The Heart

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Can fermented dairy shield you against heart disease?

Many experts have debated the effect of dairy on cardiovascular health. A recent study in Finland has shown that consuming a particular type of dairy, namely fermented dairy, may actually have a protective effect against heart disease.
assortment of dairy products
How does fermented dairy, in particular, affect heart health?

Coronary heart disease (CHD) is a condition in which the blood supply to the heart becomes restricted, usually because of a buildup of fat in the arteries that carry blood to the heart muscle.

This condition can lead to serious health events, such as chest pain, heart failure, and heart attack. Some of the main risk factors for CHD are smoking, high cholesterol, and high blood pressure.

There is still a lack of consensus on whether consuming dairy is good or bad for a person's health. However, it is important to distinguish between different types of dairy, which may vary in their effects on long-term physical health.

The results of a new study by researchers from the University of Eastern Finland, which has campuses in Joensuu, Kuopio, and Savonlinna, suggest that consuming fermented dairy products may actually protect the heart. Such products include cheese, kefir, yogurt, quark, and sour milk.

The team's findings, which appear in the British Journal of Nutrition, indicate that men who consume fermented dairy have a lower risk of incident CHD than men who prefer non-fermented dairy products.

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Fermented dairy linked to lower risk

This research was part of the ongoing Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. In their current project, the scientists studied associations between incident CHD and the consumption of different types of dairy product.

The team analyzed the data of 1,981 men aged 42–60 years who joined the KIHD study in the years 1984–1989. None of the participants had CHD at baseline, and they all provided details on their dietary habits when they joined the project.

Over an average follow-up period of 20 years, the participants reported 472 cardiovascular events relating to incident CHD.

To determine how the consumption of dairy products might influence the participants' risk of CHD, the researchers divided them into different groups depending on their dietary intake of various fermented and non-fermented dairy foods.

Among the men who consumed fermented dairy products with less than 3.5 percent fat content, those in the highest consumption group had a 27 percent lower risk of CHD compared with those in the lowest consumption category.

The researchers also observed that the most widely consumed low-fat fermented dairy product was sour milk, and that eating high-fat fermented dairy foods, such as cheese, did not appear to sway CHD risk one way or the other.

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Milk tied to higher risk of CHD

At the same time, the team found that people who consumed a lot of non-fermented dairy products, of which regular milk had the greatest use, had a higher risk of incident CHD.

More specifically, those who had a very high intake — referring to an average of 0.9 liters of milk per day — were the most vulnerable to heart disease.

However, there was no association between low consumption of non-fermented dairy products and a heightened risk of CHD.

"Here in Finland, people's habits of consuming different dairy products have changed over the past decades," notes study co-author Jyrki Virtanen, adding:

"For instance, the consumption of milk and sour milk have declined, while many fermented dairy products, such as yogurt, quark, and cheeses, have gained in popularity."

Although the researchers cannot yet confirm the underlying mechanisms that are possibly at play in these associations, they speculate that certain compounds that form during the fermentation of milk-derived products may have a protective cardiovascular effect.

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Common drugs lead to millions of cases of lung disease

Common drugs that doctors prescribe to treat heart problems, arthritis, and cancer can actually pose a threat to lung health, and this problem "affects a considerable number of people." This is the conclusion of a new review of the literature conducted by researchers from the United Kingdom.
lungs concept illustration
Drug-induced interstitial lung disease affects more people than experts had thought.

Sometimes, drugs that treat one health problem can, in time, lead to another.

This is the case for many common medications that may contribute to the development of lung disease.

A new systematic review has assessed studies looking at the risks associated with 27 common drugs over time.

It found that, in more cases than previously thought, they have negative effects on lung health and can cause a condition known as drug-induced interstitial lung disease (DIILD).

Scientists from the Universities of Manchester, Leeds, and Sheffield, as well as the National Institute for Health Research Manchester Biomedical Research Centre and the European Organisation for Research and Treatment of Cancer, conducted the research.

