The Heart

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Dairy consumption guidelines 'should be revised'

Guidelines that advise people to limit how much dairy food — particularly yogurt and cheese — they eat should be revised, according to new research.
milk, cheese and yogurt
Researchers believe that dairy consumption guidelines should now be revised.

It found that higher overall consumption of dairy products is linked to a lower risk of premature death from all causes and "cerebrovascular causes" such as stroke.

Drinking milk, on the other hand, was found to be associated with a higher risk of coronary heart disease.

However, the researchers also say that this needs further investigation.

Meanwhile, they recommend that the guideline for milk consumption should be to drink fat-free or low-fat milk, especially for those who drink a lot of milk.

Maciej Banach, who is a professor in the Department of Hypertension at Medical University of Lodz in Poland, and his colleagues analyzed national survey data from the United States and confirmed their results in a further analysis of pooled data from several other studies.

Their findings feature at the 2018 annual congress of the European Society of Cardiology, held in Munich, Germany.

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Conflicting evidence on dairy foods

Cerebrovascular diseases, such as stroke, affect the blood vessels in the brain. Stroke accounts for high rates of disability and death. In the U.S., it is the "fifth leading cause of death."

For a long time, it was thought that eating dairy foods — because they contain more saturated fat — raised people's risk of premature death, especially from cancer, cerebrovascular diseases, and coronary heart disease.

However, the researchers say that the evidence to support this idea, especially that which applies to U.S. adults, is conflicting.

Prof. Banach notes, for example, that an analysis of pooled data from 29 studies that was published in 2017 "found no association between the consumption of dairy products and either cardiovascular disease [...] or all-cause mortality."

That being said, another study of adults in Sweden that was published in the same year found that drinking more milk was linked to double the risk of premature death — including death from cardiovascular disease — in women.

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Lower risk of death

For the new analysis, the researchers used data from the 1999–2010 National Health and Nutrition Examination Surveys (NHANES) covering 24,474 adults — aged 47.6 years, on average — of whom 51.4 percent were female.

The Centers for Disease Control and Prevention (CDC) carry out a NHANES survey every year with a nationally representative sample of 5,000 U.S. residents. It includes physical examinations and interviews.

Over an average follow-up period of 76.4 months, there were 3,520 deaths. Of these, 827 were from cancer, 709 were due to heart-related causes, and 228 were due to cerebrovascular diseases.

The researchers found that overall consumption of dairy foods was linked to a 2 percent lower risk of death from all causes, while cheese consumption in particular was tied to an 8 percent lower risk.

Focusing on cerebrovascular disease deaths, the researchers found that overall dairy food intake was tied to a 4 percent lower risk, while milk consumption was linked to a 7 percent lower risk.

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Results confirmed — except for milk

The team then sought to confirm these findings by analyzing pooled data from 12 other studies that followed groups of people over time. Overall, the data covered a total of 636,726 individuals with a follow-up of around 15 years.

The analysis confirmed the earlier results, with the exception of milk consumption. Here, much like in the Swedish study that Prof. Banach mentioned, milk intake was linked to a 4 percent higher risk of death from coronary heart disease.

Consumption of yogurt and other fermented dairy foods, on the other hand, was tied to a 3 percent lower risk of death from all causes. Further adjustment, however, showed that the results on yogurt were not statistically significant and could just as likely have occurred by chance.

The researchers note that the links found between milk and coronary heart disease warrant further investigation. Because many people who drink milk also consume other dairy products, it is not easy to untangle the effect of milk from the rest.

In the meantime, they advise milk drinkers to confine their intake to the fat-free and low-fat varieties.

"In light of the protective effects of dairy products, public health officials should revise the guidelines on dairy consumption."

Prof. Maciej Banach

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Forehead wrinkles — an early sign of cardiovascular disease?

New research suggests that deep forehead wrinkles might be a quick and easy way to spot individuals at risk of atherosclerosis, a cardiovascular condition that can lead to more serious issues such as a heart attack or stroke.
close up of wrinkles on man's forehead
Numerous deep wrinkles on someone's forehead may be an early sign of atherosclerosis, suggests a new study.

In atherosclerosis, plaque builds up inside the arteries, making them less elastic and narrowing them down over time.

This limits the supply of oxygen-rich blood to the body's major organs, which, in turn, may lead to a range of diseases — depending on which organ is affected.

When plaque accumulates inside the coronary arteries, coronary heart disease and even heart attacks may ensue.

Some of the main risk factors for atherosclerosis include smoking, high cholesterol levels, insulin resistance, high blood pressure, physical inactivity, age, and a family history of heart disease.

New research adds another risk factor to the list — and one that may be more easy to detect than high blood pressure or insulin resistance. Deep forehead wrinkles, say the authors of the new study, may signal atherosclerosis.

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The new research was presented at the 2018 annual conference of the European Society of Cardiology, held in Munich, Germany.

Study author Yolande Esquirol, who is an associate professor of occupational health at the Centre Hospitalier Universitaire de Toulouse in France, shares what motivated the research. "You can't see or feel risk factors like high cholesterol or hypertension," she says.

"We explored forehead wrinkles as a marker because it's so simple and visual. Just looking at a person's face could sound an alarm, then we could give advice to lower risk."

This is not the first time that facial features are explored as a potential marker of cardiovascular health. For example, male pattern baldness and prematurely gray hair have been found to raise heart disease risk by fivefold in previous studies.

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Cardiovascular death risk 10 times higher

Esquirol and colleagues examined forehead wrinkles in 3,200 healthy adults, aged 32–62 at baseline. The researchers assessed the participants' wrinkles by applying a score ranging from 0 ("no wrinkles") to 3 ("numerous deep wrinkles").

The scientists clinically followed the participants for 2 decades. During this time, 233 participants died of various conditions.

Overall, the research revealed a directly proportional link between wrinkle score and risk of dying from a cardiovascular problem.

While a wrinkle score of 1 elevated cardiovascular death risk only slightly, people with a wrinkle score of 2 and 3 were almost 10 times more likely to die a cardiovascular death than people with wrinkle scores of 0.

These results were obtained after the scientists accounted for age and job strain in their analysis.

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Why wrinkles may signal atherosclerosis

While the prospective research was observational, the researchers speculate that the missing link between wrinkle scores and the probability of cardiovascular death may be atherosclerosis.

They base this theory on the fact that both wrinkles and atherosclerosis are subject to oxidative stress and changes in collagen protein levels.

Also, the researchers explain, blood vessels in the forehead are particularly fine, which could mean they are more sensitive to the buildup of plaque that is a hallmark of atherosclerosis.

Finally, the authors suggest that forehead wrinkles could be an easier and much less costly way of determining whether someone has the condition than lipid tests and blood pressure measurements.

"Forehead wrinkles may be a marker of atherosclerosis," says Esquirol. "This is the first time a link has been established between cardiovascular risk and forehead wrinkles, so the findings do need to be confirmed in future studies," she adds.

"[B]ut the practice could be used now in physicians' offices and clinics," she explains, referring to the use of wrinkle scores as a way to detect signs of cardiovascular conditions. "It doesn't cost anything, and there is no risk."

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'Good' cholesterol: How much is too much?

New research challenges the popular belief that high-density lipoprotein cholesterol, also known as the "good" kind, is beneficial to one's health, regardless of its levels.
lipid profile test
If your tests reveal very high levels of the 'good' kind of cholesterol, you may still be at risk of cardiovascular disease.

Physicians typically advise that people maintain high levels of high-density lipoprotein (HDL) cholesterol on the basis of the assumption that it prevents heart disease and stroke.

This protective effect is thought to be due to the HDL molecules, which "flush" cholesterol from the blood into the liver and out of the body.

However, little is known about people with very high levels of this type of cholesterol.

In fact, some recent research has suggested that high levels of it may actually raise the risk of premature mortality.

A new study reinforces this idea. It was presented by Dr. Marc Allard-Ratick, of the Emory University School of Medicine in Atlanta, GA, at the European Society of Cardiology Congress, held in Munich, Germany.

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Dr. Allard-Ratick and colleagues examined the link between "good" cholesterol levels and the risk of heart attack and cardiovascular death in almost 6,000 individuals aged 63 years, on average.

Most had heart disease; the researchers followed them up over the course of 4 years, grouping them according to their levels of HDL cholesterol, measured in milligrams per deciliter (mg/dL).

During the follow-up period, 13 percent of the participants experienced a heart attack or died from cardiovascular disease.

Participants whose HDL cholesterol levels were 41–60 mg/dL were the least likely to experience a heart attack or die from a cardiovascular event.

However, for people with very low HDL cholesterol levels (less than 41 mg/dL) and those with very high levels (higher than 60 mg/dL), the risk of adverse cardiovascular events and death increased.

Specifically, people with cholesterol levels higher than 60 mg/dL were almost 50 percent more likely to have a heart attack or die from cardiovascular disease than those with levels at 41–60 mg/dL.

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Dr. Allard-Ratick comments on these findings. "Our results," he explains, "are important because they contribute to a steadily growing body of evidence that very high HDL cholesterol levels may not be protective, and because unlike much of the other data available at this time, this study was conducted primarily in patients with established heart disease."

"It may be time to change the way we view HDL cholesterol. Traditionally, physicians have told their patients that the higher your 'good' cholesterol, the better. However, the results from this study and others suggest that this may no longer be the case."

Dr. Marc Allard-Ratick

He cautions that the reasons for the associations revealed remain unclear; but, he speculates, "one possible explanation is that extremely elevated HDL cholesterol may represent 'dysfunctional HDL' which may promote rather than protect against cardiovascular disease."

"One thing is certain," concludes Dr. Allard-Ratick: "the mantra of HDL cholesterol as the 'good' cholesterol may no longer be the case for everyone."

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Which foods lower blood sugar?

