Waist-height Ratio Can Indicate the Risk of Cardiovascular Disease Even in Healthy Individuals

Elton Alisson wrote . . . . . . . . .

Health experts have warned for years that men and women with excess abdominal fat run a greater risk of developing cardiovascular problems. However, individuals with abdominal or central obesity are not the only ones in danger, according to a new study.

The study found that physically active men who were not overweight but whose waist-stature ratio (WSR) was close to the risk threshold were also more likely to develop heart disorders than individuals with lower WSRs.

The study was conducted by Brazilian researchers affiliated with São Paulo State University (UNESP) in Presidente Prudente and Marília in collaboration with colleagues at Oxford Brookes University in the UK. The study resulted from a research project supported by FAPESP and is published in the journal Scientific Reports.

“We found that non-overweight, physically active, healthy individuals without a history of metabolic or cardiovascular disease but with WSRs close to the risk factor limit were more likely to develop heart disorders than individuals with less accumulated fat in the waist area,” Vitor Engrácia Valenti, a professor at UNESP Marília and principal investigator for the study, told Agência FAPESP.

According to Valenti, recent research suggests that the WSR (waist circumference divided by height) is a more accurate predictor of cardiovascular risk than the body mass index (BMI), a widely used measure of body fat.

The researchers further investigated this hypothesis by analyzing the autonomic recovery of heart rate after aerobic exercise in healthy men with different WSRs. To this end, 52 physically active healthy men aged 18-30 were divided into the following three groups according to WSR: between 0.40 and 0.449, which is below the risk threshold for cardiovascular disease; between 0.45 and 0.50, which is close to the threshold; and between 0.50 and 0.56, which is above the threshold.

The participants were tested on two separate days with a 48-hour interval between the two tests. On the first day, they remained seated and at rest for 15 minutes, and then performed a maximum effort test on a treadmill. After this bout of aerobic exercise, they remained standing and at rest for three minutes and then seated and at rest for the next 57 minutes, totalling one hour of recovery from the exertion.

“This test proved they were all physically active. They weren’t athletes, but they were in the habit of playing soccer on weekends, for example,” Valenti said.

On the second day, they warmed up for five minutes, and then ran at 60% of their maximum effort for 25 minutes.

Their heart rate and heart rate variability were measured while at rest and six times during the recovery hour to assess their speed of autonomic recovery after physical activity.

“Autonomic heart rate recovery time is a good indicator of the risk of cardiovascular complications immediately after aerobic exercise and of developing heart disease,” Valenti said. “If the heart rate takes a long time to return to normal, this indicates that the individual runs a significant risk of developing a heart disorder.”

Interaction with nervous system

Analysis of the measurements showed that the autonomic recovery was slower in the groups with WSRs close to and above the risk threshold for heart disease after both the maximum effort test and moderate aerobic exercise.

“We found that volunteers in the group with WSRs close to the risk limit were also more likely to develop cardiovascular disorders,” Valenti said.

The researchers at UNESP performed statistical analyses involving correlation coefficient tests and linear regression models to look for significant links between WSRs and heart rate variability after physical activity.

The results of the statistical analyses suggested that two factors were most significantly correlated during the first ten minutes of the postexercise recovery period, when the parasympathetic nervous system (PNS) was being reactivated. Among other functions, the PNS, one of the three divisions of the autonomic nervous system, slows heart rate and reduces blood pressure via the release of hormones.

“We found that PNS activity diminished as WSR increased. This heightens the risk of cardiovascular disturbance,” Valenti said.

Source: Agência FAPESP


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Updated Treatment Guidelines for Irregular Heartbeat Atrial Fibrillation

A newer type of blood-thinning medications, non-vitamin K oral anticoagulants (NOACs), is now recommended as the preferred alternative to warfarin for reducing the risk of stroke associated with atrial fibrillation (AFib), according to a focused update to the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for the Management of Patients With Atrial Fibrillation.

AFib is a type of irregular heartbeat in the atria, or upper chambers of the heart. Because the heart beat is irregular, blood can pool and then clot inside the atria, particularly in the left atrial appendage, a pouch that is part of the anatomy of the upper left chamber of the heart. If the clots formed within the left atrium migrate within the blood and reach the brain, a stroke caused by a blocked artery can occur even in people with no obvious symptoms of AFib.

Blood-thinning medications called anticoagulants have long been recommended to reduce the risk of stroke in patients with AFib who have an increased risk of thromboembolism (blockage of a blood vessel by a clot travelling in the bloodstream) and/or stroke caused by narrowed or blocked arteries

To reduce stroke risk in appropriate AFib patients, a newer class of anticoagulants known as NOACs is now the preferred recommended drug class over the traditional medication warfarin, unless patients have moderate to severe mitral stenosis (narrowing of the mitral valve) or have an artificial heart valve. NOACs include dabigatran, rivaroxaban, apixaban and edoxaban.

