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Tag: Heart

  • Mayo Clinic research shows health benefits of active workstations

    Mayo Clinic research shows health benefits of active workstations

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    A recent Mayo Clinic study suggests that active workstations incorporating a walking pad, bike, stepper and/or standing desk are successful strategies for reducing sedentary time and improving mental cognition at work without reducing job performance. Extended sedentary behavior, whether at work or home, increases a person’s risk of preventable chronic diseases.

    Our findings suggest that it is feasible to blend movement with office work that previously would have been done during long periods of sitting. Active workstations may offer a way to potentially improve cognitive performance and overall health, simply by moving at work.”


    Francisco Lopez-Jimenez, M.D., preventive cardiologist at Mayo Clinic and senior author of the study

    The research involved 44 participants in a randomized clinical trial where four office settings were evaluated over four consecutive days at Mayo Clinic’s Dan Abraham Healthy Living Center. Study findings are published in the Journal of the American Heart Association. The settings included a stationary or sitting station on the first day, followed by three active workstations (standing, walking or using a stepper) in a randomized order. Researchers analyzed participants’ neurocognitive function based on 11 assessments that evaluated reasoning, short-term memory and concentration. Fine motor skills were assessed through an online typing speed test and other tests.

    When participants used the active workstations, their brain function either improved or stayed the same, and their typing speed slowed down only a bit. However, the accuracy of their typing was not affected. The study revealed improved reasoning scores when standing, stepping and walking as compared with sitting. 

    “Being sedentary is the new smoking when it comes to your cardiovascular health, and office workers may spend a large part of their eight-hour workday sitting at a computer screen and keyboard. These findings indicate that there are more ways to do that work while remaining productive and mentally sharp. We would do well to consider an active workstation in the prescription for prevention and treatment of conditions like obesity, cardiovascular disease and diabetes,” says Dr. Lopez-Jimenez.

    Source:

    Journal reference:

    Medina‐Inojosa, J. R., et al. (2024) Effect of Active Workstations on Neurocognitive Performance and Typing Skills: A Randomized Clinical Trial. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.031228.

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  • Exploring prebiotics and probiotics as dual fighters against depression and obesity

    Exploring prebiotics and probiotics as dual fighters against depression and obesity

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    Depression is among the most prevalent and potentially serious mental health disorders, accounting for up to 800,000 suicides a year. The risk factors for depression have, therefore, undergone much exploration.

    A recent study published online in Nutrients deals with the interactions between depression and nutrition, coupled with exercise.

    Study: The Role of Gut Microbiota, Nutrition, and Physical Activity in Depression and Obesity—Interdependent Mechanisms/Co-Occurrence. Image Credit: Bits And Splits/Shutterstock.comStudy: The Role of Gut Microbiota, Nutrition, and Physical Activity in Depression and Obesity—Interdependent Mechanisms/Co-Occurrence. Image Credit: Bits And Splits/Shutterstock.com

    About depression

    Depressive disorders include several categories, including persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, as well as depression induced by addictive drugs or medications or by medical conditions.

    All are characterized by sadness and irritability, with bodily and mental changes. The effect is a lowered quality of life and impaired functioning.

    Moreover, depression is known to increase the risk for a number of metabolic diseases, such as diabetes, obesity, and ischemic heart disease.

    Conversely, dietary patterns are linked to mental health as well as malnutrition. For instance, excessive fat intake leads to chronic inflammation and obesity.

    Obesity

    Obesity is defined as the accumulation of body fat in excess, as measured by the body mass index (BMI) and the body fat percentage. It is associated with a higher risk of cardiovascular disease (CVD), insulin resistance, cancer, and nerve damage.

    Risk factors for obesity are well-known and include gender, age, smoking, apart from the consumption of excessive fat and of processed foods, which are typical of Western diets.

    Obesity and depression often affect the same individual, along with anxiety disorders. They have a common mechanism of action, as seen by their bidirectional association.

    People who are depressed often indulge in comfort eating, which may increase body weight, especially if the person is also inactive. The risk of obesity in people undergoing emotional stress is almost 40% higher.

    Similarly, obese people are almost 20% more likely to become anxious or depressed because of negative self-image as well as adverse social perceptions that they are too lazy or undisciplined to regulate their diet and their weight. The treatment of depression with antidepressants is effective but may cause weight increase.

    Unfortunately, both obesity and depression are among the most prevalent disorders globally and have a high death rate, leading to powerful scientific interest in their interrelationships.

    Gut microbiota

    The gut microbiota is essential to proper energy storage and metabolism, but shows marked variability in obese vs lean individuals. This includes lower diversity and fewer commensal bacteria but more pathogenic microbes in the obese. The resulting aberration in metabolism may contribute to obesity.

    The need for a rational diet along with therapies like psychotherapy and medication to treat patients with depression is stressed by some scientists.

    In addition, probiotics and prebiotics may be required, along with nutritional supplements, to correct dysbiosis and vitamin deficiencies.

    Probiotics and gut microbiota

    The researchers sought to understand how gut microbes may be useful in treating both obesity and depression and the role of probiotics and prebiotics in such therapy.

    The review suggests that about 57% of the composition of the gut microbiota responds to dietary patterns.

    Probiotics strengthen the gut barrier and modulate the immune system. Their use is associated with improving depressive symptoms, perhaps by supplying vitamin D and short-chain fatty acids (SCFAs), which combat inflammation.

    Some strains of probiotic bacteria directly affect neural pathways. They inhibit the depression-inducing hypothalamic–pituitary–adrenal axis (HPA axis), and promote the secretion of the anti-stress neurotransmitter GABA, also known as gamma-aminobutyric acid.

    Others produce gut neurotransmitters that also affect the brain, affecting the mood for the better.