When a person has diabetes, either their body does not produce enough insulin, or it cannot use the insulin correctly, so glucose accumulates in the blood. High levels of blood glucose can cause a range of symptoms, from exhaustion to heart disease.

One way to control blood sugar is to eat a healthful diet. Generally, foods and drinks that the body absorbs slowly are best because they do not cause spikes and dips in blood sugar.

The glycemic index (GI) measures the effects of specific foods on blood sugar levels. People looking to control their levels should pick foods with low or medium GI scores.

A person can also pair foods with low and high GI scores to ensure that a meal is balanced.

Below are some of the best foods for people looking to maintain healthy blood sugar levels.

1. Whole wheat or pumpernickel bread foods that lower blood sugar pumpernickel bread
Pumpernickel has a low GI score and fewer carbs than other breads.

Many kinds of bread are high in carbohydrates and quickly raise blood sugar levels. As a result many breads should be avoided.

However, pumpernickel bread and 100 percent stone-ground whole wheat bread have low GI scores, at 55 or less on the GI scale.

Pumpernickel and stone-ground whole wheat breads have lower GI scores than regular whole wheat bread because the ingredients go through less processing.

Processing removes the fibrous outer shells of grains and cereals. Fiber slows digestion and helps to stabilize blood sugar levels.

In a 2014 study, researchers reported that spelt and rye both caused low initial glycemic responses in rats. They also found that these ancient wheat types, as well as emmer and einkorn, suppressed genes that promote glucose metabolism.

2. Most fruits Except for pineapples and melons, most fruits have low GI scores of 55 or less. This is because most fruits contain lots of water and fiber to balance out their naturally occurring sugar, which is called fructose. However, as fruits ripen, their GI scores increase. Fruit juices also have very high GI scores because juicing removes the fibrous skins and seeds. A large 2013 study found that people who consumed whole fruits, especially blueberries, grapes, and apples, had significantly lower risks of developing type 2 diabetes. The researchers also reported that drinking fruit juice increased the risk of developing the condition. 3. Sweet potatoes and yams Regular potatoes have a high GI score, but sweet potatoes and yams have low scores and are very nutritious. Some research indicates that the flesh of the sweet potato contains more fiber than the skin, indicating that the whole vegetable could be beneficial for those with diabetes. Reporting the findings of an animal study, the researchers also noted that sweet potato consumption may lower some markers of diabetes. While there is still no conclusive evidence that sweet potatoes can help to stabilize or lower blood sugar levels in humans, they are undoubtedly a healthful, nutritious food with a low GI score. People can substitute sweet potatoes or yams for potatoes in a variety of dishes, from fries to casseroles. Thank you for supporting Medical News Today 4. Oatmeal and oat bran foods that lower blood sugar oatmeal
Oats contain B-glucans, which help maintain glycemic control. Oats have a GI score of 55 or lower, making them less likely to cause spikes and dips in blood sugar levels. Oats also contain B-glucans, which can do the following: reduce glucose and insulin responses after meals improve insulin sensitivity help maintain glycemic control reduce blood lipids (fats) A 2015 review of 16 studies concluded that oats have a beneficial effect on glucose control and lipid profiles in people with type 2 diabetes. Determining the impact of oat consumption on type 1 diabetes requires more research. Doctors still recommend that people with diabetes limit their consumption of oatmeal because 1 cup contains roughly 28 grams of carbohydrates. 5. Most nuts Nuts are very rich in dietary fiber and have GI scores of 55 or less. Nuts also contain high levels of plant proteins, unsaturated fatty acids, and other nutrients, including: A 2014 systemic review concluded that eating nuts could benefit people with diabetes. As with other foods in this article, it is best to eat nuts that are as whole and unprocessed as possible. Nuts with coatings or flavorings have higher GI scores than plain nuts. 6. Legumes Legumes, such as beans, peas, chickpeas, and lentils, have very low GI scores. They are also a good source of nutrients that can help maintain healthy blood sugar levels. These nutrients include: fiber complex carbohydrates protein A 2012 study found that incorporating legumes into the diet improved glycemic control and lowered the risk of coronary heart disease in people with type 2 diabetes. Avoid legume products that contain added sugars and simple starches, such as those in syrups, sauces, or marinades. These additions can significantly increase a product's GI score. 7. Garlic Garlic is a popular ingredient in traditional medicines for diabetes and a wide variety of other conditions. The compounds in garlic may help reduce blood sugar by improving insulin sensitivity and secretion. In a 2013 study, 60 people with type 2 diabetes and obesity took either metformin alone or a combination of metformin and garlic twice daily after meals for 12 weeks. People who took metformin and garlic saw a more significant reduction in their fasting and post-meal blood sugar levels. People can eat garlic raw, add it to salads, or use it in cooked meals. Thank you for supporting Medical News Today 8. Cold-water fish foods that lower blood sugar cod
Cod does not contain carbohydrates and may reduce the risk of developing type 2 diabetes. Fish and other meats do not have GI scores because they do not contain carbohydrates. However, cold-water fish may help manage or prevent diabetes better than other types of meat. A 2014 study included data taken from 33,704 Norwegian women over a 5-year period. The researchers found that eating 75–100 milligrams of cod, saithe, haddock, or pollock daily reduced the risk of developing type 2 diabetes. However, the researchers were uncertain whether the reduction in risk was a direct result of eating the fish or whether other healthful lifestyle factors, such as exercise, could have influenced the findings. 9. Yogurt Eating plain yogurt daily may reduce the risk of type 2 diabetes. Authors of a large 2014 meta-analysis concluded that yogurt may be the only dairy product that lowers the risk of developing the condition. They also noted that other dairy products do not seem to increase a person's risk. Researchers are still unsure why yogurt helps lower the risk of type 2 diabetes. However, plain yogurt is generally a low-GI food. Most unsweetened yogurts have a GI score of 50 or less. It is best to avoid sweetened or flavored yogurts, which often contain too much sugar for a person looking to lower their blood sugar levels. Greek-style yogurt can be a healthful alternative. Other ways to lower blood sugar levels Eating a healthful, well-balanced diet is key. Additional strategies to help lower or manage blood sugar levels include: staying hydrated by drinking plenty of clear liquids exercising regularly eating small portions more frequently not skipping meals managing or reducing stress maintaining a healthy body weight or losing weight, if necessary People with diabetes may also need to take medications and measure their blood sugar regularly to reduce the risk of potentially dangerous symptoms and complications. Speak with a doctor about how to incorporate a healthful diet into a diabetes care plan.
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Alcohol and heart health: Consistency may be key

The latest study to peer at the relationship between heart health and alcohol concludes that shifting drinking patterns across the years might increase the risk of cardiovascular disease.
Selection of alcoholic drinks
Alcohol and heart health are examined once more in a new study.

Alcohol has been addling minds since it was first brewed millennia ago.

Consumed in virtually every country on earth, understanding its health implications is important.

Already, scientists have tied plenty of health hazards to alcohol. Among other conditions, it increases the risk of certain cancers, stroke, and liver disease.

Heavy drinking has conclusively been shown to harm health, but there is still discussion surrounding the fine print.

For instance, although light drinking has been shown to increase cancer risk, there is also evidence that light drinking could protect the heart.

A recent study found that people who drank one or fewer drinks per day had lower cardiovascular risk than people who drank more, as well as people who abstained completely. Could a small amount of alcohol be heart protective?

However, the increased cardiovascular risk seen in people who do not drink at all may not be what it seems. Some have made the point that individuals who do not drink now might still have been drinkers in the past.

In other words, someone who hasn't touched a drop for months may have still been a heavy drinker for many years in the past.

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Alcohol and the heart revisited

The latest study, which is published in the journal BMC Medicine, set out to clear up this query by comparing rates of coronary heart disease (CHD) in individuals who have never drunk and those who used to drink but quit.

As corresponding author Dr. Dara O'Neill, who works at University College London in the United Kingdom, says, "This study uses long-term data to distinguish between persistent non-drinkers and former drinkers, allowing us to test the established theory that only the latter have an elevated risk of CHD."

To investigate whether the theory held true, they examined data from 35,132 people taken from six earlier studies in the U.K. and France. The data included self-reported weekly alcohol intake across a period of 10 years. Of the 35,132 people, 1,718 (4.9 percent) developed CHD. In 325 of the cases (0.9 percent), the person died.

Did persistent non-drinkers have a lower cardiovascular risk than former drinkers, as hypothesized? Dr. O'Neill says, "We did not find this to be the case, but we did observe a sex-related difference. Amongst consistent non-drinkers, women showed higher risk of developing CHD compared to consistently moderate drinkers, but their male counterparts did not."

CHD incidence was highest for former drinkers (6.1 percent had a CHD event), while incidence was lowest in consistently heavy drinkers (3.8 percent experienced a CHD event).

However, the scientists make it clear that because there were so few people who drink heavily in the dataset, the apparent reduction in risk should not be taken as fact.

As Dr. O'Neill points out, "Given that heavy drinkers are known to be undersampled in population-level surveys, interpretation of the absence of effect amongst heavy drinkers in the current study should be done very cautiously, particularly in light of the known wider health impact of heavy alcohol intake levels."

They showed that individuals who drank sensibly and in line with U.K. guidelines over a 10-year period had a lower risk than those who never drank, those who inconsistently drank in moderation, and those who had stopped drinking.

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Consistency and fluctuation

According to the authors, these findings suggest that fluctuations in drinking patterns over time are associated with an increase in CHD risk. It is probable that changes in drinking patterns mirror life events, such as long periods of ill health or other life stresses, including divorce, bereavement, or unemployment.

This complex interaction makes studies such as this difficult to draw meaning from. We all have long, complicated lives, wherein a myriad of influences increase or decrease health risks. To investigate these relationships further, the researchers split the data into age groups.

