The Heart

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The link between insomnia and cardiovascular disease

Sleeping problems can affect both mental and physical health. Now, a large-scale analysis in China highlights how insomnia might lead to potentially life threatening cardiovascular diseases.

man having trouble sleepingShare on PinterestNew research points to concerning links between insomnia and cardiovascular problems.

Insomnia is a relatively widespread problem. When a person has insomnia, they often struggle to fall asleep or stay asleep. Some people experience both.

Around 1 in 4 adults in the United States experience short-term, or acute, insomnia every year, according to research carried out at the University of Pennsylvania, PA. Acute insomnia typically means that a person experiences sleep problems for just a short period, perhaps due to stress or worry.

Approximately three-quarters of these people return to their regular sleeping patterns. Others, however, go on to develop chronic insomnia.

Chronic insomnia refers to a person who experiences problems sleeping for at least 3 nights a week for no less than 3 months.

Both acute and chronic insomnia can result in daytime drowsiness, concentration and memory problems, and a lack of energy.But studies have found more worrying links. One recent analysis, appearing in Sleep Medicine Reviews, linked insomnia to the onset of depression, anxiety, and alcohol misuse. Other studies have found a relationship between insomnia and heart disease.Now, authors of a new study, published in Neurology, point out that previous research has failed to define insomnia correctly and has included people who may not have the disorder. So they set out to find a stronger association.Tracking insomniaThe results of the new paper suggest that identifying insomnia, particularly in young people, may reduce cardiovascular disease risk later on in life.The researchers used data from the China Kadoorie Biobank, which investigates and tracks the leading causes of chronic diseases in China.The participants, aged between 30 and 79, had no history of heart disease or stroke when the study commenced.In the new study, the researchers analyzed three symptoms of insomnia, where the symptoms lasted at least 3 days a week. The symptoms were: problems falling asleep or staying asleep, waking too early, or struggling to focus during the day because of disrupted sleep.The data show that 11% of the participants reported trouble falling or staying asleep, and 10% had problems with waking up early. Only 2% of the participants reported having focusing issues during the day.The researchers followed all of the volunteers for about a decade. During that time, they identified 130,032 incidences of heart attack, stroke, and comparable diseases.A higher chance of cardiovascular diseaseAfter taking into account other risk factors, such as smoking and alcohol consumption, researchers identified several significant findings.The new study identified that the participants who reported experiencing all three insomnia symptoms had an 18% increased chance of developing cardiovascular diseases compared with those who did not experience the symptoms.Those who reported trouble focusing during the day were 13% more likely to develop heart attack, stroke, and comparable diseases than people who did not have problems focusing.Researchers identified that the people who found it difficult to fall asleep or stay asleep had a 9% higher chance of developing these diseases, while those who woke up too early were 7% more likely to experience a stroke, heart attack, or similar.Despite these results, the researchers point out that they have not established a cause and effect between insomnia and cardiovascular illnesses. The findings simply highlight an association between the two.Notably, this link "was even stronger in younger adults and people who did not have high blood pressure at the start of the study," says study author Dr. Liming Li of Beijing's Peking University in China.The researchers note that the participants in the study self-reported their symptoms of insomnia, which may mean the data are not entirely accurate. However, further analyses, enlisting medical professionals to track symptoms of insomnia rather than relying on self-reporting, would strengthen the relationship."These results suggest that if we can target people who are having trouble sleeping with behavioral therapies, it's possible that we could reduce the number of cases of stroke, heart attack, and other diseases later down the line."Dr. Liming Li
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Atrial fibrillation: Height could predict risk

Researchers from the University of Pennsylvania have found that people who are taller also have a higher risk of developing atrial fibrillation, a common heart condition, and that there may be a genetic link.

image of tall and short person standing next to each otherShare on PinterestBeing tall can make a person more prone to atrial fibrillation, new research confirms.

Atrial fibrillation is a condition characterized by an abnormal heartbeat — the heart may beat too fast, too slow, or the beats may be irregular.

According to the Centers for Disease Control and Prevention (CDC), around 2.7–6.1 million people in the United States have atrial fibrillation.

Though some people are unaware that they have it, due to a lack of obvious symptoms, atrial fibrillation can increase a person's risk of stroke.

Meanwhile, over 750,000 people end up in the hospital each year because of this heart problem, as per CDC data.

Recent research has shown that cases of atrial fibrillation have been on the rise, forecasting an "epidemic." But if people know that they are at risk of developing this condition, they can take steps to prevent it. They can also be better prepared to manage it, if it does develop.Some recognized risk factors for atrial fibrillation include high blood pressure, obesity, diabetes, and heart disease, as well as some nonclinical factors, such as being older and being of European descent.Now, a new study from Penn Medicine — a combined effort of the University of Pennsylvania Health System and the university's Perelman School of Medicine, in Philadelphia — suggests that being tall may be another risk factor for atrial fibrillation."Our findings suggest it may be beneficial to incorporate height into risk-prediction tools for [atrial fibrillation]," says lead study author Dr. Michael Levin.He and colleagues will present their findings later this week at the American Heart Association's 2019 Scientific Sessions, in Philadelphia, PA.The researchers report that for every 1-inch increase relative to average height — which they give as 5 feet and 7 inches, or approximately 1 meter and 70 centimeters — a person's risk of atrial fibrillation increases by approximately 3%.However, this finding is not surprising, since past observational studies have also suggested an association between height and atrial fibrillation risk.The issue that most interested the research team was whether there might be a causal relationship between height and atrial fibrillation risk.To answer this question, the researchers analyzed genetic data from two large databases. One was that of the Genetic Investigation of Anthropometric Trials consortium. The investigators accessed this database to analyze the genes of 700,000 participants, looking for genetic variants associated with increased height.The other was the database of the Atrial Fibrillation Genetics consortium, which allowed the researchers to analyze the genetic information of over 500,000 people, searching for genetic variants linked to a higher risk of atrial fibrillation.Putting two and two together, the investigators found that many of the genetic variants associated with increased height were also linked to a higher risk of atrial fibrillation.This relationship remained in place, even after the investigators adjusted for confounding factors, including heart disease, high blood pressure, and diabetes, which led the team to conclude that there may be a causal relationship between height and atrial fibrillation risk.This notion was backed up by further analysis: When the researchers analyzed the data of an additional cohort of almost 7,000 participants enrolled in the Penn Medicine Biobank, they once more saw that a person's height, as well as genetic variants specifically associated with increased height, were strongly linked to an increased risk of atrial fibrillation.Once again, these associations remained in place, even after the team adjusted for confounding factors, such as other known risk factors for atrial fibrillation.These findings have led the study authors to suggest that, going forward, medical professionals may want to start including height on their list of important risk factors to consider in the context of heart health."While current guidelines advise against widespread screening for [atrial fibrillation], our findings show that a certain group of patients — specifically very tall patients — may benefit from screening."Dr. Michael LevinSenior author Dr. Scott Damrauer adds that "These analyses show how we can use human genetics to help us better understand causal risk factors for common disease.""They also illustrate how we can combine summary-level statistics from large published studies with individual-level data from institutional biobanks to further our understanding of human disease," Dr. Damrauer explains.
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Listening to music while driving may help calm the heart

Driving can be very stressful, particularly if you are stuck in heavy traffic or are an inexperienced driver, and this stress will eventually take its toll on the heart. However, researchers now confirm that there is a simple fix for this problem: listening to the right music while driving.

woman drivingShare on PinterestIf we listen to relaxing music while driving, this may help relieve stress and protect the heart, a new study suggests.

Past research has shown that experiencing frequent psychological stress can be a significant risk factor for cardiovascular disease, a condition that affects almost half of those aged 20 years and older in the United States.

One source of frequent stress is driving, either due to the stressors associated with heavy traffic or the anxiety that often accompanies inexperienced drivers.

Does this mean, though, that people who drive on a daily basis are set to develop heart problems, or is there a simple way of easing the stress of driving?

According to a new study by researchers from São Paulo State University in Marília, Brazil, Oxford Brookes University in the United Kingdom, and the University of Parma in Italy, there is.

In a study paper that features in the journal Complementary Therapies in Medicine, the researchers report the encouraging results of a study involving inexperienced drivers, noting that listening to music while driving helps relieve the stress that affects heart health."We found that cardiac stress in the participants in our experiment was reduced by listening to music while they were driving," says principal investigator Prof. Vitor Engrácia Valenti.For their study, the researchers recruited five female volunteers between the ages of 18 and 23 years who were in good health, were not habitual drivers — they drove no more than twice a week — and had received their driver's license 1–7 years before the start of the study."We opted to assess women who were not habitual drivers because people who drive frequently and have had a license for a long time are better adapted to stressful situations in traffic," explains Prof. Valenti.The researchers asked the volunteers to take part in two different experiments. On one day, the participants had to drive for 20 minutes during rush hour on a 3 kilometer route in one of the busiest parts of the city of Marília. On this day, the participants did not play any music in the car as they were driving.On another day, the volunteers had to go through the same motions, with one exception: This time, they listened to instrumental music while driving.In both instances, the participants drove cars that were not their own. This measure was necessary, the investigators explain, to make sure that there was no reduction in stress due to the volunteers being familiar with the cars."To increase the degree of traffic stress, we asked them to drive a car they did not own. Driving their own car might help," says Prof. Valenti.To measure the effect of stress on the heart in each experimental condition, the investigators asked the participants to wear heart rate monitors able to record heart rate variability in real time.The activity of two key systems — the sympathetic nervous system and the parasympathetic nervous system — influences heart rate variability. The sympathetic nervous system is responsible for regulating the flight or flight response, which is the automatic bodily reaction to stressful, anxiety-inducing situations. Meanwhile, the parasympathetic nervous system is responsible for "rest and digest" processes."Elevated sympathetic nervous system activity reduces heart rate variability, whereas more intense parasympathetic nervous system activity increases it," explains the lead investigator.The researchers then analyzed the measurements that they had collected through the heart rate monitors on the two occasions. They found that when the participants had listened to music while driving under stressful conditions, they had higher heart rate variability than when they had driven under stressful conditions without any music."Listening to music attenuated the moderate stress overload the volunteers experienced as they drove," says Prof. Valenti.To readers who may be wondering why the researchers turned specifically to female participants in their study, the lead investigators explain that, at this stage, they wanted to be able to rule out the potential influence of sex-specific hormones."If men, as well as women, had participated, and we had found a significant difference between the two groups, female sex hormones might have been considered responsible," notes Prof. Valenti.The results of the small-scale experiments, the researchers argue, suggest that listening to relaxing music could, indeed, be an easy way of preventing stress levels from escalating and affecting the heart when someone finds themselves stuck in traffic."Listening to music could be [...] a preventive measure in favor of cardiovascular health in situations of intense stress, such as driving during rush hour."Prof. Vitor Engrácia Valenti
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Is there a link between muscle mass and cardiovascular risk?

