Apple-shape Older Women Have Higher Heart Disease Risk

Lisa Rapaport wrote . . . . . . . . .

Older women who are at a healthy weight may be more likely to develop heart disease when they carry excess fat around their midsection than when they store more fat in their hips and thighs, a new study suggests.

While being overweight has long been linked to a higher risk of heart disease, the risks associated with excess fat for people with a body mass index (BMI) in the healthy range aren’t as clear, researchers note in the European Heart Journal.

The current study involved 2,683 women who had already gone through menopause but didn’t have cardiovascular disease. Researchers followed half of the participants for at least 18 years.

Overall, 291 women developed heart disease. Women with the most belly fat, or an “apple” shape, were 91 percent more likely to develop heart disease than women with the least amount of fat around their midsection.

The risk was most pronounced for women who had lots of belly fat and very little fat on their thighs. These women were more than three times more likely to develop heart disease than women who had the opposite shape: fatter thighs and flatter stomachs.

“An `apple’ shape has been associated with increased heart risk in previous studies, but it mostly refers to central obesity among people already have a weight problem,” said Qibin Qi, senior author of the study and a researcher at Albert Einstein College of Medicine in Bronx, New York.

“Our study found, for the first time, that among postmenopausal women with normal body mass index (BMI), elevated trunk fat (apple shape) is associated with increased risk of cardiovascular disease, while elevated leg fat (pear shape) is associated with reduced risk of cardiovascular disease,” Qi said by email.

Women who had the most pronounced “pear” shape, with more fat on their thighs, were 38 percent less likely to develop heart disease during the study than women with the least amount of fat on their upper legs.

All of the women in the study had a healthy BMI ranging from 18.5 to 24.9.

When women go through menopause, they can also experience changes in their body shape and metabolism as more fat gets stored around the organs rather than right under the skin, the study authors note. The distribution of body fat can be shaped by genetics, as well as by eating and exercise habits.

The study wasn’t a controlled experiment designed to prove whether or how the location of excess fat in health-weight women might directly cause cardiovascular disease.

One limitation is that the participants were predominantly white, and results might differ for men or for women from other racial or ethnic groups.

It’s also not clear what dietary or exercise changes might help women shed fat specifically around their belly or shift where their body stores fat to transform their shape from an “apple” to a “pear,” Qi said.

“Unfortunately, it´s very difficult to increase leg fat at the expense of trunk fat,” said Dr. Matthias Bluher of the University of Leipzig in Germany, coauthor of an editorial accompanying the study.

“However, reducing trunk fat with a low calorie diet and regular exercise may be beneficial even if you are normal weight,” Blüher said by email.

Source: Reuters


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Higher Coronary Artery Calcium Levels in Middle-age May Indicate Higher Risk for Future Heart Problems

Higher coronary artery calcium levels in middle-age were associated with structural heart abnormalities linked to future heart failure, particularly among blacks, according to new research in Circulation: Cardiovascular Imaging, an American Heart Association journal.

Coronary artery calcium (CAC) is the buildup of calcified plaque made up of fat, calcium and cholesterol. The calcium found in this type of plaque is not related to dietary calcium. Elevated cholesterol levels in the blood can contribute to plaque buildup, known as atherosclerosis, which narrows the channel within an artery and reduces blood flow.

CAC is a risk marker for heart health problems, and CAC screening was added to the American Heart Association’s 2018 cholesterol management guidelines to further improve early detection of heart health abnormalities, especially among people who might be at a higher risk. A CAC score of zero indicates there is low risk in the absence of other high-risk conditions, while a score above zero indicates increasing risk.

In this study, researchers tracked 2,449 people (52% white, 57% women) from young adulthood to middle-age. Non-invasive computed tomography imaging tests were used to gauge the participants’ vascular health, with participants’ imaging tests and CAC scores compared at years 15 and 25 of the study period.

By year 25, participants’ average age was about 50. Seventy-two percent of the group had a CAC score of zero compared with 77% a decade earlier.

