Cardiovascular health

A large study comparing the experiences of more than 10,000 patients with suspected coronary heart diseases has found that

• women have more risk factors for heart disease than men but are typically assessed to have lower risk
• women were older (62.4 vs 59), more likely to be hypertensive (66.6% vs 63.2%), and more likely to have a family history of early heart disease (34.6% vs 29.3%); they were less likely to smoke (45.6% vs 57%)
• women were more likely to be referred for imaging stress tests compared to men, but were less likely to have a positive test (9.7% vs 15%)
• chest pain was an equally common symptom (73% of women and 72% of men complained of this when presenting), but men were more likely to characterize their chest pain as a dull ache or a burning sensation, while women most often described it as crushing/pressure/squeezing/tightness.
• women were more likely than men to have back, neck, or jaw pain, and palpitations as the primary presenting symptoms
• men were more likely to have fatigue and weakness, although this was still unusual as the primary complaint.

http://www.futurity.org/women-heart-disease-1130252-2/

Hemal K, Pagidipati NJ, Coles A, et al. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. J Am Coll Cardiol Img. 2016;9(4):337-346. doi:10.1016/j.jcmg.2016.02.001.

A review of recent neutral studies questioning the benefits of omega-3s for heart health suggests that the findings may have been due to a number of design issues, rather than a lack of substantiated clinical benefits in cardiovascular disease. The issues include such things as:

• aggressive cardiovascular drug treatment overshadowing the benefits of long-chain omega-3s
• high background long-chain omega-3 intake at study initiation
• too few subjects in the study
• treatment duration too short
• insufficient LC omega-3 dosage
• increase in omega-6 fatty acid intake during the study
• failure to assess the LC omega-3 status of the subjects prior to and during treatment
• lack of clarity concerning which mechanisms were expected to produce benefits

The existing body of gold-standard research showing omega-3s may reduce cardiovascular death risk, maintain healthy blood pressure and improve triglyceride levels also makes it difficult to conclude that EPA and DHA consumption does not contribute to a healthy heart.

http://www.eurekalert.org/pub_releases/2016-02/g-phb012916.php

Rice, H. B., Bernasconi, A., Maki, K. C., Harris, W. S., von Schacky, C., & Calder, P. C. (2016). Conducting omega-3 clinical trials with cardiovascular outcomes: Proceedings of a workshop held at ISSFAL 2014. Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA), 107, 30–42. http://doi.org/10.1016/j.plefa.2016.01.003

A 10-year French study of 7,313 older adults (65+), of whom nearly 30% of the women and 15% of the men had high levels of depressive symptoms, has found that repeated occurrences of depression produced increasing risk of heart disease or stroke. Those who had high levels of depressive symptoms on one, two, three, or four occasions during the study had 15%, 32%, 52%, and 75% greater risk, respectively, of experiencing heart disease or stroke events.

http://www.eurekalert.org/pub_releases/2016-02/ags-foa020116.php

Péquignot, R., Dufouil, C., Prugger, C., Pérès, K., Artero, S., Tzourio, C., & Empana, J.-P. (2016). High Level of Depressive Symptoms at Repeated Study Visits and Risk of Coronary Heart Disease and Stroke over 10 Years in Older Adults: The Three-City Study. Journal of the American Geriatrics Society, 64(1), 118–125. http://doi.org/10.1111/jgs.13872

A meta-analysis of 10 prospective studies involving a total of 136,265 older adults (average age 67) has found that having a high sense of purpose in life was significantly associated with lower mortality and cardiovascular events.

Most of the studies came from the United States or Japan. The US studies evaluated a sense of purpose or meaning in life, or "usefulness to others." The Japanese studies assessed the concept of ikigai, translated as "a life worth living."

http://www.eurekalert.org/pub_releases/2015-12/wkh-il120315.php

Cohen, R., Bavishi, C., & Rozanski, A. (2016). Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events: A Meta-Analysis. Psychosomatic Medicine, 78(2), 122–133. http://doi.org/10.1097/PSY.0000000000000274

A ten-year study involving 4,207 older adults (73+) demonstrates that even in this older age group, modest physical activity was associated with a lower risk of cardiovascular disease. Among both men and women in good health:

• those who were more active had significantly lower risk of future heart attacks and stroke
• those who walked faster than three miles per hour had a 50% lower risk than those who walked at a pace of less than two mph (50%, 53%, 50% lower risk of coronary heart disease, stroke and total CVD, respectively)
• those who walked an average of seven blocks per day or more had a similar advantage compared to those who walked up to five blocks per week (36%, 54% and 47% lower risk of CHD, stroke and total CVD, respectively)
• those who engaged in leisure activities such as lawn-mowing, raking, gardening, swimming, biking and hiking, also had a lower risk of CHD, stroke and total CVD, compared to those who did not engage in leisure-time activities

http://www.eurekalert.org/pub_releases/2015-11/tuhs-wfo111915.php

Soares-Miranda, L., Siscovick, D. S., Psaty, B. M., Longstreth, W. T., & Mozaffarian, D. (2015). Physical Activity and Risk of Coronary Heart Disease and Stroke in Older Adults: The Cardiovascular Health Study. Circulation, CIRCULATIONAHA.115.018323. http://doi.org/10.1161/CIRCULATIONAHA.115.018323

A meta-analysis of 61 controlled trials has concluded that consuming tree nuts, such as walnuts, lowers total cholesterol, triglycerides, LDL cholesterol, and ApoB, the primary protein found in LDL cholesterol. Walnuts were investigated in 21 of the 61 trials, more than any other nut reviewed.