A new study has found a link between lower muscle mass and a higher risk of cardiovascular events — at least in males aged 45 and over. This association, the research indicates, is valid even for males with no history of heart disease.

physiotherapist working with older manShare on PinterestMuscle mass loss is linked to a higher risk of cardiovascular problems in males aged 45 and over.

Some loss of skeletal muscle mass occurs naturally as people age. This process especially affects males.

In fact, research shows that after the age of 30, muscle mass tends to decrease by 3–5% per decade in males.

People can prevent and minimize this loss by staying active. If they do not, it may contribute to poor health and well-being.

Some past studies have suggested that people with cardiovascular disease who experience higher loss of muscle mass also have a higher risk of premature death.However, to date, little to no research has looked into the possible associations between muscle mass and cardiovascular risk in people without preexisting heart or circulatory problems.Now, specialists from the Centro de Investigación Biomédica en Red de Salud Mental in Madrid, Spain, the University of Canberra in Australia, and the University of Athens in Greece have conducted a study with the aim of filling in that research gap.The new study — the results of which appear in the Journal of Epidemiology & Community Health, and whose first author is Stefanos Tyrovolas — has analyzed the data of a cohort of male participants aged 45 and over covering a follow-up period of 10 years.Its findings suggest that, in males at least, maintaining muscle mass may help keep cardiovascular problems at bay.The team analyzed the medical information of 2,020 participants — of whom half were male and half were female — over a period of 10 years. All but one of the particpants were aged 45 and over, and all were free of heart disease at baseline.At baseline, the participants provided data regarding their lifestyle choices, such as diet and exercise, as well as measurements of circulating blood fats, systemic inflammation biomarkers, weight, and blood pressure.The researchers explain that all these values are important, since they can affect a person's risk of cardiovascular problems. In addition to these data, the investigators also calculated the participants' skeletal muscle mass adjusted in accordance with every individual's weight and height.Over the 10 year follow-up period, the researchers recorded 272 cardiovascular events — both fatal and nonfatal — that included stroke and minor stroke. These cases all occurred among the working sample of 1,019 participants who had been 45 or over at baseline.The team found that males were about four times more likely to develop cardiovascular disease than females. Moreover, they saw a link between lower muscle mass volume and a higher risk of cardiovascular problems in the case of males.At the other end of the spectrum, males with the highest muscle tissue volume at baseline had an 81% lower risk of events such as stroke and heart attack, compared with those with the lowest muscle mass at the start of the study period.The team also found that males with the highest muscle tissue volume at baseline had a lower prevalence of other risk factors for cardiovascular issues, such as high blood pressure, diabetes, or obesity.It remains unclear why the association between cardiovascular problems and muscle mass was significant only in the case of males, though the researchers hypothesize that hormonal differences between males and females as they age may explain the discrepancy.Although the authors admit that their observational study cannot establish any cause and effect relationships, they maintain that its findings "point to the importance of [skeletal muscle mass] preservation in relation to [cardiovascular disease] risk."In their study paper, they conclude that:"The prevention of [skeletal muscle mass] decline, which is becoming increasingly prevalent among middle-aged and older populations, may constitute an effective means of promoting [cardiovascular] health."
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Which jobs affect women's heart health the most?

Some occupations are likely to affect female heart health more negatively than others, but which ones? This question is what one new study set out to answer.

health care professional at workShare on PinterestFemales in some professions face a higher risk of developing heart health problems than others, according to a new study.

Heart problems are a widespread health issue, especially among older populations.

And while researchers know that several lifestyle factors can increase the risk of heart disease — including an unhealthful diet, lack of physical activity, and smoking — there is one risk factor that does not receive as much attention as it perhaps deserves, namely, someone's occupation.

Recent studies have shown that it is possible to link a person's occupation with an increased risk of heart disease or other cardiovascular problems.

For instance, one study that researchers conducted on a cohort from Japan found that individuals in managerial positions, regardless of industry, face a higher risk of heart diseaseHowever, the Centers for Disease Control and Prevention (CDC) note that it remains unclear just how occupational risk factors may contribute to heart problems, and they encourage further research in this area.At this year's American Heart Association's (AHA) Scientific Sessions — which takes place in Philadelphia, PA, between November 16–18 — Bede Nriagu and colleagues from Drexel University in Philadelphia will present research adding to the evidence that certain types of work have an association with heart disease.In their presentation at the Scientific Sessions, the researchers will explain which occupations show links with a higher risk of health problems in females, according to their study.The researchers looked for possible associations between heart health status and different occupations in a cohort of more than 65,000 females whose average age was 63 years, and who had already experienced menopause. The team accessed these participants' data through the Women's Health Initiative study.As part of their research, the investigators classified the participants according to the AHA's cardiovascular health measurements.These metrics look at lifestyle factors, such as smoking status, weight, physical activity, and nutrition, plus health risk factors, including total cholesterol, blood pressure, and fasting blood sugar. The research team also took into consideration 20 of the most common occupations among the participants.In total, the researchers noted that almost 13% of the females in the study cohort had poor cardiovascular health. They also found an association between specific jobs and an increased risk of heart health problems in these individuals.More specifically, women who performed social work were 36% more likely to experience heart health problems than those with other occupations, and retail cashiers had a 33% higher risk of cardiovascular issues.Nurses, psychiatrists, and home health aides had an up to 16% higher likelihood of developing heart problems. Among these, nurses, in particular, had a 14% higher risk of cardiovascular problems.Yet the team also found an association between some occupations and a lower risk of cardiovascular health issues.Thus, female real estate brokers and sales agents had a 24% lower risk of heart problems than those in other lines of work, while administrative assistants had an 11% lower risk of cardiovascular issues.These associations remained in place after the researchers made adjustments for confounding factors, such as the participants' age, marital status, education, and race."Several of the professions that had high risk of poor cardiovascular health were health care providers, such as nurses and home health aides. This is surprising because these women are likely more knowledgeable about cardiovascular health risk factors," notes Nriagu."We interpret this to mean that it's important to look beyond individual factors, such as health knowledge, to better understand the context of health care and other jobs that negatively impact cardiovascular health in women."Bede NriaguThe researchers argue that looking at the current finding, doctors may want to start considering their patients' occupations when they assess their risks of cardiovascular problems.
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Late evening eating may compromise women's heart health

New research finds that eating more calories in the evening is associated with poorer cardiovascular health in women.

woman eating in front of computerShare on PinterestEating more of the day's calories after 6 p.m. is linked with poorer heart health in a new study.

Evidence is accumulating that meal times can impact cardiometabolic health.

One recent study, for example, showed that eating meals earlier in the day can help people lose weight, while eating later in the day may promote weight gain and slow down metabolism.

These studies also showed that later mealtimes raise inflammatory markers that are usually associated with diabetes and heart disease.

Other studies, in mice and human participants, showed that setting strict mealtimes can help control blood sugar levels.

Now, new research adds to this mounting evidence and suggests that eating more calories in the evening may negatively affect women's cardiovascular health.The new research is preliminary and will be presented at the American Heart Association's (AHA's) Scientific Sessions 2019, which is taking place in Philadelphia, PA.Nour Makarem, Ph.D., an associate research scientist at the Columbia University Vagelos College of Physicians and Surgeons, in New York, is the lead author of the study.Studying eating patterns and heart healthMakarem and colleagues recruited 112 healthy women, who were 33 years old, on average, to participate in the study. The researchers examined the participants' cardiovascular health at baseline and 1 year later using Life's Simple 7 — a measure of cardiovascular health that comprises seven modifiable risk factors, as established by the AHA.Life's Simple 7 account for blood pressure, cholesterol, blood sugar, physical activity, diet, weight, and smoking status. Based on these factors, the researchers calculated a cardiovascular health score for each participant. The women also used food diaries on their cell phones to track and report how much, what, and when they ate for 1 week at baseline and another week 12 months later.The researchers used the data from the electronic diaries to calculate the relationship between cardiovascular health and the timing of the meals.Fewer late calories may boost heart healthThe research revealed that participants who consumed more calories after 6 p.m. tended to have poorer cardiovascular health.In fact, for each 1% increase in caloric intake after 6 p.m., the cardiovascular health score declined. Blood pressure and body mass index tended to rise, and blood sugar control tended to be poorer. The analysis yielded similar results for every 1% increase in calories after 8 p.m.Hispanic women, in particular — who made up 44% of the participants — had higher blood pressure when they ate more calories in the evening.The study's lead author comments on the findings saying, "So far, lifestyle approaches to prevent heart disease have focused on what we eat and how much we eat.""These preliminary results indicate that intentional eating that is mindful of the timing and proportion of calories in evening meals may represent a simple, modifiable behavior that can help lower heart disease risk."Nour Makarem, Ph.D.The lead researcher also points out that for the findings to be more reliable, they would have to be replicated in a larger sample and in different populations.Dr. Kristin Newby, a professor of medicine and cardiology at Duke University, in Durham, NC, who was not involved in the research, comments on the results."I think it's an important study," she says. "It's foundational more than definitive at this point, but I think it provides some really interesting insights into an aspect of nutrition and how it relates to cardiovascular risk factors that we really haven't thought about before."
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What are the effects of lowering blood pressure targets?

In 2017, the American Heart Association (AHA) lowered the threshold for what constitutes hypertension. However, what is the impact of this, and is implementing these new guidelines cost effective? Two new studies set out to investigate.

doctor taking blood pressureShare on PinterestNew research examines the effects of lowering hypertension thresholds.

According to the AHA, around 103 million adults in the United States have high blood pressure. They expect that this number will continue to rise.

Meanwhile, the Centers for Disease Control and Prevention (CDC) estimate that around 1,100 people die of a condition related to hypertension each day, including heart disease and stroke. These are some of the leading causes of death in the U.S.

The healthcare costs of hypertension are not negligible, either. The CDC suggest that hypertension results in almost $50 billion per year in costs, including the price of medications and missed days of work.

What are some of the measures that people with high blood pressure and healthcare professionals can take to prevent these adverse outcomes and increase lifespan? In 2017, the AHA recommended lowering blood pressure thresholds and treating people at risk more intensively.

Now, two new studies — both of which featured at the AHA's Scientific Sessions 2019, which takes place in Philadelphia, PA — have investigated the costs and benefits of treating hypertension more intensively, and of tailoring treatment according to degrees of cardiovascular risk.

