Study: Late Evening Meals Could Harm the Female Heart

Late dinners and heavy evening snacking do no favors for women’s hearts, a new study suggests.

Researchers at New York City’s Columbia University found that those who ate more of their daily calories in the evening had a higher risk of heart disease.

One cardiologist who looked over the new findings wasn’t surprised by the effect.

“The way metabolism, circadian rhythm, cortisol/insulin cycles work, they do not and cannot support heavy meals in the evening hours,” said Dr. Evelina Grayver.

“Not only are our bodies not meant to digest at late hours, we are also less mobile at night, thus the calories we consume are not being expended as energy,” said Grayver, who directs the coronary care unit at North Shore University Hospital in Manhasset, N.Y.

The new study involved 112 women, average age 33, whose heart health was assessed at the start of the study and then again one year later. The women recorded what they ate for one week at the start of the study and for one week 12 months later.

Most of the women ate some food after 6 p.m., but those who consumed a higher proportion of their daily calories in the evening tended to have had poorer heart health, say a team led by Nour Makarem, a Columbia associate research scientist.

In fact, with every 1% increase in calories consumed after 6 p.m., heart health declined accordingly.

Specifically, women who ate more of their daily calories in the evening were more likely to have higher blood pressure, higher body mass index and poorer long-term control of blood sugar.

Similar findings occurred with every 1% increase in daily calories consumed after 8 p.m., according to the study, which is to be presented at the American Heart Association’s annual meeting, held Nov 16 to 18 in Philadelphia.

“So far, lifestyle approaches to prevent heart disease have focused on what we eat and how much we eat,” Makarem said in an AHA news release. But he said that the when of eating may be important, too.

There’s good news from the study, because shifting the timing of eating is “a simple, modifiable behavior that can help lower heart disease risk,” Makarem said.

Dr. Satjit Bhusri is a cardiologist at Lenox Hill Hospital in New York City. He agreed the findings make sense.

“Calories are immediate energy,” he said. “I always advise patients to eat a lean, low -carbohydrate, early dinner. This simple understanding and mindfulness of when and what to eat, as the study states, can make a major impact on overall cardiovascular health and outcomes.”

Because these findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.

Source: HealthDay

Major Study Gives Women More Guidance on Hormone Therapy During Menopause

Women who receive hormone therapy to help ease menopausal symptoms have an increased risk of breast cancer, which can persist long after they stop the therapy, a new study confirms.

The new review — which included data from 58 studies involving nearly 109,000 women from around the world — is the latest chapter in the ongoing story of these hormone therapies.

“Since the Women’s Health Initiative [study] identified in 2002 that women who took hormone replacement therapy were at an increased risk for the development of breast cancer, we have seen a marked decline in their use,” noted Dr. Lauren Cassell, a breast surgeon at Lenox Hill Hospital in New York City. She wasn’t involved in the new report.

“Patients who were on hormone replacement went off them [after the 2002 study], and physicians were more cautious in prescribing them,” Cassell said.

The new report, published Aug. 29 in The Lancet, “again reinforces that known increased risk, but more importantly, it identifies that the risk persists even after the therapy is stopped, and is affected by the length of time that the patient takes hormone replacement,” Cassell said.

The new analysis was performed by a global team of experts known as the Collaborative Group on Hormonal Factors in Breast Cancer. They pored over data from 58 studies conducted worldwide between 1992 and 2018. These studies included nearly 109,000 women with breast cancer, with an average age of 65 at diagnosis.

Half of the women had received hormone therapy for menopause, the researchers noted. The average age at menopause was 50 and the average age at starting hormone therapy was also 50. Women took hormone therapy for an average of 10 years, in current users, and for seven years in past users, the team said.

For women of average weight living in Western countries who have never used hormone therapy, the average risk of developing breast cancer between ages 50 to 69 was about 6.3 per 100 women, according to the study.

However, the risk rose for women who received hormone therapy, and the formulation used seemed key to an uptick in risk.

For example, for women who took treatments involving estrogen plus daily progestogen for five years, the rate of breast cancer was 8.3 per every 100 women. It was slightly lower for women taking estrogen plus intermittent progestogen — 7.7 per 100.

The rate was lower — but still elevated — for women who used an estrogen-only therapy: 6.8 cases per 100, the findings showed.

