Have Heart Disease? Exercise Will Help at Any Age

If you are older and you have heart disease, you might think you should take it easy. But new research suggests the opposite is true.

Exercise is especially beneficial for patients who have a physical impairment, the study authors found.

“Aging is associated with several factors such as increased inflammation or oxidative stress that predispose people to cardiovascular diseases. As a result, elderly patients are usually less fit than their younger counterparts, and deconditioning is accelerated once cardiovascular disease is established,” said lead investigator Gaelle Deley. She is with Faculty of Sports Sciences at the University of Burgundy Franche-Comte in Dijon, France.

For the study, the researchers analyzed the results of 733 patients who underwent 25 sessions of a cardiac rehabilitation program from January 2015 to September 2017.

The group was divided into three subgroups by age: under 65, between 65 and 80, and 80 and older.

“We found a few weeks of exercise training not only significantly improved exercise capacity but also decreased anxiety and depression. Patients with the greatest physical impairments at baseline benefited the most from exercise,” Deley said.

The report was published in the Canadian Journal of Cardiology.

“Another interesting result was that patients younger than 65 who were very anxious before rehabilitation benefited the most from exercise training,” Deley said in a journal news release.

“A similar result was found for depressed patients older than 65,” she added. “These improvements will surely have a great positive impact on patients’ independence and quality of life, and might help both clinicians and patients to realize how beneficial exercise rehabilitation can be.”

Source: HealthDay


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High Fiber Diet Associated with Reduced Cardiovascular Risk in Hypertension, Type 2 Diabetes Patients

Patients with hypertension and Type 2 diabetes who consume a high fiber diet had improvement in their blood pressure, cholesterol and fasting glucose, according to a study presented at the American College of Cardiology (ACC) Middle East Conference 2019 together with the 10th Emirates Cardiac Society Congress. The conference is Oct. 3-5 in Dubai, United Arab Emirates.

Hypertension and diabetes are major risk factors for future cardiovascular disease. Diet also plays a role in the severity of cardiovascular disease. Researchers from Care Well Heart and Super Specialty Hospital in Amritsar, India, investigated the relation between a high fiber diet and its impact on cardiovascular disease risk factors.

According to guidelines from the National Institute of Nutrition and the Indian Council of Medical Research, the recommended dietary allowance (RDA) for dietary fiber is 40gm/2000kcal. Patients in this study had Type 2 diabetes and a calorie intake of 1,200-1,500kcal, causing their RDA for fiber to be 24-30gm. The fiber intake of these patients was increased up to 20 to 25 percent from the recommended allowances for them to be consuming a high fiber diet.

The study tracked 200 participants’ fiber intake for six months and included check-ups at the start of the study, three months and six months. Participants were provided diet prescriptions, which included detailed lists of different food groups with portion sizes in regional languages. Qualified dietitians provided the information through regular counseling sessions and used audio-visual aids to ensure understanding among study participants.

The researchers tracked participants’ fiber intake several ways, including having patients send photos of their meals on WhatsApp–which not only helped in knowing their fiber intake but also helped approximate portion sizes–and telephone calls three times a week during which detailed dietary recall was taken.

“Comprehensive evaluation of etiological effects of dietary factors on cardiometabolic outcomes, their quantitative effects and corresponding optimal intakes are well-established,” said Rohit Kapoor, MD, medical director of Care Well Heart and Super Specialty Hospital and lead author of the study. “This study helps us determine three important things for this patient population. Firstly, a high fiber diet is important in cases of diabetes and hypertension to prevent future cardiovascular disease. Secondly, medical nutrition therapy and regular counseling sessions also hold great importance in treating and prevention of diabetes and hypertension. Thirdly, this type of diet in combination with medical treatment can improve dyslipidemia, pulse wave velocity, waist-to-hip ratio and hypertension.”

Participants on a high fiber diet experienced significant improvement in several cardiovascular risk factors, including a 9 percent reduction in serum cholesterol, 23 percent reduction in triglycerides, 15 percent reduction of systolic blood pressure and a 28 percent reduction of fasting glucose. The researchers found a high fiber diet is inversely related with cardiovascular risk factors and plays a protective role against cardiovascular disease.

Source: EurekAlert!

Pesticide Exposure May Increase Heart Disease and Stroke Risk

On-the-job exposure to high levels of pesticides raised the risk of heart disease and stroke in a generally healthy group of Japanese American men in Hawaii, according to new research published in the Journal of the American Heart Association, the open access journal of the American Heart Association.

“This study emphasizes the importance of using personal protective equipment during exposure to pesticides on the job and the importance of documenting occupational exposure to pesticides in medical records, as well as controlling standard heart disease risk factors,” said Beatriz L. Rodriguez, M.D., Ph.D., M.P.H., co-author of the study and professor of geriatric medicine at the University of Hawaii at Manoa.