    Some clinical trials in humans suggest a positive effect of probiotics on depressive disorders as well as on obesity and related metabolic conditions like insulin resistance, type 2 diabetes, and nonalcoholic fatty liver disease (NAFLD).

    Further research is essential to validate these results, especially as probiotics work well on gut health and overall disease control only as part of a holistic management strategy, including proper diet, exercise, stress regulation, and adequate sleep.

    Bacterial strains linked to improved neural pathways, sometimes called psychobiotics, include multiple Lactobacillus strains like Lactobacillus casei Shirota, Lactobacillus fermentum NS8 and NS9, and Lactobacillus rhamnosus JB-1, as well as Bifidobacterium strains like Bifidobacterium longum Rosell-175, Bifidobacterium longum 1714, and Bifidobacterium longum NCC3001.

    Diet and mental health

    The brain receives a good share of absorbed nutrients and utilizes them to keep itself healthy. For instance, regeneration, neuroplasticity, and an adequate antioxidant reserve depend on the proper supply of nutrients to the brain.

    Supplementation with fatty acids like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), magnesium, folate, and vitamins E and D have been suggested to be beneficial in countering or mitigating severe depression and reducing neuroinflammation.

    Specific diets like the Mediterranean diet (MD), the DASH (Dietary Approaches to Stop Hypertension), or vegetarian diets have frequently been assessed for their relationship with physical and mental health.

    The authors of the current study found reduced depression and obesity risk with both the DASH and the MD, but contradictory data with vegetarian and vegan diets. However, high-quality vegetarian diets were protective against depression, underlining the pivotal role of diet quality in the type of diet chosen.

    Physical activity and obesity/mood disorders

    There is ample evidence that weight management is aided by increasing the overall energy expenditure and improving the mood, with reduced anxiety and depression. Aerobic exercise has been recommended for its ability to build fitness and help reduce weight.

    Physical exercise is linked with lengthening telomeres, a metabolic health biomarker. It is also associated with better brain health, sleep quality, and reduced depressive symptoms.

    Physical exercise is also linked to better gut microbiota composition, stronger commensals, and more anti-inflammatory bacteria.

    Early-life exercise may promote the development of bacteria that can help the host adapt to changing conditions and promote healthy brain development.

    The broader impact of obesity and depression

    Depression is associated with increased mortality and morbidity, absenteeism, severe decreases in the quality of life, and reduced productivity.

    Obesity, which is currently estimated to have a prevalence of 30% in the USA, also has profound impacts on personal and social health. It reduces female fertility, promotes loss of cognitive ability, reduces the lifespan, and may increase employment difficulty.

    Conclusions

    Obesity and depression have common origins and act to exacerbate each other. This interrelationship significantly impacts the quality of life. One possible explanation for their connections may be via gut dysbiosis.

    This has stimulated much study on the potential use of probiotics and prebiotics in depression and anxiety, as well as in obesity.

    “Encouraging findings from existing research underscore the need for robust clinical trials to evaluate the therapeutic potential of microbiota modulation.”

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  • New research links social factors to cardiovascular risk in Asian American adults

    New research links social factors to cardiovascular risk in Asian American adults

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    Having more unfavorable social determinants of health, such as being unemployed, uninsured or not having education beyond high school, was associated with an increased likelihood of having risk factors for cardiovascular disease among Asian American adults, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    The investigation also noted that the link between these unfavorable social determinants of health variables and cardiovascular disease risk factors varied widely among people in different Asian American subgroups in this study. An association does not mean that social determinants of health directly caused the risk factor.

    Despite the perception that Asian Americans may be less impacted by social determinants of health compared to people in other racial/ethnic groups, our findings indicate unfavorable social factors are associated with higher prevalence of cardiovascular risk factors among Asian American adults.”


    Eugene Yang, M.D., lead study author, professor of medicine at the University of Washington School of Medicine in Seattle

    “The Asian American population is the fastest growing racial/ethnic group in the United States,” Yang said. “People of South Asian heritage have higher rates of premature heart disease globally, and they recently have been found to have higher cardiovascular mortality than non-Hispanic white people. Better understanding of why differences in cardiovascular risk exist among Asian subgroups is vital to reducing risk and improving outcomes.”

    Researchers examined data from the National Health Interview Survey conducted in the U.S. from 2013 to 2018, which included 6,395 adults who self-identified as Asian.

    Researchers rated 27 social determinants of health factors as favorable or unfavorable in six areas: economic stability (which included employment and income status); neighborhood and social cohesion (which gauged neighborhood trust and whether homes were owned or rented); psychological distress; food security; education; and health care utilization.

    The analysis found a significant relationship between unfavorable social determinants of health and cardiovascular disease risk factors. This relationship varied among people in different Asian American subgroups. Among the findings:

    • For all Asian groups included in the data, a higher unfavorable social determinants of health score by one standardized unit was associated with a 14% greater risk of high blood pressure; a 17% greater risk of poor sleep; and a 24% greater risk of Type 2 diabetes -; all of which increase the risk for developing cardiovascular disease.

    • Specifically, more unfavorable social determinants were associated with:

      • a 45% greater likelihood of Type 2 diabetes among Chinese adults and a 24% greater likelihood among Filipino adults;

      • a 28% greater risk of high blood pressure among Filipino adults;

      • a 42% increased likelihood of insufficient physical activity among Asian Indian adults, a 58% increased likelihood among Chinese adults and a 24% increased likelihood among Filipino adults;

      • a 20% likelihood of suboptimal sleep among Asian Indian adults; and

      • a 56% and 50% likelihood of nicotine exposure among Chinese adults and Filipino adults, respectively.

    • Compared with other Asian American subgroups, adults who identified as Filipino reported the highest prevalence -; 4 out of 7 -; cardiovascular risk factors: poor sleep, high cholesterol, high blood pressure and obesity.

