# The Heart

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## How many calories do you burn by walking?

The number of calories the body burns while a person is walking varies depending on a range of factors, including body size and walking speed. Walking also offers a variety of other health benefits, such as reducing the risk of heart disease.

The body uses energy from food and drinks to sustain bodily functions and perform physical activities. Calories are a measure of how much energy the body receives from particular foods or drinks.

When a person consumes more calories than they burn, the body stores this excess energy as body fat. When the body needs more energy than it can get from the calories it consumes, it burns the stored body fat for energy. Regular physical activity is a good way of maintaining a healthy amount of body fat.

While other forms of physical activity can be time-consuming or expensive, walking is convenient and free for people who can do so. This article discusses how to calculate the number of calories the body burns while walking, and some of the other benefits that walking has to offer.

Calories burned while walking
Walking burns calories at different rates depending on a person's body size and walking speed.

The number of calories that the body burns during any activity will depend on a person's basal metabolic rate (BMR) and the intensity of the activity, measured in metabolic equivalents (METs).

The formula for this is:

Calories burned = BMR x METs ÷ 24 x duration of activity in hours

It is possible to use this formula to calculate how many calories the body burns by walking.

To do this, it is first necessary to understand about BMR and METs.

### BMR

Basal metabolism refers to a series of life-supporting processes that the body constantly carries out, such as breathing. The body burns calories to support these processes. The rate at which the body does this is the BMR.

The BMR varies between people. It is difficult to calculate precisely as it depends on several factors, including genetic factors that are difficult to measure. But it is possible to estimate BMR using sex, body size, and age.

The formulae to estimate BMR for males and females are:

Males:

BMR = 66 + (6.23 x weight in pounds (lbs)) + (12.7 x height in inches) - (6.8 x age in years)

Females:

BMR = 655 + (4.35 x weight in lbs) + (4.7 x height in inches) - (4.7 x age in years)

### METs

METs are a measure of how much energy the body is using for a given activity.

When a person walks, the speed at which they are walking speed will determine the number of METs.

For example, walking at a slow pace of 1.7 miles per hour (mph) equates to 2.3 METs per hour. Walking briskly at a speed of 3 mph equals 3.3 METs per hour.

### Making the calculation

Pulling all this information together, it is now possible to calculate how many calories the body burns while walking.

For example, a 40-year-old male who weighs 195 lbs and is 69" (5'9") in height will have a BMR of 1,885.2. If they walk at a brisk pace for 1 hour, they will burn 259.2 calories. This is because:

BMR (1,885.2) x METs (3.3) ÷ 24 x duration of activity in hours (1) = 259.2 calories

Comparison with other types of exercise Using this formula, it is possible to calculate how many calories the body burns during any activity. The METs for some other types of exercise are as follows: Type of exercise METs Hatha yoga 3 Weight training, 8 to 15 repetitions of various exercises 3.5 Cycling, casual pace of up to 10 miles per hour 4 Jogging 7 Rope jumping 10 For example, a 50-year old female who weighs 160 pounds and is 64" (5'4") tall will have a BMR of 1,416.8. If this person jogs for 1 hour, they will burn 413.2 calories. BMR (1,416.8) x METs (7) ÷ 24 x duration of activity in hours (1) = 413.2 calories Other benefits
Regularly walking at a brisk pace can lower blood pressure and reduce high cholesterol. The United States government recommend that healthy adults engage in at least 150 minutes, or 2.5 hours, of moderate-intensity activity every week. Moderate-intensity activity can include any activity of 3 to 6 METs. Brisk walking is an excellent way of sticking to these guidelines. Unlike some other types of activity, walking is generally free and accessible to people who are able to do so. It is a relatively low-intensity form of exercise, so it is suitable for people who are unable to engage in more vigorous forms of exercise. Walking is also easy to fit into a typical day for most people. For example, walking to work or taking a walk during a lunch break for 30 minutes every day will lead to at least 150 minutes of moderate-intensity activity every week. Regularly walking at a brisk pace can have many health benefits, including: Takeaway In addition to physical health benefits, increasing physical activity through walking may also benefit mental health. Research has found that physical activity could be beneficial for a range of mental health conditions, including anxiety and depression. Walking is a beneficial way to burn calories — the amount each person burns depends on their age, sex, and how rapidly they walk. Moderate-intensity exercise, such as walking, can provide a range of health benefits.

## Olives: Nutrition and health benefits

Olives are popular as both a snack and an ingredient in salads, sandwiches, and stews. They have a chewy texture and a rich, salty taste.

People have cultivated olive trees for more than 7,000 years, and they have long associated its fruit with health benefits.

There are hundreds of olive species, and these fruits and their oil form an integral part of the Mediterranean diet, which may help people prevent disease and live longer.

In this article, learn about the possible health benefits of olives as well as their nutritional content and how to use them.

Are olives good for you?
Eating olives can help improve cardiovascular health. Olives and olive oil have a long history of reported health benefits, and there is a growing body of scientific evidence to back up these claims. Olive oil, which manufacturers make by crushing olive fruits and then separating the oil from the pulp, plays a key role in the Mediterranean diet. Olives are low in cholesterol and a good source of dietary fiber, which the body needs for good gut health. They are also rich in iron and copper. Research shows that following the diet can help people live longer. One study of almost 26,000 women found that the Mediterranean diet could cut the risk of developing cardiovascular disease by up to 28% compared with a control diet. The Mediterranean diet involves a daily intake of whole grains, fruits, vegetables, legumes, and nuts. People who follow the diet eat fish and lean meat in moderation but limit red and processed meats to 2–3 portions per month. The diet also emphasizes swapping unhealthful fats, such as the trans fats and saturated fats that are present in butter and margarine, with healthful fats, such as the polyunsaturated and monounsaturated fats that are in olives and olive oil. Olives are a good source of oleate, which is a monounsaturated fatty acid. A 2016 study found that eating more monosaturated fat reduced the risk of premature death due to disease compared with eating more carbohydrates. The American Heart Foundation also state that monounsaturated fats can have a beneficial effect on heart health when a person consumes them in moderation. Virgin olive oil is also high in a type of antioxidant called polyphenols, which can help prevent diseases relating to the heart and blood vessels. Some people believe that these antioxidants can slow the progression of neurodegenerative diseases and even cancer. However, more studies are necessary to confirm these claims. It is worth noting that food producers usually preserve olives in brine, which has a high salt content. Over time, excess levels of salt in the body can lead to high blood pressure, heart attacks, and stroke, so people should eat olives in moderation. Nutritional content of different types of olive
Olives have a high fat content. The nutritional content of 100 grams (g) of ripe, canned black olives is as follows: Macronutrients: energy: 116 calories protein: 0.84 g total fat: 10.90 g carbohydrate: 6.04 g fiber: 1.60 g Minerals: calcium: 88 milligrams (mg) iron: 6.28 mg magnesium: 4 mg potassium: 8 mg sodium: 735 mg zinc: 0.22 mg copper: 0.25 mg Vitamins: vitamin C: 0.90 mg niacin: 0.04 mg vitamin B-6: 0.01 mg vitamin A: 17 micrograms (µg) vitamin E: 1.65 mg vitamin K: 1.4 µg The nutritional content of 100 g of canned or bottled green olives is as follows: Macronutrients: energy: 145 calories protein: 1.03 g total fat: 15.32 g carbohydrate: 3.84 g fiber: 3.30 g Minerals: calcium: 52 mg iron: 0.49 mg magnesium: 11 mg potassium: 42 mg sodium: 1,556 mg zinc: 0.04 mg copper: 0.12 mg Vitamins: niacin: 0.24 mg vitamin B-6: 0.03 mg folate: 3 µg vitamin A: 20 µg vitamin E: 3.81 mg vitamin K: 1.4 µg A tablespoon of standard olive oil contains the following nutrients, among others: energy: 119 calories total fat: 13.5 g (including 9.85 g monounsaturated fatty acids, 1.42 g polyunsaturated fatty acids, and 1.86 g saturated fatty acids) iron: 0.08 mg vitamin E: 1.94 mg vitamin K: 8.13 µg How to use
A person can benefit from olive oil by adding it to salads and vegetables. People can add olives and extra virgin olive oil to all manner of foods, including salad, raw or roasted vegetables, and whole-grain pasta. Mild-flavored variants of extra virgin olive oil can replace butter or other oils in baking. People can also cook with olive oil. While olives and olive oil contain plenty of useful nutrients, people should consume them in moderation as part of a balanced diet. Olive oil is high in fat, and the preservation process means that olives are often high in salt. Summary Generations of people have enjoyed olives and olive oil for their health-promoting qualities. Olives are low in cholesterol and a good source of dietary fiber, which the body needs for good gut health. They are also high in minerals that the body requires to function, such as iron and copper. However, it is best to consume olives in moderation, as producers usually preserve them in brine that is high in salt. Olive oil is an integral part of the Mediterranean diet, which can help people maintain a healthy weight, prevent heart disease, and live longer. The diet includes foods that contain high levels of monounsaturated fats, which are healthful fats that can benefit heart health. Olives are available for purchase in grocery stores, at food markets, and online. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above.

## What foods contain high fructose corn syrup?

High fructose corn syrup is a sweetener that manufacturers make from corn starch. As with other sugars, it can cause tooth decay, obesity, and metabolic syndrome when a person consumes it in large quantities.

Health experts continue to debate whether or not high fructose corn syrup (HFCS) is worse than other sugars. Many natural and organic health advocates argue that HFCS is more dangerous than other sugars.

The Food and Drug Administration (FDA) explain that HFCS is not more dangerous than other sugars, but research on the topic is ongoing.

HFCS is not necessary for a healthful diet. In fact, avoiding it may help a person maintain a healthful weight.

What is HFCS?
The most common varieties of HFCS contain either 42% or 55% fructose.

HFCS is a very sweet derivative of corn starch.

Starch consists of chains of glucose, which is a sugar. Breaking corn starch down into individual glucose molecules forms corn syrup.

To create HFCS, manufacturers add enzymes to corn syrup that convert some of the glucose to fructose. Fructose is the type of sugar present in fruit and is very sweet. The amount of fructose in HFCS varies, but the most common varieties contain either 42% or 55%.

As with HFCS, table sugar, or sucrose, also consists of glucose and fructose.