“Patients with AFib are at increased risk of stroke, which can be devastating. A goal of treating AFib patients is to make blood less likely to form clots, which reduces the risk of stroke. New scientific studies show that NOACs may be safer for patients because there is less risk of bleeding, and they may also be more effective at preventing blood clots than warfarin,” said Craig T. January, M.D., Ph.D., co-chair of the focused update published simultaneously in the American Heart Association journal Circulation, Journal of the American College of Cardiology and the Heart Rhythm Society journal, HeartRhythm.

Guidelines rank recommendations as strong, weak, or harmful on the basis of the quality and quantity of the scientific research that supports each recommendation. Recommendations with the highest level of evidence have more than one randomized controlled trial reporting similar results, whereas the lowest-ranked recommendations are based on the clinical experience of experts. Along with the strong recommendation to use NOACs in favor of warfarin for many patients, the new guidelines recommend:

  • Weight loss for overweight or obese patients. Studies find that losing weight can reduce the health risks associated with or even reverse AFib. It can also lower blood pressure (high blood pressure is often associated with AFib).
  • New drugs are available to reverse the effect of NOACs (called reversal agents). These reversal agents, while used infrequently, are helpful when there are signs of severe bleeding caused by a NOAC or when a patient on a NOAC needs an emergency surgical procedure.

“AFib patients should talk to their healthcare provider about any concerns they have about their prescribed medications and whether or not losing weight would benefit their health,” said January, who is professor of cardiovascular medicine at the University of Wisconsin in Madison, Wisconsin.

The new guidelines also suggest that NOACs could even be used in people at lower risk of stroke than previously thought. Although the evidence for this recommendation is not yet definitive, emerging research is beginning to suggest that the benefit of NOACs for reducing stroke risk outweighs the risk of taking them, said January.

Source : American Heart Association


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Study: Dry-cured Ham Bones – Source of Heart-healthy Peptides

Drinking bone broth is a recent diet fad that proponents claim fights inflammation, eases joint pain and promotes gut health. Simmering animal bones in water releases collagen and other proteins into the broth that may have health benefits, although more research is needed to validate these claims. Now, a new study in ACS’Journal of Agricultural and Food Chemistry has shown that ham bones contain peptides that could have cardioprotective effects.

During cooking and digestion, proteins from animal bones can be broken down into smaller pieces, or peptides, that have different properties than the intact protein. For example, some peptides from collagen act as antioxidants or inhibitors of disease-related enzymes. To see if Spanish dry-cured ham bones could be a source of beneficial peptides, Leticia Mora and colleagues ground up the bones and simulated conditions of cooking and human digestion. Then, they examined whether the bone samples could block the activities of several enzymes involved in cardiovascular disease. The researchers found that the bone peptides, most of which were derived from collagen and hemoglobin proteins, inhibited the enzymes even after heating and simulated digestion. In fact, these treatments released additional bioactive peptides, suggesting that the use of ham bones to make broths and stews could have a positive impact on cardiovascular health.

Source: American Chemical Society

Medicine for Cold May Affect People with High Blood Pressure or Heart Disease

Flu has so far infected more than 6 million Americans this season, and winter colds are making their rounds. If you’ve been hit by either, you may be thinking about heading to your local pharmacy to relieve your aches, pains and congestion.

But before you do, you need to consider how some over-the-counter cold medicines may impact your heart.

“People with uncontrolled high blood pressure or heart disease should avoid taking oral decongestants,” said Sondra DePalma, a physician assistant at the PinnacleHealth CardioVascular Institute at UPMC Pinnacle in Pennsylvania. “And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a health care provider.”

DePalma co-authored guidelines released in 2017 by the American Heart Association and American College of Cardiology focusing on the management of high blood pressure in adults. Both decongestants and non-steroidal anti-inflammatories (NSAIDs), found in many cold medicines, were listed as medications that could increase blood pressure.

Decongestants — like pseudoephedrine or phenylephrine — constrict blood vessels. They allow less fluid into your sinuses, “which dries you up,” said Dr. Erin Michos, associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore.

“But if you have high blood pressure or heart disease, the last thing you need is constricting blood vessels,” she said. “It can exacerbate or worsen the condition.”

The biggest concerns are for people who have had a heart attack or stroke, or have heart failure or uncontrolled high blood pressure, Michos said.

But research on NSAIDs suggests seemingly healthy people might also be at risk.

A 2017 study in the Journal of Infectious Diseases looked at nearly 10,000 people with respiratory infections who were hospitalized for heart attacks. Participants were 72 years old on average at the time of their heart attacks and many had cardiovascular risk factors, such as diabetes and high blood pressure. Researchers found that people who used NSAIDs while sick were more than three times as likely to have a heart attack within a week compared with the same time period about a year earlier when participants were neither sick nor taking an NSAID.