"When we split the sample by age," explains Dr. O'Neill, "we found that the elevated risk of incident CHD amongst inconsistently moderate drinkers was observed in participants aged over 55, but not those aged below," adding:

"It may be that the older group experienced lifestyle changes, such as retirement, which are known to co-occur with increases in alcohol intake and that these could have played a role in the differing risk."

As with any study that looks at alcohol intake and health, there are unavoidable gaps and plenty of room for future improvements. For instance, heavy drinkers who had fallen ill early on in the study may have dropped out, skewing the data.

Also, as ever, this is an observational study, meaning that cause and effect can not be proven. In the long line of studies investigating long-term alcohol intake and heart health, this study adds another slice of information but still leaves plenty of questions unanswered.

Thanks to humanity's fascination with alcohol, studies unpicking its potential benefits and pitfalls are sure to continue.

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High cholesterol early in life boosts heart disease risk

High levels of low-density lipoprotein cholesterol can increase a person's risk of cardiovascular disease. People may worry more about their cholesterol levels when they age, but new research suggests that they should take preventive action much earlier.
ldl cholesterol chart
You may need to start monitoring your cholesterol levels earlier in life to avoid cardiovascular disease, a new study suggests.

A new study — the findings of which appear in the journal Circulation — suggests that people with high levels of low-density lipoprotein (LDL) cholesterol early in life may experience an increased lifetime risk of death related to cardiovascular disease (CVD).

LDL cholesterol can increase cardiovascular risk at high levels because it leads to lipid buildup in the arteries, which can affect the blood flow to and from the heart.

In the new study, which was of an observational nature, the scientists considered the links between LDL cholesterol levels, high-density lipoprotein (HDL) cholesterol levels, and the risk of premature death related to CVD and coronary heart disease (CHD).

Specifically, the researchers wanted to find out whether individuals currently considered at low risk of CVD or CHD for the coming 10 years may benefit from learning about their cholesterol levels earlier in life and keeping them in check so as to prevent the development of complications.

"High cholesterol at younger ages means there will be a greater burden of cardiovascular disease as these individuals age. This research highlights the need to educate Americans of any age on the risks of elevated cholesterol, and ways to keep cholesterol at a healthy level throughout life."

Dr. Robert Eckel, the former president of the American Heart Association (AHA)

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While usually, studies about cholesterol levels and cardiovascular risk recruit participants who are at moderate to high risk of developing cardiovascular conditions, the new research focused on younger and mostly healthy individuals.

For this study, the researchers recruited 36,375 participants — of which 72 percent were men — aged 42, on average, via the Cooper Center Longitudinal Study. All the participants were free of both diabetes and CVD at baseline, and the investigators followed their health progression for a period of 27 years.

The researchers revealed that, for people who were otherwise at low risk of CVD, high LDL levels were independently associated with a heightened risk of CVD-related death.

Specifically, when compared with participants with normal LDL levels (under 100 milligrams per deciliter), those with high LDL levels (between 100–159 milligrams per deciliter) had a 30–40 percent higher likelihood of experiencing premature death due to CVD.

Also, compared with participants who displayed normal LDL readings, those with LDL cholesterol levels of 160 milligrams per deciliter or higher had a 70–90 percent higher risk of CVD-related death.

In total, within the study cohort, there were 1,086 CVD-related deaths and 598 deaths related to CHD.

"Our study demonstrates that having a low 10-year estimated cardiovascular disease risk does not eliminate the risk posed by elevated LDL over the course of a lifetime," says lead study author Dr. Shuaib Abdullah, from the University of Texas Southwestern Medical Center in Dallas.

"Those with low risk should pursue lifestyle interventions, such as diet and exercise, to achieve LDLs levels as low as possible, preferably under 100 [milligrams per deciliter]," Dr. Abdullah advises, adding, "Limiting saturated fat intake, maintaining a healthy weight, discontinuing tobacco use, and increasing aerobic exercise should apply to everyone."

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Panic attack vs. heart attack: How to tell the difference

The symptoms of a panic attack and a heart attack can be very similar, making it difficult to tell the difference.

Also, having a heart attack can cause someone to panic, which may make the situation more confusing. If someone thinks they may be having a heart attack, they should seek emergency medical attention.

Every year, about 2 to 3 percent of people in the United States experience panic disorder. Symptoms of a panic attack can include:

sharp pain in the chest tingling in the hands shortness of breath racing heart sweating shaking

Every year, about 735,000 people in the United States have a heart attack. Symptoms of a heart attack can include:

chest pain shortness of breath nausea vomiting sweating

While the symptoms of these two conditions overlap, knowing how to tell the difference can be lifesaving.

How to tell the difference Knowing the difference between a panic attack vs. heart attack can be difficult, especially if a person has never experienced the symptoms of either before. Distinguishing between the two conditions can be made easier by several factors, including: Characteristics of the pain Woman having heart attack or panic attack
A squeezing sensation may characterize a heart attack.

Although chest pain is common to both a panic attack and a heart attack, the characteristics of the pain often differ.

During a panic attack, chest pain is usually sharp or stabbing and localized to the middle of the chest.

Chest pain from a heart attack may resemble pressure or a squeezing sensation.

Chest pain that occurs due to a heart attack may also start in the center of the chest, but can then radiate from the chest to the arm, jaw, or shoulder blades.


The onset of symptoms may also help a person know if they are having a panic attack or heart attack.

Although both conditions can develop suddenly and without warning, there may still be some differences.

Sometimes heart attacks come on due to physical exertion, such as climbing the stairs.


The duration of symptoms might also help distinguish between a heart attack and panic attack.

Although it can vary, most panic attacks are over in 20 to 30 minutes.

During a heart attack, symptoms tend to last longer and get worse over time. For example, chest pain may be mild at the onset of a heart attack but become severe after several minutes.

Thank you for supporting Medical News Today Can a panic attack cause a heart attack? A panic attack will not cause a heart attack. A blockage in one or more of the blood vessels to the heart, which leads to an interruption of vital blood flow, causes a heart attack. Although a panic attack will not cause a heart attack, stress and anxiety might play a role in the development of coronary artery disease. Panic attacks can occur as isolated events or as part of an anxiety disorder. Some research indicates that people with anxiety disorders may have an increased risk of developing heart disease due to low heart rate variability (HRV). HRV is the time between each heartbeat. The autonomic nervous system controls the heart rate. The heart rate is meant to vary throughout the day, depending on a person's activities and emotions. A high HRV indicates that a person's heart rate shifts efficiently throughout the day, based on what they are doing. It is also a sign that their autonomic nervous system is working well. A low HRV means a person's heart does not switch gears as efficiently. Some studies associate a low HRV with an increased risk of heart disease. In the researchers' analysis of studies looking at HRV in people who were diagnosed with various types of anxiety disorder, including panic disorder, the results indicated the participants had a lower HRV than those without an anxiety disorder. It is crucial to understand that having a panic attack or panic disorder does not mean someone will have a heart attack. Additional research is needed to say if having panic disorder increases the risk of developing heart disease, definitively. When to see a doctor A doctor at a desk showing tablet to patient
A doctor may use a cardiogram to accurately diagnose heart disease. As the symptoms of panic attacks and heart attacks are similar, it is always best to seek immediate medical attention when in doubt. It is vital to seek emergency medical treatment if any of the following symptoms develop: sudden severe chest pain pressure in the chest, lasting more than 2 or 3 minutes chest pain, radiating down the arm or into the jaw According to the Woman's Heart Foundation, doctors may mistake heart disease for panic attacks in women. Medical tests, such as an electrocardiogram and blood tests, can help a doctor make an accurate diagnosis. A person's outlook and recovery can improve when they receive prompt treatment for a heart attack. Even if symptoms are not due to a heart attack, a person can also receive medical treatment for a panic attack. Thank you for supporting Medical News Today Outlook The outlook will vary, depending on whether a person has experienced a heart attack or a panic attack. Although a panic attack may feel very uncomfortable, it is not life-threatening. Panic attacks can interfere with a person's quality of life, so they should seek appropriate treatment. A doctor can help treat anxiety and panic attacks with various techniques, including lifestyle modifications, medication, and counseling. In some cases, a heart attack can be life-threatening. With prompt treatment, many people survive a heart attack. Following a heart attack, a person will also need to take steps to manage the underlying heart disease. Q: Is there a way to rule out a heart attack at home, or should a person always seek emergency medical attention? A: People should always seek emergency medical attention when having chest pain or discomfort, chest pain that radiates to other parts of the body, or shortness of breath. Some other symptoms that might accompany a heart attack include nausea, sweating, and lightheadedness. Gerhard Whitworth, RN Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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New 'triple pill' could eliminate high blood pressure

A new combination drug may have the potential to revolutionize hypertension treatment worldwide, after a clinical trial has declared it safe to use and very effective.
concept photo of heart pills and pulse
A recent clinical trial has confirmed that a new pill can treat hypertension more effectively than traditional therapy.

In a recent clinical trial led by researchers from the George Institute for Global Health — with branches in the United Kingdom, Australia, and India — they tested the effectiveness and safety of using an innovative drug for the treatment of high blood pressure, or hypertension.

This drug, nicknamed the "triple pill" by the investigators, combines low doses of three existing drugs for blood pressure.

Namely, these are: telmisartan (20 milligrams), amlodipine (2.5 milligrams), and chlorthalidone (12.5 milligrams).

According to World Health Organization (WHO) data from 2008, about 40 perecent of adults aged over 25 had raised blood pressure worldwide. The WHO also estimate that hypertension is responsible for 7.5 million of all deaths across the globe.

That is because this condition is a major risk factor for both heart disease and stroke, making it a priority to have effective treatments in place for the regulation of blood pressure.

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Normally, people with hypertension start taking one blood pressure drug at low doses, only to have to return to their doctors time and again. They then get prescriptions for increasingly higher doses and more hypertension drugs.