    Yang said many social determinants of health are often interconnected, such as neighborhood cohesion, economic stability and use of the health care system.

    “It is important to understand how different Asian subgroups are affected,” he said. “When Asian people are lumped together, higher risk groups like South Asian people may not be treated aggressively enough, while groups with lower risk, like people of Korean and Japanese descent, may be overtreated for blood pressure or cholesterol.”

    Study background and details:

    • The large, cross-sectional study reviewed data from 2013-2018 National Health Interview Surveys -; annual, nationally representative surveys of U.S. adults.

    • Of the 6,395 Asian adults in the survey, about 22% self-identified as Filipino adults; 22% as Asian Indian adults; 21% as Chinese adults; and 36% as other Asian.

    • The sample size of Asian American individuals in the national survey was too small to analyze several major Asian populations, including Japanese, Korean and Vietnamese people, as well as other smaller Asian subgroups.

    • Nearly 56% of the group were women, and nearly 52% were between the ages of 18 and 44. About 77% of the participants were born outside the United States.

    • Participants were assigned scores for social determinants of health by categorizing 27 variables as favorable or unfavorable.

    • The cardiovascular risk factors were self-reported and were similar to the American Heart Association’s Life’s Essential 8 -; eight lifestyle metrics assessing ideal cardiovascular health. These eight metrics include: following a healthy diet, maintaining a healthy weight, getting regular exercise and enough quality sleep, avoiding nicotine exposure and maintaining healthy levels of blood pressure, glucose and cholesterol. However, healthy diet was not measured in this study. Reaching optimal levels of these eight metrics improves heart health and reduces the risk for heart disease and stroke.

    Limitations of the study include that its small sample size did not allow for analysis of some Asian subgroups (Japanese, Korean, Vietnamese and other Asian people). In addition, it examined self-reported survey data on social factors and cardiovascular risk factors at a single point in time. Therefore, the analysis could not assess long-term social determinants of health patterns, and it could not prove that unfavorable social factors caused the development of cardiovascular disease risk factors. Furthermore, language barriers may have been a factor for some participants because the National Heath Interview Surveys were only conducted in English and Spanish.

    Study authors noted that it is vital to include more Asian Americans in national surveys to reveal potential differences in optimal social determinants of health profiles and cardiovascular risk factor prevalence and outcomes.

    Co-authors, disclosures and funding sources are listed in the manuscript.

    Source:

    American Heart Association

    Journal reference:

    Zhu, A. L., et al. (2024) Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.032509.

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  • How free sugars affect human health

    How free sugars affect human health

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    In a recent review article published in Nutrients, researchers summarized the current evidence about the effect of free sugars on health outcomes in humans, including mood, cognition, cardiovascular disease, diabetes, and obesity.

    They concluded that excessive consumption of added sugars may adversely affect health and overall well-being outcomes, highlighting the need for further research into how different carbohydrate forms affect diverse populations.

    Study: The Impact of Free Sugar on Human Health—A Narrative Review. Image Credit: qoppi/Shutterstock.comStudy: The Impact of Free Sugar on Human Health—A Narrative Review. Image Credit: qoppi/Shutterstock.com

    Background

    Noncommunicable diseases (NCDs), including chronic conditions like heart disease and diabetes, are largely preventable but account for a significant portion of global deaths.

    While researchers have emphasized lifestyle modifications to prevent and treat NCDs, with evidence suggesting that an improved diet yields significant benefits, the specific role of sugar consumption has been debated.

    In the late 20th century, reduced fat consumption led to increased intake of carbohydrates and added sugars, notably high-fructose corn syrup. This coincided with rising obesity, diabetes, and heart disease rates.

    Recent years saw a slight decline in sugar intake, prompted by health guidelines advocating limited daily sugar intake to mitigate health risks.

    Some studies have linked excess consumption of sugar to various health issues. At the same time, other research indicates that sugar might not be inherently more harmful than other energy sources in the diet.

    Effects of sugar on health

    Global obesity rates have risen significantly over the past decades, with obesity linked to various NCDs. The debate over the primary cause of obesity—excess sugar, fat, or total calorie intake—continues, with recent declines in sugar consumption alongside persistent obesity rates suggesting generational effects.

    Studies comparing low-carbohydrate and low-fat diets revealed varied results, highlighting the need for personalized dietary interventions.

    Sugar consumption, particularly from fructose and sugary beverages, is associated with an increased risk of type 2 diabetes (T2DM) in numerous studies. However, findings are inconsistent, with some shorter-term studies failing to establish clear relationships.

    Longer-term studies suggest a significant impact of fructose intake on insulin resistance and diabetes risk, especially in women. The protective effects of dietary fiber and certain fats on diabetes risk are also noted, indicating the complexity of dietary factors influencing T2DM.

    The role of refined carbohydrates and sugary beverages in heart disease is increasingly recognized, with studies indicating their association with dyslipidemia and increased cardiovascular risk.

    While some studies show a direct link between sugar consumption and heart disease, others find conflicting results, possibly due to differences in study duration and methodology.

    Research suggests that sugars may play a detrimental role in cardiovascular health, although the specific types of carbohydrates and fats consumed may have different effects.

    Chronic excessive sugar intake is hypothesized to impair cognitive function, with studies in animals and humans demonstrating neurological and cognitive impairments associated with high sugar consumption.

    Maternal sugar consumption during pregnancy and breastfeeding may also impact offspring cognition.

    While some studies suggest short-term cognitive benefits of sugar consumption, long-term effects are less clear and may be influenced by factors such as glucose control and dietary habits over time.

    The impact of sugar on mood and behavior is debated, with inconsistent findings across studies. While short-term studies suggest potential mood benefits of sugar consumption, particularly following fasting, longer-term studies indicate correlations between high-sugar diets and depression, anxiety, and other mood disorders.