The findings are the latest to emerge from the Kuakini Honolulu Heart Program, which enrolled over 8,000 Japanese American men on Oahu between 1965 and 1968. Men enrolled in the study were 45 to 68 years of age and self-reported their occupation. The group has since undergone multiple examinations and researchers are also tracking all causes of death and some disease outcomes. Data on rates of heart disease and stroke were available through December 1999, for up to 34 years of follow-up.

Pesticide exposure was estimated using a scale from the Occupational Safety and Health Administration that assesses the intensity and length of occupational exposure for each job. Compared to men who were not exposed to pesticides at work, in the first 10 years of follow-up, the researchers found:

  • Roughly a 45% higher risk of heart disease or stroke in those with high pesticide exposure, (46% after adjusting for age, and 42% after adjusting for other heart disease risk factors as well as age); and
  • There was no significant relationship between low to moderate exposure to pesticides and the risk of heart disease or stroke.

Pesticides have a long half-life, so health effects may occur years after exposure. By analyzing different time lags, the researchers found that the maximum effect of exposure on heart disease and stroke risk was during the first 10 years.

“After following the men for 34 years, the link between being exposed to pesticides at work and heart disease and stroke was no longer significant. This was probably because other factors tied to aging became more important, masking the possible relation of pesticides and cardiovascular disease later in life,” Rodriguez said.

The study was conducted only in men of Japanese descent, and the results may not apply to women or other races.

“Previous studies have found that men and women may respond differently to pesticide exposure. One class of pesticides may give women heart attacks but not men and other pesticides may give men heart disease but not women. Hormones may also play a role in the impact of pesticide exposure and the development of cardiovascular disease,” said Zara Berg, Ph.D., co-author of the study and adjunct science professor at Fort Peck Community College in Poplar, Montana.

Although the study was conducted solely in first or second-generation Japanese American men, similar results were found in Taiwan for high pesticide exposure in middle age.

Source: American Heart Association


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Bathroom Scale Could Monitor Millions with Heart Failure

“Good morning. Bill. Please. Step onto the scale. Touch the metal pads.” The device records an electrocardiogram from Bill’s fingers and – more importantly – circulation pulsing that makes his body subtly bob up and down on the scale. Machine learning tools compute that Bill’s heart failure symptoms have worsened.

This is how researchers at the Georgia Institute of Technology envision their experimental device reaching patients someday, and in a new study, they reported proof-of-concept success in recording and processing data from 43 patients with heart failure. A future marketable version of the medical monitoring scale would ideally notify a doctor, who would call Bill to adjust his medication at home, hopefully sparing him a long hospital stay and needless suffering.

The pulsing and bobbing signal is called a ballistocardiogram (BCG), a measurement researchers took more commonly about 100 years ago but gave up on as imaging technology far surpassed it. The researchers are making it useful again with modern computation.

“Our work is the first time that BCGs have been used to classify the status of heart failure patients,” said Omer Inan, the study’s principal investigator and an associate professor in Georgia Tech’s School of Electrical and Computer Engineering.

Healthcare crisis

Heart failure affects 6.5 million Americans and is a slow-progressing disease, in which the heart works less and less effectively. Many people know it as congestive heart failure because a major symptom is fluid buildup, which can overwhelm the lungs, impeding breathing and possibly causing death.

Patients endure repeat hospitalizations to adjust medications when their condition dips, or “decompensates,” making heart failure a major driver of hospital admissions and healthcare costs. Home monitoring reduces hospitalizations but currently requires an invasive procedure.

Georgia Tech research was behind the launch of such an implantable heart failure home monitoring device in 2011. But this new solution would potentially dispense with the procedure, cost much less, and be much simpler to use – lowering patients’ resistance to home monitoring.

Given its early stage, the study’s BCG-EKG scale performed well in hospital tests but also in in-home tests, which was promising, since the solution principally targets eventual home use.

The research team, which included collaborators from the University of California, San Francisco, and Northwestern University, published their results in the journal IEEE Transactions on Biomedical Engineering. The research was funded by the National Heart, Lung and Blood Institute at the National Institutes of Health.

Ballisto scribble

The EKG part of the experimental scale is not new nor its great diagnostic information, but it alone does not say enough about heart failure. The BCG part is mostly new, and it appears valuable to heart failure monitoring but also challenging to record and interpret.

“The ECG (EKG) has characteristic waves that clinicians have understood for 100 years, and now, computers read it a lot of the time,” Inan said. “Elements of the BCG signal aren’t really known well yet, and they haven’t been measured in patients with heart failure very much at all.”

