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Weight-Loss Surgery Protects Heart Patients From Future Trouble

TUESDAY, Nov. 5, 2019 — If you’re an obese heart patient, weight-loss surgery might be good medicine for you.

New research suggests it significantly reduces the risk of heart failure and fatal heart attack in this vulnerable group.

“Our findings suggest, for the first time, that bariatric [weight-loss] surgery can prevent the development of systolic heart failure and remarkably reduce death from recurrent myocardial infarction, or heart attack, in patients with a higher cardiovascular risk than the average population,” said study author Dr. David Funes. He is a research fellow at the Bariatric and Metabolic Institute at Cleveland Clinic Weston, in Florida.

For the study, Funes and his team compared severely obese people with heart disease who had weight-loss surgery (8,200) with those who did not have the surgery (79,000).

Nearly half of the weight-loss surgery patients also had a history of some form of diabetes, and about 73% had high blood pressure. But those who didn’t have weight-loss surgery had even higher rates of both diseases, which are risk factors for heart disease.

Obesity itself is a major risk factor for heart disease.

Patients who didn’t have weight-loss surgery were 1.9 times more likely to develop heart failure than those who had the surgery, according to the study.

In addition, the investigators found that patients who had weight-loss surgery were 2.5 times less likely to die from a recurrent heart attack than those who didn’t have the surgery.

A history of diabetes, which improves in most patients after weight-loss surgery, considerably increased the risk of heart failure in patients who’d previously suffered a heart attack.

The study was to be presented Tuesday at the annual meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS), in Las Vegas. Such research is considered preliminary until published in a peer-reviewed journal.

Dr. Eric DeMaria is ASMBS president and chief of East Carolina University’s division of general/bariatric surgery. “Metabolic surgery has been proven to have significant cardiovascular benefits and needs to be considered as part of the treatment plan for patients with severe obesity and coronary artery disease,” he said in a society news release.

“The key is to treat obesity sooner rather than later to slow the progression of heart disease, reduce other risk factors including hypertension and diabetes, and preserve heart function,” DeMaria added.

Nearly 40% of U.S. adults (over 93 million Americans) were obese in 2015-2016, according to the U.S. Centers for Disease Control and Prevention. About 24 million of these adults are severely obese, according to the ASMBS.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on weight-loss surgery.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

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‘Dramatic Increase’ Seen in U.S. Deaths From Heart Failure

WEDNESDAY, Oct. 30, 2019 — Heart failure deaths are reaching epidemic proportions among America’s seniors, a new study finds.

About one in eight deaths from heart disease are from heart failure, and nine out of 10 are among those over 65 years of age, researchers report.

“We are now in the midst of a ‘silver tsunami’ of heart disease and heart failure,” said senior study author Dr. Jamal Rana, chief of cardiology at Kaiser Permanente Oakland Medical Center, in California.

“This will require both innovation in clinical care for our patients and urgent policy initiatives at the health care systems level to be better prepared for its impact,” Rana added in a Kaiser news release.

The report was published online Oct. 30 in JAMA Cardiology.

According to lead author Dr. Stephen Sidney, “The United States is now experiencing a dramatic increase in the number of older people dying from heart disease, and especially heart failure.” Sidney is a senior research scientist with the Kaiser Permanente Northern California division of research.

Heart failure is a chronic, progressive disease where the heart muscle is weakened and can’t pump blood efficiently, which increasingly reduces quality of life as patients decline.

For the study, Sidney and his colleagues used data from the U.S. Centers for Disease Control and Prevention.

The investigators found that more than 647,000 Americans died from heart failure in 2017, which was about 51,000 more deaths from heart failure than in 2011.

The rate of deaths due to heart failure increased by 21%. When the researchers added the aging population as a factor, the rate of heart failure deaths jumped to 38%.

Sidney added that since the number of Americans over 65 increased by 10 million between 2011 and 2017, and is expected to grow by another 22 million by 2030, heart failure rates will likely only worsen.

More information

For more on heart failure, head to the American Heart Association.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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AHA News: Women and Men Tolerate Heart Transplants Equally Well, But Men May Get Better Hearts

FRIDAY, Oct. 11, 2019 (American Heart Association News) — Women are just as likely as men to survive after a heart transplant despite often getting poorer-quality donor hearts, new research shows.

The findings, published this week in the American Heart Association journal Circulation: Heart Failure, sought to shed new light on what role, if any, gender plays in surviving a heart transplant. Past research on post-transplant survival rates and gender have told conflicting stories.

For the new study, researchers looked at data from 34,198 international heart transplant recipients from 2004 to 2014 and, after adjusting for recipient and donor factors, they found “no significant survival difference” between men and women.

“That’s a pretty novel finding,” said study author Dr. Yasbanoo Moayedi, a postdoctoral medical fellow at Stanford University in California. “We already know that women are hugely under-represented as recipients of heart transplants, but the striking thing about the new findings is there’s no difference in survival when matched to their male counterparts.”

The study also found women who get heart transplants appear to have lower-risk features than male recipients, with fewer instances of diabetes, high blood pressure, smoking, peripheral vascular disease and past cardiovascular surgery. Yet, women appear to receive higher-risk hearts than men.

“We need to better understand the matching of risk with recipient,” Moayedi said. “We hypothesize that women tend to deteriorate more acutely, and they’re sicker, so they take any heart that’s available.”

She said the findings suggest women with advanced heart failure need to be referred a bit earlier for transplant.

