“Prescription” to Sit Less, Move More Advised for Mildly High Blood Pressure & Cholesterol

A “prescription” to sit less and move more is the optimal first treatment choice for reducing mild to moderately elevated blood pressure and blood cholesterol in otherwise healthy adults, according to the new American Heart Association scientific statement published today in the American Heart Association’s journal Hypertension.

“The current American Heart Association guidelines for diagnosing high blood pressure and cholesterol recognize that otherwise healthy individuals with mildly or moderately elevated levels of these cardiovascular risk factors should actively attempt to reduce these risks. The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity,” said Bethany Barone Gibbs, Ph.D., FAHA, chair of the statement writing group and associate professor in the department of health and human development and clinical and translational sciences at the University of Pittsburgh in Pittsburgh, Pennsylvania.

An estimated 21% of U.S. adults, about 53 million, have systolic (top number) blood pressure between 120-139 mm Hg or diastolic (bottom number) blood pressure between 80-89 mm Hg; both values are abnormally high. Individuals in this range who have an otherwise low risk of heart disease or stroke meet the American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline criteria for lifestyle-only treatment for elevated blood pressure.

Likewise, the scientific statement authors estimate that 28% of U.S. adults, or about 71 million, have an LDL cholesterol score above 70 mg/dL and otherwise meet criteria for low risk of heart disease or stroke. These people would meet the 2018 AHA/ACC Cholesterol Treatment Guidelines criteria for lifestyle-only treatment. Lifestyle changes highlighted in the blood pressure and cholesterol guidelines include increased physical activity, weight loss, improving diet, stopping smoking and moderating alcohol intake.

“Increasing physical activity can help lower blood pressure and cholesterol, along with many other health benefits.” Gibbs said. Physical activity also has benefits beyond cardiovascular health, including a decreased risk of some cancers, improved bone, brain and mental health, and better sleep.

Increasing physical activity results in clinically meaningful reductions in systolic and diastolic blood pressure, typically an average reduction of 3 or 4 mm Hg. Similar improvements are seen with blood cholesterol. For example, increased physical activity typically decreases LDL cholesterol by 3 to 6 mg/dL.

The statement highlights research concluding that physically active people have a 21% lower risk of developing cardiovascular disease and a 36% lower risk of death from cardiovascular diseases compared to those who are not physically active.

To improve health, the U.S. Department of Health and Human Services 2018 Physical Activity Guidelines for Americans suggest individuals participate in either a cumulative 150 minutes of moderate intensity aerobic exercise, or 75 minutes of vigorous aerobic activity weekly plus two or more strength training sessions each week.

However, there is no minimum amount of time to receive benefits from physical activity. “Every little bit of activity is better than none,” said Gibbs. “Even small initial increases of 5 to 10 minutes a day can yield health benefits.”

The statement provides suggestions for clinicians to provide exercise “prescriptions” such as patient counselling, incorporating health behavior professionals (e.g., health coaches) and connecting patients to local resources like community centers to help meet their physical activity needs.

According to the statement, prescribing exercise includes:

  • Screening patients about physical activity at every interaction, as recommended by the American College of Sports Medicine’s ‘Exercise is Medicine’ campaign. Clinicians can ask patients to report their physical activity with a few questions or by using a wearable device.
  • Providing ideas and resources for supporting patients to improve and sustain regular physical activity;
  • Meeting patients where they are by exploring activities that the patient enjoys and provide ideas for early success; and
  • Encouraging and celebrating small increases in physical activity, such as walking more or taking the stairs.

“In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit – and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus – the message that we must be relentless in our pursuit to ‘sit less and move more’ throughout the day is more important than ever,” said Gibbs.

Source: American Heart Association

Managing Children’s Weight, Blood Pressure & Cholesterol Protects Brain Function Mid-life

Managing weight, blood pressure and cholesterol in children may help protect brain function in later life, according to new research published in the American Heart Association’s flagship journal Circulation. This is the first study to highlight that cardiovascular risk factors accumulated from childhood through mid-life may influence poor cognitive performance at midlife.

Previous research has indicated that nearly 1 in 5 people older than 60 have at least mild loss of brain function. Cognitive deficits are known to be linked with cardiovascular risk factors, such as high blood pressure, obesity, type 2 diabetes, smoking, physical inactivity and poor diet, as well as depression and low education level.

