Expert Panel Backs Off Recommendation for Aspirin to Prevent Heart Trouble

Dennis Thompson wrote . . . . . . . . .

Most people shouldn’t bother taking daily low-dose aspirin to reduce their risk of a first heart attack or stroke, the nation’s leading panel of preventive medicine experts announced Tuesday.

The U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation that essentially backs off its previous advice urging many folks to consider taking low-dose aspirin to prevent heart disease.

If the proposal is adopted, the task force would recommend against low-dose aspirin use to prevent heart problems for people 60 and older.

The choice for people between 40 and 59 would be between themselves and their doctor, but the task force warns that the “net benefit of aspirin use in this group is small.”

“Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit,” the draft recommendation says.

The change reflects new data showing that daily aspirin does little to prevent a first heart attack or stroke, but greatly increases the risk of potentially serious side effects like bleeding.

The proposal would not change guidelines for people taking aspirin to prevent a second heart attack.

“There’s no longer a blanket statement that everybody who’s at increased risk for heart disease, even though they never had a heart attack, should be on aspirin,” task force member Dr. Chien-Wen Tseng told The New York Times. “We need to be smarter at matching primary prevention to the people who will benefit the most and have the least risk of harms.” Tseng is research director of family medicine and community health at the University of Hawaii.

While aspirin is a very effective blood thinner that can prevent blood clots from clogging arteries and causing a heart attack or stroke, heart experts have constantly weighed that benefit against the risk of internal bleeding.

New data suggest that “the increased risk of bleeding associated with aspirin use occurs relatively quickly after initiating aspirin,” with the absolute risk of bleeding increasing with age, the USPSTF says in its draft recommendation.

A low dose is between 81 milligrams and 100 milligrams.

One of the main goals of the proposed recommendations, Tseng told the Washington Post, is “to get people to talk with their clinicians instead of just buying a bottle off the shelf and saying, ‘I should be on aspirin.’ ”

The USPSTF’s current advice regarding aspirin use in preventing heart disease was issued in 2016.

At that time, it recommended low-dose aspirin for 50- to 59-year-olds who had a 10% or greater risk of a heart attack or stroke over the next decade. These folks should also have no increased risk for bleeding, a life expectancy of at least 10 years, and be willing to keep up with their daily aspirin regimen. The current recommendations say people between the ages of 60 and 69 have an individual choice to take aspirin if they have a 10% or higher risk of a potentially fatal heart-related event within the next decade.

American Heart Association President Dr. Donald Lloyd-Jones told the Post that the 2016 guidelines stemmed from clinical trial data collected in the 1980s and 1990s, “a time when we weren’t really focused on or doing a particularly good job of controlling things like blood pressure and cholesterol, so aspirin had room to add value in preventing heart attacks and strokes.”

But aspirin’s benefit has become less crucial, thanks to better medications and healthier lifestyle options that have cropped up over the years, Lloyd-Jones said.

“We just don’t really need aspirin so much anymore,” he said.

Dr. Guy Mintz, director of cardiovascular health and lipidology at the Sandra Bass Heart Hospital in Manhasset, N.Y., said lowering cholesterol, controlling diabetes, weight loss and exercise and quitting smoking are essential. But advances in preventive care make aspirin unnecessary.

“Now, 30 years later, we have more tools in primary prevention of a heart attack and extensive data to support our approach,” he said, adding: “With all of these advances the need for aspirin in all patients has been negated.”

Public comment on the draft revision to this aspirin recommendation will be accepted through Nov. 8, the USPSTF said.

The USPSTF is made up of 16 experts in preventive medicine who regularly assess the scientific data supporting different screening tools and preventive treatments.

The task force is independent, although its members are appointed by the director of the federal Agency for Healthcare Research and Quality.

The board wields considerable power. For example, Obamacare required insurers to cover the full cost of screening tests recommended by the USPSTF.

Source: HealthDay

Statins: Good for the Heart, Maybe Not So Good for Diabetes

Steven Reinberg wrote . . . . . . . . .

Statins are proven to lower cholesterol, but they may also come with a downside for patients with diabetes: A new study finds they may make the blood sugar disease worse.

Researchers found that among those taking statins, 56% saw their diabetes progress, compared with 48% of those not taking statins. And the higher the dose of the statin, the faster the progression of the diabetes.

“This study should be a start to more research examining the balance of benefits and harms of statins in patients with diabetes,” said senior researcher Dr. Ishak Mansi. He is a professor in the Departments of Medicine and Data and Population Science at the University of Texas Southwestern in Dallas.

“We know well about the benefits of statins, but the harms are much less investigated,” Mansi said. “Specifically, what is the population that may benefit less from the use of statins for primary prevention or be harmed? Answering these questions impact hundreds of millions of patients and cannot be postponed.”

He cautioned that based solely on this one finding, no patient should stop taking their statins and that association does not prove causation.

For the study, Mansi and his colleagues collected data on more than 83,000 diabetic patients who used statins and more than 83,000 who didn’t.