Better blood pressure control lengthens lifeDr. Muthiah Vaduganathan, an instructor of medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital — both in Boston, MA — is the lead author of the first study.Dr. Vaduganathan and team used data from the well-known Systolic Blood Pressure Intervention Trial (SPRINT).The SPRINT examined the effects of lowering systolic blood pressure readings to a target of 120 milligrams of mercury (mm Hg) instead of the usual 140 mm Hg.The trial followed 9,361 participants, all of whom were over the age of 50 and at high cardiovascular risk. The SPRINT followed them for 6 years and concluded that lowering blood pressure targets reduced the risk of cardiovascular problems — such as heart attack, stroke, heart failure, and cardiovascular death — by 25%.The participants were at high risk of heart disease if they had had a cardiovascular disease that was not stroke, scored highly on the 10 year cardiovascular risk score, had chronic kidney disease, or were older than 75.For the new study, the researchers analyzed the data to project the lifespans of the participants who underwent intensive hypertension treatment to lower blood pressure to a target of 120 mm Hg. They compared these projected lifespans with those of participants who received the standard treatment that aimed for a blood pressure of lower than 140 mm Hg.The study revealed that intensive blood pressure treatment increased lifespan by 4–9%, compared with standard care."In contrast with the oldest patients, middle-aged patients had the greater absolute benefit because they start with a longer expected lifespan and can receive the intensive treatment over a longer period of time," explains Dr. Vaduganathan.Dr. Mitchell S. V. Elkind — the AHA president-elect and chair of the Advisory Committee of the American Stroke Association — comments on the results. He says, "This analysis of the [SPRINT] suggests that [there are] additional years of life that can be added by more aggressive control of blood pressure."He adds, "When you tell people that lowering their blood pressure is going to reduce their chance of having a stroke or a heart attack by 25%, which is what [the SPRINT] showed," the question that naturally ensues is "what does that number mean, in real terms?""This analysis suggests that for a man who is 50 years old, lowering blood pressure to [the lower] targets could extend your lifespan by 3 years, on average." Dr. Mitchell S. V. Elkind"High blood pressure has been implicated as one of the reasons for stalled progress in reducing heart disease-related deaths in the United States," Dr. Vaduganathan says. "These data reinforce that tighter blood pressure control, especially when started earlier in life, may meaningfully prolong lifespan."New guidelines to treat an extra 5.2 millionThe second study examined the best way to implement the new blood pressure guidelines issued by the American College of Cardiology (ACC) and the AHA.These new guidelines lowered blood pressure thresholds to define hypertension as anything from 130/80 mm Hg to 140/90 mm Hg.The new guidelines also recommend medication treatment for people with a blood pressure reading of 130/80 mm Hg to 139/89 mm Hg if they have a history of heart attack or stroke, or if they have a high 10 year risk of experiencing such an event.Joanne M. Penko — a research data analyst at the University of California, San Francisco — is the lead author of this second study.To assess the cost effectiveness of implementing the new guidelines, Penko and colleagues looked at healthcare costs and quality-adjusted life years (QUALY). They used the Cardiovascular Disease Policy Model, a well-known computer simulation model, to estimate healthcare costs over a 10 year period.Compared with the 2003 guidelines, the analysis revealed, the "2017 ACC/AHA guidelines would treat 5.2 million more adults 35–84 years of age, intensify treatment in another 11.7 million, and prevent about 257,000 [cardiovascular] events over 10 years."Intensifying treatment pays off over a 10 year period for men aged 65–84 and women aged 75–84 who already have cardiovascular disease. For others, however, the costs outweigh the benefits.Furthermore, treating people at high cardiovascular risk who had not had cardiovascular disease would only be intermediately cost effective for adults whose blood pressure readings are 140/90 mm Hg or higher at baseline. It would not be cost effective at all for those whose blood pressure readings are 130/80 mm Hg to 139/89 mmHg."Previous studies have shown that compared with no treatment, treating high blood pressure according to the 2003 Seventh Report is cost effective over 10 years," Penko says. "We were surprised to learn in our study that wasn't the case for all patients indicated for medication treatment in the 2017 guidelines.""The study's findings suggest an incremental approach to implementing the 2017 ACC/AHA hypertension guidelines, first focusing limited resources on treating the oldest, highest-risk adults to intensive blood pressure goals."Joanne M. Penko
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Local vehicle exhaust may raise stroke risk

Even in environments with low air pollution, long term exposure to traffic exhaust near people's homes may heighten their risk of stroke, according to a new study from Sweden. The culprit appears to be a fine particle air pollutant called black carbon.
cars in a traffic jam
Exposure to exhaust fumes may raise the risk of stroke, new research suggests.

The researchers came to this conclusion after investigating links between exposure to different types of particulate matter and rates of heart disease and stroke in three cities in Sweden.

They report their findings in a recent Environmental Health Perspectives study paper.

The authors write that they observed "few consistent associations" between heart disease and stroke and different types of particulate matter and their sources.

"However," they conclude that "long term residential exposure to locally emitted [black carbon] from traffic exhaust was associated with stroke incidence."

Dr. Petter L. S. Ljungman is first author of the study paper and an associate professor at the Institute of Environmental Medicine at Karolinska Institutet in Stockholm, Sweden.

"This study," he says, "identifies local traffic exhaust as a risk factor for stroke, a common disease with great human suffering, high mortality and significant costs to society."

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Black carbon and particulate matter

Black carbon is a sooty material that comes from burning fossil fuels. According to the United States Environmental Protection Agency (EPA), it is a significant component of fine particle air pollution.

Vehicle and other engines that run on gas and diesel and power plants that run on coal and other fossil fuels emit black carbon along with other particulate matter.

Road traffic is the primary source of black carbon emissions in cities.

Scientists have tied black carbon inhalation to respiratory conditions, cancer, cardiovascular disease, and birth abnormalities.

Dr. Ljungman and colleagues from Karolinska Institutet and other research centers in Sweden used data on 114,758 people who were participants in other studies that had collected information about cardiovascular risk factors from examinations and questionnaires.

The participants, who lived in three cities in Sweden, were healthy and middle-aged at recruitment. The study period started in 1990 and lasted for around 20 years. The dataset included the history of the participants' residential addresses over the period.

Over the 20 years of follow-up, 5,166 individuals developed ischemic heart disease, and 3,119 experienced strokes.

Using emissions databases and dispersion models, the team estimated how much each type of emission source contributed to particulate matter, including black carbon, at specific residential addresses.

The sources that they included in the analysis were traffic exhaust, road wear, and residential heating. They included data for two grades of particulate matter: coarse, which includes particles under 10 micrometers (10μm) in diameter (PM10), and fine, which includes particles under 2.5 μm in diameter (PM2.5). Black carbon counts as PM2.5.

Black carbon and raised stroke risk

The analysis revealed that the risk of stroke went up by 4% for every additional 0.3 micrograms per cubic meter (μg/m3) of black carbon air pollutant from traffic exhaust.

The researchers found no link to stroke for black carbon emissions from residential heating.

Also, they observed no links between total levels of PM10 and PM2.5 particulate matter and either heart disease or stroke.

"There was some evidence," note the authors, "of an association between PM2.5 specifically from local emissions of residential heating and incidence of [ischemic heart disease] that warrant further investigation."

In their study background, the authors refer to research that has linked long term exposure to PM2.5 particles and atherosclerosis, the clogged artery condition that raises the risk of heart disease and stroke.

The residential areas that the new study covered were in the cities of Gothenburg, Stockholm, and Umeå. The annual averages during the study period for PM2.5 particulate matter in these cities ranged from 5.8 to 9.2 μg/m3. This range is below the 25 μg/m3 threshold in current EU standards.

Although the EU mention black carbon as a component of PM2.5 particulate air pollution, they have no specific threshold for black carbon.

"Black carbon from traffic exhaust could be an important measure to consider when assessing air quality and health consequences."

Dr. Petter L. S. Ljungman

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Atherosclerosis: Scientists identify new protein target in immune cells

The inflammatory condition atherosclerosis, where fatty, waxy deposits build up in arteries, raises the risk of stroke, heart attack, and cardiovascular disease. Now, using mice and human samples, scientists have shown for the first time that a protein in cells called macrophages promotes the disease.
scientist examining something under microscope
New research finds a protein in immune cells that may be responsible for atherosclerosis.

Macrophages are a large group of cells that do many different jobs and abound in all tissues of the body. Their diverse functions include tissue repair and immunity.

Earlier studies had already shown that macrophages in the immune system absorb excess cholesterol and that too much of the waxy substance causes the cells to transform into foam cells.

When heavy with cholesterol, foam cells are bigger than macrophages and can deposit in artery walls and cause blockages.

Scientists have also been studying a protein called Tribbles Pseudokinase 1 (TRIB1) in connection with cardiovascular disease. They have detected it in macrophages in arterial deposits in mice, and they have also linked variants of the protein's coding gene to increased risk of atherosclerosis in human populations.

The new Science Advances study plugs a gap in the research on macrophages and TRIB1 in relation to atherosclerosis. It is the first to show that TRIB1 in macrophages decides how much cholesterol the cells can carry when they transform into foam cells.

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The importance of cell specific expression

The new finding is significant not only because it offers a potential fresh treatment target for atherosclerosis, but also because it reveals how protein expression by specific cells contributes to cardiovascular disease.

"The role of TRIB1 in macrophages has remained elusive for some time," says first study author Jessica M. Johnston, Ph.D., of the Department of Infection, Immunity, and Cardiovascular Disease at the University of Sheffield in the United Kingdom.

"Our research," she adds, "provides the missing link and highlights the importance of cell specific expression in cardiovascular disease."

Other members of the international team include senior study author Endre Kiss-Toth, professor of cell signaling at the University of Sheffield, and colleagues from other centers in the U.K., the United States, and Hungary.

The study reveals that higher levels of TRIB1 promoted atherosclerosis by increasing specific receptors for taking up cholesterol in macrophages. In contrast, decreasing TRIB1 by reducing expression of its coding gene, reduced disease.

The researchers used various mouse models of human disease to test the effect of high and reduced levels of TRIB1. Data on samples from human cohorts also confirmed links between TRIB1 and cholesterol uptake.

"Collectively," write the authors, "our studies reveal an unexpected beneficial effect for selectively silencing [the gene for TRIB1] in arterial plaque macrophages."

Targeting cholesterol laden foam cells

Prof. Kiss-Toth suggests that building on the findings could help to identify which people with cardiovascular disease might benefit most from treatment that targets the formation of cholesterol laden foam cells.

Atherosclerosis raises the risk of various cardiovascular diseases and events such as stroke and heart disease, depending on which arteries it affects and how it progresses.

Atherosclerotic deposits, or plaques, can accumulate and either partially or completely block large and medium arteries that supply oxygen- and nutrient-rich blood to the heart, pelvic area, brain, legs, arms, and kidneys.