The team's findings now appear in the Journal of Clinical Medicine.

"Doctors need to be aware and vigilant to the possible lung toxicities and harm that can be caused by some drugs," says Dr. Nazia Chaudhuri, one of the researchers involved in this review.

"With newer drugs coming on the market this is an increasing yet under-recognized problem and we need better ways of detecting these side effects before they cause harm," she warns.

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The researchers analyzed data from 6,200 participants, which they collected from 156 specialized papers. Their effort is part of a large project supported by the European Union and the Innovative Medicine Initiatives, whose purpose is to develop imaging techniques for DIILD.

Some of the symptoms of DIILD include problems with breathing, pulmonary fibrosis (scarring), and inflammation. However, a person may not know that they face exposure to lung disease for many years after they have started taking the medication that causes the problem.

In this review, the investigators looked at 27 drugs that treat cardiovascular problems or cancer, as well as other health issues.

The drugs were: Bleomycin, Gemcitabine, Erlotinib, Gefitinib, Panitumumab, Cetuximab, Everolimus, Temsirolimus, Sirolimus, Ipilimumab, Nivolumab, Pembrolizumab, Atezolizumab, Avelumab, Durvalumab, Irinotecan, Pemetrexed, Methotrexate, Infliximab, Etanercept, Adalimumab, Golimumab, Leflunomide, Amiodarone, Nitrofurantoin, Distamycin, and Carbamazepine.

The researchers note that many of the studies that they analyzed were of poor quality. Despite this, they were able to establish that worldwide, doctors diagnose between 4.1 and 12.4 million cases of DIILD each year.

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Moreover, DIILD appears to account for approximately 3–5 percent of all cases of interstitial lung disease.

Some of the papers under review reported mortality rates of more than 50 percent, and 25 percent of the total number of participants passed away due to lung-related problems.

The investigators also note that people typically treat DIILD using steroids, but their overall effect on health outcomes remains unclear.

"Though this area is not well-researched, we can say that the side effects of drugs on the lung are much more widespread than previously thought," says study co-author Prof. John Waterton.

"We do know it affects a considerable number of people, which is why we want to develop better imaging tests to pick up any lung problems before they become serious. It's important to stress that patients can safely continue to take their medication — but it's also important that doctors monitor and assess them closely for side effects in the lung."

Prof. John Waterton

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Heart attack: New finding may change the face of treatment

Heart attacks are medical emergencies in which blood supply to the heart is blocked — usually by a blood clot. A new study from Sweden has made an intriguing discovery that may change existing guidelines about treating heart attacks.
concept image illustrating a heart attack
Do certain antibodies play a role in heart attacks?

Antibodies, or immunoglobulins (Ig), are a type of protein produced by plasma cells (a kind of blood cell). The immune system often co-opts these to fight potentially harmful foreign bodies.

Now, researchers from the Karolinska Institutet in Solna, Sweden, have discovered that certain antibodies — once associated with rheumatic diseases — are also present in high numbers inside the bodies of people who have had a heart attack.

These are the antiphospholipid antibodies (aPLs), which are abnormal antibodies that react to types of tissue produced by the body itself, such as cardiolipin (a lipoprotein) and beta-2-glycoprotein-I (a plasma protein).

Th scientists note that aPLs typically appear in the context of rheumatic diseases, such as systemic lupus erythematosus, or lupus.

The presence of these antibodies, they continue, can increase a person's risk of blood clots. This happens in antiphospholipid syndrome (APS), an autoimmune condition in which the body overproduces aPLs.

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Antibodies are present at high levels

In the recent study — the findings of which appear in the Annals of Internal Medicine — the authors note that aPL is distinctly present in the bodies of many people who have experienced heart attacks and are free of autoimmune conditions.

They also report that it has so far remained unclear just how common aPLs are in the case of such people, because scientists have conducted previous studies at too small a scale to provide the appropriate data.