“One takeaway of the study is that maybe we’re missing the optimal window [for women],” she said. “Many factors may determine access to transplant, but gender should not be one of the them.”

The study was limited by its observational nature and its lack of data on waitlist mortalities, donor race and information about how sick patients where when they received a transplant.

Dr. Monica Colvin, a heart failure-transplant cardiologist who was not involved in the research, called it “a contemporary analysis” because it included newer devices and current medical therapy.

“There have been anecdotes of women having worse survival than men after heart transplant and studies have been conflicting,” said Colvin, director of the Heart Failure Network Strategy at the University of Michigan. “This study should dispel that myth and inform doctors that there really is no difference. We should not delay or defer referral for this lifesaving treatment based on concern for differential survival in women.”

An estimated 6.2 million U.S. adults have heart failure. In 2018, there were 3,408 heart transplants, according to the federal Organ Procurement and Transplantation Network.

Moayedi would like to see future studies explore why more women don’t undergo heart transplants and how a doctor’s gender might play into that decision.

“Is it that women don’t see themselves worthy enough for a heart transplant? As a patient, should I be more of an advocate for my symptoms? These things need to be looked at more systematically to learn how to best help the patient,” Moayedi said.

Colvin advises women with advanced heart failure to be seen at an advanced heart failure center “and seek out as much information as they can. It’s important to know what all your options are.”

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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Sen. Bernie Sanders Leaves Hospital; Doctors Confirm He Had Heart Attack

By Margaret Farley Steele
HealthDay Reporter

SATURDAY, Oct. 5, 2019 (HealthDay News) — Senator Bernie Sanders left a Las Vegas hospital on Friday after being admitted with chest pains on Tuesday; his presidential campaign is now saying the 78-year-old suffered a heart attack.

Sanders experienced chest pain at a campaign event and received two stents to open a blocked artery. He has cancelled public events for the time being, The New York Times reported.

Sanders waved to onlookers and gave a fist pump as he left Desert Springs Hospital Medical Center and was taken away in a waiting vehicle. Later, after dropping off bags at his hotel, he was seen taking a walk in a nearby park with his wife, Jane.

“After two and a half days in the hospital, I feel great, and after taking a short time off, I look forward to getting back to work,” Sanders said in a statement.

His doctors in Las Vegas, Arturo Marchand and Arjun Gururaj, said the senator’s “hospital course was uneventful with good expected progress,” the Times added.

Although his campaign is not saying when he will resume a normal schedule, on Thursday it was announced that Sanders does plan to take part in the next Democratic debate, scheduled for Oct. 15 near Columbus, Ohio.

Dr. Steven Nissen, a cardiologist and chief academic officer at Cleveland Clinic’s Heart & Vascular Institute, said that stenting should allow Sanders to resume normal activities.

“We don’t know all the details, but this is a common, safe procedure, and with contemporary stents, it generally comes with a short recovery time,” said Nissen, who wasn’t involved in Sanders’ care. “The purpose of modern medicine is to let people continue pursuing their passions, and for this procedure, patients can generally get back to that relatively quickly.”

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City, said Sanders suffered the classic signs of heart attack and was promptly sent to emergency services.

“All heart attacks present differently. In women, for example, they typically present as a sudden shortness of breath. Mr. Sanders had the textbook symptoms of chest pain that was successfully treated,” Bhusri noted.

Continued

“If not recognized and treated early, the outcome would have been more ominous,” Bhusri added.

According to the American Heart Association, stents help keep coronary arteries open and reduce the chance of a heart attack. Doctors insert the stent — a tiny mesh tube — into the clogged artery with a balloon catheter. When they inflate the balloon, the stent expands and locks in place. This allows blood to flow more freely.

Did Sanders’ hectic schedule contribute to his heart attack? One expert isn’t sure, but said the politician’s example should be a wake-up call to many Americans.

“Lack of sleep, exercise, and increased stress can certainly lead to acute coronary events,” said Dr. Benjamin Hirsh, who directs preventive cardiology at Northwell Health Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.

“Whether or not these factors contributed to Bernie Sanders’ heart condition, we continue to learn vital lessons from this and other similar stories,” he said. “Coronary disease is on the rise, regular medical evaluation is necessary, and prioritizing healthy living is essential to keep your heart safe.”

WebMD News from HealthDay

Sources

SOURCES: Benjamin Hirsh, M.D.,  director, preventive cardiology, Northwell Health Sandra Atlas Bass Heart Hospital, Manhasset, N.Y.; Steven Nissen, M.D., cardiologist and chief academic officer, Cleveland Clinic’s Heart & Vascular Institute; Satjit Bhusri, M.D., cardiologist, Lenox Hill Hospital, New York City;The New York Times

Copyright © 2013-2018 HealthDay. All rights reserved.

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Fewer Teeth, Higher Risk of Heart Disease?

FRIDAY, Oct. 4, 2018 — Losing teeth may be associated with higher risk for heart disease, a new study suggests.

Researchers studied nearly 317,000 Americans between 40 and 79 years of age. They found that 28% of those who had lost all their teeth to gum disease also had heart problems, compared with 7% of those who kept all their teeth.

The researchers found that people with some missing teeth were more likely to develop heart disease, even when accounting for factors such as age, weight, race, tobacco and alcohol use, and dental visits.

“Our results support that there is a relationship between dental health and cardiovascular health,” said lead author Dr. Hamad Mohammed Qabha. He’s chief medical and surgical intern at Imam Muhammad Ibn Saud Islamic University in Riyadh, Saudi Arabia.