Coronary artery disease, angina, carotid artery disease, peripheral artery disease, and chronic kidney disease are some of the conditions that can arise from blood supply restriction due to vessel blockage.

However, the plaques also pose a direct risk of heart attack or stroke because, as they grow, there is a greater chance that a piece may break off and travel to the heart or brain.

"Studying the genetics of cardiovascular disease in large human populations has revealed that TRIB1 contributes to its development. However, this is the first time that its role in immune cells has been directly addressed, thus uncovering a new mechanism by which arterial disease develops."

Prof. Endre Kiss-Toth

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What to know about heart murmurs

A heart murmur is an abnormal sound that the blood makes as it moves through the heart. Doctors can hear a heart murmur through a stethoscope. Murmurs can be benign or indicate a serious heart condition.Research estimates that heart murmurs affect up to 72% of children. Most often, the murmur will go away with age. However, some may live with a heart murmur into adulthood.In adults, meanwhile, some heart diseases — including heart valve disease — can cause heart murmurs.In this article, we describe the two types of heart murmur, their causes, and some treatment options.
a doctor checking for a heart murmur with a stethoscopeShare on PinterestA doctor may check for a heart murmur with a stethoscope.Heart murmurs result from vibrations, or turbulence, that blood causes when it flows through the heart. It produces sounds that doctors can hear through a stethoscope.When heart valves open and close, they make a "valve sound." However, valves that do not open or close normally can cause blood to leak backward or prevent blood from flowing forward, which can create a sound called a murmur.Blood that moves very quickly through the heart can also create a type of murmur called a "flow murmur."There are two main types of heart murmur: innocent and abnormal. Flow murmurs are a type of innocent murmur.Innocent, or benign, heart murmurs occur when no structural abnormality or heart condition is present. Abnormal heart murmurs, meanwhile, occur where an underlying heart condition is causing the symptom.A person with a heart murmur should seek professional evaluation by a doctor to determine if their murmur is innocent or needs additional testing and monitoring.Innocent heart murmurInnocent heart murmurs can sometimes disappear over time without the need for treatment, such as if it is due to a high blood flow.Other times, the murmur may be due to minor valve dysfunction, which health professionals can monitor without needing to suggest significant intervention.People with innocent heart murmurs can live a relatively normal life. They can usually exercise and take part in sports without any problems.Abnormal heart murmurAbnormal heart murmurs indicate an underlying heart condition. These are less common than innocent heart murmurs and can either continue into adulthood or occur for the first time in adulthood.Abnormal heart murmurs in adults are usually associated with heart valve disease.
There are many possible causes of heart murmurs.People can categorize murmurs according to what causes them:Flow murmurs: Exercise, pregnancy, and anemia can all cause a high blood flow, as can hyperthyroidism, fever, and rapid growth spurts. This could lead to an innocent murmur.Valve disease-related murmurs: Problems with a valve in the heart, such as aortic stenosis or a bicuspid aortic valve, can lead to a heart murmur.Murmurs due to ventricular problems: Conditions that affect the ventricles and the flow of blood through them, such as functional mitral regurgitation, may cause a murmur.Murmurs due to complications of other conditions: Some conditions that affect the heart, such as endocarditis and lupus, may also cause a heart murmur.Murmurs related to congenital heart disease: Problems with the heart that are present from birth, such as a hole in the heart, can result in a murmur.People with abnormal heart murmurs may have congenital heart disease or a heart valve disease.Heart valve disease is the result of a defect in the heart's structure. Some of these conditions can be present at birth or acquired.Heart defects can affect the following parts of the heart:the aortic valve, which can be bicuspid (two leaflets) instead of tricuspid (three leaflets)the pulmonary valvethe atrial septum, which separates the atriathe ventricular septum, which separates the ventriclesAnother heart defect is a patent ductus arteriosus. This occurs when the opening between the aorta and pulmonary artery does not close after birth, as it should.When heart valve defects occur in adults, heart murmurs can be the result of age, tumors, or infections. For example, calcium can build up in the heart valves with age. This reduces the opening of the valves, making it harder for blood to pass through them.Sometimes, the aortic valve becomes dilated or stretched and stops working properly. This causes blood to leak backward, producing a heart murmur. Doctors call this condition aortic regurgitation.It is also possible to develop infective endocarditis. This is a bacterial infection of the lining of the heart, which can also affect the valves. The growth of bacteria will narrow the opening of the valves and affect blood flow through them.Another condition that can affect the heart is chronic rheumatic heart disease. People with this condition have chronic inflammation in the heart valves, which affects the function of the valves and therefore the blood flow through those valves.Tumors can also form on a heart valve. Tumors in other parts of the heart, such as the left atrium, can cause a heart murmur by affecting the blood flow through the heart.Other conditions that can cause heart murmurs, include:
Share on PinterestA person with an abnormal heart murmur may experience dizziness.People with heart murmurs may not experience any symptoms.Others, specifically with abnormal heart murmurs, may experience symptoms depending on the underlying cause.For example, people can experience:shortness of breathdizzinessfaintingbluish skinchronic coughpalpitationsswelling in the legs or abdomenA newborn baby may have:difficulty feedingstunted growtha bluish hue to the skin during feeding or activitybreathing difficultiesexcessive fussinessDoctors will listen to the heart with a stethoscope. They will also check for abnormal breathing patterns and any changes in skin color.They may also need to run other tests for heart function, including measuring blood pressure, the amount of oxygen in the blood, and pulse rate. Also, doctors will usually use an echocardiogram to take pictures of the heart valves.They will then provide a grade for every heart murmur. The grading system for murmurs that occur when the heart is squeezing is 1–6, where 1 is very faint and 6 is very loud. For murmurs that occur when the heart relaxes, the grading system is 1 to 4.Doctors also need to determine the duration of the heart murmur and its exact location in the heart.On rare occasions, the following procedures are also necessary:cardiac catheterizationchest X-raystress echocardiogramThese tests help doctors determine the cause of the heart murmur, as well as its intensity, its severity, and whether or not it is causing symptoms.Share on PinterestA doctor may prescribe ACE inhibitors to reduce blood pressure.Heart murmurs are usually innocent. These do not typically require treatment or further testing.Abnormal heart murmurs, however, are a symptom of an underlying condition that may require treatment.Doctors will recommend treatments that reduce blood pressure to improve blood flow across the valve, reduce damage to the valve, or both. For example, people may require medications such as:ACE inhibitorsanti-arrhythmic medicationsantibioticsanticoagulantsbeta-blockers or calcium channel blockerswater pillsvasodilatorsDoctors may prescribe single medications or a combination of several.Some people will require surgery to repair a defective valve. However, some people with mild heart valve disease may never require surgery.That said, if the heart valve defect begins to significantly affect blood flow through the heart, cause symptoms, or increase pressure in the heart, a valve repair or replacement might be necessary.Innocent heart murmurs are benign and do not usually require medical attention. Abnormal heart murmurs, however, signal an underlying heart condition.When treating abnormal heart murmurs, the doctor must first determine the cause. Sometimes, people need surgery to repair a defective valve. Others may not need surgery and will be able to lead a relatively healthy life.Heart valve disease is more common with age. Doctors can help people manage heart murmurs and improve the function of the heart.
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Everything you need to know about ACE inhibitors

Angiotensin converting enzyme, or "ACE" inhibitors, are a type of medication that doctors prescribe to treat high blood pressure, or "hypertension," and other cardiovascular conditions.This article outlines the different ACE inhibitors that are available. We also discuss the effectiveness of ACE inhibitors, along with their potential side effects and risks.
a woman picking up ACE inhibitors from a pharmacy or drug store.Share on PinterestA person may use ACE inhibitors to treat high blood pressure.ACE inhibitors prevent the body from making the hormone Angiotensin II. Ordinarily, this hormone narrows the blood vessels, which causes an increase in blood pressure and forces the heart to work harder.By inhibiting the production of Angiotensin II, ACE inhibitors keep the blood vessels open. This reduces blood pressure and lowers the risk of complications associated with hypertension.Most people take ACE inhibitors orally, but some may administer the drug intravenously.
The U.S. Food and Drug Administration (FDA) list the following types of ACE inhibitor:benazepril (Lotensin)captoprilenalapril (Vasotec)enalaprilatfosinoprillisinopril (Zestril and Prinivil)moexiprilperindoprilquinapril (Accupril)ramipril (Altace)trandolapril
Share on PinterestDoctors may prescribe ACE inhibitors to people with cardiovascular conditions, heart problems, or kidney problems.Doctors mainly prescribe ACE inhibitors to treat the following conditions:A doctor may also prescribe ACE inhibitors to treat or improve some of the symptoms of diabetes and migraine.Doctors consider some of these uses as off-label. Off-label means that the FDA have approved a drug for one condition, but doctors prescribe it to treat something different.
Most people who take ACE inhibitors do not experience side effects. When side effects do occur, they are usually minor.A 2019 review of ACE inhibitors describes some of the more common side effects of ACE inhibitors. The table below outlines these side effects, along with how many people experience them.Side effectPercentage of people affectedDizziness12–19%Low blood pressure, or "hypotension"7–11%Fainting5–7%Elevated levels of urea, nitrogen, and creatine in the blood (a possible sign of kidney problems)2–11%High potassium levels, or "hyperkalemia"2–6%A separate 2019 review notes that around 1–10% of people who take ACE inhibitors may develop a dry cough. If a person cannot tolerate this cough, they should seek their doctor's advice on whether to stop taking the medication.Some people may develop more severe side effects when taking ACE inhibitors. Examples include kidney problems and allergies to the ACE inhibitor. Another severe side effect that can occur is angioedema, which is swelling, typically of the tongue and throat.People who take ACE inhibitors should contact their doctor if they experience any side effects while on the medication. Anyone who has a swelling of the tongue or throat should call 911.ACE inhibitors can help prolong the lives of people who have had heart attacks, and those who have received a diagnosis with heart failure.These drugs can also help people who have high blood pressure due to kidney disease.When treating high blood pressure, a doctor will often combine the ACE inhibitor with another antihypertensive medication to increase the effects of the drug.Doctors have found that calcium channel blockers (CCBs) and thiazide diuretics can work well with ACE inhibitors to lower blood pressure.ACE inhibitors usually do not cause problems when a person takes them as directed.However, pregnant women should not take ACE inhibitors due to a risk of harm to the fetus. These risks include:low amniotic fluid levelskidney problemsabnormal skull developmentdeathPeople who have an allergy to ACE inhibitors should not take the medication.People with the kidney condition bilateral renal artery stenosis (BRAS) should also avoid these drugs. BRAS is a narrowing of the blood vessels within the kidneys. ACE inhibitors can cause worsening kidney function in people with this condition.People who are concerned about the potential risks of ACE inhibitors should talk to their doctor.Share on PinterestA person's age, overall health, and medical history may affect the medication they receive.Beta-blockers and CCBs are two other medications that doctors commonly prescribe to treat heart problems and high blood pressure. Both drugs work differently to ACE inhibitors.Beta-blockers prevent the release of stress hormones. This slows down the heartbeat, which, in turn, reduces the intensity of blood flow around the body.CCBs prevent calcium from interacting with the body's calcium receptors.Ordinarily, calcium plays a role in contracting the muscles within the heart and blood vessel walls. CCBs block the movement of calcium into the blood vessel walls, causing these walls to relax. This reduces blood pressure and allows the heart to receive more oxygenated blood. By blocking calcium movement into the heart muscles, the heart contracts more slowly. This puts less stress on the heart.The type of medication a person receives depends on several factors, including their:ageethnicityoverall healthmedical historyACE inhibitors are one of the more common medications used to lower blood pressure and treat cardiovascular health issues.Most people who take ACE inhibitors do not experience side effects. When side effects do occur, they are generally mild.However, ACE inhibitors are not suitable for everyone. Pregnant women, in particular, should not take these medications.Doctors often prescribe ACE inhibitors alongside other antihypertensive medications. Combined drug treatments can be particularly useful in controlling high blood pressure.
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What are the best ways to eat coconut oil?