This may be due to the compound effect.

Merely having a cold or the flu strains the cardiovascular system. Fighting the illness raises the heart rate and causes inflammation. Meanwhile, NSAIDs — which carry a warning label about the increased risk for a heart attack or stroke — can cause problems by reducing the amount of sodium excreted through the urine, which increases fluid retention and raises blood pressure, DePalma said.

NSAIDs can be especially risky for people with heart disease or heart failure, Michos added. People who are sick should use both classes of medications — decongestants and NSAIDs — judiciously and understand the potential side effects.

For decongestants, blood pressure guidelines suggest using them for the shortest duration possible or using an alternative such as nasal saline or antihistamines to help with congestion. Decongestants shouldn’t be taken longer than seven days before consulting with a health care provider, DePalma said.

NSAIDs taken as pills should be avoided when possible to avoid affecting blood pressure, guidelines advise. Rather, topical NSAIDs and acetaminophen are recommended alternatives.

“There are effective therapies that are less risky and definitely should be tried first,” DePalma said. “If other over-the-counter medications are needed, use them cautiously. And if someone finds they are having problems like high blood pressure or other things like heart palpitations, they should talk with their health care provider.”

If symptoms are mild or moderate, rest and drink plenty of fluids, Michos said. Preventing dehydration should help reduce body aches, clear mucous and may reduce the need for decongestants.

To help avoid getting sick in the first place, Michos recommends frequent hand-washing and lots of sleep, especially during cold and flu season. The Centers for Disease Control and Prevention recommends an annual flu vaccine for everyone 6 months and older, and the pneumonia vaccine for children under 2 and adults 65 and older.

Source: HealthDay


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Your Heart Needs a Minimum 6-hour Sleep Per Night to Stay Healthy

Six hours: That’s the minimum amount of sleep per night you need to help your heart stay healthy, new research suggests.

The study found that chronic lack of sleep and poor sleep quality raise the odds of fatty plaque accumulation in arteries — a condition known as atherosclerosis, which increases the odds of heart attack and stroke.

There are many ways to fight heart disease, including “pharmaceuticals, physical activity and diet,” said lead researcher Jose Ordovas. “But this study emphasizes we have to include sleep as one of the weapons we use to fight heart disease — a factor we are compromising every day.”

Ordovas is an investigator at the National Center for Cardiovascular Research in Madrid, Spain.

In the new research, his team used coronary ultrasound and CT scans to track the artery health of nearly 4,000 Spanish adults. The study participants, average age 46, did not have heart disease at the beginning of the study.

The study couldn’t prove cause and effect, but people who slept less than six hours a night were 27 percent more likely to have body-wide atherosclerosis than those who slept seven to eight hours a night, Ordovas and his colleagues reported.

Too much sleep wasn’t great for the heart, either. The study also found that women who slept more than eight hours a night had an increased risk of atherosclerosis.

Participants with “poor-quality” sleep — frequent awakenings or difficulty getting to sleep — were also 34 percent more likely to have atherosclerosis, compared to those with good-quality sleep.

The study was published in the Journal of the American College of Cardiology.

“This is the first study to show that objectively measured sleep is independently associated with atherosclerosis throughout the body, not just in the heart,” Ordovas said in a journal news release. He also directs nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging, at Tufts University in Boston.

People who had short and poor-quality sleep also tended to consume higher levels of caffeine and alcohol, Ordovas noted.

“Many people think alcohol is a good inducer of sleep, but there’s a rebound effect,” he said. “If you drink alcohol, you may wake up after a short period of sleep and have a hard time getting back to sleep. And if you do get back to sleep, it’s often a poor-quality sleep.”

Two U.S. experts agreed that sleep is a key component of cardiovascular health.

While a direct cause-and-effect relationship between sleep and heart health remains unclear, “targeting one’s sleep habits is finally getting recognized in the medical world as an important factor to improve heart disease,” said Dr. Eugenia Gianos. She directs women’s heart health at Lenox Hill Hospital in New York City.

Gianos reasoned that behaviors in a person’s waking hours may explain the sleep-heart connection. That’s “because patients with good sleep hygiene have the energy to be physically active, make healthy food choices and handle stress better,” she said.

Dr. Thomas Kilkenny directs sleep medicine at Staten Island University Hospital, also in New York City. The new study “opens a door to further investigations to hopefully demonstrate the cause and effect between poor sleep quality and the generation of atherosclerosis disease,” he said.

“In the meantime, physicians should constantly evaluate their patients to identify sleeping disorders and stress to their patients the need to maintain at least six to eight hours of sleep per night,” Kilkenny said.

Source: HealthDay


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