Is HFCS safe? Research has consistently shown links between the consumption of HFCS and obesity, metabolic dysregulation, and similar health issues. According to a 2017 study of mice, HFCS consumption increased fasting glucose and reduced the ability of mice to clear glucose from the body. The study also found changes in dopamine signaling in the group that consumed HFCS. Dopamine is a neurotransmitter that affects feelings of motivation and reward. Past research has linked impaired dopamine signaling to obesity. Contrary to some previous studies, HFCS did not increase body weight. This suggests that HFCS may undermine health even if it does not cause weight gain. A 2012 analysis of 43 countries found that rates of diabetes are 20% higher in those where HFCS is readily available. Several other studies have linked HFCS availability to higher rates of conditions such as diabetes and heart disease. However, this research is correlational and does not mean that HFCS directly causes these conditions. In countries where HFCS is prevalent, people might prefer sweetened foods or consume larger quantities of all types of sugar. This is why dissecting claims about whether or not HFCS is safe is difficult. Most research suggests that HFCS availability correlates with an increase in health issues. However, HFCS availability also correlates more generally with high sugar consumption. The FDA and most other public health agencies emphasize that HFCS, as with other added sugars, can increase the risk of diabetes and other health concerns. However, there is little evidence to suggest that HFCS is inherently more harmful than other sugars. The problem with HFCS is its prevalence. It is present in numerous foods, including those that do not taste sweet, such as pizza and crackers. Foods that contain HFCS
Almost all sodas contain high quantities of HFCS. Many foods contain HFCS, so this list is by no means exhaustive. The most common sources of this ingredient include: Soda: Almost all sodas contain HFCS, often in very large quantities. Sweetened juices: Some fruit juices, including those that manufacturers market to children, contain HFCS. Processed desserts: Packaged sweets, including candy, prepackaged cookies, muffins, and other desserts, often include HFCS. Packaged fruits: Some applesauce, cranberry sauce, dried fruit snacks, and other fruit-based snacks contain HFCS as a sweetener. Crackers: Some crackers, mixed snack packages, and other cracker-like products use HFCS to increase sweetness. Condiments and salad dressings: Many condiments, even salty ones such as ketchup, use HFCS as a sweetener. Check the labels of salad dressings, ketchup, barbecue sauce, and other condiments. Prepackaged meals: A variety of prepackaged meals, including some pizzas, contain HFCS. Granola and nutrition bars: Granola bars, protein bars, and other purportedly healthful snacks often use sweeteners to improve the taste. HFCS is one of the most popular sweeteners in these products. Peanut and other nut butters: Peanut butter might seem to be a savory treat, but it is actually very sweet. Many peanut butter manufacturers add sugar, and some add HFCS. The same is true of some other nut butters, such as cashew and almond butter. Some bread and wheat: Some sweetened breads and wheats, including some pastas, contain HFCS. How to check the label
To minimize HFCS intake, people can avoid foods that include it high up on the ingredient list. HFCS is usually visible on a product's label. Manufacturers must list ingredients in order from highest to lowest quantity. This means that the first few ingredients on a label are present in the largest quantities. So, people who want to minimize their HFCS intake should avoid any foods that list HFCS among the first few ingredients. In 2010, in response to increased concerns about the dangers of HFCS, the Corn Refiners Association petitioned the FDA to change the name of HFCS to corn sugar. The FDA rejected the request, citing concerns about consumer confusion. However, it is possible that the name might change in the future. Because HFCS is not the only sugar that can cause health problems, it is important to also look for other sugars. Sugar goes by at least 61 names on nutrition labels, including: sucrose barley malt dextrose rice syrup maltose The American Heart Association (AHA) recommend that men consume no more than 150 calories of added sugar per day. This is equivalent to 9 teaspoons, or 36 grams (g). Women should restrict their intake of added sugar to no more than 100 calories per day, which is equivalent to 6 teaspoons, or 25 g. Summary The debate regarding the risks of HFCS continues. As with other sugars, there is no need to include HFCS in a healthful diet. In fact, its inclusion may increase the risk of numerous health issues. Limiting HFCS consumption can help a person reduce their sugar intake, potentially supporting their weight loss or health goals. People who want to limit their HFCS intake may feel frustrated by the abundance of food that contains HFCS. People who cannot eliminate HFCS from their diet can still reap health benefits by reducing consumption. They can achieve this by limiting soda intake and eating fewer processed snacks.

## What to do in the event of a heart attack

Learning to recognize warning signs and risk factors can help people avoid a heart attack. When a person has a heart attack, knowing what to do and acting quickly can help them have a better outcome.

According to the Centers for Disease Control and Prevention (CDC), a person has a heart attack every 40 seconds in the United States.

A heart attack occurs when there is a blockage of blood flow to the heart. When a blockage to blood flow occurs, it can damage or even kill parts of the heart tissue.

While the movies may depict heart attacks as happening suddenly, many heart attacks begin slowly and have many warning signs.

Signs and symptoms
A heart attack may cause pain in both shoulders and arms.

The main heart attack symptoms include the following:

Chest pain or discomfort: The chest pain or discomfort may feel like pressure, tightness, or a squeezing sensation. Shortness of breath: This may occur with or without chest pain. Discomfort in other parts of the body: The back, both arms and shoulders, neck, or jaw may also be uncomfortable during a heart attack.

While both males and females may experience the primary heart attack signs and symptoms, the symptoms we have listed above are more common in males.

Females are more likely to experience additional signs and symptoms. These include:

What to do A heart attack is a life-threatening medical emergency. If someone may be having a heart attack, a person should immediately call 911 for emergency help before doing anything else. Acting quickly can help save someone's life. If a person is having a heart attack, calling 911 is often a better course of action than taking the individual to the emergency room. Paramedics typically reach a person faster than they can get to the emergency room themselves. Additionally, when paramedics arrive, they can begin lifesaving treatment immediately. If the individual having the heart attack is unconscious, someone with cardiopulmonary resuscitation (CPR) training should begin CPR. If a defibrillator is available and someone knows how to use it, they should use the defibrillator after performing CPR if necessary. If you are alone If a person is alone and experiencing any symptoms of a heart attack, they should immediately call 911. Next, they should take aspirin if available, and unlock their door, so that paramedics have access. Then they should lay down near the door but not blocking it, to make it easy for paramedics to find them. Causes and risk factors
Having high blood pressure can increase the risk of a heart attack. A person should be aware of their risk factors so they can take steps to prevent a heart attack. There are some heart attack risk factors that people can influence and others that they cannot. Heart attack risk factors that people cannot influence include: Age: While heart disease affects people of all ages, according to the American Heart Association (AHA) the most of those who die from coronary heart disease are adults over 65 years of age. Sex: Males are more likely than females to have and die of a heart attack. Family history: People with a significant family history of heart disease are more likely to experience a heart attack. Race and ethnicity: Some ethnic groups, including African Americans, some Asians, and Mexican Americans, are more likely to have a heart attack than others. While people cannot influence the above risk factors, there are many risk factors that they can modify or treat to prevent a heart attack. Modifiable risk factors for heart disease and heart attack include: Prevention
Limiting alcohol intake can help reduce the risk of a heart attack. The best way to prevent a heart attack is to reduce any risk factors. People can reduce their chances of a heart attack by: losing weight if they are obese or overweight treating high blood pressure and high cholesterol by consulting a doctor controlling diabetes through diet, medication, and managing blood sugar eating a diet rich in fresh vegetables and fruits and low in saturated fats and processed foods stopping smoking or using tobacco products limiting alcohol consumption to no more than two drinks a day for men or one per day for women getting at least 150 minutes of moderate physical activity per week Additionally, a person should have regular checkups with their doctor. Regular checkups can help identify new risk factors for heart disease that a person may develop and monitor any existing ones they have. Summary Heart attacks are life-threatening medical emergencies that require immediate medical help. Knowing the signs and symptoms of a heart attack can help a person get the help they need as early as possible. Reducing risk factors for heart disease can help a person prevent a heart attack.

## How a fruit compound may lower blood pressure

Blueberries, red grapes, red wine, and peanuts are some of the natural sources of resveratrol — a plant compound that has received much attention in the medical community recently. New research in mice and human cells breaks down the mechanism through which resveratrol may lower blood pressure.

Red grapes and some blueberries contain resveratrol.

From protecting our neurons against aging to potentially preventing cancer, a significant number of studies have recently hailed the health benefits of resveratrol.

Also, a lot of previous research has focused on the benefits of resveratrol for heart health.

Clinical studies in rats and mice have demonstrated protective effects against stroke, heart failure, and hypertension, among other heart conditions.

Although some researchers believe that the benefits of resveratrol come from its antioxidant properties, the mechanisms behind its cardioprotective effects remain unclear.

New research gets closer to understanding these mechanisms, and the findings are an intriguing paradox.

A team of scientists from King's College London (KCL), in the United Kingdom, added resveratrol to the diet of mice with high blood pressure. Joseph Burgoyne, Ph.D., a senior lecturer in cardiovascular sciences at KCL, is the lead author of the study, which appears in the journal Circulation.

## The effects of resveratrol in mice

Burgoyne and the team induced high blood pressure in a group of wild-type mice. The researchers measured the rodent's blood pressure with implanted telemetry probes and monitored this for 15 days.

During this time, they fed the mice either a diet to which they had added resveratrol or a normal diet.

By the end of the study period, the researchers noted a drop of about 20 millimeters of mercury in the blood pressure of mice that had consumed resveratrol. The scientists also discovered that resveratrol relaxed the rodents' blood vessels by oxidizing the protein PKG1a.

"Resveratrol mediates lowering of blood pressure by paradoxically inducing protein oxidation, especially during times of oxidative stress, a mechanism that may be a common feature of 'antioxidant' molecules," conclude the authors.

The findings are counterintuitive, in the sense that the compound is believed to be an antioxidant, but this study shows that it behaves like an oxidant in order to lower blood pressure.

"We're slowly realizing that oxidants aren't always the villain. Our research shows that a molecule once deemed an antioxidant exerts its beneficial effects through oxidation. We think that many other so-called 'antioxidants' might also work in this way."

Joseph Burgoyne, Ph.D.

## What do the findings mean for humans?

Importantly, the researchers were able to replicate the findings in human cell lines. Specifically, they applied resveratrol to smooth muscle cells taken from human blood vessels and noticed the same oxidization process.

However, the scientists caution against the interpretation that people should consume a lot of resveratrol-containing products in order to reap the same benefits that this study showcased in mice.

People should avoid red wine, in particular, the researchers warn. To recreate the benefits of the study in humans, say Burgoyne and colleagues, a person would have to consume 1,000 bottles of red wine every day. The compound is not very soluble, which is why high amounts of it are necessary.

"Our work could lay the foundations for chemically altering resveratrol to improve its delivery to the body," the study's lead author explains, "or designing new, more potent drugs which use the same pathway. In the future, we could have a whole new class of blood pressure drugs."

Metin Avkiran, Ph.D., a professor of molecular cardiology at KCL — who was not involved in the study — also comments on the significance of the findings.

"Unfortunately, this isn't the all-clear to open a bottle of merlot. To get the human equivalent dose of resveratrol used here, you'd need to drink an impossible amount of red wine every day."

Prof. Metin Avkiran, Ph.D.

"This study reveals the surprising way in which resveratrol works and opens up the possibility of new blood pressure drugs which work in a similar way," Prof. Avkiran adds. "The findings bring us a step closer to tackling this 'silent killer' which puts people at risk of having a devastating stroke or heart attack."

In the United States, over 100 million people are currently living with hypertension.

## What are the health benefits of lemons vs. limes?

Lemons and limes are types of citrus fruit with very similar nutritional profiles and health benefits. However, there are also some differences between them.

Lemons come from a small evergreen tree native to South Asia.

Several types of citrus tree can produce limes, such as the key lime tree, which is native to Southeast Asia.

This article will discuss the similarities and differences between these fruits, including their health benefits, nutritional contents, and uses.