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In recent years, coconut oil has gained a lot of attention due to its supposed health benefits. With many options available, people may wonder about the most healthful ways to add coconut oil to their diets and how much to use.

People consume coconut oil in many different ways, including as a cooking oil, as an alternative to butter in baking, and in smoothies. While coconut oil may have health benefits, it is high in saturated fat, and eating too much can be harmful.

In this article, we discuss ways to incorporate coconut oil into the diet and how much may be healthful.

Why eat coconut oil? a jar of coconut oil.
Coconut oil may help promote ketosis.

Saturated fat makes up nearly 90% of coconut oil. However, a medium-chain fatty acid called lauric acid makes up a substantial amount of the fat in this oil — between 48.40% and 52.84%.

Unlike other saturated fats, such as that in butter, lauric acid may have health benefits, including:

However, the researchers behind these and similar studies cannot predict the long term health effects of eating coconut oil.

Read more about the benefits and risks of coconut oil.

People may wonder how much coconut oil to consume for the maximum health benefits and minimum adverse effects.

The following sections look at how much to consume and some ways to include coconut oil in a healthful diet.

Thank you for supporting Medical News Today How much to use While small amounts of coconut oil may have health benefits, people should limit their intake. Coconut oil is a high calorie food that contains mostly saturated fatty acids. Diets high in saturated fatty acids may increase the risk of coronary heart disease. However, researchers have found that 2 tablespoons (tbsp), or 30 milliliters, of coconut oil per day can have beneficial effects. In one small 2017 study, 2 tbsp of coconut oil increased levels of HDL cholesterol, or "good cholesterol," in healthy adults. However, some participants experienced mild diarrhea during the study. According to the United States Department of Agriculture, 1 tbsp, or 13.6 grams (g), of coconut oil contain: calories: 121 kilocalories fat: 13.5 g carbohydrates: 0 g protein: 0 g The 2015–2020 Dietary Guidelines recommend that saturated fats make up less than 10% of a person's daily intake of calories. Based on this recommendation, an adult who consumes 2,000 calories per day should get fewer than 200 of their calories from saturated fats, which equals about 1.5 tbsp of coconut oil per day. People who want to start adding coconut oil to their diets can begin with 0.5 tbsp and increase to 1.5 tbsp per day. Stay in the know. Get our free daily newsletter You’ve got questions. We’ve got answers. Expert, evidence-based advice delivered straight to your inbox to help you take control of your health Your privacy is important to us. 1 . Use it as a cooking oil a woman cooking with coconut oil
A person can use coconut oil as as cooking oil. Coconut oil stays solid at room temperature. Its saturated fatty acids keep it stable at high temperatures, making it an ideal cooking oil. However, compared to other cooking oils, such as canola and soybean oils, coconut oil has a relatively low smoking point of 339.8°F (171°C). This means that it may produce carcinogens after use in continuous deep frying. As a result, people should avoid deep frying foods in coconut oil and instead opt for oils with higher smoking points, such as canola, corn, or soybean oils. For uses other than deep frying, replacing traditional cooking oils with coconut oil is an easy way to incorporate more coconut oil into the diet. Ways to cook with coconut oil include: using it when sauteing or stir-frying vegetables, meat, eggs, or fish mixing it into sauces and salad dressings coating meat or poultry in coconut oil and spices before baking Read more about the most healthful oils for cooking. 2. Bake with it People can make baked goods, such as cookies, cakes, and brownies, using coconut oil. Simply replace the oil that the recipe calls for with melted coconut oil at a 1:1 ratio. Allow any milk and eggs to come to room temperature before mixing them with coconut oil to prevent the batter from clumping. 3. Add it to drinks Another way to enjoy coconut oil is by adding a small amount — about 1–2 teaspoons (tsp) — to drinks, such as coffee, tea, and smoothies. Below are some simple drink recipes featuring coconut oil: Tropical smoothie for one: 1 tbsp of coconut oil half a cup of coconut water 1 to 1.5 cups of mango half a cup of pineapple Combine all ingredients in a blender and blend until smooth. Serve immediately. Coconut matcha latte for one: 1 tsp of coconut oil half a teaspoon of matcha powder a quarter cup of hot water 1 cup of coconut, almond, or oat milk optional: 0.5 to 1 tbsp of honey, maple syrup, or sweetener of choice Instructions: Warm the coconut milk and coconut oil in a pan over medium to high heat. Boil the water. Meanwhile, add the matcha powder to a clean mug. When the water comes to a boil, add it to the matcha and whisk until smooth. When the coconut milk and coconut oil mixture begins bubbling, turn off the heat and stir in the sweetener of choice using a milk wand or whisk. Pour the mixture over the matcha. Serve immediately. When buying coconut oil, be sure to choose pure versions that are intended for human consumption. People can buy coconut oil in supermarkets, health food stores, and online. Thank you for supporting Medical News Today Supplements a woman looking at supplement in a pharmacy
Coconut oil is available in supplement form. People can take coconut oil in capsule form. While supplements may offer convenience and easy dosage control, this is not the best method of consuming coconut oil. Most supplements contain 1–3 g per capsule, and a person would have to take 13 capsules to get the equivalent of 1 tbsp of coconut oil. Try cooking or baking with it instead. If people want to buy coconut oil supplements, these are available in supermarkets, health food stores, and online. Summary Coconut oil contains high quantities of beneficial medium-chain fatty acids, primarily lauric acid. Adding coconut oil to the diet may lead to health benefits. However, coconut oil is rich in saturated fats and a high calorie food. People should get less than 10% of their daily calories from saturated fats. To get any health benefits of coconut oil while minimizing any adverse effects, stick to 1–2 tbsp of coconut oil per day.
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Calcium channel blockers: What to know

Calcium channel blockers are a type of medication that people take to increase the flow of blood and oxygen to the heart. Doctors may prescribe a calcium channel blocker to treat high blood pressure or a variety of heart conditions.

Calcium channel blockers are common medications that have a low risk of complications. In this article, we discuss how these drugs work, as well as their uses and possible side effects.

What is a calcium channel blocker? A man pouring Calcium channel blockers from a pill container into his hands.
A doctor may prescribe calcium channel blockers to treat high blood pressure.

Calcium is necessary for muscle contractions to occur throughout the body. This mineral enters muscle cells through ion channels, which are tiny pores on the surface of the cell. This process is essential for normal bodily functioning.

Calcium channel blockers reduce the amount of calcium that can enter muscle cells in the heart and blood vessel walls via these channels.

In doing this, they lower the pressure in the blood vessels and on the heart.

Thank you for supporting Medical News Today Uses Doctors commonly use calcium channel blockers to treat high blood pressure. These drugs also have a range of other possible uses, such as for: Scientists are currently exploring other potential uses for calcium channel blockers. For example, by reducing high blood pressure, they believe that calcium channel blockers may be able to lower the risk of Alzheimer's disease. Several other types of medication have an effect similar to that of calcium channel blockers. Beta-blockers Beta-blockers slow heart activity by limiting the effects of stress hormones, such as epinephrine and norepinephrine. These medications are effective in lowering blood pressure. Examples of beta-blockers include atenolol (Tenormin) and metoprolol (Lopressor). Researchers have found that both beta-blockers and calcium channel blockers are effective in lowering blood pressure, making them useful treatments for a variety of conditions that affect the heart, including angina and arrhythmia. However, the American Heart Association recommend calcium channel blockers as a first-line pharmacological treatment for high blood pressure in most people and advise that beta-blockers should be a second-choice option. ACE inhibitors a woman speaking to a male pharmacist
ACE inhibitors can help manage a variety of heart conditions. Angiotensin converting enzyme (ACE) inhibitors are another type of medication for high blood pressure and a variety of heart conditions. They relax blood vessels and make it easier for the heart to pump blood around the body. ACE inhibitors work by blocking the enzymes that narrow blood vessels, which allows blood to flow through the vessels without putting as much pressure on them. Examples of ACE inhibitors include lisinopril (Prinivil, Zestril), enalapril (Vasotec), and benazepril (Lotensin). They can cause some common side effects, such as a cough or skin irritation. A doctor may sometimes prescribe an ACE inhibitor with a calcium channel blocker. Stay in the know. Get our free daily newsletter You’ve got questions. We’ve got answers. Expert, evidence-based advice delivered straight to your inbox to help you take control of your health Your privacy is important to us. Types and examples There are two different types of calcium channel blocker, which are called dihydropyridines and nondihydropyridines. Dihydropyridines Dihydropyridines target a specific type of calcium channel in the body. They cause the blood vessels to widen, lowering blood pressure. Examples of dihydropyridines include: amlodipine (Norvasc) felodipine (Plendil) nicardipine (Cardene) nifedipine (Adalat, Procardia) nimodipine (Nimotop) It is sometimes possible for these medications to widen the blood vessels too much, which can result in swelling in the feet and legs. Doctors are careful to prescribe a dosage that reduces the risk of this happening. Doctors may also minimize this risk by prescribing extended release calcium channel blockers. The body absorbs this form of the drug over a longer period, which prevents the blood vessels from widening too much. Nondihydropyridines Nondihydropyridines widen blood vessels in the same way as dihydropyridines. However, they have additional effects on the heart that can help control a rapid heart rate. Currently, there are only two nondihydropyridine medications: verapamil (Calan, Isoptin) and diltiazem (Cardizem). Verapamil specifically targets heart muscle cells, or the myocardium. Doctors use this drug to reduce chest pain as it relaxes blood vessels and reduces the amount of oxygen that the heart requires. Verapamil is also useful for slowing abnormally rapid and potentially dangerous heart rhythms, such as supraventricular tachycardia. Diltiazem is a medication for controlling heart dysrhythmias (rapid or irregular heart rhythms) and lowering blood pressure. In comparison with verapamil, it has a less significant effect on the heart rate. Side effects and risks a man at work yawning at his desk
Fatigue is a possible side effect of calcium channel blockers. Common side effects of calcium channel blockers include: Less commonly, these medications can cause: The rarest side effects that occur with calcium channel blockers include: If a person experiences any of these side effects from taking calcium channel blockers, they should see a doctor. If the side effects are causing serious problems, a doctor may change the prescription or reduce the dosage. Summary Calcium channel blockers are effective and widely used medications for the treatment of high blood pressure and several heart conditions. They work by relaxing blood vessels and reducing pressure on the heart. A range of alternative medications, such as ACE inhibitors and beta-blockers, are available for high blood pressure and heart conditions. They have a similar effect on the body, and doctors may prescribe a combination of these medicines. Calcium channel blockers can cause several side effects, such as fatigue and swelling in the abdomen, feet, and legs. Anyone who experiences worsening side effects should talk to a doctor about changing medications or reducing the dosage.
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Taking blood pressure pills at bedtime best for cardiovascular health