According to study co-author Dr. Ruth Webster, "Patients are brought back [to the doctor's office] at frequent intervals to see if they are meeting their targets with multiple visits required to tailor their treatments and dosage."

"The problem with this approach," she adds, is that it "is not only time inefficient, it's costly. We also know that many doctors and patients find it too complicated and often don't stick to the process."

So, Dr. Webster and colleagues tested a method that, they hoped, would be more efficient, would not have additional side effects, and would remove some of the inconveniences related to a traditional treatment.

This is how they came up with the "triple pill," which combines fixed low doses of three already existent drugs commonly used to treat hypertension.

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'Triple pill' vs. traditional therapy

The clinical trial testing the efficacy and safety of the new combination pill took place in Sri Lanka. It involved 700 participants — aged 56, on average — whose average blood pressure amounted to 154/90 millimeters of mercury (mm Hg), which is a typical sign of hypertension.

Of all the participants, some took the combination pill, while others continued to follow their usual blood pressure-lowering therapy, as per their doctors' advice.

In contrast to those following traditional therapy for hypertension, a larger number of those taking the combination pill were able to lower their blood pressure effectively, reaching their target pressure of 140/90 mm Hg or under.

The target for individuals with diabetes or kidney disease was 130/80 mm Hg, which many people taking the "triple pill" were able to reach.

More specifically, 70 percent of the people taking the "triple pill" achieved their target blood pressure, compared with a little over 50 percent of the participants who continued on traditional hypertension therapy.

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In the study paper they published in JAMA, the authors explain that after 6 months from the start of the trial, 83 percent of the people who had started on the "triple pill" were still following this same treatment.

To the contrary, most of the participants following a traditional treatment had added medication or increased drug quantities by the 6-month mark.

"The World Heart Federation [have] set an ambitious goal that by 2025 there will be a 25 percent reduction in blood pressure levels globally," says study co-author Prof. Anushka Patel.

"The triple pill," she continues, "could be a low-cost way of helping countries around the world to meet this target."

'This study has global relevance'

Researchers at the George Institute believe that their "triple pill" could really make a difference to current therapy for hypertension.

Right now, the team is looking into the combination drug's cost effectiveness for various countries and putting into place strategies to make the drug accessible across the world. "This study has global relevance," says Prof. Patel.

"While the most pressing need, from the perspective of the global burden of disease, is low- and middle-income countries, it's equally relevant in a country like Australia where we're still achieving only [40–50 percent] control rates for high blood pressure."

Prof. Anushka Patel

In the video below, you can listen to Prof. Patel as she explains exactly how the "triple pill" works.

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How much salt does it really take to harm your heart?

Too much salt is bad for you, particulary because it is associated with an increased risk of heart problems — but how much is too much? A new study suggests that we may not have to worry so much about how salty we like our food to be.
salt shaker
A new international study suggests that we may want to rethink how much salt is actually harmful.

Table salt, which we commonly use to season our food, contains sodium.

Sodium, if often ingested in large quantities, can lead to a range of cardiovascular problems, including hypertension.

The World Health Organization (WHO) say that a person should not consume more than 2 grams of sodium per day, which is about 5 grams of salt per day.

The American Heart Association (AHA) recommend no more than 2.5 grams of sodium per day, though they state that the ideal intake is of no more than 1.5 grams per day for an adult.

However, researchers from a range of international institutions — including McMaster University and Hamilton Health Sciences, both in Hamilton, Canada, as well institutions from 21 other countries — suggest that these limits are unnecessarily low.

Researcher Andrew Mente and colleagues conducted a study of 94,000 people aged 35–70, aiming to establish how much sodium really is too much for heart health.

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Current guidelines, the team notes, push for standards that are unrealistic for many, seeing as salt is often an almost invisible ingredient contained by numerous packaged foods.

"The [WHO recommend] consumption of less than 2 grams of sodium — that's one teaspoon of salt — a day as a preventative measure against cardiovascular disease," says Mente.

He also adds, however, that "there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level."

The new study, whose results are now featured in The Lancet, now suggests that we can be more lenient about our salt consumption without fearing that it will harm our cardiovascular health.

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Slightly higher sodium intake is safe

The study followed the participants — who were based in communities across 18 different countries — for an average period of 8 years.

Mente and his colleagues revealed that a high intake of sodium did lead to an increased risk of cardiovascular disease and stroke — but only in communities where the average intake for an adult was greater than 5 grams per day.

This amounts to about 2.5 teaspoons of table salt, the researchers explain.

Encouragingly, the researchers also noticed that under 5 percent of the participants coming from developed countries exceeded the 5-gram cutoff point for sodium intake.

In most of the countries, the majority of the communities that the researchers observed had an average sodium intake of 3–5 grams of sodium — or 1.5 to 2.5 teaspoons of salt — per day.

In fact, of all the populations in the study, only those from China showed a consistently high intake of sodium. Specifically, 80 percent of the communities from China had a sodium intake that was higher than 5 grams per day.

"Only in the communities with the most sodium intake — those over 5 grams [per] day of sodium — which is mainly in China, did we find a direct link between sodium intake and major cardiovascular events like heart attack and stroke," Mente explains.

On the other hand, he adds, "In communities that consumed less than 5 grams of sodium a day, the opposite was the case. Sodium consumption was inversely associated with myocardial infarction or heart attacks and total mortality, and [there was] no increase in stroke."

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Community interventions can help

Even in the case of individuals who do consume too much table salt, however, the situation is not unsalvageable, the researchers say.

Mente notes that people can easily redress the balance and protect their heart health by making a few simple adjustments to their diets, such as adding more fruits, vegetables, and foods naturally rich in potassium.

"We found all major cardiovascular problems, including death, decreased in communities and countries where there is an increased consumption of potassium which is found in foods such as fruits, vegetables, dairy foods, potatoes, and nuts and beans," says the study author.

Another one of the researches involved with the current study, Martin O'Donnell, notes that most of the studies looking at the relationship between sodium intake and cardiovascular risk so far have focused on individual data, rather than information collected from larger cohorts.

This, he suggests, may have skewed the best practice guidelines into a direction that is both unrealistic and perhaps too cautious.

"Public health strategies should be based on best evidence. Our findings demonstrate that community-level interventions to reduce sodium intake should target communities with high sodium consumption, and should be embedded within approaches to improve overall dietary quality."

Martin O'Donnell

"There is no convincing evidence that people with moderate or average sodium intake need to reduce their sodium intake for prevention of heart disease and stroke," O'Donnell adds.

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What is the difference between heartburn and acid reflux?

Understanding the differences between heartburn, acid reflux, and gastroesophageal reflux disease involves understanding the links between them.

According to the American College of Gastroenterology, heartburn is a common digestive complaint in the United States, affecting more than 60 million Americans each month.

Heartburn is not a condition on its own, and it has nothing to do with the heart. Instead, it is a symptom of acid reflux.

If symptoms of acid reflux occur frequently, it can indicate that a person has gastroesophageal reflux disease (GERD).

Distinguishing between heartburn, acid reflux, and GERD may be hard, because they may all feel the same in the moment. However, understanding the differences can help a person find the right treatment.

Symptoms The following symptoms can help a person to tell the difference between acid reflux, heartburn, and GERD: Symptoms of acid reflux Heartburn vs. acid reflux
Acid reflux causes stomach acid to travel up the food pipe into the mouth.

Acid reflux is sometimes called gastroesophageal reflux or GER. It occurs when stomach acid travels up the food pipe to the mouth.

This can happen when the muscle at the bottom of the food pipe, which acts as a gateway to the stomach, becomes weak or loose.

Heartburn is a burning sensation in the chest or abdomen, and it has nothing to do with the heart. People often feel heartburn behind the breastbone and after eating. It can get worse when sitting or lying down.

Heartburn is the most common symptom of acid reflux, though it does not appear in every case.

Acid reflux also causes the following symptoms:

bad breath nausea or vomiting difficulty or pain when swallowing breathing problems

Symptoms of GERD

GERD is the term for chronic acid reflux. The symptoms are the same, but they happen more frequently with GERD.

If a person experiences symptoms of acid reflux more than twice a week for a few weeks, they may have GERD. The disease affects about 20 percent of the U.S. population.

