Aspirin, Fish Oil May Not Prevent Heart Trouble in Those Already at Risk

Aspirin or fish oil probably won’t help prevent heart attacks or strokes in folks who are already at risk for cardiovascular issues, three new studies show.

In the first study, taking a daily, low-dose aspirin did little to ward off first strokes or heart attacks in people who smoked, or had high blood pressure or high cholesterol.

Meanwhile, a second set of studies discovered the news was just as grim for those with diabetes, as a higher risk for serious bleeding canceled out a modest benefit.

And for those diabetics who might turn to fish oil supplements in lieu of aspirin, those also failed to help guard against heart dangers.

“Aspirin has been our ‘go-to;’ it’s cheap and easy to get. But the benefit here was negated by the bleeding [in the diabetes study],” said Dr. James Catanese, chief of cardiology at Northern Westchester Hospital in Mount Kisco, N.Y. “We may need a better blood thinner.”

In the first study, researchers led by Dr. J. Michael Gaziano, a preventive cardiologist at Brigham and Women’s Hospital in Boston, followed more than 12,500 participants who took either 100 milligrams of aspirin or a placebo every day. All had some other risk factor for possible heart trouble.

After five years, the rate of events such as heart attack and stroke were virtually equal in both groups — 269 patients (4.3 percent) in the aspirin group and 281 patients (4.5 percent) in the placebo group. The study was funded by Bayer Co. and published Aug. 26 in The Lancet.

In the diabetes research, which was reported by British researchers as two studies in the Aug. 26 issue of the New England Journal of Medicine, people with diabetes were randomly chosen to follow one of four treatments.

One group received 1 gram of fish oil and 100 milligrams of aspirin daily. Another group received fish oil and a placebo instead of aspirin. The third group was given a placebo (filled with olive oil) for fish oil and received active aspirin. The final group received two placebos.

The average follow-up time was nearly 7.5 years. During that time, 8.9 percent of those given the fish oil and 9.2 percent of those given a fish oil placebo had serious vascular events, such as a heart attack or stroke. Death rates were also similar between the two groups. Both studies received funding from the British Heart Foundation and Bayer.

“Aspirin and fish oil are not a panacea to prevent cardiovascular disease in people with diabetes,” said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

“My message to people with diabetes is that treating high blood pressure, abnormal cholesterol and high blood sugar from the get-go — along with healthy lifestyle changes — is important,” said Zonszein, who was not involved in the research.

Dr. Louise Bowman, who led the fish oil study, said, “Previous research has shown no benefit of fish oil supplements for other types of patients at increased risk of cardiovascular events. Our findings are in line with this, and so we don’t believe that there is any justification for recommending fish oil supplements to protect against cardiovascular events.”

She added that other studies have shown that there doesn’t appear to be a benefit to fish oil supplements for people who’ve already had a heart attack either. Bowman is a professor of medicine and clinical trials at Oxford University’s Nuffield Department of Population Health in England.

Aspirin fared somewhat better among those with diabetes. The rate of serious vascular events was 8.5 percent for people taking aspirin and 9.6 percent for those taking a placebo. That means aspirin reduced the risk of a serious event by 12 percent.

However, that good news was countered by the risk of major bleeding. Slightly over 4 percent of people taking aspirin had a major bleeding event (including bleeding in the brain, eye and digestive system). Just 3.2 percent of those taking a placebo had any serious bleeding. Aspirin increased the risk of bleeding by 29 percent, the study found.

Dr. Jane Armitage, senior author of the aspirin/diabetes study, said, “We showed clearly that aspirin reduces the risk of vascular events, including heart attacks, strokes, and mini-strokes; however, it also increased the risk of major bleeds, mainly from the GI tract, so overall there was no clear benefit.”

Armitage said the finding provides “much needed clarity” about whether or not to recommend aspirin to people with diabetes who haven’t had a heart attack. She said for people already taking known safe treatments such as cholesterol and blood pressure medicine to prevent heart disease and stroke, “there is no added benefit of taking aspirin.”

Armitage noted that aspirin is still recommended for people who’ve already had events such as a heart attack or stroke. She is a professor of clinical trials and epidemiology at Oxford University.

Catanese, who wasn’t involved in any of the studies, said he wasn’t surprised by the fish oil findings.

“I think there’s a benefit to eating fish, not just fish oil. There’s something in the food that we may not be able to put in a pill or a capsule,” he said.

Like Zonszein, Catanese recommended that people with diabetes eat a healthy diet, exercise regularly and keep good control of their diabetes to prevent heart disease. Control of cholesterol and blood pressure is also very important for people with diabetes, he said.

The findings were presented Sunday at the European Society of Cardiology annual meeting, in Munich, Germany.

Source: HealthDay


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Study Finds Average Consumption of Salt Safe for Heart Health

Andrew Mente wrote . . . . . . . .

New research shows that for the vast majority of individuals, sodium consumption does not increase health risks except for those who eat more than five grams a day, the equivalent of 2.5 teaspoons of salt.

Fewer than five per cent of individuals in developed countries exceed that level.