    Confounders and methodological challenges complicate research on the relationship between added sugars and psychological health, warranting further investigation.

    Underlying mechanisms

    Chronic high sugar consumption is hypothesized to impact mood through neurological mechanisms. Western diets, high in sugar, are associated with inflammation, reduced BDNF in the hippocampus, and changes in dopamine signaling, resembling addictive behaviors.

    Sugar consumption can dysregulate dopaminergic pathways, leading to increased sugar seeking and consumption, akin to addiction. Microbiome disruption, particularly by high sugar diets, exacerbates inflammation, contributing to obesity and neurodegeneration.

    Sugar-induced dysbiosis may lead to gut permeability, triggering systemic inflammation and neuroinflammation, potentially explaining neurological and psychiatric impairments associated with sugar and obesity.

    Conclusions

    Minimal scientific evidence supports the claim that added dietary sugars confer health benefits; rather, a growing body of research indicates that they have negative effects, especially when consumption is excessive, prolonged, and high in fructose.

    Glucose supplementation may be beneficial under certain circumstances but can also obtained from dietary sources, including whole grains, vegetables, and foods.

    While not all added sugars need to be eliminated, nutritionists recommend limiting their intake to no more than 10% of total energy consumption.

    The reviewers emphasized the need for further exploration of how different artificial sweeteners and macronutrients impact health outcomes and the challenges posed by sugar-related impairments.

    While large-scale population studies may not be ideal for identifying individualized impacts, cohort studies and randomized controlled trials across diverse populations can yield insights into the precise effects of macronutrients and how they interact with each other to modify health outcomes.

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  • E-cigarette use linked to increased risk of heart failure, large study finds

    E-cigarette use linked to increased risk of heart failure, large study finds

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    People who use e-cigarettes are significantly more likely to develop heart failure compared with those who have never used them, according to one of the largest prospective studies to date investigating possible links between vaping and heart failure. The findings are being presented at the American College of Cardiology’s Annual Scientific Session.

    Heart failure is a condition affecting more than 6 million U.S. adults in which the heart becomes too stiff or too weak to pump blood as effectively as it should. It can often lead to debilitating symptoms and frequent hospitalizations as people age. Electronic nicotine products, which include e-cigarettes, vape pens, hookah pens, personal vaporizers and mods, e-cigars, e-pipes and e-hookahs, deliver nicotine in aerosol form without combustion. Since they were first introduced in the U.S. in the late 2000s, electronic nicotine products have often been portrayed as a safer alternative to smoking, but a growing body of research has led to increased concern about potential negative health effects.

    More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought. The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

    Yakubu Bene-Alhasan, MD, a resident physician at MedStar Health in Baltimore and the study’s lead author

    For the study, researchers used data from surveys and electronic health records in All of Us, a large national study of U.S. adults run by the National Institutes of Health, to analyze associations between e-cigarette use and new diagnoses of heart failure in 175,667 study participants (an average age of 52 years and 60.5% female). Of this sample, 3,242 participants developed heart failure within a median follow-up time of 45 months.

    The results showed that people who used e-cigarettes at any point were 19% more likely to develop heart failure compared with people who had never used e-cigarettes. In calculating this difference, researchers accounted for a variety of demographic and socioeconomic factors, other heart disease risk factors and participants’ past and current use of other substances, including alcohol and tobacco products. The researchers also found no evidence that participants’ age, sex or smoking status modified the relationship between e-cigarettes and heart failure.

    Breaking the data down by type of heart failure, the increased risk associated with e-cigarette use was statistically significant for heart failure with preserved ejection fraction (HFpEF)-;in which the heart muscle becomes stiff and does not properly fill with blood between contractions. However, this association was not significant for heart failure with reduced ejection fraction (HFrEF)-;in which the heart muscle becomes weak and the left ventricle does not squeeze as hard as it should during contractions. Rates of HFpEF have risen in recent decades, which has led to an increased focus on determining risk factors and improving treatment options for this type of heart failure.

    The findings align with previous studies conducted in animals, which signaled e-cigarette use can affect the heart in ways that are relevant to the heart changes involved in heart failure. Other studies in humans have also shown links between e-cigarette use and some risk factors associated with developing heart failure. However, previous studies attempting to assess the direct connection between e-cigarette use and heart failure have been inconclusive, which Bene-Alhasan said is due to the inherent limitations of the cross-sectional study designs, smaller sample sizes and the smaller number of heart failure events seen in previous research.

    Researchers said the new study findings point to a need for additional investigations of the potential impacts of vaping on heart health, especially considering the prevalence of e-cigarette use among younger people. Surveys indicate that about 5% to 10% of U.S. teens and adults use e-cigarettes. In 2018, the U.S. Surgeon General called youth e-cigarette use an epidemic and warned about the health risks associated with nicotine addiction.

    “I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”

    Bene-Alhasan also said e-cigarettes are not recommended as a tool to quit smoking, since many people may continue vaping long after they quit smoking. The U.S. Centers for Disease Control and Prevention recommends a combination of counseling and medications as the best strategy for quitting smoking.

    Researchers said that the study’s prospective observational design allows them to infer, but not conclusively determine, a causal relationship between e-cigarette use and heart failure. However, with its large sample size and detailed data on substance use and health information, Bene-Alhasan said the study is one of the most comprehensive studies to assess this relationship to date.

    Source:

    American College of Cardiology

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  • Study finds elevated sodium consumption in heart disease patients

    Study finds elevated sodium consumption in heart disease patients

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    Individuals with heart disease stand to gain the most from a low-sodium diet but, on average, consume over twice the recommended daily sodium intake, according to a study being presented at the American College of Cardiology’s Annual Scientific Session.