“We looked at early adulthood to middle-age because this is a window in which we can see abnormalities that might not be causing symptoms, but could later increase the risk of heart problems,” said Henrique Turin Moreira, M.D., Ph.D., study co-author and an attending physician at Hospital das Clínicas de Ribeirão Preto at the University of São Paulo in Brazil. “Prevention and control of these abnormalities are key, so early identification of risks can be crucial.”

Moreira and team found that increases in CAC scores were independently related to increasing age, male sex, black race, higher systolic blood pressure, higher total cholesterol, diabetes mellitus and current smoking, as well as the use of medications to lower blood pressure and cholesterol. Additionally, they found:

  • Compared with patients who had CAC scores of zero, those who had higher CAC scores at middle-age had a 12% increase in left ventricular mass and a 9% increase in left ventricular volume, independent of other risk factors including demographic information and cardiovascular risks. Abnormalities in the left ventricle means the heart had to work harder to effectively pump blood, and as a result, became enlarged and thickened, a risk factor for heart failure.
  • These findings were even more significant among blacks. For every one-unit change in a CAC score, blacks had four times higher increase in left ventricular mass compared with whites.
  • While progression in CAC over the follow-up was strongly related to higher left ventricular mass in blacks, this relationship was not significant in whites.

Blacks already face a greater risk and burden of heart disease and stroke: 60% of adult black men and 57% of adult black women have some form of cardiovascular disease, compared with 50% of white men and 43% of white women.

“Racial differences in our findings may be due to genetic factors or perhaps greater exposure to cardiovascular risk factors that usually appear earlier in blacks,” Moreira said. “We need more research to examine the link between coronary artery calcium and heart health.”

“Prior studies have shown that presence of CAC and higher CAC scores are associated with atherosclerotic cardiovascular disease in young to middle aged adults. The results of this study are important as they highlight that presence of CAC and higher CAC scores may also be associated with echocardiographic markers of subclinical LV systolic and diastolic dysfunction,” said Salim Virani, M.D., a member of the writing committee for the American Heart Association’s 2018 cholesterol guidelines and director of the Cardiology Fellowship Training Program at Baylor College of Medicine in Houston. “Given the burden of morbidity and mortality associated with heart failure, these are important findings. Prior studies from this cohort have also shown that a better risk factors profile in young adulthood is associated with much lower CAC and therefore, these results further highlight the importance of primordial prevention and risk factor modification in early adulthood.”

Source: American Heart Association


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Highly Processed Food Tied to Heart Disease and Earlier Death

People who get many of their meals from packages may have heightened risks of heart disease, stroke and premature death, two large studies suggest.

The findings, published online in the journal BMJ, are the latest to point the finger at “ultra-processed” foods.

They include not only “junk food” — like chips, sweets and fast food — but also the breads, processed meats, jarred sauces and frozen meals that many people consider staples.

In one study, researchers followed more than 100,000 French adults for about five years.

They found that the more ultra-processed foods people ate, the higher their odds of a first-time heart condition or stroke: Those who ate the most processed foods were 23% more likely to suffer cardiovascular trouble compared to those with the lowest intakes.

And it wasn’t only because those foods were loaded with sugar, salt or fat — or because those people were heavier, exercised less or had other unhealthy habits.

Instead, there might be other things about highly processed foods that take a health toll, according to researchers Bernard Srour and Mathilde Touvier, from the University of Paris.

Other studies, they noted, have hinted that additives or contaminants formed during food processing have negative effects on metabolism and the cardiovascular system.

The researchers stressed that their study can’t prove cause and effect.

But taken along with other research linking processed foods to ill health effects, they said the message is straightforward: Strive to eat more “whole” and minimally processed foods.

Dr. Andrew Freeman, a cardiologist not involved in the study, had the same advice.

“I like to say: The longer the shelf life, the shorter your life,” said Freeman, who directs cardiovascular prevention and wellness at National Jewish Health in Denver.

Based on the overall body of research, he said, the most heart-healthy diet is one rich in whole foods — particularly plant-based foods like fruits and vegetables, legumes, whole grains and nuts.

To make that more affordable and convenient, Freeman pointed to healthy, packaged options — like fresh-frozen vegetables.