Health benefits
Lemons and limes contain lots of vitamin C, flavonoids, and antioxidants.

Both lemons and limes have a long history of use in traditional medicine. They each contain antioxidants, vitamins, and minerals and provide a range of health benefits.

People also make claims about the health benefits of lemon water and the potential benefits of drinking lime juice.

Lemons and limes have several shared health benefits because they share the following properties:

### They contain lots of vitamin C

Both lemons and limes are high in vitamin C, an important antioxidant that helps protect cells from damage.

Vitamin C also helps the body absorb iron from foods and supports the immune system.

The body also uses vitamin C in the production of collagen, an important substance for healing wounds.

### They contain flavonoids

Lemons and limes both contain flavonoids. Flavonoids are phytochemicals that may have several health benefits, such as for heart disease and metabolic disorders.

Animal and cell studies have suggested that flavonoids have anti-inflammatory, antidiabetic, cancer-fighting, and neuroprotective properties. However, more research is needed to fully understand their effects in humans.

Research into flavonoids is still in its early stages, but the initial findings are promising.

### They contain antioxidants

Along with vitamin C, lemons and limes also contain other antioxidants.

Antioxidants help protect the body from cell damage, which appears to play a role in a range of chronic health conditions, such as diabetes, cancer, and dementia.

It is possible that antioxidants also help prevent these conditions from developing. However, again, research into this area is ongoing.

### They may aid weight loss over time

Some sources claim that consuming lemon, or lemon-based products, can help with weight loss. For example, lemon water is a mixture of fresh lemon juice and water and is a part of some weight loss diets.

However, there is currently no scientific evidence to prove that lemon, or any lemon-based product, can result in weight loss above what adequate hydration promotes. Learn more about the lemon detox diet here.

Lemons can form part of a healthful diet that eventually leads to weight loss, but this is likely to be as a result of a reduced calorie intake, regular exercise, and other more substantial lifestyle improvements.

Nutrition Lemons and limes share a similar nutritional profile, as we detail in the table below. These nutrients reflect what is present in a whole lemon or lime, not in the juice. 1 lemon, 84 g 1 lime, 67 g Macronutrients Calories 24.4 20.1 Protein 0.92 g 0.47 g Fat 0.25 g 0.13 g Carbohydrates (total) 7.83 g 7.06 g Sugars 2.1 g 1.13 g Fiber 2.35 g 1.88 g Vitamins and minerals Calcium 21.8 mg 22.1 mg Potassium 116 mg 68.3 mg Vitamin C 44.5 mg 19.5 mg Folate 9.24 mcg 5.36 mcg The nutritional benefits of lemons and limes are the same. Although lemons have slightly more of some vitamins and minerals, the difference is too small to have any effect. Acidity Both lemons and limes are high in citric acid. This means that they are acidic compared with many other foods. Lemons and limes have very similar citric acid content, though lemons may have slightly more on average: Lemon juice contains around 48 grams of citric acid per liter (g/L). Lime juice contains around 45.8 g/L. Uses
Lemon and lime rinds are popular in cooking. Many foods and drinks contain lemons or limes due to their strong, sour flavours. This might be in the form of premade or freshly squeezed juice, or as chunks or slices of the fruit. The fruits' rinds have unique bitter flavors that make them popular in cooking. For example, people can use the juice or peel from both fruits for flavoring sauces, marinades, and salad dressings. Also, lemon and thyme is a good combination for marinating chicken and fish. Lime works well with garlic, as well as with chilli powder for marinating meats. Lemons and limes are good additions to many hot or cold drinks. For example, a person can add chunks of lemon or lime to water to make citrus water, or they can use lemon or lime to flavor teas. Due to their high acidity, these citrus fruits are also effective at killing bacteria. Because of this, a range of citrus-based cleaning products are available, from bleaches to surface cleaners. Also, some studies have shown that the essential oil of lemon and other citrus fruits can enhance mental state through inhalation and aromatherapy, exert antimicrobial properties, and reduce skin inflammation through the topical application of the peel. Risks Consuming lemons or limes in moderate amounts is generally safe. However, the fruits can cause a stinging pain when in contact with open wounds, such as a cut lip or a mouth ulcer. Their high acidity also means that they may worsen heartburn or digestive issues in people with gastroesophageal reflux disease (GERD). In large amounts, citric fruits can erode tooth enamel and cause cavities over time. When using cleaning products that contain citrus or other irritating chemicals, use gloves and avoid contact with the skin. Summary Lemons and limes are citric fruits with very similar nutritional profiles. They are rich in vitamin C and contain other antioxidants and flavonoids that are beneficial to health. Both fruits are common ingredients in a variety of foods and drinks. Their acidity also makes them good for use in cleaning products. Both fruits are safe to consume in moderate amounts, but they can cause minor issues in some people, such as worsening the symptoms of GERD due to their acidity.

## What to know about nitroglycerin

When something restricts blood flow to the heart muscle, a person can experience intense chest pain that doctors call angina. People often use the drug nitroglycerin to relieve chest pain that angina causes.

Most often, the reason for the decrease in blood flow is plaque formation and narrowing of the arteries supplying blood to the heart.

Nitroglycerin helps to open up the blood vessels and allow blood to flow. People also use nitroglycerin to treat chronic anal fissures.

In this article, we provide an overview of nitroglycerin, including its uses, how it works, and the possible side effects, interactions, and warnings.

What is nitroglycerin, and how does it work?
A person can use nitroglycerin to relieve angina symptoms.

Nitroglycerin is a medication that treats angina and chronic anal fissures. It works by promoting blood flow.

The body breaks nitroglycerin down into nitric oxide. Nitric oxide causes the smooth muscle within the blood vessels to relax. This allows the arteries and veins to open up, allowing more blood to flow through. Healthcare professionals call this action vasodilation.

During an angina attack, a person will experience intense chest pain. Nitroglycerin will start working within 1 to 3 minutes, but its maximal effect occurs after 5 minutes.

When people use nitroglycerin for anal fissures, the ointment will relax the anal sphincter, which is the muscle tissue around the anus, and lower the pressure in the anus. This promotes blood flow to the area and helps heal the fissure.

Uses Doctors usually use nitroglycerin to treat the pain that angina causes. Narrowing of the arteries that supply the heart with blood is what causes unstable angina. Doctors call this condition coronary artery disease (CAD). CAD is the most common type of heart disease. More than 370,000 people in the United States die every year because of CAD. Nitroglycerin allows the blood vessels to open up, which lets oxygen and nutrient-rich blood feed the heart muscle. This action offers immediate relief from chest pain. People can also use nitroglycerin to treat anal fissures. Anal fissures are tears in the skin of the anus. People can get anal fissures from passing hard stools. Similarly to its effects for angina, nitroglycerin as a rectal ointment helps the healing process by stimulating blood flow to the affected area. How to take it The following table lists the different formulations of nitroglycerin. Form of nitroglycerin How to use aerosol solution
packet
pumpspray
tablet dissolve under the tongue ointment
24-hour patch apply to the skin rectal ointment rectal use only Angina When someone is having intense chest pain, it is vitalto resolve this symptom as quickly as possible. People can also take fast-acting nitroglycerin formulations 5 to 10 minutes before doing an activity that may cause an angina attack. The aerosol spray, pumpspray, packet, and tablet are all fast-acting forms of nitroglycerin. Aerosol spray and pumpspray People can use these devices by giving one or two sprays on or under the tongue once a person feels angina pains. They should not inhale the spray. Packet A sublingual packet of nitroglycerin contains 400 micrograms (mcg) of nitroglycerin powder. A person places the contents of the packet under their tongue when angina pains begin. Tablet At the first signs of angina pains, a person should place the tablet under their tongue or between the gums and the cheek. The tablet will dissolve and absorb through the tissues of the mouth. People who use the aerosol spray, pumpspray, packet, or tablet should not swallow the drug. Nitroglycerin will absorb through the mouth tissues. This provides faster relief than swallowing the medicine. People should also avoid rinsing or spitting for 5 minutes after administering the dose. A person can take each of these forms of fast-acting nitroglycerin at 5-minute intervals. If they do not feel relief from the intense chest pain, they can take two more doses 5 minutes apart. If someone has taken three doses of either fast-acting formulations and does not experience any pain relief, they should seek medical attention immediately. There are also two other formulations of nitroglycerin that can prevent angina attacks. These are not fast-acting, and people should not use them to stop an attack when it is happening. Patch Nitroglycerin patches come in doses ranging from 0.1 milligrams per hour (mg/hr) to 0.8 mg/hr. A person places the patch on their skin anywhere except the areas below the knee and elbow. Most people place the patch on their chest. The area should be clean, dry, and hairless to allow the nitroglycerin to absorb across the skin. A person should leave the patch on the skin for 12 to 14 hours and remove it for 10 to 12 hours. People will usually have the patch on during the day and remove it during sleep. Ointment
A person can apply nitroglycerin ointment to the skin twice a day. People can apply nitroglycerin ointment to their skin using a dose-measuring applicator that comes with the tube. A person will measure the desired dose onto the measuring applicator and then place the applicator ointment side down on the skin. They then spread the ointment across the skin. The person should not rub the medicine in but allow the ointment to absorb across the skin. Finally, they tape the applicator to the skin. People take two doses of ointment each day. Doctors will tell people to use the ointment first thing in the morning and then reapply it 6 hours later. Anal fissures The rectal ointment for anal fissures contains 0.4% nitroglycerin. A person will insert the ointment into their anus every 12 hours for up to 3 weeks. To apply the rectal ointment, a person will cover their finger with plastic wrap and squeeze out 1 inch of ointment along the finger. They then insert the finger into the anal canal up to the first finger joint. The person will then smear the ointment around the area. If this is too painful, the person may apply the ointment to the outside of the anus instead. Side effects People may experience many side effects when using nitroglycerin, including: When people take nitroglycerin for relieving angina, they should be in a relaxed, seated position. An individual's blood pressure can drop significantly after using nitroglycerin. If they stand up too quickly after administering the dose, their blood pressure may drop even lower and put them at risk of fainting. The most common side effect of long-acting nitroglycerin is headaches, but this side effect decreases with use. Although the rectal ointment is only put in the anus, a person may still experience headache and dizziness. Precautions and risks Some people may be allergic to nitroglycerin, and doctors do not recommend that people use it if they have a history of allergic reactions to nitroglycerin. Doctors will not prescribe nitroglycerin to anyone with a history of severe anemia, heart attack occurring on the right side of the heart, or increased pressure in the brain. Interactions Nitroglycerin may interact with certain other medications. PDE-5 inhibitors are drugs that doctors give to treat erectile dysfunction in males. Viagra, Cialis, and Levitra are PDE-5 inhibitors. As with nitroglycerin, these drugs also cause increased blood flow and can lower blood pressure. Doctors do not recommend that people use nitroglycerin with PDE-5 inhibitors, as they can cause fainting if someone is taking them together. Males should avoid using nitroglycerin if they have taken Viagra or Levitra within the last 24 hours or Cialis within the previous 48 hours. Any person using long-acting nitroglycerin cannot take PDE-5 inhibitors. Overdose
Throbbing headaches can be a sign of a nitroglycerin overdose. An overdose of nitroglycerin may occur when people use PDE-5 inhibitors with nitroglycerin or if they use too much nitroglycerin during an attack. Severe side effects that healthcare professionals associate with a nitroglycerin overdose include: a sudden drop in blood pressure increased heart rate increased blood flow and pressure in the brain throbbing headaches confusion dizziness disturbances in vision Currently, no drug can reverse a nitroglycerin overdose. Doctors can provide care to people experiencing an overdose by giving intravenous fluids and elevating their legs. Summary Using nitroglycerin in the appropriate way can delay the serious complications of angina that can include heart attack, stroke, and even death. People may experience side effects with nitroglycerin and should remain seated while the drug is having its effect. Nitroglycerin can interact with medications for erectile dysfunction. Males with angina should report the use of Viagra, Cialis, and Levitra to their doctor because the use of both drugs together may be dangerous. People can also treat anal fissures with nitroglycerin rectal ointment. Side effects and interactions can also occur with topical use of nitroglycerin.