Consuming at least two servings (two ounces) per day of tree nuts had stronger effects on total cholesterol and LDL. The evidence also suggests that tree nut consumption may be particularly important for lowering the risk of heart disease in individuals with type 2 diabetes.

Walnuts have also been shown to reduce inflammation, and improve arterial function.

http://www.eurekalert.org/pub_releases/2015-11/es-sft111815.php

Del Gobbo, L., Falk, M.C., Feldman, R., Lewis, K., Mozaffarian, D. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis and dose-response of 61 controlled intervention trials. Am J Clin Nutr.2015; doi: 10.3945/ajcn.115.110965.

Kris-Etherton P. Walnuts decrease risk of cardiovascular disease: a summary of efficacy and biologic mechanisms. J Nutr. 2014; 10.39:2S-8S.

Zhao G, Etherton TD, Martin KR, et al. Dietary alpha-linolenic acid reduces inflammatory and lipid cardiovascular risk factors in hypercholesterolemic men and women. J Nutr 2004; 134: 2991-2997.

Medical and genetic data from thousands of patients has enabled researchers to compare the similarity between patients with type 2 diabetes, revealing three distinctive clusters. These sub-types of type 2 diabetes are associated with different genetic variants, and have quite different health implications.

Subtype 1 patients were more likely to suffer from well-known diabetes problems with kidneys and eyes (diabetic nephropathy and diabetic retinopathy); subtype 2 was more likely to suffer from cancer and cardiovascular diseases; and subtype 3 was associated most strongly with cardiovascular diseases, neurological diseases, allergies, and HIV infections.

http://www.fastcoexist.com/3052935/the-latest-breakthrough-in-understanding-diabetes-was-made-by-an-algorithm

Li, L., Cheng, W.-Y., Glicksberg, B. S., Gottesman, O., Tamler, R., Chen, R., … Dudley, J. T. (2015). Identification of type 2 diabetes subgroups through topological analysis of patient similarity. Science Translational Medicine, 7(311), 311ra174-311ra174. http://doi.org/10.1126/scitranslmed.aaa9364

Data from 4.1 million British adults who were free of diabetes and cardiovascular disease at the start of the study has found that those with high blood pressure were almost 60% more likely to develop type 2 diabetes.

The strength of the association declined with increasing body mass index and age.

The finding strengthens previous research indicating that you are more at risk of diabetes if you have had high blood pressure, a heart attack or a stroke.

http://www.theguardian.com/society/2015/sep/29/study-gives-strongest-link-yet-between-blood-pressure-and-diabetes

Emdin CA, Anderson SG, Woodward M, Rahimi K. Usual Blood Pressure and Risk of New-Onset Diabetes: Evidence From 4.1 Million Adults and a Meta-Analysis of Prospective Studies. J Am Coll Cardiol. 2015;66(14):1552-1562. doi:10.1016/j.jacc.2015.07.059.

A study has revealed that the immune system has a seasonal cycle, in which its activity is boosted during the winter and relaxes during the summer. While the winter increase in immune defences presumably helps us stave off infections, it also raises the risk of harmful inflammation, effectively lowering the threshold for heart attacks, stroke, diabetes and even some psychiatric conditions. This may explain why deaths from conditions ranging from heart attacks to diabetes and schizophrenia increase in winter.

The study used blood samples from more than 16,000 people living in both the northern and southern hemisphere

http://www.theguardian.com/science/2015/may/12/winter-immune-boost-may-actually-cause-deaths-study-suggests

Dopico, X. C., Evangelou, M., Ferreira, R. C., Guo, H., Pekalski, M. L., Smyth, D. J., … Todd, J. A. (2015). Widespread seasonal gene expression reveals annual differences in human immunity and physiology. Nature Communications, 6, 7000. http://doi.org/10.1038/ncomms8000

A British study involving 165 healthy nonsmoking adults (aged 40–70) has found that a diet based on UK health guidelines could reduce risk of a heart attack or a stroke by up to a third, compared to a traditional British diet

The predicted risk of cardiovascular disease over the next 10 years for the participants was estimated to be about 8% in the men and 4% in the women. Participants followed their diets for 12 weeks. Those on the modified diet ate oily fish once a week, more fruit and vegetables, replaced refined with wholegrain cereals, swapped high-fat dairy products and meats for low-fat alternatives, and restricted their intake of added sugar and salt. Participants were asked to replace cakes and cookies with fruit and nuts and were also supplied with cooking oils and spreads high in monounsaturated fat.

The average body weight in the group on the modified diet fell by 1.3 kg; that in the control group rose by 0.6 kg. Waist circumference was 1.7 cm lower in the dietary group compared to the control group. There were also significant falls in systolic blood pressure/diastolic blood pressure (4.2/2.5 mm Hg for daytime and 2.9/1.9 mm Hg for night time) and average heart rate. Cholesterol fell by 8%. High-sensitivity C-reactive protein (a marker for inflammation) was 36% lower. There was no significant change in markers for insulin sensitivity. Much of the fall in blood pressure could be accounted for by the drop in sodium.

http://www.eurekalert.org/pub_releases/2015-03/kcl-hdr031715.php

Reidlinger, D. P., Darzi, J., Hall, W. L., Seed, P. T., Chowienczyk, P. J., & Sanders, T. A. (2015). How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial. The American Journal of Clinical Nutrition, 101(5), 922–930. http://doi.org/10.3945/ajcn.114.097352