New research suggests that the best time for people with hypertension to take their blood pressure pills is at bedtime rather than in the morning.

woman checking her blood pressureShare on PinterestTaking blood pressure medication at bedtime is most likely to reduce cardiovascular risk, new research suggests.

It appears that not only does this timing result in better blood pressure control, but that it also markedly reduces the risk of cardiovascular death and events such as a heart attack or stroke.

Researchers came to these conclusions after analyzing data from the Hygia Chronotherapy Trial.

Hygia is the largest and longest lasting clinical trial to examine the effects of antihypertensive medication timing on the risk of cardiovascular events.

The investigators behind the present findings randomly assigned 19,084 adults to take the blood pressure pills that their doctors had prescribed either when they woke up in the morning or at bedtime. The participants were of Caucasian Spanish descent, and 8,470 were female.

During an average follow-up of 6 years, all individuals underwent 48-hour ambulatory blood pressure monitoring at least once per year.

"The results of this study," says Ramón C. Hermida, Ph.D., the leader of the Hygia project, "show that patients who routinely take their antihypertensive medication at bedtime, as opposed to when they wake up, have better-controlled blood pressure and, most importantly, a significantly decreased risk of death or illness from heart and blood vessel problems."

Hermida is a professor at the University of Vigo, in Spain, and director of its bioengineering and chronobiology labs.

He and colleagues report the recent findings in the European Heart Journal.

Markedly lower risk of cardiovascular eventsThe new study shows that, compared with individuals who took their blood pressure pills in the morning, those who took them before retiring to bed at night had a 45% lower risk of dying from or experiencing cardiovascular events, such as a heart attack, stroke, or heart failure.The team adjusted the results to remove the effect of potential influencing factors. These factors include sex, age, cholesterol levels, smoking status, and presence of kidney disease or type 2 diabetes.The researchers also examined the effect of medication timing on the risk of certain individual cardiovascular events.These analyses showed that, compared with taking blood pressure pills in the morning, taking them at bedtime can reduce the risk of:death due to heart or blood vessel conditions by 66%coronary revascularization by 40%Coronary revascularization is a procedure that unblocks or widens a vessel that supplies the heart to restore blood flow.No mention of timing in current guidelinesProf. Hermida explains that the current guidelines on how to treat high blood pressure do not mention or give advice about the best time of day to take the pills."Morning ingestion has been the most common recommendation by physicians, based on the misleading goal of reducing morning blood pressure levels," he observes.However, previous findings from the Hygia project have shown that the most significant independent marker of people's cardiovascular risk is their average systolic blood pressure during sleep.This link is independent of blood pressure readings taken during waking hours or at visits to the doctor, notes Prof. Hermida."Furthermore," he adds, "there are no studies showing that treating hypertension in the morning improves the reduction in the risk of cardiovascular disease."A limitation that he and his colleagues highlight is that, because the participants came from one ethnic group, they cannot say how true the findings might be for other populations.Origins of these benefits are unclearPaul Leeson, Ph.D., a professor of cardiovascular medicine at the University of Oxford, in the United Kingdom, was not involved in the trial.He commends the findings and describes the scale, length of follow-up, and effect size as "impressive.""Where the benefit comes from remains unclear," Prof. Leeson observes.Do these effects arise because the drugs improve sleep patterns or because side effects present less of a problem at night? he muses.Or, could it be that overnight blood pressure is a better marker of heart health?Prof. Leeson remarks that other studies looking into the timing of blood pressure medication are about to complete and report findings.It will be interesting to see whether they confirm these recent results and shed any insights on the underlying mechanisms of these effects."This study has the potential to transform how we prescribe blood pressure medication."Prof. Paul Leeson
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Heart and brain health are connected, but what influences both?

Studies have shown that there is a link between cardiovascular health and brain health, but it is unclear whether genetic or environmental factors are most important in determining them both. A new study in twins suggests that nurture, rather than nature, may be decisive.

senior man looking at photosShare on PinterestNurture may be more important than genetic factors in determining heart and brain health outcomes.

Evidence from different studies has suggested that there is a strong link between cardiovascular health and brain health.

Researchers have explained that poor cardiovascular health can, with age, contribute to dementia mechanisms, affecting cognitive function.

But what predisposes a person to poorer — or better — cardiovascular and brain health? So far, scientists have been unable to answer this question with any degree of certainty.Generally speaking, there are two types of factors that could influence aspects of heart and brain health in the long term. These are genetic (nonmodifiable) factors and environmental (modifiable) factors, a conjuncture that people sometimes refer to as the "nature vs. nurture" conundrum.To try to determine whether genes or environmental factors play a more important role in long term health outcomes for the heart and brain, researchers from Emory University in Atlanta, GA, decided to study a cohort able to provide more solid answers: pairs of twins.Identical (monozygotic) twins have the same genetic profile, while fraternal (dizygotic) twins share about 50% of their genes. As a result, pairs of twins can allow researchers to compare the effects of nature with those of nurture more effectively than other populations.In the current study — the findings of which appear in the Journal of Alzheimer's Disease — the researchers analyzed the data of 272 male pairs of monozygotic and dizygotic twins, which they were able to access via the Vietnam Era Twin Registry. All of the participants were free of both cardiovascular disease and dementia at baseline.More specifically, the investigators looked at the relationship between cardiovascular health — which they determined by scoring blood sugar and cholesterol, blood pressure, body mass index (BMI), physical activity, diet, and cigarette smoking — and cognitive performance."Our study across the entire sample of twins confirmed that better [cardiovascular health] is associated with better cognitive health in several domains," notes senior author Dr. Viola Vaccarino, Ph.D."The analyses further suggested that familial factors shared by the twins explain a large part of the association and thus could be important for both cardiovascular and brain health," she adds.According to the findings of the study, the association between heart and brain health was similar among all pairs of twins, regardless of whether they were identical or fraternal.The researchers believe that some of the modifiable factors that contribute to a predisposition toward certain heart and brain health outcomes include factors relating to early family life, as well as socioeconomic status and education."Improving population-level [cardiovascular health] scores, which are extremely low in the United States, has the potential to reduce the burden of dementia along with heart disease," notes co-author Dr. Ambar Kulshreshtha, Ph.D."Because [cardiovascular health] factors are modifiable, prevention of cardiovascular risk factors and promotion of a healthy lifestyle beginning early in life should achieve the best results for promoting not only cardiovascular health but also cognitive health."Dr. Ambar Kulshreshtha, Ph.D.The findings, the investigators add, are relevant in the context of the American Heart Association's 2020 Strategic Impact Goal. This goal is a 20% improvement in cardiovascular health and a 20% reduction in deaths from cardiovascular diseases and stroke in the U.S., both by next year.
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Could an existing heart drug help treat cancer?

When cells in the human body age incorrectly, this can sometimes make it easier for cancer to develop or spread. For this reason, scientists are looking for new drugs able to act on processes that relate to cell aging. But could an existing drug come in handy?

conducting cancer research in the labShare on PinterestResearchers believe an existing heart drug may prove useful against cancer.

Cellular aging — that scientists call senescence — is a natural process that allows the body to filter out old and damaged cells that no longer fulfill their purpose.

However, senescence sometimes malfunctions, and some researchers believe that this can contribute to the growth and spread of cancer tumors.

Thus, specialists have been hard at work to find new drugs, which they term senolytics, that can kill senescent cells that may pose a threat to health.Previous studies in animal models have shown that senolytics could have a number of benefits, including keeping individuals healthier for longer and prolonging life span.And some senolytics, such as navitoclax, have demonstrated some effectiveness in treating blood cancers, including leukemia and lymphoma. Yet navitoclax can also have serious side effects, including thrombocytopenia, or abnormally low platelet levels in the blood.Recently, however, researchers from the MRC London Institute of Medical Sciences in the United Kingdom may have identified an alternative senolytic — in the form of an existing heart drug known as ouabain.In the study paper that appears in the journal Nature Metabolism, the investigators explain that they experimented with various existing drugs, testing them on both healthy and senescent cells to see how they would act.In doing so, they closed in on ouabain, a compound that forms part of the same class of drugs as digoxin and digitoxin, namely cardiac glycosides. Such compounds can treat heart conditions, including cardiac arrhythmias and atrial fibrillation, both of which have characteristics of irregular or abnormal heartbeats.The research team found that ouabain can selectively kill different types of aging cells, including those that have become senescent because of cancer, or due to exposure to radiotherapy or chemotherapy, including treatments with drugs such as etoposide and doxorubicin.This makes ouabain a potential candidate for use as a broad spectrum senolytic: a drug that targets a very varied array of aging cells.The researchers reached this conclusion by testing the drug in vivo, in aging mice, and "in precancerous lesions in the liver and upon radiotherapy," as senior author Prof. Jesús Gil explains.Prof. Gil and colleagues also point out that the fact that it is already readily available makes further research using this drug easier."These drugs are already used in the clinic, so they could be repurposed to treat a long list of diseases, including cancer. This is something we are keen to explore with our clinical collaborators."Prof. Jesús Gil"Moreover," the senior author adds, "many patients are being treated with digoxin, and an epidemiologist could look retrospectively and ask the question of whether those patients who were treated with digoxin are doing better than those who weren't."Thus, future studies could compare the health outcomes for people who have received treatment with cardiac glycosides versus those who have not, making it easier to confirm whether this class of drugs has true potential as a senolytic.
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Work and family demands may impact women's heart health

Researchers believe that stress and cardiovascular health are linked in some way, but the association is not yet fully clear. A large-scale new study has recently delved into the effects of a unique kind of stress.

woman working with baby on her lapShare on PinterestBalancing work and family life puts a strain on women's heart health.