Causes The stomach is built to withstand acid. The food pipe is not, and when acid rises into it, a person experiences burning pain. The muscle at the end of the food pipe is called the lower esophageal sphincter. It can weaken or relax, and potentially cause acid reflux, for several reasons. For example, high amounts of pressure on the abdomen can cause the sphincter to grow slack. For this reason, acid reflux is common in people who are overweight, obese, or pregnant. Other causes of acid reflux involve: smoking or regular exposure to secondhand smoke alcohol consumption a type of hernia called a hiatal hernia eating large meals eating late at night or just before bed consuming high-fat or fried foods acidic drinks, such as fruit juice Various medications can also trigger acid reflux, including: Thank you for supporting Medical News Today Heartburn vs. heart attack Heartburn vs. acid reflux chest pain
Seek medical care immediately if chest pain accompanies shortness of breath and a squeezing feeling. Chest pain and related symptoms are among the top reasons for visits to emergency departments in the U.S. Acid reflux is a common cause of chest pain, and it can be easy to confuse this pain with that of a heart attack. Because heartburn can spread to the neck, throat, and jaw, it may feel like the radiating chest pain of a heart attack. There are a few ways to tell the difference between heartburn and a heart attack. If the pain improves after a quick antacid or a belch, or if there is a sour taste in the mouth, a person most likely has heartburn. A person having a heart attack often experiences a feeling of squeezing or pressure and shortness of breath. Due to the seriousness of a heart attack, The American Heart Association recommend that anyone who believes they may be having a heart attack should seek medical care as soon as possible. This includes people who are unsure whether their chest pain results from a heart. Diagnosis A doctor is a good place to start for an acid reflux or GERD diagnosis. Assessments typically begin with a few questions and a review of the person's medical history. The doctor may suggest changes to the diet or medications because these can influence symptoms. If the symptoms persist, especially any related to swallowing, the doctor may work with a gastroenterologist, surgeon, or another healthcare professional to confirm a diagnosis. Tests that can help diagnose GERD include: Upper gastrointestinal (GI) endoscopy and biopsy. A doctor inserts a thin, tube-like camera down the food pipe to look inside the stomach and perhaps take a tissue sample. Upper GI series. A doctor checks X-rays to see whether something inside the body, such as a hernia, is causing the acid reflux. Esophageal pH and impedance monitoring. The doctor places a thin tube inside the food pipe for about 1 day to measure acid levels. Bravo wireless esophageal pH monitoring. The doctor monitors acid levels using a small capsule inside the food pipe and a receiver outside the body. Esophageal manometry. This allows the doctor to measure muscle contractions in the food pipe. Complications If a person does not receive treatment for GERD, it can lead to more severe complications, including: esophagitis, or inflammation of the food pipe narrowing of the food pipe that causes trouble swallowing respiratory problems, such as pneumonia or laryngitis Barrett's esophagus, a condition that causes cells in the food pipe to change. Without treatment, this can potentially lead to cancer. Thank you for supporting Medical News Today Treatment and prevention Heartburn vs. acid reflux antacids
Antacids neutralize stomach acid and may reduce the symptoms of acid reflux. Acid reflux and GERD are treatable with medications, lifestyle changes, or both. Some medications for acid reflux include: Antacids, which neutralize stomach acid. Options include Tums, Rolaids, Pepto-Bismol, and Mylanta. Many brands can be purchased online. H2 blockers, which reduce acid production. Options include Pepcid, Zantac, Axid, and Tagamet. Proton pump inhibitors, a group of longer-term prescription medications that can reduce stomach acid. Options include Nexium, Prevacid, and Prilosec. Prokinetics, a type of prescription drug that helps to empty the stomach more quickly. Options include Reglan and Urecholine. People with acid reflux or GERD can manage symptoms by taking steps to avoid triggers. Start by avoiding some or all of the following: fried and fatty foods large meals smoking alcohol coffee tomatoes and tomato products spicy food peppermint citrus fruits and juices Weight loss can also help to reduce symptoms, as it decreases pressure on the food pipe. People should also try not to eat late at night or lie down soon after eating. In serious cases of GERD, surgery may help to strengthen the muscles in the gut. Children and pregnancy Children, adolescents, and pregnant women often experience acid reflux. Heartburn may occur with 17 to 45 percent of pregnancies. Fortunately, over-the-counter heartburn and acid reflux treatments tend to be safe to use during pregnancy. About 10 percent of teenagers and pre-teens experience GERD, according to the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. The symptoms, diagnosis, and treatments for children with GERD are similar to those for adults. Check with a pediatrician to learn more. When to see a doctor If acid reflux occurs on a regular basis, use an antacid, and try different brands if the first is ineffective. Also, try making lifestyle changes, such as eliminating certain foods or drinks from the diet. If the acid reflux still recurs after making these changes, it may be time to call the doctor. Although chest pain is often a symptom of acid reflux or GERD, do not hesitate to visit the doctor or the emergency room if it seems more serious. Sometimes GERD symptoms warrant urgent attention. A person experiencing any of the following should seek immediate medical care: regular, forceful vomiting persistent upper body pain difficulty breathing difficulty swallowing Outlook The relationship between heartburn and acid reflux is that of a symptom and its cause. Heartburn is a painful, common problem that can affect a person's quality of life. To eliminate it, a person needs to treat the underlying cause, which is acid reflux. Manage symptoms of acid reflux by avoiding the many potential triggers. If acid reflux goes unchecked or untreated, it may develop into GERD.
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How red blood cells harm cardiovascular health in diabetes

People with type 2 diabetes are more exposed to cardiovascular injury and recover with more difficulty from events such as heart attacks. Still, it has so far been unclear why that is, exactly. Two new studies now explain the causes.
red blood cells concept
Researchers investigate why people with type 2 diabetes are more exposed to cardiovascular injury.

According to the National Institute of Diabetes and Digestive Kidney Diseases, an estimated 23.1 million people in the United States have type 2 diabetes.

This is a metabolic disease in which the pancreas does not produce enough of the hormone tasked with keeping blood sugar levels in check.

The Centers for Disease Control and Prevention (CDC) note that people with type 2 diabetes face twice the risk of heart disease and stroke, compared with those who are free of diabetes. They are also exposed to cardiovascular risks at an earlier age, say the CDC.

However, the reasons why people with diabetes are more exposed to cardiovascular harm have remained largely unclear, which also means that there is currently no specific preventive treatment.

Now, scientists from the Karolinska Institutet in Stockholm, Sweden, have conducted a series of studies to further investigate the causes of cardiovascular risk in diabetes.

They have revealed that red blood cells undergo certain changes in the case of people with type 2 diabetes, which means that those individuals are more predisposed to heart problems and less well equipped to recover following a cardiovascular event.

These findings now appear in two related papers: the first one published in The Journal of the American College of Cardiology, and the second one in JACC: Basic to Translational Science.

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'Damage to the innermost cell layers'

In the first paper, the authors report that when otherwise healthy blood vessels come into contact with red blood cells taken from people with diabetes, the vessels' tissue became damaged.

"We found that healthy blood vessels exposed to red blood cells from patients with type 2 diabetes suffer damage to their innermost cell layers, the endothelial cells."

Study co-author Prof. John Pernow

"This phenomenon, which is called endothelial dysfunction, appears early on in the development of diabetes-related vessel injury and greatly reduces the ability of the vessels to dilate while aggravating the inflammation," Prof. Pernow explains.

In the second published paper, the research team explains how red blood cells affect heart health and predispose individuals to greater harm in the case of a heart attack.

Prof. Pernow and colleagues conducted experiments using red blood cells from mouse models of diabetes, as well as from human patients with this condition. They ascertained that the increased injury occurs due to the abnormal activity of the enzyme arginase.

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Findings may lead to preventive therapy

Overactive arginase can impair the production of the free radical nitric oxide, which would normally help blood vessels dilate. It also increased the production of other harmful free radicals within red blood cells.

These findings also allowed the researchers to come up with a solution to address the problem.

"We also found," says Prof. Pernow, "that treatment that targeted arginase or oxygen-derived free radicals normalised red blood cell function, which meant that their harmful effect on cardiovascular function could be prevented."

In the future, the team hopes that this will eventually lead to new preventive treatments, which would — as far as possible — eliminate the risk of cardiovascular harm in type 2 diabetes.

"Our hope," Prof. Pernow adds, "is that this knowledge will give rise to new treatments, specifically targeted at red blood cells, that prevent vascular injury and protect the heart in the event of heart attack in patients with type 2 diabetes."

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Common chemo drug may cause heart toxicity

New research suggests that the widely used chemotherapy drug doxorubicin may cause heart toxicity, potentially leading to congestive heart failure.
doctor's hand changing iv drip
New research examines the effects of a common chemotherapy drug on the heart, spleen, and the body's immune cells.

Doxorubicin is a chemotherapy drug commonly used to treat certain types of cancer, such as breast, bladder, stomach, lung, and ovarian cancer. Sometimes, it is also used to treat cancer of the uterus.

The drug stops cancer cells from spreading by blocking an enzyme that cancer cells need in order to divide and multiply.

Despite the drug's widespread use, its effects on the body's immunometabolism — that is, how the body's metabolism regulates the behavior of immune cells — are largely unknown.

So, researchers at the University of Alabama at Birmingham (UAB) set out to fill this research gap by investigating the effects of the drug doxorubicin on the immunometabolism of mice.

Ganesh Halade, Ph.D. — an assistant professor in UAB's Division of Cardiovascular Disease — led the researchers, who have now published their findings in the American Journal of Physiology: Heart and Circulatory Physiology.

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Halade and colleagues treated 2-month-old, cancer-free male mice with either a high or low dose of the drug. The researchers also treated a group of control mice with saline solution.

After sacrificing the rodents, the team studied the effects of the drug on their organs and tissues.

Doxorubicin caused fibrosis of the heart, in which the heart's walls stiffen and cannot contract as much. This, in turn, causes the heart to malfunction. As a result, the mice's hearts couldn't pump as much blood as they should.

The drug also induced programmed cell death and caused the heart and spleen to shrink.

The main roles of the spleen are to filter the blood and protect the body against pathogens.

This organ — which is the largest in the lymphatic system — stores immune cells and, in the case of a heart attack, releases and sends them to the site of the heart injury to clear the damage. In this study, however, the researchers showed that doxorubicin harms the spleen.

The drug also reduced levels of two enzymes key for the body's immune response: lipoxygenases and cyclooxygenases.

Doxorubicin decreased the levels of these enzymes in the left ventricle of the heart. In turn, this lowered the levels of other lipid mediators that would normally stop the inflammation.

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Also, the drug killed a group of immune cells called CD169+ macrophages, which induced a wasting syndrome in the spleen.

The name macrophages literally means "big eaters," as the main job of these large white blood cells is to locate and "eat up" pathogens.

Finally, the drug upset the balance of two cell signaling molecules: chemokines and cytokines. As the authors explain, this suggests that the leukocytes in the spleen were less able to defend the body against pathogens.

These findings, explains Halade, suggest that doxorubicin has a "splenocardiac impact" that needs to be studied further in order to minimize the harms of the drug on the heart and spleen.

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Too much sleep could be worse for health than too little

Sleeping more or less than 7–8 hours per night could be bad for your health, with too much sleep being worse than too little, say researchers.
young woman sleeping
Both too much and too little sleep can lead to poor health.