The findings were scheduled to be presented Thursday at a meeting of the American College of Cardiology, in Dubai, United Arab Emirates. The study only revealed an association rather than a cause-and-effect link.

“If a person’s teeth fall out, there may be other underlying health concerns,” Qabha said in a meeting news release. “Clinicians should be recommending that people in this age group receive adequate oral health care to prevent the diseases that lead to tooth loss in the first place and as potentially another way of reducing risk of future cardiovascular disease.”

Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

More information

For more about steps to prevent heart disease, visit the American Heart Association.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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Sen. Bernie Sanders Leaves Hospital; Doctors Confirm He Had Heart Attack

SATURDAY, Oct. 5, 2019 — Senator Bernie Sanders left a Las Vegas hospital on Friday after being admitted with chest pains on Tuesday; his presidential campaign is now saying the 78-year-old suffered a heart attack.

Sanders experienced chest pain at a campaign event and received two stents to open a blocked artery. He has cancelled public events for the time being, The New York Times reported.

Sanders waved to onlookers and gave a fist pump as he left Desert Springs Hospital Medical Center and was taken away in a waiting vehicle. Later, after dropping off bags at his hotel, he was seen taking a walk in a nearby park with his wife, Jane.

“After two and a half days in the hospital, I feel great, and after taking a short time off, I look forward to getting back to work,” Sanders said in a statement.

His doctors in Las Vegas, Arturo Marchand and Arjun Gururaj, said the senator’s “hospital course was uneventful with good expected progress,” the Times added.

Although his campaign is not saying when he will resume a normal schedule, on Thursday it was announced that Sanders does plan to take part in the next Democratic debate, scheduled for Oct. 15 near Columbus, Ohio.

Dr. Steven Nissen, a cardiologist and chief academic officer at Cleveland Clinic’s Heart & Vascular Institute, said that stenting should allow Sanders to resume normal activities.

“We don’t know all the details, but this is a common, safe procedure, and with contemporary stents, it generally comes with a short recovery time,” said Nissen, who wasn’t involved in Sanders’ care. “The purpose of modern medicine is to let people continue pursuing their passions, and for this procedure, patients can generally get back to that relatively quickly.”

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City, said Sanders suffered the classic signs of heart attack and was promptly sent to emergency services.

“All heart attacks present differently. In women, for example, they typically present as a sudden shortness of breath. Mr. Sanders had the textbook symptoms of chest pain that was successfully treated,” Bhusri noted.

“If not recognized and treated early, the outcome would have been more ominous,” Bhusri added.

According to the American Heart Association, stents help keep coronary arteries open and reduce the chance of a heart attack. Doctors insert the stent — a tiny mesh tube — into the clogged artery with a balloon catheter. When they inflate the balloon, the stent expands and locks in place. This allows blood to flow more freely.

Did Sanders’ hectic schedule contribute to his heart attack? One expert isn’t sure, but said the politician’s example should be a wake-up call to many Americans.

“Lack of sleep, exercise, and increased stress can certainly lead to acute coronary events,” said Dr. Benjamin Hirsh, who directs preventive cardiology at Northwell Health Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.

“Whether or not these factors contributed to Bernie Sanders’ heart condition, we continue to learn vital lessons from this and other similar stories,” he said. “Coronary disease is on the rise, regular medical evaluation is necessary, and prioritizing healthy living is essential to keep your heart safe.”

More information

To learn more about stents, visit the American Heart Association.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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High-Fiber Diet Tied to Lower Heart Risk in Diabetes Patients

FRIDAY, Oct. 4, 2019 — A fiber-rich diet appears to help people with high blood pressure and type 2 diabetes in multiple ways, lowering their blood pressure, cholesterol and blood sugar levels, a new study suggests.

High blood pressure (hypertension) and diabetes raise the risk for heart disease, and diet may help keep it at bay, researchers say.

“This study helps us determine three important things for this patient population,” said lead author Dr. Rohit Kapoor, medical director of Care Well Heart and Super Specialty Hospital in Amritsar, India.

“Firstly, a high-fiber diet is important in cases of diabetes and hypertension to prevent future cardiovascular disease,” Kapoor said in a news release from the American College of Cardiology.

“Secondly, medical nutrition therapy and regular counseling sessions also hold great importance in treating and prevention of diabetes and hypertension,” he added.

Thirdly, this type of diet in combination with medical treatment can improve lipid levels, pulse wave velocity [a measure of arterial stiffness], waist-to-hip ratio and high blood pressure, Kapoor said.

For the study, Kapoor’s team tracked fiber consumption among 200 participants over six months. Patients sent photos of their meals on WhatsApp and engaged in phone calls three times a week during which they were asked to recall their diet.

The study found that those participants eating a high-fiber diet showed significant improvement in several risk factors, including a 9% reduction in cholesterol, 23% reduction in triglycerides, 15% reduction in systolic (top number) blood pressure and a 28% reduction in blood sugar.

Foods high in fiber include fruits and vegetables, beans, whole grains and nuts.

The study results were scheduled to be presented Thursday at an American College of Cardiology meeting, in Dubai, United Arab Emirates. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

More information

For more on type 2 diabetes, head to the American Diabetes Association.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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Fish Oil Supplements May Do Your Heart Good

By Alan Mozes
HealthDay Reporter

MONDAY, Sept. 30, 2019 (HealthDay News) — Millions of Americans pop a fish oil supplement each day, hoping to bolster their heart health. Now, research suggests they may be on the right track.

