Even 1 Sugary Drink a Day Could Boost Heart Disease, Stroke Risk in Women

Women who drink one or more sugar-laden beverages – such as soda, sweetened water and teas, and fruit drinks – every day could boost their risk of cardiovascular disease by 20% compared to women who rarely or never drink them, according to new research.

The daily drinks also were associated with a 26% higher likelihood of needing a procedure to open clogged arteries, such as angioplasty, and a 21% higher chance of having a stroke.

“Although the study is observational and does not prove cause and effect, we hypothesize that sugar may increase the risk of cardiovascular diseases in several ways,” senior study author Cheryl Anderson said in a news release. She is professor and interim chair of family and public health at the University of California San Diego. “It raises glucose levels and insulin concentrations in the blood, which may increase appetite and lead to obesity, a major risk factor for cardiovascular disease.”

The research, part of the ongoing California Teacher’s Study that began in 1995, included more than 106,000 women who reported how much and what they drank via a food questionnaire. Participants, whose average age was 52, had not been diagnosed with heart disease, stroke or diabetes when they enrolled in the study. The work was published Wednesday in the Journal of the American Heart Association.

Anderson, chair of the AHA’s nutrition committee, said too much sugar in the blood also is linked to “oxidative stress and inflammation, insulin resistance, unhealthy cholesterol profiles and Type 2 diabetes, conditions that are strongly linked to the development of atherosclerosis, the slow narrowing of the arteries that underlies most cardiovascular disease.”

Women who drank the most sugar-sweetened beverages were younger, more likely to be current smokers, obese and less likely to eat healthy foods.

The new study defined sugary beverages as caloric soft drinks, sweetened bottled waters or teas and sugar-added fruit drinks, not 100% fruit juices.

The kind of sugary drinks women chose made a difference. One or more sugar-added fruit drinks a day was associated with a 42% greater likelihood of developing cardiovascular disease compared to women who rarely or never drank them. With soft drinks, that likelihood was 23%.

The study was limited by having only one measurement of sugar-sweetened beverage intake, and it also was unable to evaluate consumption of artificially sweetened beverages and/or sweetened hot beverages.

Sugar-sweetened beverages are the biggest source of added sugars in the American diet; a typical 12-ounce can of regular soda has 130 calories and 8 teaspoons (34 grams) of sugar.

The AHA recommends limiting added sugar to no more than 100 calories a day, which is about 6 teaspoons, or 25 grams, for most women. For men, the recommendation is no more than 150 calories a day, which is about 9 teaspoons of sugar or 38 grams.

Source: American Heart Association

Major Study Casts Doubt on Routine Use of Stents, Bypass

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

Folks with clogged arteries do as well with medication and lifestyle changes as they do after undergoing invasive procedures to reopen their blood vessels, a major new clinical trial reports.

Bypass surgery, balloon angioplasty and stenting are no better than drugs, eating right and exercising at reducing the risk of heart attack and death in people with stable ischemic heart disease, a condition where there’s been no heart attack but the heart is under strain from clogged arteries, trial results show.

“No matter how you look at it, there’s no statistically significant difference overall,” said study chair Dr. Judith Hochman, senior associate dean for clinical sciences at the NYU Grossman School of Medicine.

These results indicate that tens of thousands of elective procedures to reopen clogged arteries are performed on people whose health won’t benefit from it, Hochman noted.

The best that can happen is people suffering daily or weekly chest pain from angina will feel some symptom relief if they receive a stent, the results indicate.

As much as $570 million a year could be saved if heart patients without any chest pain or other symptoms stopped receiving unnecessary stents, Hochman estimated.

Dr. John Osborne, director of cardiology for State of the Heart Cardiology in Dallas, said the clinical trial should cause doctors and patients to rethink whether stenting is really needed.

“All these mechanical procedures don’t actually treat heart disease. They treat the symptoms,” said Osborne, a spokesman for the American Heart Association. “They don’t make you live longer. They don’t prevent heart attacks.”

The trial results were published in the New England Journal of Medicine.

This clinical trial did not focus on people suffering from heart attacks. Stenting to reopen clogged arteries during a heart attack is a proven lifesaving treatment, Hochman stressed.

Instead, this study focused on the estimated 19 million Americans who suffer from stable ischemic heart disease, with clogged arteries that might cause chest pain or shortness of breath but pose no immediate threat to their lives, Hochman said.

Of those, more than 9 million have stable angina — occasional or regular chest pain or discomfort caused by poor blood flow to the heart.

As few as 45% of patients with stable angina are given a chance to control their symptoms through medication and lifestyle before their doctors turn to stenting or bypass surgery, Hochman said. The rest are wheeled into the catheterization lab as soon as possible.