An analysis of pooled data from dozens of studies covering more than 3 million people finds that self-reported sleep duration outside of 7–8 hours each night is linked to a higher risk of death and cardiovascular diseases.

The study — which scientists at Keele University in the United Kingdom led and which is now published in the Journal of the American Heart Association — found a "J-shaped" relationship between duration of sleep and deaths. The same relationship was observed with incidents of cardiovascular illness.

The authors say that their findings suggest that sleeping for more than 7–8 hours "may be associated with a moderate degree of harm" compared with sleeping less.

The J-shaped relationship showed that the size of the risk rose in line with greater duration of sleep. Sleeping for 9 hours, for example, carried a 14 percent higher risk of death, while 10-hour sleeps carried a 30 percent higher risk.

The results also showed that poor-quality sleep was linked to a 44 percent higher risk of coronary heart disease.

"Our study," says lead study author Dr. Chun Shing Kwok, a clinical lecturer in cardiology at Keele University, "has an important public health impact in that it shows that excessive sleep is a marker of elevated cardiovascular risk."

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Cardiovascular diseases and events

Cardiovascular disease is an umbrella term for disorders of the heart and blood vessels. The heart provides the pressure for pumping the blood through the vessels that carry it to all parts of the body.

Some of the diseases overlap due to a common underlying condition. Atherosclerosis, for example, is an inflammatory condition in which plaque builds up in artery walls and restricts blood flow. This can lead to heart disease, heart attack, and stroke.

Heart failure, in which the heart does not pump enough blood to meet the body's needs, is another type of cardiovascular disease. Abnormal heartbeat, or arrhythmia, and defective heart valves are also classed as cardiovascular diseases.

In the United States, where 610,000 people die of it every year, heart disease is the primary cause of death in men and women.

Also, every year in the U.S., around 735,000 people experience a heart attack. This number includes 210,000 people for whom it is not their first.

In their analysis, the researchers focused on links between sleep, rates of death, and cardiovascular events such as heart attack, stroke, and coronary heart disease.

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Sleep duration and quality

In their study paper, the researchers explain that while there appears to be "growing evidence" to support the idea, current guidelines for reducing the risk of cardiovascular diseases "make limited recommendations" about duration and quality of sleep.

The National Sleep Foundation's latest guidelines recommend 7–9 hours of sleep every night for adults aged 26–64, and 7–8 hours for older people.

For their study, the researchers used 7–8 hours as the recommendation against which to compare the various results.

They note that while previous studies had examined the relationship between hours of sleep, deaths, and cardiovascular disease, they had not evaluated the effect of each hour of increase or decrease on the relationship. Also, none had evaluated the effect of sleep quality.

They suggest that their findings are significant because they highlight a problem with longer as opposed to shorter sleep, and that the greater the duration of sleep, the more severe the problem appears to be.

They also note that their study is the first to declare sleep quality as a risk factor for coronary heart disease and suggest that doctors should take into account "nonrestorative sleep (or 'waking up unrefreshed')" when they assess their patients.

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Mechanisms are poorly understood

The biology of the relationship between sleep duration, sleep quality, and cardiovascular diseases and mortality is unclear. Those who have studied it conclude that it is complex and involves many factors that interact with each other.

There is some evidence that insufficient sleep raises levels of the energy and appetite hormones leptin and ghrelin and that this can lead to obesity and impaired control of blood sugar. Reduced sleep can also promote inflammation, which some have linked to cardiovascular diseases and cancer.

Too much sleep may be linked to cardiovascular diseases because of existing conditions that increase fatigue. These include persistent inflammatory conditions and anemia.

Scientists also tie low physical activity, depression, unemployment, and low socioeconomic status to longer sleep. These may contribute to, but they could also mask, the link between longer sleep duration and cardiovascular disease and risk of death.

Dr. Kwok remarks that in modern society sleep is subject to many "cultural, social, psychological, behavioral, pathophysiological, and environmental influences."

These influences arise for many different reasons. He lists examples ranging from caring for children and other relatives, to shift-working, mental and physical illnesses, and the "24-hour availability of commodities."

"Our findings have important implications as clinicians should have greater consideration for exploring sleep duration and quality during consultations."

Dr. Chun Shing Kwok

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How 30 minutes of hookah smoking affects your heart

Smoking traditional cigarettes causes a range of serious health issues, but many people think alternatives such as electronic cigarettes or waterpipe smoking are less harmful. The conclusions of a new study dispel such beliefs.
hookah smoking
A new study shows that only 30 minutes of hookah smoking has serious cardiovascular consequences.

The practice of hookah smoking, or waterpipe smoking, has been around for centuries.

Originating in Africa and Asia, hookah smoking has become a worldwide phenomenon in the past few decades — particularly among teenagers.

The practice is widely perceived and marketed as a safer alternative to traditional cigarettes.

However, the World Health Organization (WHO) warn that "contrary to ancient lore and popular belief, the smoke that emerges from a waterpipe contains numerous toxicants known to cause lung cancer, heart disease, and other diseases."

A new study conducted by researchers at the University of California Los Angeles (UCLA) supports the WHO's conclusion. Specifically, the researchers show the effects of just one session of hookah smoking on heart rate, blood pressure, and arterial stiffness.

The researchers — led by Mary Rezk-Hanna, an assistant professor at UCLA — published their findings in the American Journal of Cardiology.

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Hookah smoking and cardiovascular health

Rezk-Hanna and her colleagues investigated the cardiovascular effects of hookah smoking in 48 healthy young adults who were not in the habit of smoking traditional cigarettes.

To examine these effects, the researchers took the following measurements: heart rate, peripheral and central blood pressure, a measure of arterial stiffness called "carotid-femoral pulse wave velocity," and an index of aortic enlargement.

Arterial stiffness, or the loss of arterial elasticity, is a reliable predictor of stroke. The enlargement of the aorta — which is the main artery that transports blood from the heart to the rest of the body — is a condition that can be fatal if left untreated.

Both aortic enlargement and artery stiffness can increase the risk of heart attack and other adverse cardiovascular events.

In the new study, the researchers also looked at blood levels of nicotine, as well as the levels of exhaled carbon monoxide.

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Not a more healthful alternative to cigarettes

After only 30 minutes of hookah smoking, the participants' heart rates increased by 16 beats per minute, and their blood pressure rose.

Additionally, the researchers found hookah smoking to heighten arterial stiffness to a degree comparable with the damage caused by smoking one traditional cigarette.

The results are concerning given that the study tested only the effects of half an hour of smoking, whereas most people smoke hookahs for several hours.

The authors report additional concerns. "We know that flavored tobacco products are frequently the first kind of tobacco product used by youth," says the study's lead author.

"One of the major issues with hookah is the fact that the tobacco is flavored with fruit, candy, and alcohol flavors, making hookah the most popular flavored tobacco product among this audience."

"Our findings challenge the concept that fruit-flavored hookah tobacco smoking is a healthier tobacco alternative. It is not."

Mary Rezk-Hanna

To the authors' knowledge, this is the first time that a study has examined the effects of hookah smoking on the elasticity of the arteries.

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Scientists link 151 genes to atrial fibrillation

Using genomic data from more than 1 million people, scientists have picked out 151 genes that are likely associated with atrial fibrillation, which is a condition that causes irregular heartbeat and raises the risk of stroke.
female genetic scientists in a lab
New research uncovers 151 genes linked to A-fib.

The findings of the "big data" international study — now published in the journal Nature Genetics — should improve our understanding of the biology of atrial fibrillation (A-fib) and lead to better treatments.

They could also "have important implications for precision health and prevention of cardiovascular disease," says co-senior study author Cristen J. Willer, an associate professor of computational medicine and bioinformatics at the University of Michigan in Ann Arbor.

From the genes that they identified, the researchers compiled a genetic "risk score" for helping to pick out individuals at higher risk for A-fib for closer monitoring.

Many of the genes influence heart development in the fetus. The team says that this implies that variants in these genes could instil susceptibility to A-fib before birth.

Another possibility is that they could cause genes that have been inactive since before birth to switch on again in adulthood.

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A-fib needs new treatments

Around 2.2 million people in the United States have A-fib, a condition in which the left side of the heart's upper chamber, or atrium, beats irregularly. This causes blood to pool and raises the likelihood of blood clots.

If a blood clot forms in the atrium, it can travel to the brain and block one of its arteries, giving rise to a stroke. This is why having A-fib raises a person's risk of stroke by an average of four to six times.

Some people with A-fib experience symptoms such as chest pain, fluttering in the chest, fatigue, fainting, and shortness of breath. Others have none.

The earlier A-fib is detected, the greater the chances of preventing stroke, heart failure, and other complications.

However, there are few current options for treating A-fib, and those that do exist rarely cure it and often result in grave side effects.

Willer and her colleagues claim that it is likely that 32 of the 151 genes that they identified interact with drugs already approved for treating other conditions.

They suggest that their findings provide a foundation for further research into whether or not such drugs can prevent or cure A-fib.

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Data from several biobanks

The researchers carried out a genome-wide association study on data pooled from six studies. The datasets came from a number of "biobanks" in different countries. These included datasets from: AFGen Consortium, DiscovEHR, Michigan Genomics Initiative, UK Biobank, deCODE Genetics in Iceland, and the HUNT study in Norway.

By using a collaborative big data approach, the researchers believe that they were able to identify genes that do not emerge from analyses of individual datasets.

They note that many of the risk variants they identified are located near genes where more harmful mutations "have been reported to cause serious heart defects in humans [...] or near genes important for striated muscle function and integrity."

They also discovered that people who develop A-fib early in life carry more of the risk genes than those who develop it later.

The team concludes that, while the findings are significant, further studies now need to confirm them.