The EKG is electrical; the body conducts its signals well, and the recordings are clear.

The BCG is a mechanical signal; body fat dampens it, and it faces a lot of interference in the body like tissue variations and muscle movement. BCGs are also noisier in people with cardiovascular disease.

Patients with heart failure tend to be feebler, and initially, the researchers worried they would wobble on scales during home tests, adding even more noise to the BCGs. But the recordings were very productive.

Though a BCG read-out is scribble compared to an EKG’s near-uniform etchings, BCGs have some patterns that parallel an EKG’s. For example, the big upward spike in an EKG is followed by the BCG’s big “J-wave.”

Inconsistent throbbing

The researchers processed BCGs with three machine learning algorithms, revealing patterns that differ when a patient’s heart failure is compensated, that is, healthier, from when it is decompensated.

“In someone with decompensated heart failure, the cardiovascular system can no longer compensate for the reduced heart function, and then the flow of blood through the arteries is more disorderly, and we see it in the mechanical signal of the BCG,” Inan said. “That difference does not show up in the ECG because it’s an electrical signal.”

“The most important characteristic was the degree to which the BCG is variable, which would mean inconsistent blood flow. If you chop up the recording into 20-second intervals and the individual segments differ from each other a lot, that’s a good marker of decompensation,” Inan said.

Source: Georgia Institute of Technology

Healthy Foods More Important than Type of Diet to Reduce Heart Disease Risk

Lindsey Diaz-MacInnis wrote . . . . . . . . .

Everyone knows that achieving or maintaining a healthy body weight is one key to preventing cardiovascular disease. But even experts don’t agree on the best way to achieve that goal, with some recommending eliminating carbohydrates and others emphasizing reducing fats to lose weight. Few studies have investigated the effects of these specific macronutrients on cardiovascular health.

In a study published online in the International Journal of Cardiology, researchers at Beth Israel Deaconess Medical Center (BIDMC) examined the effects of three healthy diets emphasizing different macronutrients – carbohydrates, proteins, or unsaturated fats – on a biomarker that directly reflects heart injury. Using highly specific tests, the team found that all three diets reduced heart cell damage and inflammation, consistent with improved heart health.

“It’s possible that macronutrients matter less than simply eating healthy foods,” said corresponding author Stephen Juraschek, MD, PhD, Assistant Professor of Medicine at BIDMC and Harvard Medical School. “Our findings support flexibility in food selection for people attempting to eat a healthier diet and should make it easier. With the average American eating fewer than two servings of fruit and vegetables a day, the typical American diet is quite different from any of these diets, which all included at least four to six servings of fruits and vegetables a day.”

Juraschek and colleagues analyzed stored blood samples from 150 participants of the Optimal MacroNutrient Intake Trial to Prevent Heart Disease (OmniHeart) trial, a two-center, inpatient feeding study conducted in Boston and Baltimore between April 2003 and June 2005. The average age among the study participants was 53.6 years, while 55 percent were African American and 45 percent were women. The participants – all of whom had elevated blood pressure, but were not yet taking medications to control hypertension or cholesterol – were fed each of three diets – emphasizing carbohydrates, protein, or unsaturated fat – for six weeks with feeding periods separated by a washout period.

The diets were: a carbohydrate-rich diet similar to the well-known DASH diet, with sugars, grains and starches accounting for more than half of its calories; a protein-rich diet with 10 percent of calories from carbohydrates replaced by protein; and an unsaturated fat-rich diet with 10 percent of calories from carbohydrates replaced by the healthy fats found in avocados, fish and nuts. All three diets were low in unhealthy saturated fat, cholesterol, and sodium, while providing other nutrients at recommended dietary levels. The research team looked at the effects of each diet on biomarkers measured at the end of each dietary period compared to baseline and compared between diets.

All three healthy diets reduced heart injury and inflammation and acted quickly within a 6-week period. However, changing the macronutrients of the diet did not provide extra benefits. This is important for two reasons: First, the effects of diet on heart injury are rapid and cardiac injury can be reduced soon after adopting a healthy diet. Second, it is not the type of diet that matters for cardiac injury (high or low fat, high or low carb), but rather the overall healthfulness of the diet.

“There are multiple debates about dietary carbs and fat, but the message from our data is clear: eating a balanced diet rich in fruits and vegetables, lean meats, and high in fiber that is restricted in red meats, sugary beverages, and sweets, will not only improve cardiovascular risk factors, but also reduce direct injury to the heart,” said Juraschek. “Hopefully, these findings will resonate with adults as they shop in grocery stores and with health practitioners providing counsel in clinics throughout the country.”

Source: Beth Israel Deaconess Medical Center


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