The most up-to-date review of data from 13 prior studies found daily omega-3 fish oil supplement use tied to a significant lowering of risk for heart attack, according to a team led by Dr. JoAnn Manson. She is a professor of epidemiology at Harvard’s T.H. Chan School of Public Health, in Boston.

Daily use of the supplement — typically about 840 milligrams per day — was also linked to a lower overall risk of dying from heart disease, the review found.

In total, the 13 studies involved data on more than 120,000 adults, a sample size that is 64% larger than any other yet conducted, the researchers said.

Although the findings are encouraging, fish oil remains just one factor in heart health, Manson said in a school news release.

“Public health recommendations should focus on increasing fish consumption, having an overall heart-healthy diet, being physically active, and having other healthy lifestyle practices,” she said. However, “this study suggests that omega-3 supplementation may have a role in appropriate patients.”

Overall, Manson’s team concluded that people who took a fish oil supplement on a daily basis had an 8% drop in their risk for heart attack or death due to coronary heart disease.

The study couldn’t prove that fish oil supplements directly caused the improvements in heart health. After all, people who take the supplements might also be doing other things to boost their cardiovascular systems.

However, the researchers pointed out that there was a “dose-response” relationship in the findings: The more omega-3 fish oil a person took in each day, the greater their protection against heart disease.

As a practical matter, that could mean that “high-dose” supplementation — a daily regimen that exceeds the 840 mg threshold that’s the subject of most research — could be of even greater benefit than lower doses.

There was one exception to these trends, however: No evidence was found to indicate that omega-3 fish oil also helped to decrease stroke risk, the researchers reported.

Continued

Two experts in heart health agreed that the supplement may help the heart, but shouldn’t be viewed as a cure-all.

“Supplementation only mitigates the risk” for heart trouble, said Katrina Hartog, clinical nutritionist at Lenox Hill Hospital in New York City. “As always, addressing the main risk factors [for heart disease] may be of the greatest benefit to reduce risk of developing chronic disease.”

But she said the new data should reassure Americans that fish oil does help.

Dr. Guy Mintz directs cardiovascular health at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. Reviewing the new study, he said “there is nothing ‘fishy’ here: This study is enlightening and reinforces the need for supplemental treatment options for patients at increased risk for cardiovascular events.”

Just how might fish oil be working its magic? According to Mintz, “the mechanism of benefit is unknown but may be due to an anti-inflammatory effect and or anti-arrhythmic effect.”

He believes that the supplements may be most helpful for patients at known risk for heart disease.

Based on the new data review, “every physician should have a discussion with their patients at increased cardiovascular risk — including diabetic patients, patients with heart disease, or patients with stents and a history of coronary bypass — to see how the addition of omega-3 supplementation at an optimal dosage could further reduce their risk for future cardiac events,” Mintz said.

The new study was funded by the National Institutes of Health and was published online Sept. 30 in the Journal of the American Heart Association.

WebMD News from HealthDay

Sources

SOURCES: Katrina Hartog, M.P.H., R.D., clinical nutrition manager, Lenox Hill Hospital, New York City; Guy L. Mintz, M.D., director of cardiovascular health & lipidology, Northwell Health’s Sandra Atlas Bass Heart Hospital, Manhasset, N.Y.;  Harvard T.H. Chan School of Public Health, news release, Sept. 30, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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AHA News: His Heart Stopped. But His Golf Cart Kept Going

FRIDAY, Sept. 27, 2019 (American Heart Association News) — On a sunny April day in 2018, Bill Doss pushed through his exhaustion and met his buddies for their regular round of golf. As he headed to the final tee, he was rounding a turn in his cart and his world went black.

His heart had stopped. But his cart kept going.

The runaway cart careened over the green, ripping up grass before crashing into a ball-washing station near the 17th hole of the Forsyth Country Club in Winston-Salem, N.C.

A foursome on a nearby hole heard the commotion. One of the players was a doctor. Beyond being banged up, the doctor discovered Doss’ heart wasn’t beating. He started CPR. Another player called 911.

Meanwhile the others called the clubhouse for help. The pro raced to the scene with an automated external defibrillator. He and another doctor, who had been playing the 10th hole, worked the AED to try restoring a normal heart rhythm.

Will Doss, Bill’s son, was at work 10 minutes away when a caller said, “Get in your car and come to the club. Your dad’s down on 18!”

On the drive, Will tried to assure himself everything would be OK. His dad, then 70, had health problems before, including diabetes and multiple sclerosis. Will hoped whatever this was, Bill would pull through.

When Will reached his father, firefighters and first responders were giving CPR and using the AED.

Will begged his father not to leave him, his sister and their mother.

“I wasn’t ready for him to go,” the 48-year-old said. “In some ways I expected something like that because of his health problems. But then when it came down to it, all I knew is that I wanted more time with him.”

After six shocks, Bill still had no sustainable pulse. A seventh try restored it.

In the emergency room, he had vague recollections of driving around the green and of his son yelling at him, but he didn’t remember much of anything else after arriving at the club that day.

Bill was told a low potassium level likely caused the cardiac arrest and would explain his earlier sluggishness. He had been on medication for it, but acknowledged he didn’t always take the prescribed amount.

Bill credited his resuscitation to the luck of having a doctor nearby, the speed of first responders and his son’s presence.

“It’s just a miracle any way you look at it,” the 71-year-old said.