"We are hopeful that additional molecular biology experiments will determine how to create sustained regular heart rhythms by studying the genes we and others have identified."

Cristen J. Willer

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Even low air pollution may cause you serious heart problems

A new study that appears in the journal Circulation looks at the effects of low levels of pollution on the anatomy of the heart.
cars in traffic
Living next to a busy road may cause you serious heart problems, a new study suggests.

The perils of air pollution are real and plentiful. Two years ago, a study published in The Lancet Neurology claimed that air pollution was one of the leading risk factors for stroke worldwide.

Also, even low levels of pollution seem to be very harmful. Medical News Today recently reported on a study that linked levels of air pollution deemed "safe" by the Environmental Protection Agency (EPA) with a high risk of diabetes.

Now, Steffen Petersen — a professor of cardiovascular medicine at Queen Mary University of London in the United Kingdom — has led a new study that suggests that low levels of air pollution may cause changes in the heart that are similar to those seen in heart failure.

Dr. Nay Aung, who is also affiliated with Queen Mary University, is the first and corresponding author of the paper.

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Air pollution may cause heart enlargement

Dr. Aung and colleagues examined data on over 3,900 healthy people enrolled in the UK Biobank study.

The participants volunteered information about their health, residential area, and lifestyle, and they allowed the researchers to take measurements of their hearts' size, weight, and function using MRI.

The study revealed a strong correlation between living next to a busy road and therefore being exposed to nitrogen dioxide (NO2) and developing enlarged right and left heart ventricles.

The researchers note that ventricle enlargement of this type is often seen in the early stages of heart failure.

Furthermore, Dr. Aung and team found a dose-response relationship between pollution exposure and changes in heart anatomy.

Using fine particulate matter (PM2.5) to measure air pollution particles, the scientists found that the heart ventricles enlarged by 1 percent for every microgram of PM2.5 per cubic meter and for every 10 micrograms per cubic meter of NO2.

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Air pollution just as important as cholesterol

Dr. Aung comments on the findings, saying, "Although our study was observational and hasn't yet shown a causal link, we saw significant changes in the heart, even at relatively low levels of air pollution exposure."

"Air pollution should be seen as a modifiable risk factor," the first author adds.

"Doctors and the general public all need to be aware of their exposure when they think about their heart health, just like they think about their blood pressure, their cholesterol, and their weight."

Dr. Nay Aung

"Our future studies," says Dr. Aung, "will include data from those living in inner cities like Central Manchester and London, using more in-depth measurements of heart function, and we would expect the findings to be even more pronounced and clinically important."

Prof. Jeremy Pearson, the associate medical director at the British Heart Foundation — a nonprofit organization that partially funded the study — also weighs in on the findings.

"We can't expect people to move home to avoid air pollution," he says. "Governments and public bodies must be acting right now to make all areas safe and protect the population from these harms."

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Vitamin D: Recent research uncovers new benefits

As much of the world experiences a record-breaking heat wave, this Spotlight turns its attention to vitamin D, the so-called sunshine vitamin. Here, we inspect the latest research.
Tropical sun
The "sunshine vitamin" has a range of surprising benefits.

Vitamin D is a hot topic currently, with a raft of studies proclaiming its benefits for a variety of serious conditions.

Conversely, other recent studies have been more cautious, questioning its perceived usefulness for treating some illnesses.

Vitamin D is a nutrient that is synthesized in our skin when it is exposed to sunlight, and it is also present in some foods.

Sunlight is the best source of vitamin D, but in the winter months, the National Institutes of Health (NIH) recommend topping up vitamin D levels by eating vitamin D-containing foods each day. These include oily fish, fortified milk, beef liver, egg yolks, mushrooms, and fortified breakfast cereals.

What does vitamin D do?

Scientists know that vitamin D is essential for many aspects of maintaining good health and that deficiency is linked with problems for both physical and mental health.

Perhaps most notably, vitamin D helps to regulate the levels of calcium in our bodies, strengthening our bones and preventing bone-weakening conditions, such as osteoporosis.

Increasingly though, studies are also suggesting that vitamin D might have protective benefits against heart failure, diabetes, cancer, respiratory tract infections, autoimmune disease, and even hair loss.

A surprisingly large number of people have insufficient levels of vitamin D. For instance, according to one study, more than 40 percent of adults in the United States are deficient. Because of its prevalence, it is important to determine what the public health implications of this epidemic might be.

Symptoms of vitamin D deficiency can vary between individuals, but they typically include pain in the joints, muscles, or bones; fatigue; breathing problems; and low mood or seasonal affective disorder (SAD).

Below, we run through a number of intriguing recent studies that investigate associations between vitamin D and an assortment of illnesses.

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Vitamin D and heart failure

Several studies have suggested that vitamin D could offer protective benefits against cardiovascular illness, but scientists have yet to pinpoint what mechanisms are driving this association.

Recently, though, Medical News Today reported on a study that used a mouse model to investigate how a type of vitamin D, called 1,25-dihydroxyvitamin D3, affects heart cells. In particular, the researchers looked at the cells responsible for developing scar tissue following a heart attack, called cardiac colony-forming unit fibroblasts (cCFU-Fs).

cCFU-Fs are an important area of study because, when heart tissue is scarred, the heart has a harder time pumping blood, which can lead to heart failure.

The researchers behind the study found that vitamin D inhibited the action of cCFU-Fs, which prevented scar tissue from building around the hearts of the mice in the study, potentially preventing blockages in the cardiovascular system.

"With further study," wrote the authors, "vitamin D could prove to be an exciting, low-cost addition to current treatments, and we hope to progress these findings into clinical trials for humans."

Vitamin D and cancer

Breast cancer and bowel cancer have both been linked with cases of vitamin D deficiency in recent studies. One of these analyzed data from two randomized clinical trials and a prospective cohort study.

The researchers found that high levels of vitamin D were inversely associated with risk of breast cancer among women who were cancer-free at baseline.

Pink ribbon blue background
Studies suggest that vitamin D impacts breast cancer risk.

According to the study results, the higher the levels of vitamin D, the lower the risk of breast cancer.

This relationship remained significant even after the results were adjusted for confounding factors, such as age, body mass index (BMI), intake of calcium supplements, and smoking habits.

Although a link between vitamin D deficiency and colorectal cancer has previously been reported, not all studies have been able to replicate these findings. A new, large-scale study attempted to settle this by drawing on data from three continents, including 5,700 colorectal cancer cases and 7,100 controls.

The researchers calculated that people whose levels of vitamin D fall below those specified in the current guidelines have a 31 percent increased risk of developing bowel cancer. By contrast, those with vitamin D levels above the current recommended levels were 22 percent less likely to develop this cancer.

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Vitamin D and belly fat

Another recent study examined a previously observed link between obesity and lower levels of vitamin D, focusing in particular on how different types of body fat might interact with vitamin D.

The study authors reported that having excess belly fat was linked with lower levels of vitamin D:

"[T]he strong relationship between increasing amounts of abdominal fat and lower levels of vitamin D suggests that individuals with larger waistlines are at a greater risk of developing deficiency and should consider having their vitamin D levels checked."

However, the study was not able to prove whether a deficiency in vitamin D causes fat to be stored around the belly, or if having belly fat somehow contributes to a deficiency in vitamin D. The researchers say that future studies will attempt to determine cause and effect in this relationship.

Vitamin D and Alzheimer's disease

A systematic review from researchers in Australia recently attempted to settle the debate surrounding vitamin D's ability to protect against Alzheimer's. The systematic review analyzed more than 70 studies looking at the association.

They concluded that there was no significant association between vitamin D deficiency and risk of Alzheimer's.

Intriguingly, the authors did suggest that — based on their systematic review — there may be an association between exposure to the sun's ultraviolet rays and protection against multiple sclerosis, Parkinson's disease, and Alzheimer's, but that this may be independent of vitamin D production.

The authors said that further studies would be needed to confirm these links and identify the mechanism responsible for such associations.

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Vitamin D and chronic pain

Over the years, some scientists have theorized that low levels of vitamin D might cause or worsen chronic pain.

So, in 2015, a group of scientists set out to collate existing evidence to examine the relationship.

Woman in pain
Could vitamin D ease chronic pain?

The resulting Cochrane review, updated in 2015, explains that:

"Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the etiology of chronic painful conditions." The team scrutinized the findings from a number of studies.

Following the analysis, they concluded that the available scientific evidence is not strong enough to support a connection between vitamin D deficiency and chronic pain.

The authors write, "Based on this evidence, a large beneficial effect of vitamin D across different chronic painful conditions is unlikely. Whether vitamin D can have beneficial effects in specific chronic painful conditions needs further investigation."

So, as ever, more work will be needed to finally close the lid on this interaction.

We hope this article has enhanced your understanding of the latest scientific thinking around this fascinating chemical. Please remember, however, that over-exposure to sunlight — especially the hot, midday sun — can result in skin damage and increase risk of skin cancer.

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Heart health: What to eat and what to avoid

Is dairy good or bad for your heart? And what about coffee? Are foods rich in omega-3 really as good as people say? These are legitimate questions that riddle the average consumer. A new review sifts through the nutritional studies available in order to give us the bottom line on which foods are best for heart health.
legumes in the shape of a heart
Legumes such as beans and peas are great for your heart, concludes the new review.

Here at Medical News Today, we're constantly keeping our readers informed on the latest trends in healthful nutrition, as well as the scientific evidence that backs them up.

For instance, we recently reported on a review that critically examines the hype around omega-3 supplements.

The scientific evidence doesn't support the claim that fish supplements protect against heart disease, the review concluded, even though millions of people in the United States take them.

Similarly, a new meta-analysis of existing studies — conducted by the American College of Cardiology Nutrition & Lifestyle Workgroup of the Prevention of Cardiovascular Disease Council — reviews the pros and cons of popular foods for heart health.