Those who were taking statins were more likely to see their diabetes progress and need to start using insulin and other types of drugs to lower high blood sugar levels sooner than those who weren’t taking statins.

“The study may alert clinicians that they may need to pay close attention and expect to adjust anti-diabetes medications when they initiate statins,” Mansi said.

Dr. Joel Zonszein, an emeritus professor of medicine at the Albert Einstein College of Medicine in New York City, said that blood sugar is not the only key to managing type 2 diabetes.

“Management of type 2 diabetes is not centered on lowering blood sugars,” explained Zonszein, who wasn’t part of the study. “In addition to lifestyle changes, medications are often necessary to prevent or attenuate complications. Statins are highly effective in lowering cholesterol and protecting against heart attacks and strokes.”

Statins do not cause diabetes and the modestly increased rate in precipitating new-onset diabetes is well-known, though the exact mechanism remains unknown, he said.

“The benefits of statins in patients with type 2 diabetes are far greater than the potential side effects,” Zonszein added.

Millions of people have been treated with statins, and its widespread application has been a major public health advance, he noted.

Treatment of obesity, hypertension and high cholesterol is as important as improving glycemic control, Zonszein added, and statins are one of the best medications for these in patients with type 2 diabetes.

“When prescribing any medication, a careful balance between benefits and side effects is discussed between the health care provider and the patient,” Zonszein said. “In the case of statins, the benefits, particularly in patients with type 2 diabetes, are by far better than potential side effects.”

The report was published online in the journal JAMA Internal Medicine.

Source: HealthDay

A Year of Committed Exercise in Middle Age Reversed Worrisome Heart Stiffness

Karen Schmidt wrote . . . . . . . . .

A year of exercise training helped to preserve or increase the youthful elasticity of the heart muscle among people showing early signs of heart failure, a small study shows.

The new research, published in the American Heart Association journal Circulation, bolsters the idea that “exercise is medicine,” an important shift in approach, the researchers wrote.

The study focused on a condition called heart failure with preserved ejection fraction, which affects about half of the 6 million people in the United States with heart failure. Characterized by increasing stiffness of the heart muscle and high pressures inside the heart during exercise, the condition is largely untreatable once established and causes fatigue, excess fluid in the lungs and legs, and shortness of breath.

“It is considered by some to be one of the most important virtually untreatable diseases in cardiovascular medicine,” said Dr. Benjamin Levine, the study’s senior author. He is a professor of internal medicine at UT Southwestern and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Dallas. “So, of course, if there are no therapies, then the most important thing to do is to figure out how to prevent it from happening in the first place.”

Previous studies show prolonged exercise training could improve heart elasticity in younger people, but that it had no effect on heart stiffness in people 65 and older. So, the researchers wondered if committed exercise could improve heart stiffness in healthy, sedentary men and women ages 45 to 64.

The study, funded in part by the AHA, included 31 people who showed some thickening of the heart muscle and an increase in blood biomarkers associated with heart failure, even though they had no symptoms such as shortness of breath.

Eleven were randomly assigned to a control group and prescribed a program of yoga, balance and strength training three times a week. The rest were assigned to an individually tailored exercise regimen of walking, cycling or swimming that built gradually until the participants were doing intensive aerobic interval training for at least 30 minutes at least twice a week, plus two to three moderate-intensity training sessions and one to two strength training sessions each week. Everyone had a personal trainer or exercise physiologist to monitor their training.

After a year, the people doing the vigorous exercise training showed a physiologically and statistically significant improvement in measures of cardiac stiffness and cardiorespiratory fitness, compared to no change in the control group.

The results suggest late middle age may be a “sweet spot” for using exercise to prevent heart failure with preserved ejection fraction, before the heart gets too stiff, Levine said. He compared the heart muscle to a rubber band. A new one stretches easily and snaps right back.

“That’s a youthful cardiovascular system,” he said. “Now, stick it in a drawer and come back 30 years later – it doesn’t stretch, and it doesn’t snap back. And that’s one of the things that happens to the circulation, both the heart and the blood vessels as we age, particularly with sedentary aging.”

Researchers can’t determine from the new study whether these people will go on to develop heart failure; larger studies will be needed for that. In addition, it isn’t easy for people to stick to an exercise program, and the intensive intervention studied may be difficult and expensive to replicate on a large scale.

“That may be a challenge, but I think this study is a good first step,” said Dr. Shannon M. Dunlay, an advanced heart failure and transplant cardiologist who was not involved in the study. She is a professor of medicine at Mayo Clinic in Rochester, Minnesota. “Heart failure is a tough thing to live with, and if we’re able to prevent it with exercise – if additional studies also show that – that’s really useful information.”

Since this type of heart failure can be so hard to treat, the new results could help clinicians in counseling their patients, she said. “This gives us more information to say to a patient, you already have these early findings that you are at risk for heart failure, and exercise could help your heart to become less stiff.”