At this year’s Winston-Salem American Heart Association Heart Ball, firefighters who had been at the scene surprised Bill by appearing onstage with him.

More than 350,000 cardiac arrests occur outside of the hospital each year. CPR, especially if administered immediately after cardiac arrest, can double or triple a person’s chance of survival.

Bill spent about a month in the hospital and a rehabilitation facility. He still goes to outpatient rehab three times a week to work on balance, strength and cardiovascular stamina.

“They monitor everything and put electrodes on me, and I feel safe,” he said.

Today, Bill has made his way back onto the golf course, although only nine holes at a time.

Emotionally, though, the recovery has been harder than he expected.

“It’s been tough, but my family looks after me really well,” he said.

Will said he is grateful he took his father on a couple “bucket trips” a couple years after Bill retired in 2014. They played two mecca courses – Pebble Beach in California and St. Andrews in Scotland.

His father’s cardiac arrest has made time together even more special.

“This reminded me that I need to take the time with Dad while I have it,” Will said.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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‘First Responders’ on 9/11 Face Lingering Heart Woes, Study Finds

FRIDAY, Sept. 6, 2019 — The firefighters who flooded into Ground Zero on 9/11 put their lives on the line to help others. Now, a new study shows they are still paying the price for their selflessness.

Those who were first on the scene or worked for months among the ruins of the World Trade Center disaster in 2001 have an increased risk of heart disease, stroke and heart attack that persists to this day, researchers report.

Their exposure to the airborne dust and fine particles created by the collapse of New York City’s Twin Towers is wreaking long-term havoc on the health of their blood vessels and heart, experts said.

Firefighters first on the scene have a 44% increased risk of heart attack, stroke, heart disease, sudden heart death, cardiac surgery or other life-threatening heart problems, when compared against those who arrived later in the day, researchers found.

Further, those who worked at Ground Zero for six months or more have a 30% higher risk of a heart health emergency than those who worked fewer months on the scene.

The risk from exposure to the World Trade Center disaster was about the same as that associated with chronic high blood pressure, said Dr. Jacqueline Moline, vice president of occupational medicine, epidemiology and prevention for Northwell Health in Manhasset, N.Y.

“The concern is the dust was pro-inflammatory,” said Moline, who treats World Trade Center survivors. “It makes it more likely for particles and platelets and other substances to aggregate in the coronary arteries, and that can lead to more deposits, more plaque, more build-up, more blockage.”

Prior studies have linked World Trade Center exposure with respiratory problems, post-traumatic stress disorder (PTSD) and several types of cancer, researchers said in background notes. However, studies of the site’s effect on heart health up to now have produced inconsistent results.

For this study, researchers led by Rachel Zeig-Owens and Hillel Cohen, from the Department of Epidemiology and Population Health at Albert Einstein College of Medicine in New York City, tracked 16 years of health records for nearly 9,800 New York City firefighters who worked at Ground Zero.

They divided the firefighters into four groups:

  • Those first on the scene the morning of 9/11, who are believed to have been exposed to the most dust.
  • Those who arrived that afternoon.
  • Those who arrived the day after the attack.
  • Those who arrived 3 to 14 days following the attack.

These firefighters all were very healthy people who had to undergo regular stress tests, breathing tests and physical examinations as part of their job, said Dr. Mary Ann McLaughlin, a cardiologist at Mount Sinai Hospital in New York City.

Three-fourths of the firefighters had never smoked, and were generally in great physical shape prior to 9/11, researchers said.

“These were all healthy workers at the onset of the study,” McLaughlin said. “They excluded anyone from the study who had prior heart disease.”

The results show that exposure to air pollution from the World Trade Center is a heart risk factor all on its own, after accounting for other risk factors like high cholesterol, smoking, excess weight, elevated blood pressure, diabetes and smoking.

“The typical risk factors were present, but the World Trade Center added an additional risk,” Moline said, though the study could not prove that exposure actually caused heart risks to rise.

The greatest heart health problems were faced by those first on the scene, but working a long time at Ground Zero also created an increased risk, researchers found.

“They didn’t have that acute high exposure on that first day, but they had continued lower levels of exposure,” Moline said of people who worked six months or more at the site.

It’s very likely that the heart risk posed by exposure at Ground Zero is even greater than observed in this study, McLaughlin said.

“They may even be underestimating the results of the exposure, because the people they compared to did have some exposure, just less exposure,” McLaughlin said. “The absolute risk of heart disease may even be more if you compared them to a control group that was never exposed.”

Fine particles that are inhaled can make their way into a person’s bloodstream, contributing to inflammation and stiffening of the arteries much in the same way as cigarette smoking, McLaughlin and Moline said. Previous environmental studies have linked particle air pollution to heart health problems.

This study didn’t consider obstructive sleep apnea as a possible risk factor, but that sleep disorder could also contribute to the firefighters’ heart health problems, McLaughlin speculated.

“We know obstructive sleep apnea is considered a World Trade Center condition in those who have chronic sinusitis and snoring,” McLaughlin said. “Sleep apnea is an important risk factor for heart disease as well.”

These results show that people who volunteered at Ground Zero need to pay particular attention to their heart health, Moline said.

In the years to come, it will be crucial that they eat right, exercise, control their blood pressure and cholesterol, and avoid smoking, she said.

“We know you can control all those other risk factors that are still going to be there, so it’s really important for anyone who had World Trade Center exposure that they take care of their heart and achieve good heart health,” Moline said.

The findings were published Sept. 6 in the journal JAMA Network Open.