    Sodium is an essential nutrient, but consuming too much can raise blood pressure, which damages blood vessels and forces the heart to work harder. Excess sodium can also cause the body to retain fluid, exacerbating conditions like heart failure. The current U.S. Dietary Guidelines put out by the U.S. Department of Agriculture recommends most adults limit their sodium intake to less than 2,300 mg/day, which is equivalent to about 1 teaspoon of table salt. For individuals with cardiovascular diseases, the limit is even lower at 1,500 mg/day, according to guideline recommendations from the ACC and the American Heart Association.

    This new study found that among a sample of more than 3,100 people with heart disease, 89% consumed more than the recommended daily maximum of 1,500 mg of sodium and, on average, study participants consumed more than twice this amount. Limiting sodium intake is a fundamental lifestyle modification shown to reduce the likelihood of subsequent major adverse cardiovascular events, researchers said. Their findings underscore the challenges many people face in keeping within recommended sodium limits, regardless of other factors such as socioeconomic status.

    Estimating sodium quantities in a meal can be challenging. Food labels aid in dietary sodium estimation by providing sodium quantities in packaged food. Yet, adhering to a low sodium diet remains challenging even for individuals with cardiovascular disease who have a strong incentive to adhere.”


    Elsie Kodjoe, MD, MPH, internal medicine resident at Piedmont Athens Regional Hospital in Athens, Georgia, and study’s lead author

    The study used data from patients diagnosed with a heart attack, stroke, heart failure, coronary artery disease or angina who participated in the National Health and Nutrition Examination Survey (NHANES) between 2009–2018.

    Researchers estimated sodium intake based on questionnaires in which participants were asked to report everything they had consumed in 24 hours. According to the results, study participants with cardiovascular disease consumed an average of 3,096 mg of sodium per day, which is slightly lower than the national average of 3,400 mg/day reported by the U.S. Centers for Disease Control and Prevention.

    “The relatively small difference in sodium intake suggests that people with cardiovascular disease are not limiting their intake very much compared with the general population and are also consuming more than double what is recommended,” Kodjoe said. “To make it easier for patients to adhere to dietary guidelines, we need to find more practical ways for the general public to estimate dietary sodium levels or perhaps consider a reduction in the sodium content of the food we consume right from the source.”

    The researchers also compared sodium intake among people in different socioeconomic groups, but they did not find any significant differences between wealthier and less affluent participants after accounting for age, sex, race and educational attainment.

    Individuals can take proactive measures to lower their sodium intake, Kodjoe said. This includes preparing more meals at home where they have greater control over the sodium content and paying close attention to food labels, particularly targeting foods with sodium levels of 140 mg or less per serving. Researchers suggested that better education around the benefits of limiting sodium could also help motivate more people to follow the recommendations.

    “Cardiovascular disease is real, and it is the number one cause of morbidity and mortality worldwide according to the World Health Organization,” Kodjoe said. “Adhering to sodium guidelines is one of the easier strategies individuals could readily adopt to reduce hospitalizations, health care costs, morbidity and mortality associated with cardiovascular disease.”

    One limitation of the study is that sodium intake was estimated based on food recall questionnaires, rather than 24-hour urine sodium measurements, which is considered the gold standard method. NHANES has included 24-hour urine sodium measurements in its data gathering methods in recent survey cycles, so future studies using this data could provide a more accurate assessment of sodium intake among people with cardiovascular disease.

    Source:

    American College of Cardiology

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  • Cardiovascular risk can rise sharply after women go through menopause

    Cardiovascular risk can rise sharply after women go through menopause

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    Study shows women quickly catch up to men in terms of cardiovascular risk; underscores the need for increased awareness and screening.

    A woman’s cardiovascular risk can rise sharply after she goes through menopause, quickly catching up to men of a similar age and health profile, according to new findings presented at the American College of Cardiology’s Annual Scientific Session. Researchers said the study underscores the importance of recognizing and addressing early warning signs of heart disease risk in women as they lose the protective effects of estrogen after menopause.

    This is a unique study cohort of only post-menopausal statin users that signals that post-menopausal women may have risk of heart disease that is on par with males. Women are underscreened and undertreated, especially post-menopausal women, who have a barrage of new risk factors that many are not aware of. This study raises awareness of what those risk factors are and opens the door to indicating the importance of increased screening for coronary artery calcium (CAC).”


    Ella Ishaaya, MD, internal medicine physician at Harbor-UCLA Medical Center in Torrance, California, and study’s lead author

    In the study, post-menopausal women underwent heart scans to assess their CAC score, a measure of plaque buildup—fat, calcium and other substances—in the heart’s arteries. CAC levels are assessed with a quick, non-invasive scan similar to an X-ray. A higher CAC score indicates a higher risk of a heart attack or other cardiac events.

    Researchers analyzed data from 579 post-menopausal women who were taking statins to control their cholesterol and had undergone two CAC scans at least one year apart. Participants did not have heart disease at the time of the first scan. To compare CAC changes in men and women, each female participant was matched with a male of a similar profile in terms of age, race, statin use, blood pressure and diabetes status.

    Researchers divided the participants into three groups with CAC levels of 1-99, 100-399, and 400 or higher at baseline. Between their first and second heart scan, women with baseline CAC of 1-99 saw their CAC rise by a median of eight points, double the median of four seen in their male counterparts. Similarly, women with baseline CAC of 100-399 saw their CAC rise by a median of 31 points, about double the median of 16 seen in males. There was no significant difference between sexes for those with baseline CAC of 400 or higher.

    The findings suggest plaque buildup is accelerated in post-menopausal women compared to men, indicating that many women experience a steep rise in the risk of heart problems. Ishaaya said this is likely related to the drop in estrogen that women experience during menopause. Estrogen has long been known to have a protective effect on heart health, but researchers said many women and even many clinicians are not aware of what it means to lose that protection during menopause.