The large, international study also shows that even for those individuals there is good news. Any health risk of sodium intake is virtually eliminated if people improve their diet quality by adding fruits, vegetables, dairy foods, potatoes, and other potassium rich foods.

The research, published in The Lancet, is by scientists of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, along with their research colleagues from 21 countries.

The study followed 94,000 people, aged 35 to 70, for an average of eight years in communities from 18 countries around the world and found there an associated risk of cardiovascular disease and strokes only where the average intake is greater than five grams of sodium a day.

China is the only country in their study where 80 per cent of communities have a sodium intake of more than five grams a day. In the other countries, the majority of the communities had an average sodium consumption of 3 to 5 grams a day (equivalent to 1.5 to 2.5 teaspoons of salt).

“The World Health Organization recommends consumption of less than two grams of sodium — that’s one teaspoon of salt — a day as a preventative measure against cardiovascular disease, but there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level,” said Andrew Mente, first author of the study and a PHRI researcher.

He added that the American Heart Association recommends even less — 1.5 grams of sodium a day for individuals at risk of heart disease.

“Only in the communities with the most sodium intake — those over five grams a day of sodium – which is mainly in China, did we find a direct link between sodium intake and major cardiovascular events like heart attack and stroke.

“In communities that consumed less than five grams of sodium a day, the opposite was the case. Sodium consumption was inversely associated with myocardial infarction or heart attacks and total mortality, and no increase in stroke.”

Mente added: “We found all major cardiovascular problems, including death, decreased in communities and countries where there is an increased consumption of potassium which is found in foods such as fruits, vegetables, dairy foods, potatoes and nuts and beans.”

The information for the research article came from the ongoing, international Prospective Urban Rural Epidemiology (PURE) study run by the PHRI. Mente is also an associate professor of the Department of Health Research Methods, Evidence and Impact at McMaster University.

Most previous studies relating sodium intake to heart disease and stroke were based on individual-level information, said Martin O’Donnell, co-author of the report, a PHRI researcher and an associate clinical professor of medicine at McMaster.

“Public health strategies should be based on best evidence. Our findings demonstrate that community-level interventions to reduce sodium intake should target communities with high sodium consumption, and should be embedded within approaches to improve overall dietary quality.

“There is no convincing evidence that people with moderate or average sodium intake need to reduce their sodium intake for prevention of heart disease and stroke,” said O’Donnell.

Besides Canada, this research paper involved individual and community information from the countries of Argentina, Bangladesh, Brazil, Chile, China, Columbia, India, Iran, Malaysia, occupied Palestinian territory, Pakistan, Philippines, Poland, Saudi Arabia, South Africa, Sweden, Tanzania, Turkey, United Arab Emirates, and Zimbabwe.

The study was funded by PHRI, Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, European Research Council, as well as unrestricted grants from several pharmaceutical companies, and grants from health agencies or ministries of 18 countries.

Source: McMaster University


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A Diverse Diet May Not be the Healthiest One

Encouraging people to eat a wide variety of foods to ensure they meet all their dietary needs may backfire, according to a new scientific statement from the American Heart Association that provides an overview of recent scientific studies.

“Eating a more diverse diet might be associated with eating a greater variety of both healthy and unhealthy foods” said Marcia C. de Oliveira Otto, Ph.D., lead author of the statement published in the American Heart Association journal Circulation. “Combined, such an eating pattern may lead to increased food consumption and obesity.

“Eating a variety of foods” has been a public health recommendation in the United States and worldwide for decades. While some dietary guidelines highlight greater diversity of recommended foods, there is little consensus about what so-called dietary diversity is, how it is measured and whether it is a healthy dietary goal. The statement authors conducted a thorough scientific literature review of articles published between January 2000 and December 2017. They concluded:

  • There is no evidence that greater overall dietary diversity promotes healthy weight or optimal eating.
  • There is some evidence that a wider variety of food options in a meal may delay people’s feeling of satiation (fullness), increasing the amount of food they eat.
  • Limited evidence suggests that greater dietary diversity is associated with eating more calories, poor eating patterns and weight gain in adults.

Instead of telling people to eat a variety of foods, the statement authors conclude that dietary recommendations should emphasize adequate consumption of plant foods, such as fruit, vegetables, beans and whole grains, low-fat dairy products, non-tropical vegetable oils, nuts, poultry and fish, and limit consumption of red meat, sweets and sugary drinks. The American Heart Association Dietary Recommendations and the DASH Diet (Dietary Approaches to Stop Hypertension) are both examples of healthy eating patterns.

“Selecting a range of healthy foods, which fits one’s budget or taste, and sticking with them, is potentially better at helping people maintain a healthy weight than choosing a greater range of foods that may include less healthy items such as donuts, chips, fries and cheeseburgers, even in moderation,” said Otto, who is also assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health in Houston.

Source: American Heart Association


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Portfolio Diet Lowers Many Risk Factors for Heart Disease

See large image . . . . .

University of Toronto researchers have found that the portfolio diet, a plant-based way of eating previously shown to lower cholesterol levels, reduces other risk factors for cardiovascular disease including blood pressure, triglycerides and inflammation.