Duration of use mattered, as well. The rise in breast cancer risk was about twice as high for women who used hormone therapy for 10 years rather than five years, the study found.

Conversely, there was little increased risk of breast cancer after using any form of hormone therapy for less than a year, the researchers said.

One major finding was just how long hormone therapies left their mark for women who used the treatment for five years; any elevation in breast cancer risk didn’t fully subside until 15 years after stopping the therapy.

The findings suggest that all types of hormone therapy for menopause — with the exception of topical vaginal estrogens — are associated with an increased risk of breast cancer, the study authors said.

“Our new findings indicate that some increased risk persists even after stopping use of menopausal hormone therapy,” study co-author Valerie Beral, a professor at the University of Oxford in England, said in a journal news release.

The use of hormone therapy for menopause rose sharply in the 1990s, fell by half in the early 2000s and stabilized in the 2010s. Currently, there are about 12 million users in Western countries — about 6 million in North America and 6 million in Europe.

Ten years of use was once common, but about five years of use is now more likely, the researchers said.

Dr. Alice Police directs breast surgery at Northwell Health Cancer Institute in Sleepy Hollow, N.Y. Looking over the study, she said that as time goes by, research like this is giving women better guidelines on what is or is not safe when it comes to hormonal therapies.

For example, “we now know that topical vaginal creams do not increase the risk of breast cancer as they mostly work locally and absorption is minimal. This is great news for many women who depend on these therapies to prevent UTIs [urinary tract infections] and vaginal dryness,” Police said.

“We also know which medications, in what combinations, are the most dangerous,” she added. “For example, estrogen alone is safer than estrogen and progesterone together.”

For her part, Cassell said that, going forward, “oral hormone replacement therapy should be prescribed judiciously for patients who are having intolerable symptoms of menopause and understand the increased risk for breast cancer.”

That means, “the use of progesterone should be minimized and the length of the hormone replacement should be as short as possible,” Cassell said.

Source: HealthDay


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Rising Blood Pressure Puts Women At Greater Stroke Risk Than Men

As the severity of high blood pressure rises, the risk of stroke rises almost twice as quickly in women compared with men, according to a new study.

Published Tuesday in the journal Hypertension, the research raises the question of whether sex-specific guidelines may be needed for controlling high blood pressure.

High blood pressure is the most common modifiable risk factor for stroke, which is the third leading cause of death for women and the fifth leading cause for men.

For people under 60, high blood pressure is less prevalent in women than men, study authors said. But it becomes more prevalent in older women, who are less likely to keep their blood pressure under control as they age.

“Our findings basically suggest that the risk of stroke may increase with each level of hypertension, more so in women than men,” said Dr. Tracy Madsen, the study’s lead author. She is an assistant professor of emergency medicine at Alpert Medical School of Brown University in Providence, Rhode Island.

Madsen’s team looked at sex and racial differences in the level of hypertension severity and stroke risk in 26,461 men and women in the United States. More than half of participants were women, 40% were black, and the average age of men was 66, while for women it was 64.

The study included an oversampling of people living in the southeastern states of the so-called “stroke belt,” which includes Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee. People in the region have a 34% higher risk of stroke than their counterparts elsewhere in the country.

Researchers found that for every 10 mmHg increase in blood pressure, the risk of stroke widened between white women and men, and the risk of stroke across increasing levels of blood pressure was about twice as high in women than men. These sex differences did not hold true, however, among black men and women, even though this group experienced more severe hypertension than whites.

The dramatic contrast in stroke risk between men and women suggests a need for closer examination of how hypertension behaves in each group, Madsen said. Women have too often been underrepresented in clinical trials, despite their higher prevalence for stroke and stroke-related mortality.

“We need to see if this (gap) holds true in a prospective, randomized clinical trial and whether it would be helpful to have tighter blood pressure control for women,” she said.

Not everyone agrees these findings point to a potential need for sex-specific guidelines for treating hypertension.

That issue was evaluated when the American Heart Association and the American College of Cardiology developed new guidelines for controlling blood pressure in 2017, said Dr. Paul Whelton, who chaired the guideline writing committee. People are considered to have high blood pressure if their systolic, or top number, is 130 or higher or their diastolic, the bottom number, is 80 or higher.