    “After menopause, women have much less estrogen and shift to a more testosterone-heavy profile,” Ishaaya said. “This affects the way your body stores fat, where it stores fat and the way it processes fat; it even affects the way your blood clots. And all of those [changes] increase your risk for developing heart disease.”

    Heart disease is the leading cause of death in both men and women, but women’s cardiovascular risk has traditionally been undertreated because women tend to develop heart disease at an older age than men and may experience different and sometimes more subtle symptoms.

    Based on these results, researchers suggested post-menopausal women should talk to their doctor about heart disease risk factors and follow up on any recommended tests or monitoring. More women may benefit from heart scans when compared to the number of women currently receiving them, Ishaaya said.

    Since all the women in the study were taking statins but many still saw a substantial rise in CAC, the results may also indicate that statins are not sufficient to keep plaque buildup in check for this population, Ishaaya said. Future studies could investigate the effectiveness of statins or other therapies in reducing plaque burden in post-menopausal women, she said.

    ACC/American Heart Association guidelines recommend considering a heart scan to assess CAC when a person’s risk level is ambiguous or borderline based on standard risk factors. In the U.S. and many other countries, CAC scoring is most used to determine recommendations for statins for intermediate-risk and asymptomatic patients.

    Source:

    American College of Cardiology

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  • AI deciphers city designs that could cut heart disease rates

    AI deciphers city designs that could cut heart disease rates

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    In a recent study published in the European Heart Journal, researchers used cutting-edge artificial intelligence (AI) techniques and analyses to evaluate the association between AI model-identified ‘built environment features’ and the observed variance in coronary heart disease (CHD). Specifically, the team used custom convolutional neural networks (CNNs), linear mixed-effects models (LMEM), and activation maps to identify CHD-related feature associations and predict health outcomes at the census tract level.

    In the first of its kind, the study used more than 0.53 million Google Street View (GSV) for model training and evaluation, the outcomes of which suggest that AI algorithms may be able to design future cities with significantly reduced CHD burden.

    Study: Artificial intelligence–based assessment of built environment from Google Street View and coronary artery disease prevalence. Image Credit: yanto kw / ShutterstockStudy: Artificial intelligence–based assessment of built environment from Google Street View and coronary artery disease prevalence. Image Credit: yanto kw / Shutterstock

    CHD, GSV, and the potential for machine vision in built environments evaluations

    Coronary heart disease (CHD), also known as coronary artery disease (CAD), is a potentially life-threatening chronic, non-communicable disease characterized by plaque deposition along the walls of the coronary arteries, thereby hindering or outright blocking the movement of oxygenated blood to the heart. This buildup is usually gradual—it may begin during childhood, slowly progress, and eventually manifest as CHD during later life phases.

    Despite decades of research and substantial scientific progress in CHD risk detection and prevention, CHD remains a leading cause of heart-disease-associated mortality, particularly in the United States of America (USA), where it is estimated to account for well over 50% of all cardiac mortality (~400,000 deaths in 2020 alone). Recent evidence suggests that non-traditional risk factors, including race, income, culture, and education, may play a profound role in CHD pathology.

    Environmental factors such as temperature and environmental pollution (noise and air) have also been implicated in the disease, though evidence for these hypotheses remains lacking. A large-scale repository of ‘built’ urban features (buildings, green spaces, and roads) would allow for location-specific CHD risk detection and form the first step in policy-based healthcare interventions.

    “Large-scale integrated assessment of the environment at the neighbourhood level can facilitate rapid and complete assessment of its impact on CHD. Such data are however scarce, partly because of the costly and time-consuming nature of neighbourhood audits and inconsistent measurements and standards for data collection. Machine vision approaches such as Google Street View (GSV) have become an increasingly popular approach for virtual neighbourhood audits since its launch in 2007.”

    Google Street View (GSV) is an imaging technology featured in numerous Google applications, including Google Maps and Google Earth. First launched in 2007, the predominantly crowd-sourced image dataset displays interactive panoramas of stitched VR photographs and has achieved almost 100% coverage of the USA. Unrelated research utilizing the hitherto untapped potential of GSV has established the technology comparable to human ground-truthing in accuracy, especially when using machine learning algorithms to classify and assess built environmental features from GSV images.

    About the study

    The present study aims to use GSV images to evaluate built environments across seven USA cities and use these results to estimate CHD prevalence at the census tract level. Census tract-level data (for the year 2015-16) was obtained from the Behavioral Risk Factor Surveillance System (BRFSS), a collaboration between the 2018 Centers for Disease Control and Prevention (CDC) Population Level Analysis and Community Estimates (PLACES) and the Robert Wood Johnson Foundation. The dataset comprised American adults (>18 years) with clinically confirmed angina or CHD status (either positive or negative) from 789 census tracts across Bellevue, WA; Brownsville, TX; Cleveland, OH; Denver, CO; Detroit, MI; Fremont, CA; and Kansas City, KS.

    Data collected as a part of this study included de-identified demographic and socioeconomic (DSE; age, race, sex, education level, income, and occupation) factors and medical history. The image dataset comprised more than 0.53 million images from the GSV server, leaving Google’s image classification intact. Imagine data extraction was carried out using a deep CNN (DCNN) called Places365CNN, the default extractor for the Places Database. Given the similarity between GSV and Places image feature classification, Places365CNN was found to be robust for current study data extraction following training using more than 10 million training images.

    To explore the associations between raw DCNN extracted features (N = 4096) and tract-level CHD prevalence, researchers trained and tested three independent machine learning (ML) models, namely the extra-trees regressor (ET), the random forest regressor (RF), and the light gradient boosted machine regressor (LGBM). To improve the models’ predictive accuracy and result in robustness, all three models were subjected to 10-fold cross-validation. Following model training, multilevel regression analyses using both linear-fixed effects and random effects models were carried out with variables adjusted for age, sex, income, race, and education level.