Many diseases that cause neurological deficits, such as Alzheimer’s, have a long preclinical phase before noticeable symptoms begin, so finding links between childhood obesity and other cardiovascular risk factors is important for cognitive health. The researchers noted that there are currently no cures for major causes of dementia, so it is important to learn how early in life cardiovascular risk factors may affect the brain.

“We can use these results to turn the focus of brain health from old age and midlife to people in younger age groups,” said the study’s first author Juuso O. Hakala, M.D., a Ph.D. student at the Research Centre of Applied and Prevention Cardiovascular Medicine at the University of Turku, in Turku, Finland. ”Our results show active monitoring and prevention of heart disease and stroke risk factors, beginning from early childhood, can also matter greatly when it comes to brain health. Children who have adverse cardiovascular risk factors might benefit from early intervention and lifestyle modifications.”

The Cardiovascular Risk in Young Finns Study is a national, longitudinal study on cardiovascular risk from childhood to adulthood in Finland. Researchers followed the participants’ cardiovascular risk factor profiles for 31 years from childhood to adulthood. Baseline clinical examinations were conducted in 1980 on approximately 3,600 randomly selected boys and girls, ranging in ages from 3 to 18, all of whom were white. More than 2,000 of the participants, ranging in ages from 34 to 49, underwent a computerized cognitive function test in 2011. The test measured four different cognitive domains: episodic memory and associative learning; short-term working memory; reaction and movement time; and visual processing and sustained attention.

Researchers found:

  • Systolic blood pressure, total blood cholesterol and low-density lipoprotein (LDL) cholesterol, as well as body mass index, from childhood to midlife are associated with brain function in middle age.
  • Consistently high systolic blood pressure or high blood total cholesterol and LDL cholesterol were linked to worse memory and learning by midlife when compared with lower measures.
  • Obesity from childhood to adulthood was associated with lower visual information processing speed and maintaining attention.
  • Having all three cardiovascular risk factors was linked to poorer memory and associative learning, worse visual processing, decreased attention span, and slower reaction and movement time.

These results are from observational findings, so more studies are needed to learn whether there are specific ages in childhood and/or adolescence when cardiovascular risk factors are particularly important to brain health in adulthood. Study limitations include that a definite cause-and-effect link between cardiovascular risk factors and cognitive performance cannot be determined in this type of population-based study; cognition was measured at a single point in time; and because all study participants are white, the results may not be generalizable to people from other racial or ethnic groups.

Source: American Heart Association

Not All “Good” Cholesterol is Healthy

HDL cholesterol (high-density lipoprotein cholesterol) or good cholesterol is associated with a decreased risk of cardiovascular disease as it transports cholesterol deposited in the arteries to the liver to be eliminated. This contrasts with the so-called bad cholesterol, LDL (low-density lipoprotein cholesterol), which causes cholesterol to accumulate in the arteries and increases cardiovascular risk. Although drugs that lower bad cholesterol reduce cardiovascular risk, those that raise good cholesterol have not proven effective in reducing the risk of heart disease. This paradox has called into question the relationship between good cholesterol and cardiovascular risk, and researchers are now studying the characteristics of these HDL or good cholesterol particles.

A study led by the Hospital del Mar Medical Research Institute (IMIM), published in the journal Metabolism, Clinical and Experimental, has now demonstrated that not all good cholesterol is healthy. Researchers from the CIBER on Cardiovascular Diseases (CIBERCV), the CIBER on Obesity and Nutrition (CIBEROBN), and the CIBER on Epidemiology and Public Health (CIBERESP), as well as others from Hospital Clínic-IDIBAPS, IDIBELL, the Hospital de la Santa Creu i Sant Pau Research Institute, and the Hospital Clínico Universitario in Zaragoza also took part in this study.

In the work, the researchers analysed genetic characteristics that determine the size of good cholesterol particles, and then studied their relationship with the risk of myocardial infarction. The conclusion is that genetic characteristics linked to the generation of large good cholesterol particles are directly associated with a higher risk of heart attack, while features linked to small good cholesterol particles are related to a lower risk of heart attack. “There is a positive causal relationship between the size of HDL cholesterol particles and the risk of heart attack, so although we have to increase the levels of good cholesterol in the blood, they must always be small particles”, explains the study’s principal investigator, Dr. Robert Elosua, a researcher at the Hospital del Mar-IMIM, CIBERCV, and the University of Vic-Central University of Catalonia (UVic-UCC).