## Supplement for joint pain linked to lower heart disease risk

Glucosamine, a dietary supplement that people commonly take to ease joint pain and reduce symptoms of osteoarthritis, may lower the risk of cardiovascular problems, according to a study analyzing health data from over 400,000 participants.

Does glucosamine, a popular dietary supplement, have a preventive effect against heart disease?

Information from the National Center for Complementary and Integrative Health shows that about 2.6% of adults in the United States — which equates to 6.5 million people — take glucosamine, chondroitin, or both. These two dietary supplements treat joint pain and strengthen cartilage, respectively.

This statistic makes glucosamine one of the most popular supplements among the U.S. adult population.

Now, researchers from Tulane University in New Orleans, LA, have carried out a large observational study and found that people who take glucosamine may also have a lower risk of cardiovascular disease and adverse health events relating to the heart or the vascular system, such as stroke.

The research team, which Prof. Lu Qi from Tulane led, accessed the U.K. Biobank study database to use available data from 466,039 participants. None of these participants had cardiovascular disease at baseline, and they all submitted information on their use of dietary supplements.

Among these participants, 19.3% — or about one in five — said that they took glucosamine when they joined the study.

The study's findings, which appear in the BMJ, suggest that taking glucosamine on a regular basis may help prevent cardiovascular problems. However, the current study is observational, and the authors warn that further trials should test whether there is a causal relationship behind this association.

Prof. Qi and team looked at the participants' hospital records and, when necessary, their death records over an average follow-up period of 7 years. They noted whether each participant developed cardiovascular disease, experienced any cardiovascular problems — including coronary heart disease and stroke — or died due to cardiovascular disease.

The researchers found that people who had reported using this supplement had a 15% lower risk of experiencing a cardiovascular disease-related event compared with participants who did not take glucosamine. They also had a 9–22% lower risk of developing coronary heart disease, experiencing a stroke, and dying from cardiovascular-related causes.

These associations were independent of modifying factors, such as a person's age, biological sex, body mass index (BMI), lifestyle and diet, and medication and supplement use, for which the researchers accounted.

At the same time, Prof. Qi and colleagues also noted that these associations were stronger in current smokers, who saw a 37% lower risk of heart disease with glucosamine supplementation, than in former smokers and never-smokers, whose risk was 18% and 12% lower respectively.

The researchers hypothesize that if there is a causal explanation, it may lie in certain biological mechanisms that relate to inflammation. For instance, they note that there is an association between glucosamine use and lower levels of C-reactive protein in the body.

Researchers have linked this protein to heightened inflammation. Therefore, glucosamine may actually help reduce that inflammation, which is present at higher levels in smokers than in never-smokers and former smokers.

Another hypothesis is that taking glucosamine may have similar effects to following a diet low in carbohydrates, which studies have also tied to a lower risk of cardiovascular disease.

The study authors conclude their paper by saying:

"Habitual use of glucosamine supplement to relieve osteoarthritis pain might also be related to lower risks of [cardiovascular disease] events."

However, they also caution that, due to the observational nature of this study, "[f]urther clinical trials are needed to test this hypothesis."

## What to know about raisins

In general, and when people consume them in moderation, raisins are a healthful, tasty food to add to the diet. Raisins are a good source of essential nutrients, minerals, and energy in the form of calories and sugars.

Raisins themselves make a quick and simple snack throughout the day. People can use them as a topping for yogurt or cereals, and they can also include them in many other products, such as baked goods, trail mix, and granola.

Benefits
Raisins can aid digestion and fight cancer cells.

Aid in digestion

Raisins may be a simple way to help keep the digestive system healthy. Raisins contain helpful soluble fibers, which give body to the stool and help it pass through the intestines easier. This may help improve digestion and promote regularity.

Prevent anemia

Raisins may play a part in preventing anemia. They contain good amounts of iron, copper, and vitamins that are essential for making red blood cells and carrying oxygen throughout the body.

Prevent too much acidity

Raisins contain substantial amounts of beneficial minerals, such as iron, copper, magnesium, and potassium. These are alkaline, or basic, minerals on the pH scale and may help balance acidity levels in the stomach.

Lower risk of heart disease risk factors

A study posted to Postgraduate Medicine noted that regularly eating raisins may help reduce cardiovascular risk factors, such as blood pressure rate, when compared to other snacks. This is because raisins are a low sodium food that also contains a good source of potassium, which helps the blood vessels relax.

Fight against cancer cells

Raisins are also a good source of antioxidant compounds.

Dietary antioxidants are essential, as they may protect the body from oxidative damage and free radicals. Oxidative damage and free radicals are risk factors in many types of cancer, tumor growth, and aging.

Protect eye health

Raisins contain polyphenols, which are antioxidants that may protect the cells in the eyes from free radical damage. This may in turn help protect the eyes from eye disorders, such as age-related macular degeneration and cataracts.

Improve skin health

Antioxidants may help keep the skin cells young and prevent damage from aging cells. Raisins also contain valuable nutrients, such as vitamin C, selenium, and zinc. This combination of nutrients and antioxidants may be a helpful addition to a diet that focuses on creating good skin health.

Lower blood sugar

The Postgraduate Medicine study also noted that compared to eating other snacks, regularly eating raisins may help lower a person's blood sugar. Even though raisins contain a more concentrated amount of sugars than fresh fruit, raisin intake compared to processed snacks decreased hemoglobin a1c, which is a marker of blood sugar management.

This means that a serving of raisins may be an excellent way to satisfy a sweet craving.

Are there risks of eating raisins? While raisins are generally beneficial, there are some times when raisins may not be the best snack. For instance, people looking to reduce their calorie intake may want to be careful about eating large amounts of raisins. While a single raisin contains the same number of calories as a single grape, raisins are much smaller. This can easily lead to eating too many calories. Another concern about eating too many raisins is the increase in soluble fiber. Too much fiber may cause gastrointestinal upset, such as cramps, gas, and bloating. Some people may even develop diarrhea. However, it is important to note that this would only result from eating a significant amount of raisins since they do not contain excessively high amounts of fiber. Lastly, because of their small size, people prone to choking and small children may need to avoid raisins and opt for fresh fruit instead. However, enjoying raisins in moderation is generally safe. Nutrition of raisins

## Does soy protein reduce 'bad' cholesterol? The debate continues

There is an ongoing debate surrounding soy protein and its influence on cholesterol. A new meta-analysis digs into the existing data and concludes that the protein does, indeed, reduce levels of "bad" cholesterol.

Soy protein and cholesterol: The debate rages on.

Soy protein is derived from soybeans. It is high in protein but contains no cholesterol and only low levels of saturated fat.

Soybeans are among the few vegetable-based foods that contain all of the essential amino acids.

As it stands, the Food and Drug Administration (FDA) includes soy protein in its list of foods that can lower cholesterol.

However, they are considering removing it from this list because studies have provided inconsistent results.

If the FDA do remove it, manufacturers who market products that include soy would no longer be able to label them as heart-healthy. The FDA are basing their potential change in stance on the findings of 46 trials.

Recently, researchers — many from St. Michael's Hospital in Toronto, Canada — decided to revisit the data and run a meta-analysis on the papers in question.

## Revisiting the soy debate

Of the 46 studies that the FDA had chosen, 43 provided enough data to be added to the scientists' analysis. In total, 41 studies looked specifically at low-density lipoprotein (LDL) cholesterol, commonly called bad cholesterol.

LDL cholesterol earns its bad name because, when it builds up in arteries, it increases the risk of stroke and heart disease. Any food that can reduce this risk is of great interest.

The authors recently published the results of their analysis in The Journal of Nutrition. They conclude:

"Soy protein significantly reduced LDL cholesterol by approximately 3–4% in adults. Our data support the advice given to the general public internationally to increase plant protein intake."

Although the effect size seems small, the results are significant. The authors also believe that, in the real world, the effect may be stronger. They argue that when someone adds soy protein to their diet, in most cases, it will replace other sources of protein that have high levels of LDL cholesterol, such as meat and dairy.

Dr. David Jenkins, who led the study, explains, "When one adds the displacement of high saturated fat and cholesterol-rich meats to a diet that includes soy, the reduction of cholesterol could be greater."

A study published in 2010 examines this displacement. The authors concluded that when combining direct LDL reduction from soy protein with displacement, overall, LDL cholesterol would be reduced by 3.6–6.0%.

## Limitations and high hopes

As the authors of the recent investigation explain, a significant limitation of their research is that it only looked at a small subset of relevant studies. However, the purpose of this study was to test the strength of the FDA's conclusions using the very data that they had used to draw their conclusions.

The authors write that "These data were extracted by the FDA as representing those trials on which a final decision would be made concerning the soy protein health claim. Because we are addressing the question raised by the FDA, our inclusion criteria included only those trials selected by the FDA."

It is also worth noting that the studies that the scientists analyzed only used a total of 2,607 participants; of these, only 37% were men. Also, the majority of women that were involved in these trials were postmenopausal. In other words, the demographics of the studies do not match the demographics of the public at large.

However, to reiterate, the main thrust of this study was not to collate all relevant data; it was specifically designed to test the FDA's change in stance.

Dr. Jenkins concludes simply, "The existing data and our analysis of it suggest soy protein contributes to heart health."

Other official bodies, including Heart UK, the European Atherosclerosis Society, the National Cholesterol Education Program, and the Canadian Cardiovascular Society include soy protein as a heart-healthy food.

The authors hope that the FDA will consider their meta-analysis when discussing whether to keep soy protein in their heart-healthy category.

## Natural ways to lower cholesterol

Cholesterol is a waxy, fat-like substance that the liver produces. It is also present in animal-based foods. Cholesterol supports many essential bodily functions, but high levels can lead to health issues.

According to the National Heart, Lung, and Blood Institute (NHLBI), unhealthful lifestyle choices are the leading cause of high cholesterol. However, genetics, certain medical conditions, and medications can also contribute to high cholesterol.

Having high cholesterol does not cause symptoms, but it can increase the risk of heart disease and stroke. Doctors can prescribe statins to help lower a person's cholesterol levels, but these medications can cause side effects, such as headaches, muscle cramps, and nausea.