    “…we employed the Grad-CAM technique to create the saliency map to highlight these prominent features in the original GSV images. This process provides certain explanations of what environmental features the CNN thinks to be associated with neighbourhood CHD prevalence.”

    Study findings and takeaways

    Geographic CHD prevalence was found to vary substantially, with Bellevue presenting a median prevalence % of 4.70 while Cleveland was much higher at 8.70. DCNN-extracted features were found to comprise more than 4,096 ML-classified features. A highlight of this work is that these extracted features alone were able to explain 63% of the observed inter-region variability in CHD prevalence.

    “We found a small number of extreme values that were underestimated by the models in certain census tracts of Detroit and Cleveland. The CHD prevalence of these underestimated census tracts was often more than 12%. When examining the CNN-extracted features using t-SNE, we noticed clustering of census tracts with similar values of CHD prevalence.”

    Multilevel modeling revealed that DSE factors (especially age, sex, and education status) were found to be more accurate predictors of CHD than GSV features. These results suggest that, while GSV features may indeed be helpful in highlighting specific built environment information related to CHD prevalence at the neighborhood level, additional computation (e.g., Grad-CAM methods) is required before the technology can be used to provide a potential way of identifying built environment information.

    “The outcomes of our study provide proof of concept for machine vision–enabled identification of urban network features associated with risk that in principle may enable rapid identification and targeting interventions in at-risk neighbourhoods to reduce cardiovascular burden.”

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  • Childhood BMI tied to higher blood pressure in middle age

    Childhood BMI tied to higher blood pressure in middle age

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    Children and teenagers living with overweight or obesity are more likely to have high blood pressure as adults (aged 50-64 years), suggesting the processes behind the condition could begin as early as childhood, suggests new research being presented at this year’s European Congress on Obesity (ECO) in Venice, Italy (12-15 May). 

    Results of the Swedish population-based study showed that blood pressure in adult men increased in a linear relationship with both higher childhood BMI (at age 8 years) and greater BMI change during puberty (BMI at 20 years minus childhood BMI), independent of each other. In women, blood pressure in middle age increased in linear association with greater pubertal BMI change, but not childhood BMI.

    Our results suggest that preventing overweight and obesity beginning in childhood matters when it comes to achieving a healthy blood pressure in later life. Children and teenagers living with overweight or obesity might benefit from targeted initiatives and lifestyle modifications to reduce the substantial disease burden associated with high blood pressure in later life from diseases such as heart attacks, strokes, and kidney damage.”

    Dr. Lina Lilja, lead author from the University of Gothenburg, Sweden

    Hypertension (persistent high blood pressure) is an important public health challenge worldwide because of its high prevalence and the associated risk of cardiovascular disease. WHO estimates that 1.28 billion adults aged 30-79 years are living with hypertension around the world. High blood pressure is the main cause of heart attacks, strokes, and chronic kidney disease, and is one of the most preventable and treatable causes of premature deaths worldwide. Modifiable risk factors include unhealthy diets, physical inactivity, and being overweight or obese.

    A high BMI in adults is strongly associated with increased blood pressure and hypertension. However, the relative contribution of an elevated BMI during childhood and puberty to blood pressure in midlife is unknown.

    To find out more, researchers analyzed data on 1,683 individuals (858 men and 825 women) born between 1948 and 1968 who were involved in two population-based cohorts-;both the BMI Epidemiology Study Gothenburg (BEST) cohort and the Swedish CArdioPulmonary bioImage Study (SCAPIS)-;to examine the association between BMI during development and systolic and diastolic blood pressure in midlife (50-64 years of age).

    The researchers measured the developmental BMI of participants from the BEST Gothenburg cohort using school health care records (at the age of 7 to 8 years) and for young adult age (at age 18 to 20) from school health care or medical examinations on enrolment in the military which was mandatory for young men until 2010. Information on blood pressure in midlife (at age 50-64 years) was taken from participants in the SCAPIS study who were not on medication for high blood pressure at the time of blood pressure measurement. All analyses were adjusted for birth year.

    The researchers used standard deviation, a commonly used statistical tool that shows what is within a normal range compared to the average.

    In analyses including both childhood BMI and the pubertal BMI change in the same model, results showed that for men, an increase of one BMI unit from the average BMI in childhood (BMI 15.6kg/m2) was associated with a 1.30 mmHg increase in systolic blood pressure and a 0.75 mmHg increase in diastolic blood pressure, independent of each other.

    Similarly, a one BMI unit increase from the average pubertal BMI (equivalent to an average pubertal BMI change of 5.4kg/m2) in men was associated with a 1.03 mmHg increase in systolic blood pressure and a 0.53 mmHg increase in diastolic blood pressure in middle age, independent of each other.

    In women, a one BMI unit increase in pubertal BMI was associated with a 0.96 mmHg increase in systolic blood pressure and a 0.77 mmHg increase in diastolic blood pressure in middle age, irrespective of childhood BMI. In contrast, childhood BMI was not linked with systolic or diastolic blood pressure in midlife, irrespective of the pubertal BMI change.

    “Although the differences in blood pressure are not very large, if blood pressure is slightly elevated over many years, it can damage blood vessels and lead to cardiovascular and kidney disease”, explains co-author Dr Jenny Kindblom from Sahlgrenska University Hospital i Sweden. “Our findings indicate that high blood pressure may originate in early life. Excessive fat mass induces chronic low grade inflammation and endothelial dysfunction [impaired functioning of the lining of the blood vessels] already in childhood. Higher amounts of visceral abdominal fat increases the risk of developing hypertension in adults. And we have previously shown that a large pubertal BMI change in men is associated with visceral obesity [fat around the internal organs] at a young adult age. So enlarged visceral fat mass might, in individuals with a high BMI increase during puberty, be a possible mechanism contributing to higher blood pressure.”