“For treatment, there hasn’t been any convincing demonstration that there’s much of a difference between men and women,” said Whelton, a professor at Tulane University in New Orleans and the Show Chwan Health System Endowed Chair in Global Public Health.

He said the new study’s findings surprised him, but more research is needed before making any conclusions.

“The differences in this study are fairly substantial,” he said. “It raises a red flag, but for me, at least, I don’t think it has convincingly demonstrated an answer one way or another.”

Madsen’s team also looked at how the number of hypertensive medications a person was taking impacted their risk for stroke.

They found the more medications it took to maintain good blood pressure control, the higher that person’s stroke risk. That risk increased 23% for each additional class of medication. This held equally true for both men and women.

“This does not suggest that the medications themselves increase the risk of stroke,” Madsen said. “But someone who takes three medications to maintain a systolic blood pressure level of 140 mmHg has a higher stroke risk than someone who needs only one medication to reach that same level. It’s because their blood pressure is more difficult to control or resistant to treatment.”

Madsen said the study points to the need to gather more sex-specific data in future investigations.

“There are hidden sex differences in many disease processes that we really don’t even know about,” she said. “We may not have enough data to say that tomorrow we need to implement sex-specific guidelines for how we treat hypertension, but we also don’t have the data to say that our one-size-fits-all approach to stroke prevention is the right one.”

Source: HealthDay


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Pulse Waves Measured at the Wrist Uncover Artery Changes in Menopausal Women

Measuring a menopausal woman’s pulse wave at her wrist may help explain the increase in cardiovascular disease risk during menopause better than a standard blood pressure measurement, according to preliminary research presented at the American Heart Association’s Basic Cardiovascular Sciences 2019 Scientific Sessions.

While research shows that age, gender and body mass index (BMI) play important roles in cardiovascular disease risk, it’s not clear why the risk spikes when women are in menopause.

Researchers in this study used radial pulse waves, measuring the beat of the heart through the artery at the base of the wrist. Checking radial pulse waves is easy, non-invasive and can offer more data than just looking at systolic or diastolic blood pressures, the researchers said.

They studied 327 premenopausal and postmenopausal women with no history of heart disease, tracking the women’s systolic and diastolic blood pressure measurements, as well as 12-second continuous radial pulse data.

“Through mathematical models, we converted the pressure wave of the radial pulse into frequency waves. Each frequency wave was assigned a corresponding harmonic amplitude classification from C1 to C5 which provides different information than pulse rate or blood pressure,” said Chi-Wei Chang, Ph.D., the study lead author and director of research and development at the Mii-Ann Medical Research Center in Taipei, Taiwan.

“For example, a violin and clarinet can play the same note but sound different because of the harmonic components of these instruments’ overtones,” Chang said. “Two people can have a heart rate of 75 beats per minute, but their harmonic amplitudes can vary dramatically. Analyzing the differences between these harmonic components reveals more individualized information about a person’s circulatory system.”

The researchers found radial pulse wave information reflected changes during menopause that were not evident in systolic or diastolic blood pressure measurements. Specifically, the first and third harmonics — C1 and C3 — were impacted. C1 is related to heart attack and heart failure, according to Chang.

They also found:

  • BMI is the largest factor affecting a woman’s blood pressure and risk for hypertension.
  • Age affects only systolic blood pressure.
  • Menopause does not change blood pressure but can increase one’s cardiovascular disease risk, as seen in changes in harmonic components of the radial pulse.

Additionally, according to this study, the C1 and C3 harmonics in radial pulse waves may shed light on hormonal changes during menopause that indicate the progression of atherosclerosis, but more work is needed to know for sure, Chang said. This information can be useful in better understanding a woman’s cardiovascular disease risk.

“Healthcare providers can measure a menopausal woman’s radial pulse to see if the patient’s C1 harmonic is affected. If it is, they can monitor a patient’s situation more closely and take action to prevent cardiovascular disease from becoming more severe,” Chang said.

One of the limitations of the study is this increase in the amplitude of the first and third harmonics of the radial pulse wave only suggests that menopause increases the risk of heart disease by exacerbating atherosclerosis. More research is needed to demonstrate how and why that occurs, Chang said.

Source: American Heart Association


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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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