More information

The U.S. Environmental Protection Agency has more about the heart health effects of particle pollution.

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Posted: September 2019

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Cancer Overtakes Heart Disease as #1 Killer of Middle-Aged in Wealthy Nations

TUESDAY, Sept. 3, 2019 — Heart disease still claims the lives of more people globally, but in more affluent nations it has now ceded its place as the leading killer to cancer, a major new report finds.

Around the world, 40% of all deaths are caused by heart disease, making it the number one global killer. That means that of the estimated 55 million people who died around the world in 2017, approximately 17.7 million succumbed to heart disease.

Cancer was the second leading killer globally, accounting for 26% of all deaths, the study authors said.

However, when middle- and lower-income countries were taken out of the calculation, a different picture emerged, according to a report published online Sept. 3 in The Lancet.

For people living in “high-income” countries such as Canada, Sweden and Saudi Arabia, heart disease represented just 23% of deaths, while cancer was to blame for 55% of deaths, the researchers said.

The findings come from a global study of more than 162,500 middle-aged people living in four high-income countries, 12 countries considered middle-income, and five low-income countries. The study was led by Dr. Gilles Dagenais, emeritus professor at Laval University in Quebec, Canada.

Speaking in a journal news release, Dagenais said that the world is undergoing a “transition” in terms of causes of death, “with cardiovascular disease no longer the leading cause of death in high-income countries.”

But as better prevention and treatment of heart disease becomes more common, and cases of the disease “continue to fall, cancer could likely become the leading cause of death worldwide, within just a few decades,” Dagenais said.

Study principal investigator Dr. Salim Yusuf, a professor of medicine at McMaster University in Canada, agreed that “long-term cardiovascular disease prevention and management strategies have proved successful in reducing the burden in high-income countries.”

But poorer nations often lack either the resources or leadership to tackle high rates of heart disease, he added, so “governments in these countries need to start by investing a greater portion of their gross domestic product in preventing and managing non-communicable diseases, including cardiovascular disease, rather than focusing largely on infectious diseases.”

A second report focused on why people around the world continue to die in great numbers from heart disease. The same team of researchers used data on almost 156,000 middle-aged people to look at the role played by 14 heart disease risk factors.

The good news: 70% of the factors driving heart disease and heart disease death are “modifiable,” meaning changes to lifestyle and environment can greatly lessen people’s risk. Some of those factors include “metabolic” ones — overweight, diabetes and the like — or high blood pressure. In poorer countries, environmental factors, such as air pollution or poor diets, play a greater role.

The study was also presented Tuesday at the annual meeting of the European Society of Cardiology, in Paris.

More information

The American Heart Association has more on heart disease.

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Posted: September 2019

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Lifestyle May Matter More Than Your Genes in Early Heart Disease

MONDAY, Sept. 2, 2019 — An unhealthy lifestyle is a bigger contributor to heart disease than genetics for many younger adults, according to a new study.

The findings show that good health habits should be a key part of prevention efforts, even in people with a family history of early heart disease, researchers said.

The study included 1,075 people under age 50. Of those, 555 had coronary artery disease.

The investigators assessed five lifestyle factors linked to heart disease: physical inactivity, smoking, high blood pressure, diabetes and high cholesterol.

In all, 73% of patients had at least three of the risk factors compared to 31% of those without coronary artery disease (the control group).

In both groups, the odds of coronary artery disease increased with each additional risk factor. The risk was three times higher for those with a single risk factor and 24 times higher for those with three or more, the findings showed.

The researchers also found that the patients with coronary artery disease had a higher average genetic risk, based on 33 factors.

While their overall score on those 33 factors was an independent predictor for premature heart disease, the influence of genetics declined as the number of modifiable lifestyle factors increased, according to the study presented Monday at a meeting of the European Society of Cardiology (ESC), in Paris.

Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

“Genetics are an important contributor to premature heart disease but should not be used as an excuse to say it is inevitable,” study author Dr. Joao Sousa said in an ESC news release. Sousa is a cardiologist at Funchal Central Hospital in Portugal.

“In our clinical practice, we often hear young patients with premature heart disease ‘seek shelter’ and explanations in their genetics/family history,” he noted. “However, when we look at the data in our study, these young patients were frequently smokers, physically inactive, with high cholesterol levels and high blood pressure — all of which can be changed.”

Sousa said the study provides strong evidence that people with a family history of early heart disease should embrace a healthy lifestyle. “That means quit smoking, exercise regularly, eat a healthy diet, and get blood pressure and cholesterol levels checked,” he concluded.

More information

The U.S. Centers for Disease Control and Prevention has more on heart disease prevention.

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Posted: September 2019

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After Heart Attack, Stenting More Than the Blocked Artery May Be Best

SUNDAY, Sept. 1, 2019 — Opening all of a person’s clogged arteries after a heart attack can protect their health better than reopening only the one that caused it, a major international clinical trial has concluded.

Opening all blockages and not just the “culprit” behind the attack reduces a patient’s risk of dying or having another heart attack by 26%, researchers reported Sept. 1 in the New England Journal of Medicine.

This large-scale trial confirms nearly a decade’s worth of research pointing in the same direction, and should lead to this approach becoming standard practice, said lead researcher Dr. Shamir Mehta. He’s director of interventional cardiology at Hamilton Health Sciences in Hamilton, Ontario.

“The results were very clear. They weren’t borderline,” he said. “It will almost certainly have an impact on the guidelines and on clinical practice, not just in the U.S. or Canada, but worldwide.”