Levine said physical activity, with its profound health benefits, should be woven into our everyday lives.

“I tell my patients, you brush your teeth every day, take a shower, change your underwear, have dinner,” he said. “These are things you do for your health and your personal hygiene. Exercise needs to be part of that process. And that’s how we can stay as healthy as possible throughout the lifespan.”

Source: American Heart Association

What Helps Your Heart More, Losing Fat or Gaining Muscle?

Alan Mozes wrote . . . . . . . . .

Shedding excess weight does much more for the long-term heart health of young people than building muscle, new research suggests.

It’s not that gaining muscle while young proved to be a cardiovascular problem. It’s just that losing fat offered bigger heart benefits.

“We absolutely still encourage exercise,” said study lead author Joshua Bell, a senior research associate in epidemiology at the University of Bristol in England.

“There are many other health benefits, and strength is a prize in itself,” he said. “We may just need to temper expectations for what gaining muscle can really do for avoiding heart disease. Fat gain is the real driver.”

The study followed more than 3,200 Brits born in the 1990s. It found those who had primarily lost fat during adolescence and young adulthood were much less likely than those who had gained muscle to develop risk factors such as high glucose, inflammation or “bad” cholesterol by age 25.

Participants had scans to assess levels of body fat and lean mass at ages 10, 13, 18 and 25. Handgrip strength tests were also assessed at 12 and 25.

At 25, participants underwent blood pressure and blood sample testing to assess levels of roughly 200 metabolic factors viewed as “a gateway for heart disease and other health problems,” Bell explained.

Such factors included insulin, C-reactive protein, cholesterol, triglycerides, glucose, creatinine and branched chain amino acids.

The result: For lowering risk factors for heart disease, “changes in body fat seem to matter much more than changes in muscle,” Bell said. By some measures — such as lowering levels of “bad” cholesterol — fat loss appeared to be as much as five times more protective than muscle gain, he added.

“Muscle gain only seemed beneficial when it happened in adolescence, between 13 and 18 years old,” Bell said. “This is a busy time of growth and maturity, and might be when we should promote some muscle gain as well. [Heart] benefits seem to fade after then.”

His bottom-line message: While muscle is important for outcomes like mobility and independence, fat control seems to be a higher priority when it comes to keeping markers for heart disease in check.

The results were published recently in PLOS Medicine.

Bell stressed that the findings are critical because the seeds of future heart trouble are sown among youths and adolescents, who are otherwise healthy.

While “serious events like heart attacks don’t tend to happen until older ages, heart disease doesn’t happen overnight,” Bell noted.

Lona Sandon is an associate professor in the school of health professions at UT Southwestern Medical Center in Dallas, and reviewed the study findings.

She said you should aim to prevent excess fat gain from the start, rather than focus on fat loss later.

“Instill healthy eating and activity habits early on to maintain a healthy body weight throughout childhood and adolescence for the best chance of reducing early onset of heart disease risk factors,” said Sandon. “And by early on, I mean in the womb and infancy.”

There should be focus on educating parents about healthy pregnancies and healthy feeding patterns, Sandon advised. “Start with breastfeeding and feeding healthy whole foods and age-appropriate portions during infancy and early childhood,” she said.

Restricting calories during childhood is generally not a good idea, as this is a time of growth, Sandon cautioned. “Calories and quality foods are needed for proper growth and development,” she said.

Instead, exercise and sports can be a great way to keep a growing body trim. “Active play goes a long way toward keeping kids fit without putting the focus on body fat,” Sandon stressed. “Also active kids may be more likely to carry over those active habits into adulthood.”

Source: HealthDay

Breastfeeding May Strengthen Preterm Baby’s Heart

Breast milk can give preemies’ hearts a big boost, a groundbreaking study suggests.

“This study … adds to the already known benefits of breast milk for infants born prematurely,” said study leader Dr. Afif El-Khuffash, a clinical professor of pediatrics at the Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences in Dublin.

He said the findings offer the first evidence of a link between early diet in preemies and heart function over the first year of life.

Because preemies’ heart function is significantly lower than that of healthy full-term babies, they are more likely to develop heart problems later in life — including heart disease, heart failure, systemic and pulmonary high blood pressure, the researchers said. They also have a higher risk of death from heart disease.

This study of 80 preterm infants found that those initially fed only their mother’s breast milk had improved heart function at 1 year of age, and that it approached the level found in healthy full-term babies.

Specifically, preemies who received high amounts of mother’s milk during the first weeks of life had healthier heart structures and functions and a better heart response to stress at age 1 than did preemies who were given higher amounts of formula.

These improvements were apparent before babies left the hospital and persisted up to age 1, according to findings published in the journal JAMA Network Open.

“Preterm infants have abnormal heart function. However, those who are fed their mother’s own milk demonstrate recovery of their heart function to levels comparable to healthy term born infants,” El-Khuffash said in a college news release. “Preterm infants fed formula do not demonstrate this recovery.”

Source: HealthDay