In this article, we explore some natural ways to lower cholesterol without medication. We also discuss what cholesterol is and why high levels can be harmful.

Avoid trans fats
Eating fried food can raise a person's LDL cholesterol.

Trans unsaturated fatty acids, which people commonly refer to as trans fats, are unsaturated vegetable fats that have undergone an industrial process called hydrogenation, which makes them solid at room temperature. Food manufacturers use trans fats because they are relatively inexpensive and long-lasting.

Sources of trans fats include:

margarine vegetable shortening partially hydrogenated vegetable oils fried foods certain processed and prepackaged foods

Bacteria in the stomachs of cows, sheep, and goats produce natural trans fats. Cheese, milk, and other dairy products may contain modest amounts of natural trans fats.

According to the American Heart Association (AHA), consuming trans fats can negatively affect a person's health in two different ways:

they can raise blood levels of low-density lipoprotein (LDL) cholesterol, or "bad cholesterol" they can reduce blood levels of high-density lipoprotein (HDL) cholesterol, or "good cholesterol"

LDL cholesterol can accumulate in the arteries and increase the risk of heart disease, heart attack, and stroke. HDL cholesterol helps remove LDL cholesterol from the bloodstream.

According to a 2019 review, low levels of HDL cholesterol are common in people with type 2 diabetes, which increases their risk of heart disease. The authors suggest that treatment should focus on lowering LDL cholesterol levels to reduce this risk.

In a 2017 study, researchers used cell cultures to show that a trans fat called elaidic acid had toxic effects in neuron-like cells. Elaidic acid led to cell death and increased markers of oxidative stress.

Consume fewer saturated fats Saturated fats generally stay solid at room temperature whereas unsaturated fats are usually liquid. Dietary sources of saturated fats include: red meat pork chicken with the skin on butter cheese and other dairy products cooking oils, such as palm oil and coconut oil The AHA recommend that saturated fat should only represent about 5–6% of a person's daily calorie intake. A diet high in saturated fats may raise a person's LDL cholesterol levels. Excess LDL cholesterol can accumulate and form hard deposits in the arteries, which may lead to a condition called atherosclerosis. A 2018 study examined how different dietary fats affected blood levels of cholesterol. The 4-week study involved 96 healthy adults who consumed 50 grams (g) daily of either: extra virgin coconut oil butter extra virgin olive oil Coconut oil and butter predominately contain saturated fat, whereas olive oil contains mostly monounsaturated fat. According to the results, the participants who consumed butter had significantly higher levels of LDL cholesterol than those in the coconut oil and olive oil groups. The study also showed that different types of saturated fat can vary in their effects on cholesterol levels. For example, coconut oil significantly increased the participants' levels of HDL cholesterol whereas butter significantly raised LDL cholesterol levels. However, a 2015 systematic review did not find a direct association between saturated fat intake and risk of death, coronary heart disease, cardiovascular disease, stroke, or type 2 diabetes. Consume more monounsaturated fats Vegetables, nuts, and fish are rich in monounsaturated fats. These fats take the form of liquids at room temperature. Good sources of monounsaturated fats include: avocados nuts, such as almonds, peanuts, and Brazil nuts seeds vegetable oils, such as olive, peanut, sesame, and sunflower oils In a 2019 study involving 119 adults with a high waist circumference, consuming a diet high in a monounsaturated fat called oleic acid resulted in lower LDL and total cholesterol levels than a diet that was higher in saturated fats and lower in monounsaturated fats. Oleic acid had no effect on the levels of triglycerides or HDL cholesterol in the blood of the participants. Eat more polyunsaturated fats
Eating foods rich in polyunsaturated fats can reduce LDL cholesterol. Polyunsaturated fats include omega-3 and omega-6 fatty acids. Consuming these fats in moderation can reduce LDL cholesterol without affecting HDL cholesterol levels. Dietary sources of polyunsaturated fats include: walnuts fish, such as salmon, tuna, and trout plant oils, such as soybean, corn, and sunflower oils A 2017 review found evidence suggesting that diets rich in polyunsaturated fats from fish oil may prevent some mechanisms of arrhythmia, which is an irregular heartbeat, and promote overall heart health. It is important to balance the intake of omega-6 fatty acids with that of omega-3 fatty acids. Consuming too many omega-6 fatty acids may cause adverse health effects. In a 2018 study, mice that consumed a diet high in omega-6 fatty acids had low-grade chronic inflammation that was due to oxidative stress. Eat more soluble fiber Soluble fiber absorbs water to create a thick, gel-like paste in a person's digestive tract. Soluble fiber not only supports digestive health but also lowers levels of LDL cholesterol and promotes overall heart health. A 2017 study investigated the benefits of a high-fiber diet in 69 Asian Indians with higher-than-normal cholesterol levels. The participants who consumed 70 g per day of soluble fiber had lower total cholesterol and LDL cholesterol levels than those who ate their usual diet. Foods rich in soluble fiber include: vegetables fruits whole grains, such as oatmeal and brown rice legumes beans Soluble fiber lowers LDL cholesterol levels but does not affect HDL cholesterol or triglyceride levels. Consuming too much soluble fiber can lead to constipation, bloating, and stomach pain. People should try to increase their soluble fiber intake gradually over time. Exercise regularly

## Cancer treatments: Patients need to know heart risks

Recent research on the health risks that people undergoing cancer treatment face warns that there is a lack of awareness about the risks that some of these therapies can pose to heart health.

Not enough cancer patients are aware of the potential adverse effects of cancer treatment on their heart.

Investigators from Flinders University in Adelaide, Australia have found that many people who receive chemotherapy or radiotherapy for cancer risk their heart health by having these treatments.

At the same time, the new research shows that most of these people have limited or no knowledge about the cardiovascular risks because their doctors never tell them.

The authors recently presented their findings at EuroHeartCare 2019, a congress of the European Society of Cardiology, which took place at the start of May in Milan, Italy.

"Depending on the type of chemotherapy and radiotherapy, between 1% and 25% [of] cancer patients may develop heart failure due to cancer treatment," warns study author Prof. Robyn Clark.

"Risk," she adds, "also depends on cardiovascular risk factors, such as smoking and obesity. Better monitoring of the heart and intervention before, during, and after treatment can prevent or lessen the impact of this cardiotoxicity."

## Cancer patients unaware of risks

The study authors explain that people who experience heart problems following cancer treatment may not do so immediately.

In fact, according to research investigating heart failure risk in people who have undergone cancer treatment, therapy-related heart failure can develop up to 20 years after the treatment has concluded.

In the current study, the researchers looked at the medical records of 46 people who had received cancer treatment at one of three hospitals between 1979 and 2015. All of these people had cardiotoxicity (damage to the heart muscle), and the research team selected them at random.

The investigators found that of these 46 patients, only 11% had received a referral to a specialized cardiologist before beginning chemotherapy, and medical professionals had only referred 48% of them to a heart failure clinic following their treatment.

Prof. Clark and colleagues also note that among the individuals whose records they studied, about 40% were overweight or had obesity, 41% had smoked or were still smoking, 24% used alcohol regularly, 48% had high blood pressure, and 26% lived with diabetes.

## Patients miss crucial self-care information

The researchers then looked at the provision of care received by subsets of cancer patients during two different periods: 1994–2011 and 2012–2015. They selected these dates so that they could look at the effect of the publication of the European Society for Medical Oncology's Clinical Practice Guidelines, which appeared for the first time in 2012.

When they compared the provision of care in the two periods, the investigators found that the rate of appropriate heart care did actually increase.

The percentage of people who received a referral to a cardiologist before starting chemotherapy went from 0% to 23%, while the percentage of patients receiving a baseline echocardiogram — a scan that allows doctors to assess heart function — rose from 57% to 77%.

Moreover, the researchers went on to interview 11 cancer patients, of whom seven also belonged to the randomly selected group of 46 people whose medical records the investigators initially analyzed.

None of these individuals were aware of their heart health needs, and while more than half of the interviewees reported developing more healthful eating habits following their diagnosis, none of them had a solid understanding of what a balanced diet should entail.

## Doctors should issue more referrals

Based on all of these findings, the study authors stress the importance of monitoring heart health in people about to undergo cancer treatment and adjusting care to meet each person's needs.

"Monitoring the heart throughout the cancer journey can ensure it is protected. Cardiotoxicity can occur even in people without cardiovascular risk factors since drugs like anthracyclines and trastuzumab are toxic to the heart, so it is an innocent bystander."

Prof. Robyn Clark

Prof. Clark and team also note that doctors should explicitly tell cancer patients about the risks that their recommended cancer treatments carry and advise them on the best ways to minimize heart risks — for instance, by working to improve relevant lifestyle factors, such as physical activity and diet.

However, if a cancer patient does develop heart failure, they can still access helpful therapies as long as doctors keep a close eye on the condition, says Prof. Clark.

The researchers explain that healthcare professionals can identify cardiotoxicity either by using echocardiograms or cardiac imaging or by looking for specific biomarkers. People who may develop or already have heart failure could receive angiotensin converting enzyme inhibitors or beta-blockers as a treatment.

At the same time, people whose cancer treatments are damaging their heart health could benefit from modified cancer therapies that minimize this harm, if their doctors closely monitor any cardiovascular developments.

"For cancer patients who do develop heart failure, there are clinics that will improve their quality of life, but our study shows many are not referred," Prof. Clark points out.

"Telephone calls to support and monitor those with cancer and heart failure would reduce the burden of hospital appointments, which patients said was a priority," she emphasizes.

## Atherosclerosis: Research reveals new mechanism and therapeutic target

New research offers fresh insights into how a type of immune cell can destabilize the fatty deposits, or plaques, that form in arteries during atherosclerosis.

Healthy arteries keep the heart healthy. A new study may help prevent atherosclerosis — a disease that affects our blood vessels.

Atherosclerosis is a persistent, inflammatory condition in which plaques build up inside arteries, causing them to narrow and restrict blood flow.

When an atherosclerotic plaque bursts or breaks, it can trigger a heart attack or stroke.

Neutrophils are an abundant type of leukocyte (white blood cell) that defend against infection by attacking microbes. They also serve "many roles in inflammation."

The new international study reveals that neutrophils can aggravate atherosclerosis by triggering a previously unknown type of cell death that destabilizes arterial plaques.

A recent Nature paper describes how neutrophils can induce a series of molecular events that also kills the smooth muscle cells that help to retain the plaques in the artery wall.

"Every inflammatory reaction," says co-corresponding study author Prof. Oliver Söhnlein, who is the director of the Institute for Cardiovascular Prevention at the Ludwig Maximilian University (LMU) of Munich in Germany, "results in some collateral damage, because neutrophils also attack healthy cells."

He and his colleagues have also designed and made a "tailored peptide" that could potentially target and block the cell-death process.

## Atherosclerosis and its consequences

Arteries are vessels that supply the heart and other parts of the body with oxygen- and nutrient-rich blood, which cells need to function and live.