Dr. Andrew Freeman, a Fellow of the American College of Cardiologists and the director of cardiovascular prevention and wellness at National Jewish Health in Denver, CO, led the research.

The findings were published in the Journal of the American College of Cardiology.

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Controversy over heart-healthy foods

Dr. Freeman explains the rationale for the review, saying, "The current nutritional recommendations show a heart-healthy diet is high in fruits, vegetables, whole grains, and nuts in moderation."

"However," he adds, "there are many food groups which can result in confusion for patients, including dairy, added sugar, coffee, and alcohol."

Indeed, while the National Institutes of Health (NIH) recommend fat-free or low-fat dairy for optimal heart health, several recent studies have suggested that full-fat dairy is not harmful to the heart and may even have cardiovascular benefits.

Similarly, moderate alcohol consumption has been associated with heart health benefits in many studies, but other researchers point out the methodological flaws and biases that may be responsible for these results.

So, Dr. Freeman and his team reviewed several meta-analyses of only the highest-quality papers to elucidate the link between heart health and alcohol, dairy, and other controversial foods.

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Foods you should avoid

The researchers found studies suggesting that low-fat dairy can lower blood pressure. However, they also found that it may raise levels of "bad" cholesterol, fractures, and death risk from any cause.

So, in light of this controversial evidence — and given that dairy is rich in saturated fats and salt — the researchers concluded that ideally, dairy products should be avoided or at least consumed with caution.

Additionally, the team found a link between added sugars, such as table sugar or syrups, and a high risk of coronary heart disease, stroke, and death resulting from atherosclerosis.

As a result, they strongly advise that people avoid processed foods that have added sugar, as well as sweetened drinks such as soda, fruit drinks, sports drinks, and energy drinks.

Finally, although a low to moderate intake of alcohol reduces the risk of cardiovascular disease, the researchers warn that people should not drink alcohol for its alleged cardiovascular benefits. This is due to the high risks of liver disease and cancer, which outweigh its potential benefits.

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Foods you should add to your diet

Conversely, legumes such as beans, chickpeas, lentils, peas, soybeans, and peanuts lower the risk of coronary heart disease, cholesterol levels, and blood pressure. The consumption of legumes also helps reduce weight.

"Legumes are affordable and a rich source of protein," Dr. Freeman says. "We should be incorporating more beans and bean-dishes like hummus into our diets to promote heart health."

Coffee was associated with a reduced risk of death from any cause, as well as death from heart disease. No links were found between coffee consumption and the risk of high blood pressure.

Some studies suggested that black and green tea, when consumed without added dairy, sugar, or sweeteners, can contribute to a healthy heart and safe levels of blood lipids — which include cholesterol and triglycerides.

Overall, evidence supports the cardiovascular benefits of plant-based proteins such as the ones from legumes, foods rich in omega-3 fatty acids, mushrooms, coffee, and tea.

However, "There is no perfect, one-size-fits-all dietary pattern for preventing heart disease," Dr. Freeman says.

"But, most of the evidence continues to reinforce that a predominantly plant-based diet lower in fat, added sugars, added salt, processed foods, and with limited if any animal products [benefits heart health]."

Dr. Andrew Freeman

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Does 'good cholesterol' really protect heart health?

Traditionally, our high-density lipoprotein levels — also known as "good cholesterol" — have been considered a good indicator of heart health, particularly for women. Increasingly, however, research is casting doubts over this idea.
concept illustration for cholesterol effects
New research urges specialists to reassess existing notions about HDL cholesterol and cardiovascular health.

High-density lipoproteins (HDL) are molecules that transport fat through the body and to the liver so that it can be processed.

This helps to prevent excess accumulation, which is why it is also referred to as "good cholesterol."

High levels of HDL cholesterol have always been considered to be protective for heart health.

Women, in particular, tend to have higher levels of HDL cholesterol than men, but these do normally begin to decline when they reach menopause.

For this reason, specialists will often advise women on how to raise their "good cholesterol" levels at middle age. However, in recent years, some studies have suggested that HDL cholesterol may not, in fact, be as good for heart health as previous believed.

Now, researchers at the University of Pittsburgh Graduate School of Public Health in Pennsylvania — in collaboration with colleagues from other institutions — are questioning whether the ways in which we look at HDL cholesterol levels to predict cardiovascular risk may not be helpful for women.

"The results of our study," says lead author Samar El Khoudary, "are particularly interesting to both the public and clinicians because total HDL cholesterol is still used to predict cardiovascular disease risk."

Questioning the usefulness of looking at "good cholesterol" as protective for the heart, the team's findings are published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology of the American Heart Association.

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Current notions may be inaccurate

The scientists analyzed the medical data of 1,138 women, aged 45–84, recruited through the Multi-Ethnic Study of Atherosclerosis.

"We have been seeing an unexpected relationship between HDL cholesterol and postmenopausal women in previous studies, but have never deeply explored it," notes El Khoudary.

At menopause, women's bodies go through several changes, especially hormonal fluctuations that can influence various physiological processes and measurements. El Khoudary and team believe that changes in estrogen levels, as well as other metabolic alterations, might lead to chronic inflammation, which can affect the quality of HDL particles over time.

The research assessed the number and size of HDL particles, as well as the total cholesterol that these particles carried, to establish whether high HDL levels were, in fact, protective for cardiovascular health in postmenopausal women.

El Khoudary and team also considered the influence of women's age at menopause and the time it took for women to transition to the postmenopausal period on HDL's contribution to heart health.

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'Total HDL could mask significant risk'

Following their analysis, the researchers concluded that traditional methods of assesing HDL levels and their impact on cardiovascular health are not reliable enough in the case of postmenopausal women.

The scientists found a link between high HDL cholesterol and increased risk of atherosclerosis, particularly among women who had a greater age at the time of menopause and those at least 10 years into the postmenopausal period.

However, the researchers also found that a higher concentration of total HDL particles indicated a lower risk of developing atherosclerosis among the study participants.

But the results get even more complicated: having a high number of small-sized HDL particles, El Koudary and team observed, seemed to have cardioprotective effects for all postmenopausal women, regardless of their age at menopause or how far into postmenopause they were.

Conversely, large-sized HDL particles indicated an increased risk of cardiovascular disease in the case of women who were close to menopause. This, the researchers explain, is likely due to the fact that at this time, the quality of HDL is affected.

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But as women transition away from the menopause period, later in life, it may be that HDL quality increases once more, meaning that HDL cholesterol regains its protective effects.

"Identifying the proper method to measure active 'good' HDL is critical to understanding the true cardiovascular health of these women," notes senior study author Dr. Matthew Budoff.

El Khoudary explains, "This study confirms our previous work on a different group of women and suggests that clinicians need to take a closer look at the type of HDL in middle-aged and older women, because higher HDL cholesterol may not always be as protective in postmenopausal women as we once thought."

"High total HDL cholesterol in postmenopausal women could mask a significant heart disease risk that we still need to understand."

Samar El Khoudary

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Diabetes: Switching to common drugs raises risk of complications

A new study, published in the journal BMJ, finds that switching to a class of drugs called sulfonylureas could raise the risk of complications for people living with type 2 diabetes.
diabetes pills and syringe
New research shows that switching to sulfonylureas, a common class of antidiabetic drugs, may raise the risk of major complications.

Researchers set out to investigate how safe it is for patients with type 2 diabetes to switch from taking metformin, which is a standard "first-line" antidiabetic drug, to taking sulfonylureas, often prescribed to control blood sugar levels when metformin alone fails.

They were led by Prof. Samy Suissa, from McGill University in Quebec, Canada.

As Prof. Suissa and colleagues explain in their paper, numerous studies have confirmed the safety of sulfonylureas.

Fewer, however, have focused on their safety when patients have switched to the drugs or when they have added them to their previous treatment.

So, to fill this research gap, the scientists examined whether adding sulfonylureas or switching to them from metformin raises the risk of cardiovascular problems such as heart attack or stroke, or the risk of death from cardiovascular problems or from any other causes.

Also, the team examined whether or not switching to, or adding, sulfonylureas raised the risk of severe hypoglycemia, or low blood sugar. All these risks were compared with taking metformin alone.

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In order to study these links, the researchers examined over 77,138 people with type 2 diabetes who started taking metformin between 1998 and 2013.

Of these, 25,699 either added sulfonylureas to their treatment or switched to them altogether during the study period.

The team compared these people with age-matched controls who continued to take only metformin over a follow-up period of 1.1 years, on average.

Overall, when compared with staying on metformin, the study found that adding, or switching to, sulfonylureas was linked with a higher risk of a heart attack, death from any causes, and severe hypoglycemia.

More specifically, people adding, or switching to, the second-line treatment were 26 percent more likely to have a heart attack, 28 percent more likely to die from any causes, and over seven times more likely to have severe hypoglycemia, on average.

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The researchers also discovered a trend toward a higher likelihood of stroke and death from heart problems in those switching to, or adding, sulfonylureas.

Finally, when comparing just adding sulfonylureas to metformin with switching to sulfonylureas completely, the latter raised the risk of a heart attack by 51 percent and mortality from all causes by 23 percent.

However, no differences were found in the risk of stroke, cardiovascular death, or hypoglycemia between just adding the drugs and switching to them.

Prof. Suissa and colleagues conclude, "Sulfonylureas as second-line drugs are associated with an increased risk of myocardial infarction, all-cause mortality, and severe hypoglycemia, compared with remaining on metformin monotherapy."

"Thus, in line with current recommendations on the treatment of type 2 diabetes, continuing metformin when introducing sulfonylureas is safer than switching."

As with any observational study, causality cannot be inferred from the results. But researchers Lucy D'Agostino McGowan and Christianne Roumie deem the study "well designed and the relations [...] strong and consistent" in an accompanying editorial, which is also published in the BMJ.

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