According to the American Heart Association (AHA), stress may affect factors that increase the risk of heart disease, including blood pressure and cholesterol level.

One major source of stress is the workplace.

In fact, a 2015 review of 27 studies that appeared in the journal Current Cardiology Reports found an association between work stress and a "moderately elevated risk of incident coronary heart disease and stroke."

However, one type of stress that researchers often leave out of studies is that felt by a person who needs to simultaneously balance the demands of work and family life.

Examining this in more depth may eventually help health professionals better identify and treat cardiovascular issues. This is according to the authors of the new study, which now appears in the Journal of the American Heart Association.What is work-family conflict?Cardiovascular diseases are currently the leading cause of death worldwide, say the World Health Organization (WHO).Health professionals can determine people's cardiovascular health score. Based on seven metrics including diet, blood pressure, and physical activity levels, the researchers who conducted the new study used this score to investigate how work and family stress can impact heart health.According to the study paper, work-family conflict refers to "a form of inter-role conflict in which the role pressures from the work and family domains are mutually incompatible in some respect."More than 11,000 workers ages 35–74, from six state capitals in Brazil, made up the study's sample. The participants came from a variety of educational and work backgrounds, and the study included a slightly higher number of women.Each participant filled out a questionnaire to determine how their job affected their family life, and how their family life impacted their work.The researchers calculated the participants' cardiovascular health scores using a combination of clinical examinations, laboratory test results, and self-reported questionnaires.An unequal impactThe analysis showed a distinct sex difference. Men reported less work interference with family and more time for personal care and leisure. Both sexes reported a similar amount of family interference with work.However, women appeared to be worse off. Those who reported a number of frequent work-family conflicts had lower cardiovascular health scores."This was interesting because in our previous study, job stress alone affected men and women almost equally," says senior study author Dr. Itamar Santos, a professor at the University of São Paulo in Brazil.There could be a simple explanation as to why this is the case, and it has to do with traditional gender roles. "You feel the stress to fulfill the gender roles, and I think women still feel more of a need to have that nurturing home life," says Dr. Gina Price Lundberg, clinical director of the Emory Women's Heart Center in Atlanta, GA."Men are helping more than ever, but I think working women still feel the stress of trying to do it all." She goes on to describe the study as "well-designed," due to its large sample size, the diverse background of the participants, and the balance of men and women.However, certain elements of the study relied on the participants' own thoughts and feelings, which may have biased the results.How to live with stressWhat this study has dipped into is the need for a good work-life balance. However, this is easier said than done in many cases.Dr. Santos hopes that the new findings will encourage workplaces to introduce stress reducing initiatives and encourage doctors to look for signs of stress when examining people."We're not going to eliminate stress," Dr. Santos says. "But we should learn how to live with it to not have so many bad consequences."Whether that would be through measures such as at-home meditation or employer-led strategies is yet to be determined.Dr. Santos and team are now planning to follow the same participants for up to a decade to gain further insight.
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What is an echocardiogram?

An echocardiogram is an ultrasound image of the heart. It can help doctors diagnose a range of heart problems.

Doctors use echocardiograms to help them diagnose heart problems, such as damaged cardiac tissue, chamber enlargement, stiffening of the heart muscle, blood clots in the heart, fluid around the heart, and damaged or poorly functioning heart valves.

In this article, we explain how doctors use echocardiograms, what to expect during the test, and how to interpret the results.

What is an echocardiogram? a screen showing an echocardiogram
An echocardiogram helps a doctor diagnose heart problems.

Echocardiography uses ultrasound waves to create a picture of the heart, called an echocardiogram (echo).

It is a noninvasive medical procedure that produces no radiation and does not typically cause side effects.

During an echocardiogram, a doctor can see:

the size and thickness of the chambers how the valves of the heart are functioning the direction of blood flow through the heart any blood clots in the heart areas of damaged or weak cardiac muscle tissue problems affecting the pericardium, which is the fluid filled sac around the heart

Doctors also use echocardiography when they want to examine a person's general heart health, especially after a heart attack or stroke.

Thank you for supporting Medical News Today What are they used for? Doctors can use echocardiograms to: determine how well the heart is pumping blood assess the reasons for an abnormal electrical test of the heart, called an electrocardiogram (EKG) diagnose heart disease — including weak pumping or stiffening of the heart muscle, leaky or blocked heart valves, and chamber enlargement — in adults locate blood clots or tumors assess the pressure in the heart to diagnose a condition called pulmonary hypertension identify congenital heart abnormalities in infants and young children monitor how well the heart responds to different heart treatments, such as heart failure medications, artificial valves, and pacemakers A doctor will order an echocardiogram if they suspect that someone has heart problems. Signs and symptoms that may indicate a heart condition include: an irregular heartbeat shortness of breath high or low blood pressure leg swelling abnormal EKG results unusual sounds between heartbeats, known as heart murmurs Types of echocardiogram Doctors can order different types of echocardiogram, all of which use high frequency sound waves. The common types include those below. Transthoracic echocardiogram a doctor doing an echocardiogram on a male patient.
All types of echocardiogram use high frequency sound waves. The transthoracic echocardiogram is the most common type of echocardiogram test. This test involves placing an ultrasound wand called a transducer on the outside of the chest, near the heart. The device sends sound waves through the chest and into the heart. The application of a gel to the chest helps the sound waves travel better. These waves bounce off the heart and create images of the heart structures on a screen. Transesophageal echocardiogram A transesophageal echocardiogram uses a thinner transducer that attaches to the end of a long tube. The individual will swallow the tube to insert it into the esophagus, the tube that connects the mouth and stomach, which runs behind the heart. This type of echocardiogram provides more detailed pictures of the heart compared with the traditional transthoracic echocardiogram because it gives a "close up" view of this organ. Doppler ultrasound Doctors use doppler ultrasounds to check the flow of blood. They do this by generating sound waves at specific frequencies and determining how the sound waves bounce off and return to the transducer. Doctors can use colored doppler ultrasounds to map the direction and velocity of blood flow in the heart. Blood that flows toward the transducer appears red, while blood that flows away looks blue. The results of a doppler ultrasound can reveal problems with valves or holes in the walls of the heart and assess how the blood is traveling through it. Three-dimensional echocardiogram A three-dimensional (3D) echocardiogram creates detailed 3D images of the heart. Doctors can use 3D echocardiograms to: assess valve functionality in people who have heart failure diagnose heart problems in infants and children plan heart valve or structural interventional surgery assess the function of the heart in 3D image complex structures within the heart Stress echocardiogram A doctor can order an echocardiogram as part of a stress test. A stress test involves physical exercise, such as walking or jogging on a treadmill. During the test, the doctor will monitor heart rate, blood pressure, and the heart's electrical activity. A sonographer will take a transthoracic echocardiogram before and after the exercise. Doctors use stress tests to diagnose: Fetal echocardiogram Doctors can use a fetal echocardiogram to view an unborn baby's heart. This exam usually takes place at about 18–22 weeks of pregnancy. Echocardiograms do not use radiation, so they are not harmful to the woman or baby. Echocardiogram procedure Echocardiograms are noninvasive and relatively quick procedures that require minimal preparation. Below, we discuss what to expect before, during, and after an echocardiogram. Preparation In cases where a healthcare professional takes the echocardiogram from the outside of the body, the person will not need to prepare. For people who get a transesophageal echocardiogram, a doctor will recommend avoiding eating or drinking anything for at least 4 hours before the exam. People can resume eating and drinking about 1–2 hours after the echocardiogram once the local anesthesia has worn off. During the test A sonographer will perform the echocardiogram. Sonographers are healthcare professionals who specialize in using ultrasound devices to produce images and videos for diagnostic purposes. During the test, the person receiving the echocardiogram will remove their clothes from the waist up. They can wear a hospital gown if they wish to cover themselves during the exam. The sonographer will then instruct the person to lie on a table, on either their back or their left side. They may inject a saline solution or dye into the person's veins, which makes the heart appear more defined on the echocardiogram. The exact procedure depends on the type of echocardiogram. For instance: Transthoracic echocardiogram If a doctor ordered a transthoracic echocardiogram, the sonographer will apply a gel to the chest. The sonographer will then move the transducer around the chest to get different images of the heart. During the exam, the sonographer may ask someone to change positions or take or hold a deep breath. They might press the transducer into the chest to get a better picture of the heart. Transesophageal echocardiogram A doctor might order a transesophageal echocardiogram if they want more detailed or clearer images of the heart than those that a transthoracic echocardiogram can produce. During a transesophageal echocardiogram, the person may receive a mild sedative to help relax the muscles in their throat and a local anesthetic to numb the gag reflex. Once the sedative takes effect, a doctor will guide a small transducer on the end of a long tube down the throat and esophagus until it reaches the back of the heart. The sonographer will record images of the heart as the doctor moves the transducer around the esophagus. The person should not feel the transducer or the tube in their esophagus after initially swallowing the probe. After the test Most people can return to their regular activities after having a transthoracic echocardiogram. People who have a transesophageal echocardiogram may need to stay at the hospital or healthcare clinic for a few hours after the exam. They may have a sore throat initially, but it should improve within a few hours to a day. People who received a sedative before the exam should not drive for several hours after the echocardiogram. Interpreting the results After the exam, the sonographer will send the echocardiographic images to the doctor who ordered the test. The doctor will review the images and look for signs of heart problems, such as: damaged heart muscle tissue thick or thin ventricle walls abnormal chamber size poorly functioning valves decreased pumping strength masses in the heart, such as blood clots or tumors Thank you for supporting Medical News Today Echocardiogram vs. electrocardiogram People should not confuse an echocardiogram with another diagnostic test called an EKG. An EKG measures the electrical impulses or waves that travel through cardiac muscle tissue. The electrical activity in the heart causes the heart muscle tissues to contract and relax, which creates the rhythmic heartbeat that people can hear through a stethoscope. A trained technician, nurse, or doctor can take an EKG by placing electrodes on the skin of the chest, arms, or legs. These electrodes record electrical activity and send the information to a computer that converts it into a graph, which a doctor can print out. Are there any side effects? a woman experiencing left sided facial numbness and a headache
A person may experience headaches from contrast dyes. An echocardiogram presents a very low risk of side effects or complications. A transesophageal electrocardiogram may trigger a person's gag reflex when the sonographer guides the tube down the throat. People may also have a sore throat after the exam. Very rarely, a serious complication can occur as a result of the transesophageal echocardiogram, such as damage to the throat, vocal cords, or esophagus. The use of local anesthetics, sedatives, and contrast dyes during the exam may trigger an allergic reaction in some people. Contrast dyes can cause the following side effects: Some people may experience changes in blood pressure or a decrease in the supply of oxygen to the heart during a stress test. A stress test will take place in a fully equipped medical facility in case a person experiences any complications during the exam. Whenever a person receives sedatives, there is a chance that the stomach contents may enter the lungs. To prevent this, the doctor will ask the individual to attend the procedure with an empty stomach. Thank you for supporting Medical News Today Summary Doctors use echocardiography to diagnose problems that affect the heart. During the test, a doctor will evaluate how well a person's heart pumps blood. Doctors can also use echocardiography to look for signs of heart disease, such as weak heart muscle, blood clots inside the heart, or poorly functioning heart valves. A doctor might order an echocardiogram if a person shows symptoms of heart conditions, such as: shortness of breath leg swelling heart murmurs irregular heartbeat abnormal blood pressure In general, the test carries a low risk of significant complications or side effects. However, people may feel some discomfort, and some individuals can have an allergic reaction to the contrast material or anesthetic.
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Atrial fibrillation: Daily alcoholic drink riskier than binge drinking