Atherosclerosis develops when various materials, such as cholesterol, fat, and cellular waste, deposit in the tissue lining the arteries. The deposits, or plaques, build up slowly over time causing the arteries to narrow and harden.

When arteries narrow, they impede blood flow and restrict the supply of oxygen and nutrients to cells. Depending on where it occurs, the restricted blood flow can result in heart disease, angina, carotid artery disease, peripheral artery disease, and chronic kidney disease.

The plaques themselves are also a risk. They can rupture, or pieces can break off, causing blockages. In addition, blockages can arise from blood clots that stick to the inner walls of narrowed arteries.

If the blockage is in an artery that supplies blood to the brain or the heart, it can result in a stroke or heart attack. Blockages in arteries that supply the legs can lead to tissue death, or gangrene.

According to statistics that the American Heart Association publish online, cardiovascular conditions, such as heart attack and stroke, were the primary cause of 840,678 deaths in 2016 in the United States.

## Neutrophils help plaques become unstable

Another feature of atherosclerosis is that it triggers signals that prompt the immune system to send neutrophils and other immune cells through the bloodstream to the plaques.

When they reach a plaque site, the immune cells slip between the endothelial tissue cells of the artery lining. At the same time, they release chemicals that signal to the immune system to send even more immune cells.

This can set up a cycle that turns the initial inflammation response into persistent, or chronic, inflammation. Once the inflammation becomes chronic, it raises the risk that the plaque will grow, rupture, and cause a blockage.

Using mouse models of atherosclerosis to investigate what goes on at cell level, the researchers discovered that neutrophils can play a particularly destructive role in destabilizing plaques.

"They bind to the smooth muscle cells that underlie the vessel wall, and are activated," Prof. Söhnlein explains.

Once active, the neutrophils release "chromosomal DNA and its associated histones, which are highly charged and [toxic to cells]," he continues, adding: "Free histones kill nearby cells – in the case of atherosclerosis, smooth muscle cells."

Histones are proteins that help to package DNA tightly inside chromosomes.

## Peptide could block toxic histones

The histones kill the smooth muscle cells by causing pores to form in their walls. This allows extracellular fluids to seep through the pores into the cells, causing them to burst.

Because smooth muscle cells help to retain the plaques in the artery wall, their destruction causes the fatty deposits to become unstable and more likely to rupture and break.

In another part of the study, the team used molecular modeling to design a small protein molecule, or peptide, that could block the toxic effect of the free histones.

The authors suggest that the "histone-inhibitory peptide" could disrupt the histones by binding to them so that they cannot create pores in the cell membranes.

Prof. Söhnlein says that the synthetic peptide could have a similar effect on other conditions that involve chronic inflammation, such as chronic bowel inflammation and arthritis.

He and his co-authors conclude:

"Our data identify a form of cell death found at the core of chronic vascular disease that is instigated by leukocytes and can be targeted therapeutically."

## 'A Viagra-like drug could reverse heart failure'

New research in sheep shows that a drug that doctors usually prescribe for the treatment of erectile dysfunction can also treat heart failure.

A drug that treats erectile dysfunction could also reverse heart failure, according to an animal study.

In people with heart failure, the heart muscle becomes unable to pump out blood efficiently, meaning that some organs may not receive the amount of oxygen that they need to function properly.

The Centers for Disease Control and Prevention (CDC) note that 5.7 million adults in the United States have heart failure and that approximately half of the people with this condition die within about 5 years of receiving their diagnosis.

Moreover, research that Cardiac Failure Review published in 2017 argued that there is a "global pandemic" of heart failure, with this condition affecting an estimated 26 million people worldwide.

Such numbers suggest that finding new ways to treat heart failure is a priority for specialists who study this condition.

Recently, Prof. Andrew Trafford led a team of researchers from the University of Manchester in the United Kingdom who found that a drug that doctors typically use to treat erectile dysfunction could also treat systolic heart failure, in which the heart's left ventricle loses the ability to contract as normal.

The findings of the new study, which the researchers conducted in sheep, appeared today in the journal Scientific Reports.

Prof. Trafford and team decided to focus on tadalafil, which is available under the brand name Cialis among others. This drug falls under the same category as sildenafil, which people commonly refer to by the brand name Viagra.

"We do have limited evidence from human trials and epidemiological studies that show tadalafil can be effective in treating heart failure," Prof. Trafford says.

The researchers studied the effects of the drug in sheep, whose hearts are very similar to those of humans. The team treated the sheep with tadalafil once they had developed heart failure symptoms that were serious enough to require intervention.

Prof. Trafford and colleagues induced heart failure in the animals through the use of a pacemaker, and when they treated them with tadalafil, they gave them doses consistent with what a human patient would usually receive for erectile dysfunction.

After just 3 weeks of tadalafil treatment, the researchers began to notice improvements in the animals that received this drug.

The drug improved the heart's contraction and almost completely restored its ability to respond to epinephrine. It is a lack of response to this hormone that causes breathlessness in heart failure.

Although so far, the researchers have only tested the effects of this drug in sheep, Prof. Trafford maintains that humans are likely to experience the same benefits.

"This study provides further confirmation, adds mechanistic details, and demonstrates that tadalafil could now be a possible therapy for heart failure," the researcher notes, adding, "It's entirely possible that some patients taking it for erectile dysfunction have also unwittingly enjoyed a protective effect on their heart."

## 'We need safe and effective new treatments'

So, why does this drug have a therapeutic effect on heart failure? The scientists explain that tadalafil helps treat erectile dysfunction by acting on a particular enzyme called phosphodiesterase 5. This enzyme plays a key role in determining how different types of tissue interact with hormones, including epinephrine.

In the case of heart failure, the research team notes, tadalafil allows the heart to start responding to epinephrine once more, which means that the heart muscle regains its ability to pump out blood effectively.

These findings are promising because, as Prof. Trafford says, tadalafil "is a widely used and very safe drug with minimal side effects," but the researcher nevertheless cautions against self-prescription.

"[W]e would not advise the public to treat themselves with the drug, and [they] should always [speak] to their doctor if they have any concerns or questions," Prof. Trafford emphasizes.

"Tadalafil is only suitable as a treatment for systolic heart failure — when the heart is not able to pump properly — and there may be interactions with other drugs patients are taking," he warns.

Prof. Metin Avkiran, who is Associate Medical Director at the British Heart Foundation, which funded the current study, expresses hope that these findings might lead to a better treatment that could not only reduce the symptoms of heart failure but also potentially reverse the condition entirely.

"We need safe and effective new treatments for heart failure [...]. The evidence from this study — that a Viagra-like drug could reverse heart failure — should encourage further research in humans to determine if such drugs may help to save and improve lives."

Prof. Metin Avkiran

"Viagra-type drugs were initially developed as potential treatments for heart disease before they were found to have unexpected benefits in the treatment of erectile dysfunction," Prof. Avkiran notes.

"We seem to have gone full circle," he continues, "with findings from recent studies suggesting that they may be effective in the treatment of some forms of heart disease — in this case, heart failure."

## Blood test may predict cardiovascular disease

New research suggests that a simple blood test, which doctors currently use to diagnose heart attacks, may be useful in predicting the risk of cardiovascular disease.

New research suggests a simple blood test could accurately predict who will go on to develop cardiovascular disease.

According to the latest statistics from the American Heart Association (AHA), almost half of the people living in the United States have some form of cardiovascular disease.

In fact, according to 2016 figures, 121.5 million U.S. adults, or 48 percent of the entire population, have cardiovascular disease (CVD), which is a cluster of conditions that includes hypertension. Doctors often call hypertension the "silent killer" because it does not show any visible symptoms until it is too late.

The same AHA report predicts that by 2035, over 130 million adults will have a form of CVD that could bring costs in the U.S. to 1.1 trillion dollars.

Currently, heart disease is the top leading cause of death in the U.S., while stroke is the fifth.

But what if there was a blood test that could accurately predict whether a person will have heart disease or a stroke?

New research suggests that such a test may already exist. By detecting the blood levels of specific proteins that heart muscles release when they are injured, scientists may be able to predict a person's risk of eventually developing CVD.

Dr. Christie Ballantyne, who is the cardiology chief at Baylor College of Medicine in Houston, TX, and his team, detail this idea in a new study that appears in the AHA journal Circulation.

Troponins are proteins that signal heart muscle damage, and in the new research, Dr. Ballantyne and his colleagues wanted to see if detecting troponin in the blood of healthy middle-aged adults or seniors could predict CVD risk.

Dr. Ballantyne and colleagues analyzed a group of 8,121 people aged 54–74 who participated in the "Atherosclerosis Risk in Communities" study. None of the participants had a history of cardiovascular disease.

The scientists identified troponin levels in 85% of the participants and applied Cox proportional hazards models to examine the links between these levels and cardiovascular disease.

Namely, they studied correlations with coronary heart disease, myocardial infarction, ischemic stroke, atherosclerotic cardiovascular disease, heart failure hospitalization, global cardiovascular disease, and all-cause mortality.

The research found that high levels of troponin correlated strongly with "increased global CVD incidence in the general population independent of traditional risk factors."

High-sensitivity troponin tests, therefore, proved to be an accurate way of predicting CVD risk, especially when combined with a standard method of calculating a person's 10-year cardiovascular risk.

"What we're finding out is that these tests can be used in the general population to give us information as to who is most likely to have a future problem, whether it be a heart attack, stroke, or heart failure," says Dr. Ballantyne.

"If you can treat someone much earlier, before {they] have symptoms, you will be far more effective in preventing events," continues the researcher, who adds, "Our major problem is that we do too little too late."

"If the first time you find out that you're at risk for heart failure is when you actually start getting short of breath and you end up in the hospital, you probably have advanced heart disease already, and it is going to be harder to treat than if that person took steps years earlier."

Dr. C. Ballantyne

Instead, knowing the risk in advance can prompt people to take preventive measures, such as exercising more and watching their blood pressure.

However, the scientists explain that although doctors currently use troponin tests to diagnose a heart attack, they do not yet accept them as a tool for predicting risk. Scientists need to do more research before using these tests to evaluate risk.

"Research in this area is leading us toward individualized care more and more, so we can better predict who's at risk for developing adverse cardiovascular outcomes," comments Dr. Rebecca Vigen, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas, who did not participate in the research.

"This study is a step in the direction of personalizing care," Dr. Vigen says.

## Patterns of antibiotic use may predict cardiovascular risk

A new study that analyzed the health information of thousands of women found that prolonged antibiotic use is correlated with a higher risk of experiencing a cardiovascular event.

Women may wish to consider limiting their use of antibiotics to prevent cardiovascular issues.

Scientists at Tulane University in New Orleans, LA, Harvard Medical School and Harvard T. H. Chan School of Public Health in Boston, MA, and Fudan University in Shanghai, China investigated how antibiotic use is linked to women's risk of experiencing cardiovascular problems.

They were interested in the link between antibiotics and cardiovascular health because, they explain, antibiotics can have an important impact on gut microbiota, which, in turn, can affect various other aspects of health.

"Antibiotic use is the most critical factor in altering the balance of microorganisms in the gut," says study co-author Prof. Lu Qi.

