it may protect against stroke.
A study following more than 37,000 Swedish men showed those eating the most chocolate were the least likely to have a stroke.
It follows on from other studies that have suggested eating chocolate can improve the health of the heart.
However, researchers and the Stroke Association warned the findings were not an excuse to overeat chocolate.
Everyone taking part in the study was asked about their eating habits and their health was monitored for a decade.
They were split into four groups based on the amount of chocolate, with the bottom group eating, on average, no chocolate each week and the top group having 63g (2.2oz) - slightly more than an average bar.
Comparing the top and bottom groups showed those eating the most chocolate were 17% less likely to have a stroke during the study, published in the journal Neurology.
One of the researchers, Prof Susanna Larsson, from the Karolinska Institute in Sweden, said: "The beneficial effect of chocolate consumption on stroke may be related to the flavonoids in chocolate.
"Flavonoids appear to be protective against cardiovascular disease through antioxidant, anti-clotting and anti-inflammatory properties.
"It's also possible that flavonoids in chocolate may decrease blood concentrations of bad cholesterol and reduce blood pressure."
The study also noted that while dark chocolate had been linked to benefits for the heart in the past, milk chocolate was the preferred option in Sweden and in the study.
Dr Clare Walton, from the Stroke Association, said: "Past research has shown that eating dark chocolate might go some way to reducing your stroke risk if it is eaten as part of a healthy, balanced diet.
"This study suggests that eating a moderate amount of other types of chocolate could also be beneficial in men.
"However, a lot more research is needed and these results should not be used as an excuse for men to eat chocolate as an alternative to regular exercise or eating a healthy diet to reduce their risk of stroke."
The authors of the study warned of the high sugar and fat content of chocolate.
"It should be consumed in moderation," they said.