In addition to reducing LDL (or ‘bad’) cholesterol by about 30 per cent when combined with a low-saturated fat diet — a level comparable to medications — the researchers found the diet limited other factors for an estimated 13 per cent reduction in the overall risk for coronary heart disease, which includes angina and heart attack.

“We’ve known the portfolio diet lowers LDL cholesterol, but we didn’t have a clear picture of what else it could do,” says John Sievenpiper, an associate professor in the Department of Nutritional Sciences at U of T and a staff physician and scientist at St. Michael’s Hospital. “This study allows for greater clarity and certainty about the effects of the diet and its health potential.”

The researchers conducted a meta-analysis that combined results from seven controlled trials involving more than 400 patients, and found that specific risk factors varied from about a 2 per cent reduction (for blood pressure) to a 32 per cent reduction (for inflammation). The journal Progress in Cardiovascular Diseases published the results today.

“When you look at individual trials alone, data on these other risk factors can appear random,” says David Jenkins, a professor in the Departments of Nutritional Sciences and Medicine at U of T who holds a Canada Research Chair in Nutrition and Metabolism, and who developed the portfolio diet in the early 2000s. “But when you pool the results of several trials, the risk reductions become clear and together they provide a really strong case for the cardiovascular benefits of the dietary portfolio.”

The portfolio diet has four main components. Based on a 2,000 calorie diet, it includes 45 grams of nuts, or about a handful; 50 grams of plant protein such as soy, or pulses like beans and peas; 20 grams of viscous soluble fibre from oats, eggplant, apples, etc.; and 2 grams of plant sterols — natural compounds that inhibit absorption of cholesterol and are often included in enriched products like margarine.

Dietary and lifestyle modifications can enable patients to manage high cholesterol and cardiovascular risk, and the current study provides further rationale for that approach. “We’re starting to say to patients, ‘This diet will help you meet your cholesterol goals, but it will also improve your blood lipids and blood pressure, and lower inflammation,'” says Sievenpiper. “The same is not true for drugs, and they often produce other effects you don’t want.”

Adherence to the diet can be challenging for some patients, but many find that incorporating just a few more plant-based foods offers noticeable benefits. “One nice thing about the diet is that the effects are additive, so adopting one or more components is better than none. It’s not an all or nothing proposition, which is why we also call it a dietary portfolio,” says Sievenpiper.

The study’s findings on inflammation are particularly exciting, Jenkins says. Growing evidence suggests inflammation plays a role in cardiovascular disease, but recent studies have linked it to a host of other diseases, including cancer. “Especially with chronic lymphocytic leukemia, prostate cancer, and other watch-and-wait diseases, reducing inflammation may greatly extend a patient’s lifetime,” says Jenkins.

Some patients also choose the portfolio diet for ethical and environmental reasons — plant-based diets generally have a smaller eco-footprint than standard Western diets — or in the case of children, to head-off future health problems. “Cardiovascular and other health risk factors can be elevated in children, and we’re learning that early intervention is really important for them,” says Sievenpiper, who is also a scientist in the Joannah & Brian Lawson Centre for Child Nutrition. “There are many reasons to consider this diet, from its planetary significance to health across the lifespan.”

Source: EurekAlert!


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Healthier Hearts Linked to Healthier Guts

Lisa Owens Viani wrote . . . . . . . .

It turns out that exercise can do more than slim down your waistline and boost heart health. It might also make what’s inside your gut healthier, according to a new study by San Francisco State University.

In this first-of-its-kind study, just published in the International Journal of Sport Nutrition and Exercise Metabolism, recent SF State graduate student Ryan Durk and Assistant Professor of Kinesiology Jimmy Bagley partnered with the SF State Health Equity Research (HER) Lab to test the relationship between gut health and cardiovascular fitness.

Durk (who received his master’s degree in kinesiology last December) recruited 20 men and 17 women, mostly from the SF State campus, and tested their cardiovascular fitness on a treadmill. He also assessed their body composition in the lab’s BOD POD, an air displacement chamber that determines a person’s fat and fat-free mass. Participants kept food logs for seven days and provided stool samples at the end of the week. The HER Lab then extracted DNA to analyze the bacteria composition in the samples. The researchers were investigating the ratio of bacteria called firmicutes to another group, bacteroides, which can be used to gauge overall gut health and composition.

Analysis showed that participants with the best cardiovascular fitness had a higher firmicutes to bacteroides ratio. While most gut bacteria can be beneficial (even bacteroides in some cases), firmicutes bacteria are associated with metabolic byproducts that help prevent bacteria in the gut from leaking into the body. “These metabolic byproducts help strengthen the intestinal lining and help prevent leaky gut syndrome,” said Durk. He says this research reinforces the idea of “exercise as medicine.”

“When we say that phrase, we think of it as meaning that exercise will help people stay healthier and live longer. But you don’t think about your gut bacteria,” Durk said. “We now know that exercise is crucial for increasing beneficial bacteria in the gut.”

According to Durk, findings from this study and other studies about the gut microbiome could eventually be used to create individual exercise prescriptions to improve gut — and overall — health. “We’re not there yet,” he said, “but this helps create that foundation.”

Source: San Francisco State University


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