When asked in a survey, a majority of doctors said it was “easier to accept the death of a patient getting an angioplasty than the death of a patient sent home without the procedure,” Hochman said.

Between August 2012 and January 2018, the study enrolled nearly 5,200 patients at 320 sites in 37 countries who had moderate to severely blocked arteries. Patients were 64 years old, on average, and 21% reported daily or weekly chest pain in the past.

“These are people who had severe disease. They had very abnormal stress tests. This is not the general population,” Hochman said of the participants.

Patients were randomly assigned to either receive conservative medical therapy alone unless their condition worsened, or to receive stenting or bypass surgery.

By the end of the trial, the death rates of the two groups were essentially the same.

The rate of heart-related events, including heart attack and stroke, also was mostly the same.

People who underwent invasive procedures had slightly more heart attacks and heart-related deaths within the first six months — about 2 in every 100 patients — but by four years out they had a slightly lower rate of heart attack and heart-related death that also amounted to 2 of every 100 patients.

Researchers are discussing whether to keep following these patients, to see if the seemingly small advantage of the invasive approach will grow larger over time, said Dr. Yves Rosenberg, study co-author and chief of the National Heart, Lung and Blood Institute’s Atherothrombosis and Coronary Artery Disease Branch.

“There’s still a possibility it takes more time to really observe the benefit of this invasive approach,” Rosenberg said. “You may need more time to observe a real clinically significant difference between these two groups.”

The only true benefit appeared in people who have stable heart disease but regularly suffer angina.

Within three months, about 45% of patients who had weekly chest pain from angina reported a reduction in their symptoms if they underwent stenting, compared with 15% of people treated with medicine and lifestyle changes, Hochman said.

“This was the first study that showed that stents had a durable beneficial effect on angina-related quality of life,” Hochman said.

The clinical trial team suggests that patients with regular chest pain talk with their doctor and make a shared decision about whether stenting would be best for them, Hochman said.

Cardiologist Dr. Hadley Wilson said the study “gives us a new perspective on how we should be treating our angina patients.” He is executive vice chair of Atrium Health’s Sanger Heart & Vascular Institute in Charlotte, N.C., and a member of the American College of Cardiology Board of Trustees.

“We need to come to grips with the reality that the invasive approach should be primarily for symptoms, for patients who are having significant symptoms of angina where it’s affecting their quality of life,” said Wilson.

Osborne noted that previous studies have found similar results to these, but that this is the highest-powered effort to date to compare invasive strategies against more conservative treatments when it comes to stable heart disease.

“Really what the study shows is that heart disease is a medical problem best treated medically, by treating blood pressure and cholesterol, not smoking, diet, lifestyle, taking care of diabetes,” Osborne said. “It’s not a surgical condition.”

Source: HealthDay

Today’s Comic

Severe COVID-19 Might Injure the Heart

Amy Norton wrote . . . . . . . . .

The new coronavirus may be a respiratory bug, but it’s becoming clear that some severely ill patients sustain heart damage. And it may substantially raise their risk of death, doctors in China are reporting.

They found that among 416 patients hospitalized for severe COVID-19 infections, almost 20% developed damage to the heart muscle. More than half of those patients died.

Doctors in China have already warned that heart injuries appear common in COVID-19 patients, particularly those with existing heart disease or high blood pressure. A recent, smaller study found that 12% of hospitalized patients had the complication.

These latest findings, from a team led by Dr. Bo Yang of Renmin Hospital of Wuhan University, and published in JAMA Cardiology, add a concerning layer: Patients who develop heart damage may face an “unexpectedly” high risk of death.

Much remains to be learned. For one, the findings come from a single hospital in Wuhan, where the outbreak began. U.S. experts said it’s not known whether the grim outlook will hold true at other hospitals worldwide.

“We certainly hope not,” said Dr. Thomas Maddox, head of the Science and Quality Committee of the American College of Cardiology (ACC).

The ACC has already issued clinical guidance to cardiologists. Among other things, it highlights the extra risks to patients with heart disease, and tells cardiologists to be ready to jump in to assist other doctors caring for severely ill patients.

“We’re anticipating that patients with underlying cardiovascular disease will struggle,” Maddox said.

The novelty of the coronavirus means that it’s not fully clear how to best manage those hospitalized patients. Standard heart medications and devices to provide cardiac support are being used, according to Maddox.

“We are continuing to figure this out,” he said.

But the importance of prevention is more obvious than ever. Maddox said people with existing heart disease — such as a past heart attack — or a history of stroke should consider themselves at “high risk” and be vigilant about protecting themselves.