About half of all heart attack victims have more clogged arteries than the one that caused their heart attack, the researchers said in background notes.

Of those patients with multiple blockages, at least 80% should be able to benefit from having all of their clogged arteries reopened, said Dr. Samin Sharma, director of clinical and interventional cardiology at Mount Sinai Hospital, in New York City.

Importantly, having the additional blockages reopened did not increase a patient’s risk of other health problems, Sharma noted.

Mehta said, “This study shows that if you do it correctly, nothing happens. The kidney injuries were identical. The vascular complications were identical. There was no increase in stroke. This approach appears to be a home run in a large number of cases.”

Heart attacks happen because a single clogged artery prevents the flow of blood to the heart, damaging the organ.

Initial treatment focuses on reopening that artery and restoring the flow of oxygen to the heart muscle, Mehta said.

But there has been great debate about what to do about other blocked arteries that a patient might have.

“That’s where all the controversy has been,” Mehta said. “Should we just leave them alone? Have they been there for years, and are they not going to cause any problems in the future? Should we really run the risk of going back in and opening them just after a patient’s had a major heart attack?”

The guidelines were “really on the fence about this issue,” Mehta said. “The data wasn’t there to say 100% go ahead and fix them or don’t fix them. It was kind of in the middle.”

At least eight years of studies and clinical trials have provided mounting evidence that reopening all of the blockages should improve a person’s outcome, said Dr. C. Michael Valentine, president of the American College of Cardiology.

“This is the long-awaited confirmation that most cardiologists have been waiting for,” said Valentine, a senior cardiologist at Stroobants Cardiovascular Center of Centra Health in Lynchburg, Va.

To provide this definitive answer, the researchers undertook a clinical trial involving more than 4,000 patients treated at 140 hospitals in 31 countries.

All patients had their blocked “culprit” vessel reopened, Mehta said.

After that initial procedure, about half were randomly chosen for a second procedure days later to reopen the rest of their blocked arteries.

Taking care of the other blockages cut in half a person’s combined risk of either death from heart disease, a repeat heart attack, or a need to return and have another clogged artery reopened due to chest pain or other symptoms, the findings showed.

Over a median of three years, about 8% of patients who had everything reopened suffered a second heart attack or cardiovascular death. That compared to about 11% of those who received treatment only for the artery that caused the first heart attack.

“We’ve shown clearly that putting stents in these clogged arteries and opening them provides a major benefit,” Mehta said. “The interesting thing is that the benefit accrues over the long term. The trial followed patients for up to three years, and the benefit continued to accrue over that period.”

Mehta and Sharma expect fully opening all blockages also would save money over the long run, compared with people returning to the hospital with future problems caused by untreated clogged arteries.

“You can’t really send a patient with a full-blown heart attack home anyway. You have to keep them in hospital for 48 hours, at minimum,” Mehta said. “They’re sitting around anyway in the hospital. To bring them down the next day and fix the other blockages is not that huge an increase in cost.”

However, the results also show there’s no rush. Patients benefitted from having all blockages reopened even if the follow-up procedure took place weeks later, Mehta said.

“The nice thing about the trial is if a person is frail or elderly, or if they have kidney disease, it’s OK to delay it and let the patient recover from the initial heart attack,” he said. “Then when they’re strong enough, you can bring them back and do the other vessels.”

It’s important for physicians to understand there are options, he said. “You don’t have to do it right away.”

Still, Sharma suggested, it might be even more cost-effective to clear all the blockages during the initial procedure.

“If you know it’s a simple blockage, why do you need to wait until the next day? Why don’t you do it at the same time? That’s the only question that’s not answered by this study,” Sharma said.

The results of the clinical trial were also presented Sunday at the European Society of Cardiology’s annual meeting, in Paris.

More information

The American Heart Association has more on the warning signs of a heart attack.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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Obesity Harming Strides Made Against Heart Disease

By Steven Reinberg
HealthDay Reporter

TUESDAY, Aug. 27, 2019 (HealthDay News) — Rising obesity rates, coupled with an associated jump in diabetes and high blood pressure cases, appears to be undoing decades of gains made against heart disease, a new study finds.

After 2010, the rate of deaths from heart disease continued to drop, but more slowly. Deaths from stroke leveled off, and deaths from high blood pressure (“hypertension”) increased, researchers report.

“These findings are surprising and alarming, because despite medical and surgical advances and public policy initiatives around cholesterol and blood pressure awareness, we are losing ground in the battle against cardiovascular disease,” said lead researcher Dr. Sadiya Khan. She is an assistant professor of cardiology at Northwestern University Feinberg School of Medicine, in Chicago.

“The culprit may be the rise in obesity,” she added, though the study could not prove that definitively.

“One of the greatest success stories of the past century has been the marked reduction in cardiovascular disease death rates,” Khan said.

Despite this progress, heart disease continues to be the number one killer of American men and women. Moreover, the positive progress that was being made has slowed or stopped, Khan noted.

“The reversal of these trends is concerning,” she said. “Even more alarming is the fact that cardiovascular death rates for black Americans remain higher than those for white Americans.”

For the study, Khan and her colleagues used data from the U.S. Centers for Disease Control and Prevention on deaths from heart disease, stroke, diabetes and hypertension from 1999 through 2017.

The findings highlight the urgency to address the obesity epidemic and the increasing deaths from heart disease, Khan said. “We need to come up with better ways to fight cardiovascular disease, and quickly,” she explained.