    She adds, “This study is important given the rising tide of obesity among children and teens. It is vital that we turn the focus from high blood pressure in adults to include people in younger age groups.”

    The authors note that the results are from observational findings, so more studies are needed to understand whether there are specific ages in childhood and/or adolescence when BMI is particularly important to blood pressure in adulthood. They also point to some limitations, including that a definite cause-and-effect link between BMI and high blood pressure cannot be determined in this type of population-based study; blood pressure was measured at a single point in time; the analyses were unable to account for the influence of other known risk factors such as diet and physical activity which could have influenced the results; and because most of the study participants were white, the results may not be generalizable to people from other racial or ethnic groups.

    High blood pressure is defined as a systolic blood pressure (SBP) at or above 140mmHg or diastolic blood pressure (DBP) at or above 90mmHg.

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  • Heavy drinkers who cut back see major heart health benefits, study finds

    Heavy drinkers who cut back see major heart health benefits, study finds

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    In a recent study published in JAMA Network Open, a group of researchers explored the link between lowering alcohol intake and the occurrence of major adverse cardiovascular events (MACEs) in heavy drinkers, focusing on different subtypes of cardiovascular disease (CVD).

    Study: Reduced Alcohol Consumption and Major Adverse Cardiovascular Events Among Individuals With Previously High Alcohol Consumption. Image Credit: Vaclav Mach / ShutterstockStudy: Reduced Alcohol Consumption and Major Adverse Cardiovascular Events Among Individuals With Previously High Alcohol Consumption. Image Credit: Vaclav Mach / Shutterstock

    Background 

    Alcohol consumption significantly influences both individual and public health, with research showing its complex relationship with CVD. While light to moderate drinking is believed to offer some protection against CVD, this effect varies by the type of CVD, and the relationship between alcohol intake and heart health is not linear. Previous studies have typically measured alcohol consumption at a single point in time and compared drinkers to non-drinkers without considering changes in drinking habits over time. Further research is essential to understand the mechanisms underlying the cardiovascular benefits of reduced alcohol consumption and to establish tailored guidelines for different populations and CVD subtypes.

    About the study 

    In the present study, researchers utilized data from the Korean National Health Insurance Service–Health Screening (NHIS-HEALS) database to examine a representative sample of Korean adults aged 40 to 79. Approved by Chungbuk National University Hospital’s institutional review board (IRB) and adhering to the Declaration of Helsinki and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, the study utilized the National Health Screening Program’s (NHSP’s) broad coverage to analyze information on demographics, medical histories, and lifestyle factors, including alcohol consumption. This careful documentation provided a foundation for a detailed investigation into the effects of alcohol on health.

    Participant selection was methodical, excluding non-drinkers in the latter period to avoid confounding factors like the sick-quitter effect. The study’s rigor extended to defining heavy drinking based on established criteria and dividing participants into groups based on their drinking habits over time. 

    Confounding variables were identified with precision, including a range of demographic, health, and lifestyle factors. The study’s outcomes centered on MACEs, with detailed coding and procedures to ensure accuracy. Statistical analyses were conducted with sophisticated tools and methods, including propensity score matching (PSM) and multivariate Cox proportional hazards regression models, to draw reliable conclusions about the relationship between alcohol consumption and cardiovascular health.

    Study results 

    In the comprehensive study analyzing 21,011 participants with initially high alcohol consumption levels, 14,220 maintained their heavy drinking habits, while 6,791 reduced their intake to mild or moderate levels. Predominantly male (90.3%) and averaging 56 years of age, this cohort provided a detailed snapshot of baseline health and lifestyle characteristics. Initially, the heavy drinkers were younger on average and had a higher proportion of males compared to those who reduced their alcohol consumption.

    Clinical indicators such as body mass index (BMI), blood pressure, and various biochemical markers showed differences between the groups, with the sustained heavy drinkers generally presenting poorer health metrics. Interestingly, despite the health disparities, after PSM, these groups were closely aligned on most variables, allowing for a more accurate comparison of outcomes.

    Over the course of the study, the incidence of MACEs was notably higher in the group that continued heavy drinking compared to those who reduced their intake, with a significant divergence in outcomes over time. Specifically, reduced drinking was associated with a 23% lower risk of experiencing a MACE. When examining specific CVDs, reductions in alcohol consumption significantly lowered the risk of coronary artery disease (CAD), angina, any stroke, ischemic stroke, and all-cause mortality, while no benefits were observed for nonfatal myocardial infarction (MI) or hemorrhagic stroke.

    Subgroup analyses highlighted the cardiovascular advantages of reducing alcohol intake across various demographics and health statuses, including age, gender, BMI, smoking status, and levels of physical activity. Notably, these benefits were evident regardless of pre-existing conditions like atrial fibrillation and chronic kidney disease and were consistent across different socioeconomic statuses and comorbidities.

    Further sensitivity analyses, which excluded variables potentially modifiable by alcohol consumption changes, reaffirmed the cardiovascular benefits of reducing alcohol intake. 

    Conclusions 

    To summarize, in the study, heavy drinkers who reduced their alcohol intake demonstrated a significantly lower risk of cardiovascular events over a decade, with notable health improvements visible three years post-reduction. This reduction in alcohol consumption correlated with a broad array of cardiovascular benefits, especially in lowering the risk of ischemic stroke and angina-related interventions. The study clarifies the complex biological mechanisms through which moderate alcohol consumption may confer cardiovascular protection, highlighting improvements in lipid regulation, endothelial function, and reduced inflammation. Importantly, it revealed specific reductions in CAD and ischemic stroke risk among heavy drinkers, underlining the potential health benefits of moderating alcohol intake.

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