For those living in a community with a COVID-19 outbreak, that means staying home as much as possible, according to the U.S. Centers for Disease Control and Prevention. Meanwhile, all high-risk people should wash their hands often, disinfect surfaces they routinely touch, and be serious about “social distance” if they do go out.

Among the unknowns, though, is whether people with high blood pressure might also fall into the high-risk category.

“This is an important question, and one on many people’s minds,” said Dr. Elliott Antman, former president of the American Heart Association and a senior physician at Brigham and Women’s Hospital in Boston.

Of the 82 patients in this study who developed a heart injury, 60% had high blood pressure. About 30% had a previous diagnosis of coronary heart disease, while almost 15% had chronic heart failure.

Antman said it’s hard to tell whether high blood pressure alone — without other health issues — was a risk factor for heart injury. Plus, he said, there’s no information on whether patients’ high blood pressure was under control with medication or not.

Of patients who sustained heart damage, just over 51% died in the hospital, according to the study. That compared with 4.5% of those without heart injury.

It’s not certain, though, that the heart complication is actually what caused those deaths, Antman said. “This could all be a reflection of a very bad infection,” he explained.

Why does the coronavirus wreak havoc on some patients’ hearts?

Again, no one is sure, Maddox said. But he explained the leading theories.

One suspect is the immune system’s reaction to the coronavirus. If it veers out of control, in what’s called a “cytokine storm,” it can damage the body’s organs. A second possibility is that in people who already have heart disease, the overall stress of the infection harms the heart muscle.

Finally, it’s possible that the new coronavirus directly invades the heart, Maddox said. Researchers say the virus very effectively latches onto receptors on our body cells called ACE2. Those receptors are found not only in the lungs, but elsewhere in the body — including the heart and digestive tract, he explained.

There has been some speculation that common blood pressure drugs — ACE inhibitors and angiotensin receptor blockers — might make people more vulnerable to falling ill with COVID-19. But that is based only on animal research suggesting that the drugs can boost the activity of ACE2 receptors.

Maddox and Antman stressed that no one should stop taking their prescriptions, since poorly controlled high blood pressure or heart disease would be dangerous — especially now.

Source: HealthDay

Today’s Comic

Study: Heart Drug Combos Might Also Lower Your Dementia Risk

Certain combinations of cholesterol and blood pressure drugs may do more than help the heart — they might also lower a person’s risk of dementia, a new study finds.

The drugs in question include two common types of blood pressure medications — ACE inhibitors and angiotensin II receptor blockers (ARBs) — as well as cholesterol-lowering statins.

It’s long been known that keeping blood pressure and cholesterol under control is important for a healthy heart. But “this study tells us there might be certain combinations of drugs that have additional benefits for Alzheimer’s and other dementias beyond the management of those targeted conditions,” study co-author Douglas Barthold said in a University of Southern California news release.

Barthold is a research assistant professor in the department of pharmacy at the University of Washington in Seattle.

In the study, a team led by USC researcher Julie Zissimopoulos tracked 2007-2014 data from nearly 700,000 Medicare beneficiaries. The participants were ages 67 and older, and had used both a high blood pressure drug and a cholesterol-lowering statin drug for the two previous years. None had been diagnosed with dementia, and they had never taken any Alzheimer’s disease-specific medications.

The use of the statins pravastatin and rosuvastatin, combined with ACE inhibitors or angiotensin II receptor blockers (ARBs) for high blood pressure, was associated with a reduced risk for dementia, compared to other combinations of drugs.

One combination — pravastatin or rosuvastatin in combination with ARBs — was especially good at lowering the risk, with men benefiting even more than women.

For example, using a combination of ARBs and pravastatin was associated with a 21% lower risk of dementia diagnosis over the seven years of the study, compared to other combinations of drugs, according to the study.

Dementia affects about 7 million Americans and that number is expected to increase to 12 million over the next two decades.

“We don’t currently have drugs that are proven to treat dementia, but even small delays in onset can dramatically reduce the burden on patients, caregivers, and the health system as a whole,” Zissimopoulos said in the release. She directs the Aging and Cognition program at USC’s Center for Health Policy and Economics. “Our research found dementia risk may be reduced with specific combinations of drug treatments for vascular health.”

If these findings are replicated in future research, they might lead to specific combinations of statins and high blood pressure drugs being recommended to reduce the risk of Alzheimer’s disease and related dementias, the researchers said.

Two experts in brain and heart health said the new findings make sense, given links between the two organs.

“Yet another study that says heart health equals brain health,” said Dr. Gayatri Devi, a neurologist and psychiatrist at Lenox Hill Hospital in New York City.

She said that besides using meds to better your heart health, people interested in keeping their brain healthy should consider “eating a Mediterranean diet, doing aerobic exercise 30-45 minutes three to four days a week, maintaining healthy sleep habits and having community involvement.”