A new study suggests that drinking small amounts of alcohol frequently rather than having infrequent bouts of binge drinking is more likely to increase the risk of developing atrial fibrillation (A-fib), a condition in which the heart beats irregularly.

close up of red wine being pouredShare on PinterestNew research suggests that drinking daily may harm the heart's regular rhythm more than binge drinking.

"Recommendations about alcohol consumption have focused on reducing the absolute amount rather than the frequency," says study author Dr. Jong-Il Choi, a professor in the department of internal medicine at the Korea University College of Medicine in Seoul.

"Our study suggests that drinking less often may also be important to protect against atrial fibrillation," he adds.

Prof. Choi, who also works at the Korea University Anam Hospital in Seoul, and his colleagues report their findings in a recent EP Europace study paper.

A-fib is the most common form of heart arrhythmia, a condition in which the heart beats too quickly, too slowly, or in an irregular way.

Prof. Choi observes that "atrial fibrillation is a disease with multiple dreadful complications and significantly impaired quality of life."

The common symptoms of A-fib include an irregular or fast pulse, palpitations, shortness of breath, fatigue, dizziness, and chest pain.

Between 2.7 and 6.1 million people in the United States have A-fib, according to the Centers for Disease Control and Prevention (CDC).

A-fib causes and consequences

It is sometimes difficult to say what causes A-fib. However, it appears that damage to the heart's electrical system is often to blame. This damage can happen as a result of heart disease or as a complication of heart surgery. Other conditions, such as chronic uncontrolled high blood pressure, can also affect the heart in this way.One of the main effects of A-fib is that it causes blood to pool in the lower chambers of the heart, which, in turn, increases the likelihood of clotting.The potential for clotting is the main reason why the risk of stroke is four to five times higher in people with A-fib than in people without the condition.An earlier pooled analysis of data from several studies had found that the chances of developing A-fib went up in line with increasing alcohol consumption.Those findings showed that for every 12 grams of alcohol — roughly the amount in a single drink — that a person consumed per week, there was an 8% higher risk of A-fib.However, that analysis did not clarify whether the total alcohol consumption or the number of drinking episodes had the strongest effect.Frequent drinking vs. binge drinkingIn the new study, Dr. Choi and colleagues compared the effect of frequent drinking with that of binge drinking on the risk of new-onset A-fib.They analyzed data on 9,776,956 individuals in the Korean National Health Insurance Service database, which holds records on nearly everybody in the Republic of Korea.None of the individuals in the analysis had A-fib when, as part of a health checkup in 2009, they completed a survey about alcohol intake.Using the database records, the researchers were able to track these individuals through to 2017 to spot any occurrences of A-fib.They assessed the effect of weekly alcohol consumption — which they calculated by multiplying the number of drinking sessions per week by the amount of alcohol consumed in each session — on the risk of new-onset A-fib.Daily consumption riskier than binge drinkingThe analysis revealed weekly alcohol intake to be a significant risk factor for new-onset A-fib.However, the team found that the strongest factor was drinking sessions per week. Having a daily drink of alcohol was associated with a higher risk of A-fib than drinking twice a week, while drinking once a week was less risky.In contrast, there was no link between consuming a large amount of alcohol in one session, or binge drinking, and new-onset A-fib."Drinking [a] small amount of alcohol frequently," conclude the authors, "may not be a good strategy to prevent new-onset A-fib."They note that the association between the number of drinking episodes and A-fib onset held regardless of sex and age.Speculating on the reason for the link, Prof. Choi suggests that alcohol could trigger an individual episode of A-fib and that if this keeps repeating, it could "lead to overt disease.""In addition," he notes, "drinking can provoke sleep disturbance, which is a known risk factor for [A-fib]."'Reduce frequency and weekly consumption'When they looked at weekly consumption of alcohol, the researchers saw that their results supported those of other studies.They saw a 2% rise in the risk of new-onset A-fib for each additional weekly gram of alcohol consumption.The results also showed what appeared to be a protective effect of mild alcohol intake compared both with no drinking and with moderate and high levels of consumption.Those who consumed no alcohol or drank moderate or high amounts had elevated risks of new-onset A-fib of 8.6%, 7.7%, and 21.5%, respectively, compared with mild drinkers.Prof. Choi proposes, however, that this might not be a "true benefit," but could be due to the "confounding effect of unmeasured variables." Only further studies can confirm this.He suggests that alcohol is likely to be the A-fib risk factor that people can alter most easily."To prevent new-onset atrial fibrillation, both the frequency and weekly amount of alcohol consumption should be reduced."Prof. Jong-Il Choi
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Having a dog may boost survival after a heart attack or stroke

Plenty of research has suggested that owning a dog can be beneficial to health. Two new studies now add to the existing evidence, finding an association between dog ownership and a significantly lower death risk following a stroke or heart attack.
man sitting with two dogs
Owning a dog could help prolong the lifespan of a person who has experienced a serious cardiovascular event.

"The findings in these two well-done studies and analyses build upon prior studies and the conclusions of the 2013 [American Heart Association] scientific statement 'Pet Ownership and Cardiovascular Risk' — that dog ownership is associated with reductions in factors that contribute to cardiac risk and to cardiovascular events," says Dr. Glenn Levine, chair of the writing group that authored this scientific statement.

"Further, these two studies provide good, quality data indicating [that] dog ownership is associated with reduced cardiac and all-cause mortality," Dr. Levine, who was not involved in this research, adds.

"While these non-randomized studies cannot 'prove' that adopting or owning a dog directly leads to reduced mortality, these robust findings are certainly at least suggestive of this."

Dr. Glenn Levine

Previous research has suggested that people who live with dogs appear to have a much lower risk of both cardiovascular and all-cause mortality, compared with individuals who do not count dogs among their family members.

The two new studies have now found an association between dog ownership and a lower risk of death among individuals who have experienced a heart attack, a stroke, or another cardiovascular problem.

The results of both studies appear in the journal Circulation: Cardiovascular Quality and Outcomes.

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Dogs 'an important factor in rehabilitation'?

The first study — conducted by researchers from Uppsala University and the Swedish University of Agricultural Sciences, both in Uppsala, Sweden — used the Swedish National Patient Register to identify individuals aged 40–85 who had experienced either a heart attack or an ischemic stroke between 2001 and 2012.

In total, this amounted to 344,272 individuals, of whom 186, 421 had experienced a heart attack and 157,851 a stroke within this period. To find out how many of these people owned dogs, the researchers consulted Swedish Board of Agriculture and Swedish Kennel Club records.

The researchers found that in this cohort, people who owned dogs had better health prospects than those who did not.

Specifically, people who had experienced a heart attack between 2001 and 2012 and who owned a dog had a 33% lower risk of death after hospitalization if they otherwise lived alone and a 15% lower death risk if they owned a dog and lived with a partner or child.

As for people who had experienced a stroke and owned a dog, if they otherwise lived alone after hospitalization, they had a 27% lower risk of death, and if they also lived with a partner or a child, they had a 12% lower risk of death.

The researchers believe that the decrease in death risk for dog owners could be explained by the fact that having a dog forces people to become more physically active.

Dogs also help people feel less lonely and experience fewer negative moods, which may contribute to better overall health.

"We know that social isolation is a strong risk factor for worse health outcomes and premature death," says Prof. Tove Fall, who co-authored this study.

"Previous studies have indicated that dog owners experience less social isolation and have more interaction with other people. Furthermore, keeping a dog is a good motivation for physical activity, which is an important factor in rehabilitation and mental health," Prof. Fall explains.

While their results are based on data from a very large cohort, the researchers admit that certain factors may have skewed the findings. Some of these factors the researchers were unable to verify, such as shared ownership of a dog, loss of a dog, or a change of ownership.

Still, "The results of this study suggest positive effects of dog ownership for patients who have experienced a heart attack or stroke," Prof. Fall notes. "However, more research is needed to confirm a causal relationship and [give] recommendations about prescribing dogs for prevention," she adds.

She also cautions that these results are not meant to motivate people to buy or adopt dogs as "medicine" without considering what owning a dog really entails.

"Moreover, from an animal welfare perspective, dogs should only be acquired by people who feel they have the capacity and knowledge to give the pet a good life," Prof. Tove emphasizes.

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Dog owners have a 24% lower risk of death

The second study comes from Mount Sinai Hospital, in Toronto, Canada, and it is a systematic review and meta-analysis of 10 studies, collectively featuring data from 3,837,005 people.

Of these studies, nine compared all-cause mortality outcomes for people who did or did not own dogs, and four looked specifically at cardiovascular health outcomes in these demographics.

This review also found that people who own dogs have better health outcomes, compared with those who do not. Dog owners, the review authors note, have a 24% lower risk of all-cause mortality, a 65% lower risk of death after a heart attack, and a 31% lower risk of death from cardiovascular causes.

"Having a dog was associated with increased physical exercise, lower blood pressure levels, and better cholesterol profile in previous reports," says first author Dr. Caroline Kramer.

"As such," she adds, "the findings that people who owned dogs lived longer and their risk for cardiovascular death was also lower are somewhat expected."

At the same time, the researcher points out that she and her team were unable to account for some confounding factors, including "better fitness or an overall healthier lifestyle that could be associated with dog ownership."

"The results, however, were very positive," she maintains. "The next step on this topic would be an interventional study to evaluate cardiovascular outcomes after adopting a dog and the social and psychological benefits of dog ownership," Dr. Kramer suggests.

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