Heart disease is largely preventable. “We know that prevention of risk factors and aggressive management beginning early in life is critical,” Khan added. People should talk with their doctor about their risk factors and how to live a heart-healthy lifestyle, she suggested.

Targeting people early in life and focusing on prevention even in childhood and young adulthood can go a long way to prevent heart disease later, she said.

Continued

“To support individual lifestyle changes, policymakers need prevention strategies to support Americans in eating a healthy diet, having safe places to exercise in the neighborhood, and access to health care and medications,” she said.

The report was published Aug. 27 in the Journal of the American Medical Association.

The findings really emphasize the need to focus on prevention, said Dr. Richard Becker, an American Heart Association expert and chair of medicine at the University of Cincinnati College of Medicine.

The increase in deaths from heart disease is a public health challenge that involves health care providers, national organizations and the health care industry, Becker said.

Prevention needs to start early, he stressed. “Without early identification and early intervention, we will not be able to reverse these alarming trends,” he added.

Curbing the obesity epidemic, with its probable effect of reducing the prevalence of diabetes and high blood pressure, is needed, Becker suggested.

“But in all likelihood, if we started today with some initiatives, it may take five to 10 years before you’re going to see the fruits of these labors,” Becker said. “So, we could start seeing an increase in cardiovascular deaths before they start to go down again.”

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Sources

SOURCES: Sadiya Khan, M.D., assistant professor, cardiology, Northwestern University Feinberg School of Medicine, Chicago; Richard Becker, M.D., American Heart Association expert and chair and professor, medicine, University of Cincinnati College of Medicine; Aug. 27, 2019,Journal of the American Medical Association

Copyright © 2013-2018 HealthDay. All rights reserved.

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Your Dog May Be Leading You to a Healthier Heart

By Amy Norton
HealthDay Reporter

FRIDAY, Aug. 23, 2019 (HealthDay News) — Your dog might be your heart‘s best friend, if a new study is any indication.

Researchers found that compared with people who had no pets, dog owners tended to have fewer risk factors for heart disease: They got more exercise, and had healthier diets and lower blood sugar levels.

Even compared with other pet owners, they were doing better with diet and exercise.

The study of nearly 1,800 Czech adults is not the first to suggest our canine friends can do our hearts good. In fact, in 2013 the American Heart Association (AHA) issued a scientific statement saying that dog ownership is likely linked to a lower risk of heart disease.

That was largely based on evidence that people with dogs are more physically active. The new findings suggest the benefit might extend to diet and blood sugar levels.

It’s easy to see how having a dog could get people moving, according to senior researcher Dr. Francisco Lopez-Jimenez.

And it’s possible that dog owners’ lower blood sugar levels were related to their exercise habits, said Lopez-Jimenez, a cardiologist at the Mayo Clinic in Rochester, Minn.

It’s less obvious, though, why dog ownership would encourage a healthier diet. One possibility is that the two are not directly related, he said.

On the other hand, past research has shown that dogs do more than demand walks and get us moving: They offer companionship and emotional support, according to Lopez-Jimenez.

“They can decrease your feelings of loneliness, and give you a sense of purpose,” he said. “You have someone to look after.”

And that, he speculated, might encourage people to take better care of themselves.

Dr. Glenn Levine, a volunteer medical expert with the AHA, was lead author of its statement on pets and heart health. He said that, overall, there is “reasonably good data” that adopting a dog can increase people’s physical activity levels.

“That’s the strongest and most direct (cardiovascular) benefit,” said Levine, who is also a professor at Baylor College of Medicine in Houston.

Continued

He agreed, though, that pets might support heart health in less-direct ways, too. “There may be other benefits as well — including reduced stress, greater companionship and happiness, and other factors that could lead people to take better care of themselves.”

For the study, the researchers used data from a health survey of 1,769 Czech adults, aged 25 to 64.

Overall, more than two-thirds of dog owners (67%) met the “ideal” AHA recommendations for exercise. That means 150 minutes of moderate aerobic exercise, or 75 minutes of vigorous activity, each week — along with muscle strengthening exercises a couple of days per week.

In contrast, only 48% of people without pets met that ideal, as did 55% of other pet owners, the findings showed.

When it came to diet, few people met the AHA ideal, which includes plenty of fruits, vegetables, beans, fiber-rich grains, fish and lean meat. But dog owners were doing better than others: Fewer than 7% scored in the “poor” range for diet, versus 16% of people without pets, and 13% of other pet owners.

Dog owners did, however, fall short in one heart-health measure: Their smoking rates were highest.

It’s not clear why, according to Lopez-Jimenez — and it might not hold true in other countries, such as the United States. In general, smoking is more common in Eastern Europe.

The bottom line, according to Levine, is that people might enjoy health benefits from having a canine companion. But the AHA does not advocate adopting a dog for that purpose.

“The primary purpose of adopting or rescuing a dog should be to give the dog a loving and caring home,” Levine said. “The health benefits that may come from this are a bonus.”

The findings were published Aug. 23 in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

WebMD News from HealthDay

Sources

SOURCES: Francisco Lopez-Jimenez, M.D., M.B.A., cardiologist, Mayo Clinic, Rochester, Minn.; Glenn Levine, M.D., volunteer medical expert, American Heart Association, and professor of medicine-cardiology, Baylor College of Medicine, Houston;  Aug. 23, 2019,Mayo Clinic Proceedings: Innovations, Quality & Outcomes, online

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‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

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