Dr. Guy Mintz directs cardiovascular health at the Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. Reading over the findings, he said that “this choice of medications make sense because not only do ARBs reduce blood pressure, but they have an anti-inflammatory effect,” as do statins — and inflammation negatively affects blood vessel health in the brain.

“As we move into an era of precision medicine, the idea of targeted combination therapies for hypertension and cholesterol in patients over 67 years of age — translating to better vascular health in the brain and leading to a reduction of brain dysfunction — is exciting and warrants further research,” Mintz said.

The study was published recently in the journal PLOS One.

Source: HealthDay

Today’s Comic

Better Lifestyle Habits are Useful Additions to Optimize Management of Atrial Fibrillation

Weight loss, regular physical activity and other lifestyle changes are effective yet underused strategies that should be added to optimize management of atrial fibrillation (an abnormal heart rhythm), according to “Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation,” a new Scientific Statement from the American Heart Association published today in the Association’s flagship journal Circulation.

Atrial fibrillation (AF) is an abnormal heart rhythm that affects at least 2.7 million people in the United States and is increasing as the population grows older. In AF, the upper chambers of the heart, called the atria, beat rapidly and erratically, interfering with proper movement of blood through the chambers, which can allow blood clots to form. Parts of these clots can break off and flow to the brain, causing an ischemic stroke. People who have AF have a five-fold greater risk of having a stroke compared to people without the condition.

To reduce stroke risk in their patients, health professionals use medications or procedures to regulate the heart rate, prevent abnormal heart rhythms (AF) and reduce blood clotting.

“While established medical treatment protocols remain essential, helping AF patients adopt healthier lifestyle habits whenever possible may further help to reduce episodes of AF,” said Mina K. Chung, M.D., chair of the writing group for the scientific statement, and a cardiologist and professor of medicine at the Cleveland Clinic.

Weight management with weight loss, nutrition interventions among individuals who are overweight and appropriate, individualized physical activity plans to increase fitness are three lifestyle modifications that have the potential to benefit AF patients.

Obesity can contribute to enlargement and stretching of the heart’s upper chambers, changing the way the chambers work and making AF more likely to occur and to be persistent rather than occasional. In an Australian study, people who were overweight or had obesity and lost at least 10% of their body weight were less likely to develop AF or to have it become persistent; and, in some cases, persistent AF became intermittent or disappeared entirely.

In addition, obesity is often associated with sleep apnea, a type of disordered breathing that also raises the risk of AF. Patients with obesity/overweight should be screened for sleep apnea and receive treatment if they have it.

Regular, moderate physical activity does not increase AF risk and may help in preventing and treating the condition. However, the statement notes that extreme levels of physical activity, such as that undertaken by endurance athletes and professional football players, may raise the risk of AF.

“To help patients make healthy lifestyle changes, we suggest setting specific, progressive achievable weight and exercise targets, and prescribing lifestyle intervention programs that can provide appropriate supports. Using a pedometer, smartphone/watch apps or other wearable devices that provide activity feedback, as well as apps that help people track food intake, can be helpful to keep people motivated. Encouragement and reinforcement from the patients’ physicians and health care team can also increase patients’ dedication,” said Chung.

Other lifestyle habits that raise the risk of AF include smoking and moderate or high alcohol use. Smoking not only raises the risk of getting AF, it also reduces the effectiveness of a treatment for AF called ablation (a procedure to destroy cells that generate abnormal rhythms). Patients should be counseled to stop smoking and may be referred to a smoking cessation program.

Studies have also found that moderate or high alcohol use – drinking more than 7 drinks/week in women and 14 drinks/week in men – raises the risk of AF. In a recent study, reducing or abstaining from alcohol was shown to improve heart rhythm control.

Although drinking caffeinated beverages has not been shown to increase the risk of AF, about 1 in 4 people with the condition report that it can trigger an episode according to several studies noted in the statement.

The scientific evidence on lifestyle and AF is limited because the studies on the subject are mostly observational, which can identify links but cannot prove cause and effect.

“We need more research in this area, including randomized trials (which can prove cause and effect) to help determine the effects of and the best ways to achieve long-term, lifestyle and risk factor modification for our patients with AF. In particular, we need further work on the effects of high intensity and other physical activities, and studies on the need for and effects of screening and treating sleep apnea for AF. However, the data emerging support the beneficial effects of lifestyle modification to reduce AF and are a call to action to develop and utilize integrated, multidisciplinary teams and/or structured programs that can facilitate intensive and comprehensive lifestyle counseling for our patients with AF. We encourage health care teams to consider lifestyle interventions in addition to medical management for all patients with AF,” said Chung.

Source: American Heart Association