Srour agreed that not all packaged food is bad. It’s the degree of processing that seems key.

For example, he said a canned soup made of water, vegetables, vegetable oil, herbs and spices would not fall into the “ultra-processed” category. A dried soup loaded with preservatives would.

The French study included more than 105,000 men and women who were, on average, 43 years old at the start. Over the next five years, just over 1,400 suffered a heart attack or stroke, or developed clogged heart arteries.

The risk was 23% greater among those who ate the most ultra-processed foods — even with a host of other factors considered, including body weight, exercise habits, and salt, sugar and fat intake.

In the second study — of nearly 20,000 Spanish adults — ultra-processed foods were linked to a shorter life span: Those with the highest intake were 62% more likely to die over two decades, compared to those with the lowest intake.

Again, factors such as weight and lifestyle habits did not fully explain the link.

Then what else could be going on?

There is growing evidence that heavy processing itself plays a role, said Mark Lawrence, a professor of public health nutrition at Deakin University in Australia. He wrote an editorial published with the studies.

Food additives and compounds produced by industrial processes — such as acrylamide and acrolein — may help explain the health risks tied to highly refined foods, according to Lawrence.

“It’s ultra-processing that’s the problem,” he said, adding that convenient, minimally processed food can fit into a healthy lifestyle. Simple switches — from sugary drinks to water, or sweet treats to fresh fruit — are good starting points, Lawrence said.

The fewer nutritionally empty foods we eat, the more room there is for nutrient-rich ones, Freeman pointed out.

“It behooves us all,” he said, “to use nature to our advantage — to eat more nutritious foods, and rely less on medication.”

Source: HealthDay


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Substituting Healthy Plant Proteins for Red Meat Lowers Risk for Heart Disease

Diets that replaced red meat with healthy plant proteins led to decreases in risk factors for cardiovascular disease (CVD), according to a new study from Harvard T.H. Chan School of Public Health and Purdue University.

The study is the first meta-analysis of randomized controlled trials examining the health effects of red meat by substituting it for other specific types of foods.

The study was published in the journal Circulation.

“Previous findings from randomized controlled trials evaluating the effects of red meat on cardiovascular disease risk factors have been inconsistent. But our new study, which makes specific comparisons between diets high in red meat versus diets high in other types of foods, shows that substituting red meat with high-quality protein sources lead to more favorable changes in cardiovascular risk factors,” said Marta Guasch-Ferré, research scientist in the Department of Nutrition and lead author of the study.

The study included data from 36 randomized controlled trials involving 1,803 participants. The researchers compared people who ate diets with red meat with people who ate more of other types of foods (i.e. chicken, fish, carbohydrates, or plant proteins such as legumes, soy, or nuts), looking at blood concentrations of cholesterol, triglycerides, lipoproteins, and blood pressure—all risk factors for CVD.

The study found that when diets with red meat were compared with all other types of diets combined, there were no significant differences in total cholesterol, lipoproteins, or blood pressure, although diets higher in red meat did lead to higher triglyceride concentrations than the comparison diets. However, researchers found that diets higher in high-quality plant protein sources such as legumes, soy, and nuts resulted in lower levels of both total and LDL (“bad”) cholesterol compared to diets with red meat.

The results are consistent with long-term epidemiologic studies showing lower risks of heart attacks when nuts and other plant sources of protein are compared to red meat, the authors said. The findings also suggest that the inconsistencies found in prior studies regarding the effects of red meat on cardiovascular risk factors may be due, in part, to the composition of the comparison diet. They recommended that future studies take specific comparisons into account.

“Asking ‘Is red meat good or bad?’ is useless,” said Meir Stampfer, professor of epidemiology and nutrition and senior author of the study. “It has to be ‘Compared to what?’ If you replace burgers with cookies or fries, you don’t get healthier. But if you replace red meat with healthy plant protein sources, like nuts and beans, you get a health benefit.”

The authors recommended adherence to healthy vegetarian and Mediterranean-style diets, both for their health benefits and to promote environmental sustainability.