"Previous studies have shown a link between alterations in the microbiotic environment of the gut and inflammation and narrowing of the blood vessels, stroke, and heart disease," he adds.

The study — the findings of which appear in the European Heart Journal — analyzes information the scientists collected from a cohort of 36,429 women enrolled in the Nurses' Health Study.

Specifically, the researchers examined data from 2004–2012; at the beginning of this period, all the women in the cohort were 60 or older.

All the participants reported how often they used antibiotics and other relevant information during three periods of their lives: ages 20–39, ages 40–59, and ages 60 and over.

Based on the antibiotic use patterns that the women reported, the scientists split them into four groups:

those who had never used antibiotics those who took antibiotics for fewer than 15 consecutive days at a time those who used antibiotics for between 15 days and 2 months those who took antibiotics for over 2 months

## 'A cumulative effect' of antibiotic use?

Over a follow-up period of almost 8 years, on average, 1,056 participants developed cardiovascular problems.

Throughout this period, the women continued to offer information about their antibiotic use every couple of years.

The scientists analyzed the data they took throughout this time, adjusting the results for potentially confounding factors. These included age, race, dietary choices, lifestyle habits, medical conditions, and overall drug use.

Women who took antibiotics for very long periods of time (for 2 months or longer) at age 60 or over had a 32% higher risk of experiencing cardiovascular disease compared with those who had never taken antibiotics.

Those who took antibiotics for 2 months or longer at ages 40–59 were 28% more likely to develop cardiovascular problems than women who did not take antibiotics at that age. However, the team found no correlation between prolonged antibiotic use at ages 20–39 and cardiovascular risk.

"By investigating the duration of antibiotic use in various stages of adulthood," points out first study author Yoriko Heianza, Ph.D., "we have found an association between long-term use in middle age and later life and an increased risk of stroke and heart disease during the following 8 years."

"As these women grew older they were more likely to need more antibiotics, and sometimes for longer periods of time, which suggests a cumulative effect may be the reason for the stronger link in older age between antibiotic use and cardiovascular disease."

Yoriko Heianza, Ph.D.

## 'The shorter time of use, the better'

The researchers also note that some of the most common reasons women cited for their antibiotic use included infections — respiratory and pertaining to the urinary tract — and oral health conditions.

Though this is the largest prospective study to date that has looked at the correlation between the use of antibiotics for long periods of time and cardiovascular risk, the research was not without its limitations.

For example, the researchers admit that the main problem they faced in this study was the fact that the participants self-reported their use of antibiotics, which tends to leave room for inaccuracies.

However, they also argue that the participants were likely to report fairly precise information, being healthcare professionals themselves.

The scientists are quite confident in their findings, but they explain that the study was observational and cannot, as yet, speak to cause and effect.

"This is an observational study," notes Prof. Qi, "and so it cannot show that antibiotics cause heart disease and stroke, only that there is a link between them."

"It's possible that women who reported more antibiotic use might be sicker in other ways that we were unable to measure, or there may be other factors that could affect the results that we have not been able [to] take account of," he goes on.

Despite these points, Prof. Qi concludes: "Our study suggests that antibiotics should be used only when they are absolutely needed. Considering the potentially cumulative adverse effects, the shorter time of antibiotic use the better."

## Innovative patch may reduce muscle damage after a heart attack

A recent study in rats shows that an innovative patch prevented the stretching of the heart muscle common after a heart attack.

An innovative new patch limits heart muscle damage after a heart attack.

A heart attack occurs when the blood flow that provides the heart muscle with oxygen is significantly reduced or blocked.

The heart muscle is injured in the process, and the amount of damage usually depends on the size of the area supplied by the blocked artery.

It can take about 8 weeks for the heart muscle to heal. Despite the damage, the rest of the heart has to keep on pumping blood.

Scar tissue may form in the injured area and have an impact on the amount of blood that the heart is able to pump.

Most people who survive a heart attack have some degree of coronary artery disease. This occurs when arteries become hardened and narrowed. Usually, survivors have to make crucial lifestyle changes and may have to take medication to prevent a future heart attack.

According to the Centers for Disease Control and Prevention (CDC), more than 700,000 people in the United States have a heart attack every year. Of these, more than 500,000 experience their first heart attack and about 200,000 have already had one.

Signs of a heart attack include chest pain and shortness of breath. Half of U.S. individuals have at least one of the following risk factors: high blood pressure, high cholesterol, or smoking.

Diabetes, obesity, physical inactivity, and excessive alcohol use also increase the risk of a heart attack.

## Testing a new type of adhesive heart patch

Scientists at Brown University in Providence, RI, Fudan University in Shanghai, China, and Soochow University in Suzhou, China have collaborated to create and test a new type of adhesive heart patch on rats.

The study was an interdisciplinary effort among researchers in computer modeling and mechanics, material scientists, and cardiology. The scientists published their findings in the journal Nature Biomedical Engineering.

The scientists created this adhesive patch using a water-based hydrogel material and developed it using computer simulations. The patch can sit directly on the heart, and the results of the study show that it may help limit the muscle damage that often occurs after a heart attack.

"The idea here," explains study co-author Prof. Huajian Gao, from Brown University, "is to provide mechanical support for damaged tissue, which hopefully gives it a chance to heal."

Prof. Gao goes on to say that past studies had shown that mechanical patches could be effective, but no research had attempted to identify the "optimum mechanical properties." Getting those properties right is crucial to ensuring that the patch can work properly.

"If the material is too hard or stiff," he adds, "then you could confine the movement of the heart so that it can't expand to the volume it needs to. But, if the material is too soft, then it won't provide enough support. So, we needed some mechanical principles to guide us."

## Creating right mechanical properties is key

The researchers developed a computer model focused on two key components, one of which was the expanding and contracting of the heart and the impact the patch had on these functions.

The other was to model the injuries that occur after a heart attack. In this way, the team could look at how much mechanical support would be necessary to limit the damage.

Following the results of the computer model, the researchers — led by Prof. Lei Yang, of Soochow University — created a hydrogel material using food-sourced starch. This material is inexpensive, easy to make, and viscoelastic, which means that "it combines fluid and solid properties."

The study in rats showed that this new type of adhesive patch was effective in reducing muscle damage after a heart attack.

"[It] maintained a better cardiac output and thus greatly reduced the overload of those remaining cardiomyocytes and adverse cardiac remodeling," says study co-author Ning Sun, a cardiology researcher at Fudan University.

Their research found that the patch can reduce cell death, the accumulation of scar tissue, and oxidative stress. The researchers believe that more testing is required, but the results are promising.

"It remains to be seen if it will work in humans, but it's very promising."

Prof. Huajian Gao

## Using small molecules to regenerate heart tissue

New research, which appears in the journal Nature Communications, shows that delivering two small molecules to mice helps their hearts regenerate after a heart attack.

New research may pave the way for regenerating the heart muscle after a heart attack.

Heart disease is the leading cause of death in the United States and responsible for almost 1 in 4 deaths in the country.

An adverse cardiovascular event, such as a heart attack, typically damages the cells that make up the heart muscle.

These cells are called cardiomyocytes, and losing them puts people at risk of heart failure — a condition wherein the heart cannot pump blood effectively to the rest of the body.

The scientific consensus is that adult hearts can no longer create new cardiomyocytes. This inability is why the heart cannot regenerate itself after a heart attack when huge numbers of cardiomyocytes are lost.

New research, however, renews hope of protecting damaged heart tissue by using small molecules called microRNAs.

## Why microRNAs are important for the heart

MicroRNAs control gene function and they can be found in abundance when the heart is developing.

Past research has identified a cluster of microRNAs called miR-17-92 that controls how cardiomyocytes proliferate. Da-Zhi Wang, Ph.D., a cardiology researcher at Boston Children's Hospital and a professor of pediatrics at Harvard Medical School in Boston, MA, led this previous research.

Now, Prof. Wang and his colleagues have zoomed in on two members of this microRNA family: miR-19a and miR-19b.

In the new study, Prof. Wang and his colleagues show how these two microRNA molecules can drive heart regeneration after myocardial infarction.

The findings could help prevent heart failure following a heart attack, which is, according to the researchers, "the leading cause of mortality and morbidity in humans."

## The short- and long-term effect of microRNAs

Prof. Wang and team used a mouse model of a heart attack and delivered the microRNAs in two different ways.

Firstly, they administered the lipid-coated molecules directly to the mice. Secondly, the researchers placed the microRNAs in an adeno-associated virus — that is, a gene therapy vector that targeted the heart.

With both delivery methods, the results were promising, both in the long term and in the short term.

Namely, in the first 10 days after a heart attack, the microRNAs reduced cell death and stopped the inflammatory reaction that typically damages the heart muscle during a heart attack.

The researchers also carried out a genome-wide transcriptome analysis that revealed how miR-19a/19b repressed the genes that controlled the inflammatory response and acute cell death.

Over time, the hearts of the mice that received the molecules had more healthy tissue, less damaged tissue, better heart muscle contractility, and reduced dilated cardiomyopathy — a condition in which the heart muscle thins, which, ultimately, weakens the heart.

"The initial purpose is to rescue and protect the heart from long-term damage," explains Prof. Wang. "In the second phase, we believe microRNAs help with cardiomyocyte proliferation."

## The advantages of microRNA therapy

The researchers go on to explain the benefits of microRNA therapy. Unlike gene therapy, they say, the microRNA molecules do not stay in the heart after they have fulfilled their purpose.

"They go in very fast and do not last long, but they have a lasting effect in repairing damaged hearts," explains one of the corresponding authors of the study, Jinghai Chen, Ph.D.

"We gave mice only one shot when the heart needed the most help, then [...] we kept checking expression level of miRNA19a/b post-injection," adds Chen. "After one week, expression decreased to a normal level, but the protection lasted for more than one year."

"MicroRNAs hold tremendous promise to become powerful tools to battle cardiovascular disease," write the researchers, who are next planning to test the treatment in a larger mammal before moving on to human studies. Prof. Wang and colleagues conclude:

"[M]iR-19a/19b-mediated early cardiac protection could open a window to the development of effective therapy for heart attack and bring great benefits to heart failure patients."

## Is this chest pain from GERD or a heart attack?

Chest pain can be a sign that a person is having a heart attack. However, chest pain is also a common symptom of other, less serious conditions, such as gastroesophageal reflux disease.

Doctors refer to pain from heart attacks and other conditions that affect the cardiovascular system as cardiac chest pain. Pain that does not come from the cardiovascular system is called noncardiac chest pain.

Gastroesophageal reflux disease (GERD) can cause heartburn, which is a common type of noncardiac chest pain.

While heart attacks are a life-threatening medical emergency, heartburn is not. Therefore, being able to recognize the difference between cardiac and noncardiac chest pain is essential.

In this article, we discuss the symptoms of GERD and heart attacks along with the differences between cardiac and noncardiac chest pain. We also cover other causes of both types of chest pain.

Is it GERD?
Many conditions can cause chest pain, including acid reflux.

Acid reflux occurs when acid from the stomach leaks up into the food pipe, or esophagus. One of the most common symptoms of acid reflux is heartburn, which is a painful burning sensation in the center of the chest just behind the breastbone, or sternum.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, a person who experiences acid reflux more than twice a week for a few weeks may have GERD. Close to 20 percent of people in the United States have GERD.