The good cholesterol particles are more effective in transferring cholesterol to the liver so that it can be eliminated. “If we need to do something in relation to HDL, it is to increase the number of small particles, which are those that adequately perform the function of eliminating cholesterol, those that really move it to the liver for removal, and do not allow it to accumulate in the arteries and cause cardiovascular disease”, says Dr. Álvaro Hernáez, a IDIBAPS and CIBEROBN researcher.

Currently, there are no drugs that increase good cholesterol levels and reduce the risk of cardiovascular disease. “This study highlights new and potential therapeutic targets in the field of cardiovascular diseases, including several genes related to the qualitative aspects of HDL particles, which may contribute to cardiovascular prevention”, concludes Dr. Albert Prats, a researcher in the Epidemiology and Cardiovascular Genetics Research Group at the Hospital del Mar-IMIM and first author of the study.

Source: EurekAlert!

Making Sense of Cholesterol – the Good, the Bad and the Dietary

Cholesterol can be confusing. But understanding it could help you live a longer, healthier life.

So in honor of Cholesterol Education Month, we asked a pair of experts to clear up five common questions.

Do my blood cholesterol numbers matter?

“The answer is yes,” said Dr. Neil J. Stone, Bonow Professor in Medicine-Cardiology at Northwestern University’s Feinberg School of Medicine in Chicago.

Studies show healthy people with LDL levels of 100 mg/dL or below tend to have lower rates of heart disease and stroke, supporting a “lower is better” philosophy, according to cholesterol guidelines issued by the American College of Cardiology and American Heart Association in 2018.

Older recommendations emphasized targeting specific cholesterol numbers. But today, doctors use cholesterol tests as part of a personalized assessment of overall cardiovascular risk. Those with the highest risk have the most to gain from cholesterol-lowering, said Stone, who was vice chair of the task force for the guidelines.

But “cholesterol doesn’t exist in isolation,” he said. “One has to think about diet and lifestyle and medication to treat the whole risk continuum of blood pressure, cholesterol, blood sugar and weight.”

The guidelines recommend getting cholesterol and other traditional risk factors checked every four to six years starting at age 20. If the COVID-19 pandemic has complicated those plans, get up to date when you can do so safely, said Kristina Petersen, an assistant professor in the department of nutritional sciences at Texas Tech University in Lubbock.

I’m confused about “good” cholesterol versus “bad.” What should I focus on?

When you get your blood tested, you’ll probably see numbers for total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.

LDL is the so-called bad cholesterol because it increases the risk of heart disease, stroke and other health problems. HDL is dubbed the good cholesterol because having a higher level is associated with lower risk of heart disease and stroke.

Lowering LDL should be the priority, said Petersen, co-author of an AHA science advisory on dietary cholesterol and heart disease published in December in the journal Circulation.

“The most important thing is to lower LDL cholesterol, because that is what ultimately increases your risk of heart disease,” she said.

Should I worry about cholesterol in food?

Many sources of cholesterol in the diet also are sources of saturated fat, Petersen said. “We do want to limit dietary saturated fat intake. And if you do that, your intake of dietary cholesterol will be low.” Cutting back on saturated fat can improve your LDL number in four to six weeks, she said.

The advisory on dietary cholesterol emphasizes that a healthy diet is more important than focusing on a specific cholesterol target, and such a diet highlights fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean animal protein or plant protein sources, nuts, seeds and liquid vegetable oils.

Selecting the right food may be particularly important for people who are sensitive to dietary cholesterol, which some studies suggest could be the case for roughly 1 in 4 people. A 2019 review published in JAMA of long-term studies suggested that each additional 300 milligrams of dietary cholesterol consumed per day was significantly associated with higher risk of heart disease.

“The patient should talk to the doctor about individualizing” limits on dietary cholesterol, Stone said.

Is it OK to eat eggs?

Egg yolks are known for their cholesterol, with one large scrambled egg containing 169 milligrams of cholesterol.

“You can eat eggs,” Petersen said. “We suggest eating no more than one full egg per day in order to keep your cholesterol intake low, but you can definitely have eggs as part of a healthy dietary pattern.”

The research is inconsistent, she said, because eggs often are consumed with foods high in saturated fat, making it hard to parse out potential harm.

And people vary, Stone said. “Some patients have two eggs a day, and their cholesterol doesn’t budge. Other patients have two eggs a day and their cholesterol goes up 50 points.”