Source: Harvard T.H. Chan School of Public Health

Higher Egg and Cholesterol Consumption Hikes Heart Disease and Death Risk

Marla Paul wrote . . . . . . . . .

Cancel the cheese omelet. There is sobering news for egg lovers who have been happily gobbling up their favorite breakfast since the 2015-2020 Dietary Guidelines for Americans no longer limited how much dietary cholesterol or how many eggs they could eat.

A large, new Northwestern Medicine study reports adults who ate more eggs and dietary cholesterol had a significantly higher risk of cardiovascular disease and death from any cause.

“The take-home message is really about cholesterol, which happens to be high in eggs and specifically yolks,” said co-corresponding study author Norrina Allen, associate professor of preventive medicine at Northwestern University Feinberg School of Medicine. “As part of a healthy diet, people need to consume lower amounts of cholesterol. People who consume less cholesterol have a lower risk of heart disease.”

Egg yolks are one of the richest sources of dietary cholesterol among all commonly consumed foods. One large egg has 186 milligrams of dietary cholesterol in the yolk.

Other animal products such as red meat, processed meat and high-fat dairy products (butter or whipped cream) also have high cholesterol content, said lead author Wenze Zhong, a postdoctoral fellow in preventive medicine at Northwestern.

Debate over disease

Whether eating dietary cholesterol or eggs is linked to cardiovascular disease and death has been debated for decades. Eating less than 300 milligrams of dietary cholesterol per day was the guideline recommendation before 2015. However, the most recent dietary guidelines omitted a daily limit for dietary cholesterol. The guidelines also include weekly egg consumption as part of a healthy diet.

An adult in the U.S. gets an average of 300 milligrams per day of cholesterol and eats about three or four eggs per week.

The study findings mean the current U.S. dietary guideline recommendations for dietary cholesterol and eggs may need to be re-evaluated, the authors said.

The evidence for eggs has been mixed. Previous studies found eating eggs did not raise the risk of cardiovascular disease. But those studies generally had a less diverse sample, shorter follow-up time and limited ability to adjust for other parts of the diet, Allen said.

“Our study showed if two people had exact same diet and the only difference in diet was eggs, then you could directly measure the effect of the egg consumption on heart disease,” Allen said. “We found cholesterol, regardless of the source, was associated with an increased risk of heart disease.

Exercise, overall diet quality and the amount and type of fat in the diet didn’t change the association between the dietary cholesterol and cardiovascular disease and death risk.

The new study looked at pooled data on 29,615 U.S. racially and ethnically diverse adults from six prospective cohort studies for up to 31 years of follow up.

It found:

  • Eating 300 mg of dietary cholesterol per day was associated with 17 percent higher risk of incident cardiovascular disease and 18 percent higher risk of all-cause deaths. The cholesterol was the driving factor independent of saturated fat consumption and other dietary fat.
  • Eating three to four eggs per week was associated with 6 percent higher risk of cardiovascular disease and 8 percent higher risk of any cause of death.

Should I stop eating eggs?

Based on the study, people should keep dietary cholesterol intake low by reducing cholesterol-rich foods such as eggs and red meat in their diet.

But don’t completely banish eggs and other cholesterol-rich foods from meals, Zhong said, because eggs and red meat aregood sources of important nutrients such as essential amino acids, iron and choline. Instead, choose egg whites instead of whole eggs or eat whole eggs in moderation.

“We want to remind people there is cholesterol in eggs, specifically yolks, and this has a harmful effect,” said Allen, who cooked scrambled eggs for her children that morning. “Eat them in moderation.”

Estimating dietary intake

Diet data were collected using food frequency questionnaires or by taking a diet history. Each participant was asked a long list of what they’d eaten for the previous year or month. The data were collected during a single visit.The study had up to 31 years of follow up (median: 17.5 years), during which 5,400 cardiovascular events and 6,132 all-cause deaths were diagnosed.

A major limitation of the study is participants’ long-term eating patterns weren’t assessed.

“We have one snapshot of what their eating pattern looked like,” Allen said. “But we think they represent an estimate of a person’s dietary intake. Still, people may have changed their diet, and we can’t account for that.”

Source: Northwestern University