Other symptoms of acid reflux and GERD can include:

People with persistent symptoms of acid reflux or GERD should see a doctor.

Is it a heart attack? Heart attacks occur when the blood supply to the heart muscles becomes completely blocked. If a person does not receive immediate treatment, part of the heart muscle can die. A common symptom of a heart attack is pain or discomfort that typically occurs in the center or left side of the chest. This pain may come and go, and its severity can range from mild to severe. It can also sometimes feel like heartburn or indigestion. However, not everyone who has a heart attack experiences chest pain. The symptoms of a heart attack can vary considerably from person to person, and they may come on slowly or very suddenly. Other symptoms of a heart attack might include: intense pressure or tightness in the center of the chest a feeling of heaviness or weakness in one or both arms pain, numbness, or a tingling sensation in the arms, neck, jaw, lips, or stomach difficulty breathing or shortness of breath nausea and vomiting dizziness or lightheadedness fatigue breaking out in a cold sweat Anyone who suspects that they or someone else is having a heart attack should immediately call 911 or go to the emergency room. Cardiac vs. noncardiac chest pain
A person experiencing recurring or severe chest pain should speak to a doctor. When trying to distinguish between cardiac and noncardiac chest pain, a person needs to consider the following three factors: the location of the pain how the pain feels the accompanying symptoms We discuss each of these in more detail below: Location of chest pain Both cardiac and noncardiac chest pain can occur in the center of the chest behind the breastbone. However, cardiac chest pain can spread across the chest and even affect other parts of the body, such as the: arms back shoulders neck or throat jaw teeth Noncardiac chest pain, such as heartburn, tends to remain localized, meaning that it does not spread to other areas. Heartburn typically develops behind or underneath the breastbone. How the pain feels Some of the words that people use to describe cardiac chest pain are: pressure squeezing heaviness fullness tightening aching burning In contrast, noncardiac chest pain tends to feel like an intense stabbing or burning sensation just beneath the surface of the skin. Coughing, breathing, or moving can affect the intensity of noncardiac chest pain, while the severity of cardiac chest pain usually remains stable, even when resting. Accompanying symptoms The symptoms accompanying chest pain can be an important indication of whether it is cardiac or noncardiac. The symptoms that can occur along with cardiac chest pain may include: shortness of breath irregular heartbeat dizziness or lightheadedness numbness pain or discomfort in other parts of the body, such as the arms, neck, jaw, shoulders, and back Symptoms that indicate that the chest pain is from heartburn or GERD can include: Other causes of cardiac chest pain Causes of cardiac chest pain can include: Angina Coronary artery disease (CAD), also called ischemic heart disease or coronary heart disease, occurs when fatty deposits build up in the arteries that supply blood to the heart muscle. Over time, these deposits can restrict blood flow, which can cause a type of chest pain called angina. CAD can also lead to heart attacks and heart failure. People often describe angina as a feeling of pressure, squeezing, burning, or tightness behind the breastbone. This pain can spread to other parts of the body, including the arms, jaw, neck, and shoulders. Angina often occurs during physical activity, and stress can also bring it on. If the pain continues after rest, this can be a sign of a heart attack. People who are unsure whether they are experiencing angina or a heart attack should call 911 immediately or go to the emergency room. Myocarditis Myocarditis is a rare form of cardiovascular disease that causes inflammation of the heart muscle. This inflammation can lead to chest pain, heart failure, or sudden death. According to the National Organization for Rare Disorders, myocarditis commonly develops without an identifiable cause. However, doctors often diagnose people with myocarditis following a viral or bacterial infection. Myocarditis produces symptoms similar to those of other heart conditions, such as chest tightness and fatigue. Leaning forward can help relieve chest pain resulting from myocarditis. Other symptoms of myocarditis include: slow heart rate irregular heartbeat dizziness or lightheadedness loss of consciousness Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is a thickening of the muscle wall in the heart. People can inherit genes from their parents that increase their risk of developing HCM. However, HCM can also occur as a result of high blood pressure, diabetes, or thyroid disease. The symptoms of HCM include: chest pain that often results from exercise shortness of breath fainting fluttering heartbeat or heart palpitations Pulmonary hypertension Pulmonary hypertension refers to high blood pressure in the arteries that supply the lungs. Common symptoms include shortness of breath and chest pain, which may occur or worsen with physical activity. Over time, symptoms may become more frequent as the disease progresses. People with pulmonary hypertension may also experience: fatigue and weakness fainting, lightheadedness, or dizziness irregular heartbeat a dry cough that may bring up blood swelling of the legs or feet that results from fluid buildup Other causes of noncardiac chest pain Causes of noncardiac chest pain can include: Pneumonia
Pneumonia can cause shortness of breath and chest pain. Pneumonia is a chest infection that causes the tiny air sacs inside the lungs to become inflamed and fill with fluid. A common symptom of pneumonia is chest pain that typically worsens when a person inhales deeply or coughs. The chest pain can range from mild to severe. Other symptoms of pneumonia can include: Peptic ulcer A peptic ulcer is an open sore in the lining of the stomach or small intestine. Bacterial infections and long-term use of nonsteroidal anti-inflammatory drugs can lead to peptic ulcers. Peptic ulcers can cause a painful burning sensation that starts in the abdomen and extends to the chest. This pain can come and go and may get better when a person eats or takes an antacid. Other symptoms of peptic ulcers can include: bloating belching nausea and vomiting dark stools unexplained weight loss loss of appetite lightheadedness However, not everyone with peptic ulcers experiences symptoms. Costochondritis Costochondritis is an inflammation of the cartilage around the breastbone. This inflammation can cause tenderness and sharp chest pain that may feel similar to the pain of a heart attack. The pain from costochondritis usually affects the left side of the chest, but it can sometimes affect both sides. Deep breathing, coughing, and physical activity may make the pain worse. Possible causes of costochondritis include severe coughing, chest injuries, infections, and overexertion. Esophageal spasms Involuntary spasms or contractions of the food pipe can cause intense chest pain. These spasms can come on suddenly and sometimes last for several hours. Other symptoms of esophageal spasms may include: intense pain or tightness in the chest feeling as though something has become stuck in the throat stomach contents coming up the food pipe difficulty swallowing It is not always clear why esophageal spasms occur, but risk factors include GERD, anxiety, and high blood pressure. Panic attack A panic attack refers to a sudden attack of intense anxiety and fear. These attacks can last for between a few minutes and several hours, and a person may feel as though they are having a heart attack. Symptoms of a panic attack can include: chest pain pounding, rapid, or irregular heartbeat trembling or shaking shortness of breath a sensation of choking or suffocating nausea dizziness or lightheadedness numbness sweating feelings of doom, loss of control, or unreality A person may have a panic attack in response to a stressful event, but an attack can also occur unexpectedly. Recurrent panic attacks are a symptom of panic disorder. Summary Heartburn is a symptom of acid reflux and GERD that causes a painful burning sensation in the center of the chest. This sensation can sometimes feel similar to the chest pain that people experience during a heart attack or attacks of angina. A heart attack is a medical emergency, so being able to tell the difference between heartburn and cardiac chest pain is crucial. If chest pain spreads to other areas of the body, such as the arms or jaw, or occurs alongside symptoms such as shortness of breath and a feeling of tightness in the chest, it might be a sign of a heart attack. If chest pain lasts for more than a few minutes, call 911 immediately. A person who suspects that they or someone else is having a heart attack should immediately call 911 or go straight to the emergency room. It is also advisable to see a doctor about any unexplained chest pain, even if it goes away on its own.

## Plant-based diet cuts heart failure risk by over 40 percent

New research finds that sticking to a diet rich in fruits, vegetables, and fish can slash heart failure risk by 41 percent. By contrast, a diet rich in fats, fried foods, processed meat, and sugary drinks can raise the risk of this condition.

Adding more vegetables to our plate could keep heart failure at bay.

Heart failure occurs when the heart cannot supply enough blood and oxygen to the main organs in the body.

The condition affects about 5.7 million people in the United States and approximately 26 million people worldwide.

Some experts predict that heart failure will become more and more prevalent worldwide, which has led them to refer to it as a "global pandemic."

However, emerging evidence suggests that a diet consisting mainly of fruits and vegetables can prevent cardiovascular disease. Now, a new study strengthens this idea.

Dr. Kyla Lara, a cardiology fellow at the Mayo Clinic in Rochester, MN, and her colleagues, have examined the associations between five major dietary patterns and the risk of heart failure among people without any known history of heart disease.

Dr. Lara and her team published the results of their study in the Journal of the American College of Cardiology.

## The effect of diets on heart failure

The researchers examined data available from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Namely, they looked at the dietary patterns among 16,068 black and white people who were 45 years old, on average.

The participants answered a 150-item survey, which included 107 food items. The researchers grouped the foods into five dietary patterns:

"convenience" diets, which consisted of meat-heavy dishes, pasta, pizza, and fast food "plant-based" diets, consisting mainly of vegetables, fruit, beans, and fish "Southern" diets, which comprised a significant amount of fried foods, processed meat, eggs, added fats, and sugary drinks "alcohol/salads" diets, which included lots of wine, liquor, beer, leafy greens, and salad dressing.

Dr. Lara and team followed the participants for 8.7 years on average, during which time, 363 people spent time in the hospital for heart failure for the first time.

Of these, 133 people had heart failure with preserved ejection fraction, and 157 had heart failure with reduced ejection fraction. The former refers to a form of heart failure in which the ejection fraction — a measure of how well the heart is pumping blood — is "normal," or "preserved."

## Plant-based diets slash heart failure risk

Overall, the researchers found that adhering to the Southern diet increased the risk of hospitalization due to heart failure by 72 percent.

But when the researchers adjusted for body mass index (BMI), "waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease," this association became no longer statistically significant.

This could mean that the Southern diet raises heart failure risk by increasing obesity and abdominal fat, explain the researchers.

Importantly, the researchers found that the risk of heart failure hospitalizations was 41 percent lower among people who adhered to the plant-based diet.

Finally, the researchers found no statistically significant associations among heart failure risk and the other three dietary patterns.

"Adherence to a plant-based dietary pattern was inversely associated with incident [heart failure] risk, whereas the Southern dietary pattern was positively associated with incident [heart failure] risk," conclude the researchers, who also outline some strengths and limitations to their study.

The researchers say that the socio-economically and demographically diverse study sample made the associations stronger. However, the study participants may have wrongly estimated their dietary intakes, which may have biased the results.

Also, the researchers examined the participants' diets only at the beginning of the study, and these dietary habits may have changed throughout the study period.

In a linked editorial, Dr. Dong Wang, a research fellow at the Harvard T.H. Chan School of Public Health in Boston, MA, comments on the significance of the findings, "This study represents an important step forward in establishing a robust evidence base for the dietary prevention of heart failure."

"The need for population-based preventive strategies for heart failure is critical [...] These findings support a population-based dietary strategy for lowering the risk of incident heart failure."

Dr. Kyla Lara