Is possible to inherit high cholesterol?

High LDL cholesterol is sometimes caused by a genetic abnormality called familial hypercholesterolemia that affects an estimated 1 in 212 U.S. adults. If it’s picked up early, medication combined with a healthy diet and exercise can be very effective.

The ACC/AHA guidelines say it’s reasonable to check cholesterol in children as young as 2 who have a family history of early heart disease or high cholesterol.

Everyone needs to stay aware of their cholesterol levels and be mindful of the connection to overall health, even amid the pandemic, Stone said.

“This is exactly not the right time to let diet and regular exercise go – to develop habits that are not heart-healthy,” he said. “This is exactly the right time to learn how to eat less, eat smarter, move more daily, and keep from gaining weight.”

Source: American Heart Association


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New Digital Tools Help People with High Blood Pressure and High Cholesterol Make Meaningful Behavior Change

About 22% of people with heart disease struggle with depression and according to a 2015 study published in the Journal of Clinical Psychiatry, depression alone costs the U.S. economy an estimated $210 billion per year, with more than 60% of the cost related to treating comorbid conditions such as diabetes and heart disease. To help people with heart disease make meaningful behavior change so they can live life more fully, the American Heart Association, the leading voluntary health organization devoted to a world of longer, healthier lives, and Happify Health have worked together to incorporate the Association’s science-based health content into Happify Heart and Mind, a new mental health program offered through the Happify Health Solutions platform to employers and health plans.

Happify Heart and Mind teaches people with high blood pressure and high cholesterol strategies to reduce stress, incorporate more heart-healthy foods into their diet, and integrate more movement into their days. A variety of activities are available, including guided meditations, healthy meal prep strategies, psychoeducational content and goal-setting exercises. Happify Heart and Mind features a total of 10 content tracks, including the exclusive track developed by the Association, “Defeat Stress and Live a Heart-Healthy Life,” as well as many of Happify’s specially curated tracks for a healthy lifestyle, such as “Get Motivated to Get Fit,” and “Your Anxiety Antidote: Mindfulness Meditation.” Also incorporated in the program are heart-healthy physical activities, including short videos that feature stretching, core exercises, resistance training, and mindful yoga flows.

“We are honored to be working with the American Heart Association to help meet the mental health needs of those living with cardiovascular disease–needs that have become more complicated during this global pandemic,” said Ofer Leidner, president and co-founder at Happify Health, “We’re proud to offer Heart and Mind as a healthy resource that can be used anywhere and at any time, to help people with heart disease and stroke survivors better cope with their symptoms while at home, now, and in the future.”

Multiple studies recently presented at the American Heart Association’s Scientific Sessions reinforced the link between mental health and cardiovascular health. The correlation is also a focus of the Association’s 40-plus member CEO Roundtable leadership collaborative, which produced a roadmap for employers to tackle growing challenges for addressing mental health issues. The CEO Roundtable has also launched a nationwide public awareness campaign that aims to normalize the conversation around mental health, reduce stigma, and help employees engage with company-provided resources to address this prevalent health issue.

“With our increased focus on the links between mental health and cardiovascular disease and stroke, this collaboration with Happify is a natural extension of the Association’s increased focus on the links between mental health and cardiovascular disease,” said Eduardo Sanchez, M.D., chief medical officer for prevention at the American Heart Association. “As we work toward a world of longer, healthier lives, it’s important for us to address all of the risk factors that impact people’s health, from Life’s Simple 7 to mental health.”

Following the Association’s Life’s Simple 7, the seven risk factors that people can improve through lifestyle changes to help achieve ideal cardiovascular health, can greatly increase physical and mental wellness and decrease deaths by 76%. However, according to an AHA Journals published study, just 1% of people do all seven, and 91% do just one. A study published by the National Center for Biotechnology Information (NCBI) found that up to 40% of cardiac patients meet the criteria for major depressive disorder or experience an elevation in depressive symptoms.

The efficacy of Happify’s therapy has been proven through two randomized controlled trials and three published studies in peer-reviewed publications. One published randomized controlled trial found a 25% reduction in both the symptoms of anxiety and depression for those using Happify, when compared with an active comparison condition, psychoeducation, used as directed by this study. More information about Happify’s scientific testing and research science can be found on the Happify Labs page.

Source: American Heart Association


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