For the new study, the investigators worked with 800 people admitted as patients at 17 Swedish hospitals after having experienced a heart attack for the first time.

To be able to compare data, the researchers also recruited an equal number of healthy participants to act as the control group.

The researchers analyzed blood samples from the first group at 6 and then again at 10 weeks after the heart attack. They looked for three distinct types of aPL: immunoglobulin G (IgG), M (IgM) and A (IgA).

When they looked at the data, the investigators saw that 11 percent of the participants who had experienced heart attacks had aPL that reacted to both cardiolipin and beta-2-glycoprotein-I. That was 10 times more people than in the control group.

"I've long been convinced that the antibodies are more common than we think and have now been able to analyze their presence in a large patient material," says study author Prof. Elisabet Svenungsson.

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'This would change prevailing guidelines'

"It was a surprisingly high proportion of the patients and the levels were also clearly high," explains Prof. Svenungsson.

Specifically, the volunteers had high levels of IgG antibodies, which are most commonly associated with a heightened risk of blood clots.

However, the researchers admit that they only collected one set of blood samples, which may not accurately reflect the levels of aPL over time and may instead be a one-off reaction to the heart attack.

Still, should their aPL levels remain high over 3 months, this would mean that the participants have APS, which would predispose them to blood clots.

"In which case they should," notes Prof. Svenungsson, "according to current recommendations, be prescribed lifelong treatment with the anticoagulant warfarin, which reduces the risk of new blood clots," concluding:

"This would change the prevailing guidelines for the investigation and treatment of heart attacks."

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What is orthopnea?

Orthopnea is a shortness of breath that affects a person when they are lying down but subsides in other positions, such as standing or sitting up. Orthopnea is often a symptom of heart failure or lung disease, but it can also result from other conditions.

For people with orthopnea, the breathing difficulty typically disappears quickly after they get up from a horizontal position. In a related condition known as paroxysmal nocturnal dyspnea, the shortness of breath wakes the person up a couple of hours after they fall asleep.

In this article, we look at the symptoms, causes, diagnosis, and treatment of orthopnea.

Symptoms Man lying down holding chest in pain because of shortness of breath or orthopnea
Orthopnea is shortness of breath that occurs while lying down.

Orthopnea is a symptom rather than a condition in itself. The medical term for shortness of breath is dyspnea. Orthopnea is a type of dyspnea that only occurs when a person is lying down.

People often describe orthopnea as a sensation of tightness in the chest that makes breathing difficult or uncomfortable. Some individuals may also experience chest pain.

Orthopnea can be mild or severe. Some people may barely notice this symptom when they use one or two pillows to prop up their upper body. For others, it can cause significant breathing difficulties that they can only relieve by sitting upright or standing.

Other symptoms can also occur, which will depend on the underlying cause. For example, a common cause of orthopnea is heart failure, which can also cause the following symptoms:

fatigue changes in appetite nausea confusion increased heart rate persistent coughing or wheezing Thank you for supporting Medical News Today Causes Orthopnea is often a symptom of conditions that affect the normal functioning of the lungs. These can include heart conditions. Heart disease may result in the heart being unable to redistribute blood and other bodily fluids effectively while a person is lying down. The increased pressure in the blood vessels in the lungs can push fluid into the alveoli, causing a condition known as pulmonary edema. The alveoli are small air sacs in the lungs. Here, oxygen passes from the lungs into the bloodstream, while carbon dioxide moves from the blood into the lungs. Fluid in the alveoli can interfere with this gaseous exchange, preventing a person from getting enough oxygen around their body. Several other conditions can also cause orthopnea, including: chronic obstructive pulmonary disease (COPD) obesity anxiety and stress-related disorders sleep apnea snoring Diagnosis As orthopnea is usually a symptom of another condition, such as heart failure, a doctor will focus on trying to identify the underlying cause. The doctor may begin with a physical examination to check the severity and timing of the breathing difficulties. They will also ask about other symptoms and review the person's medical history. Depending on the suspected cause, the doctor may recommend one or more of the following tests: X-ray or CT scan of the chest. These tests create an image of the inside of the chest, which allows the doctor to see if there are any problems with the lungs or heart. Electrocardiogram (ECG). This test involves placing sensors on a person's skin to measure electrical signals from the heart. Doctors use an ECG to check the functioning of the heart. Echocardiogram. Also known as an "echo," this is a type of ultrasound scan that uses sound waves to create an image of the heart. Doctors use this test to check for any problems with this organ. Pulmonary function tests. These tests include spirometry, which involves breathing into a machine. A doctor can use the results to determine how well the lungs are functioning. Arterial blood gas. This is a type of blood test that checks whether a person is getting enough oxygen. Blood tests. These involve taking a small sample of a person's blood, and doctors use them to check for signs of a wide range of conditions. Thank you for supporting Medical News Today Treatment Pillows on a bed
Propping up the upper body with pillows during sleep can help relieve orthopnea. The purpose of orthopnea treatment is to lessen the symptoms and address the underlying cause. Some people may be able to relieve symptoms temporarily by sleeping in a more elevated position. A simple way to do this is to prop up the upper body using pillows. Alternatively, a person could try placing foam wedges underneath the mattress or raising the head of the bed using wooden blocks. If the individual is overweight or obese, losing weight may also help reduce orthopnea. A doctor or dietician can advise on an exercise or diet plan for losing weight. Depending on the underlying cause of a person's orthopnea, a doctor may prescribe medications, such as: anti-inflammatory medications drugs to improve the clearance of mucus from the lungs steroids diuretics vasodilators inotropic drugs, which alter the force of the heart's contractions Orthopnea is often a symptom of an underlying heart condition. The treatment of this condition may involve ongoing care and lifestyle changes. Depending on the severity of the heart condition, a person may sometimes require surgery. Takeaway Orthopnea is a shortness of breath that occurs when lying down but usually resolves on sitting or standing up. Orthopnea is often a symptom of heart failure, but it can develop due to other conditions that affect the normal functioning of the lungs, such as COPD. Anyone who experiences orthopnea should see a doctor for an evaluation. The treatment of orthopnea will depend on its underlying cause. However, a person may find temporary relief by raising their head and chest with some pillows when lying in bed.
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Could it be possible to eliminate clogged arteries?

A new clinical trial to study a potential way of reducing the risk of early-onset atherosclerosis may be on the way.
Atherosclerosis clogged artery
Atherosclerosis can lead to a range of cardiovascular problems.

After evaluating previous research, a report published in the Journal of the American Heart Association concludes that a clinical trial might pave the way for a new treatment to help reduce the early onset of atherosclerosis.

According to lead author Dr. Jennifer G. Robinson, a professor of epidemiology and director of the Prevention Intervention Center at the University of Iowa in Iowa City, the key may be targeting B lipoproteins in young and middle-aged adults.

These blood proteins (also called apolipoprotein B) include low-density lipoprotein (LDL), or the "bad," cholesterol. Scientists think that LDL and other B lipoproteins are among the leading causes of atherosclerosis.

Preventing atherosclerosis

"Lowering them may have a big impact on making atherosclerosis go away," says Dr. Robinson. "If this works, you could completely eliminate heart attacks and strokes within a generation, because you can't have a heart attack or stroke unless you have atherosclerosis."

The potential study aims to determine whether it is possible to reverse atherosclerosis in high-risk adults aged 25–55 using medications known as statins and PCSK9 inhibitors over a 3-year period. Both statins and PCSK9 inhibitors work to lower LDL cholesterol in the blood.

"The idea is to get the cholesterol very low for a short period of time, let all the early cholesterol buildup dissolve, and let the arteries heal," says Dr. Robinson, confirming that this method has been successful in animal studies. "Then patients might need to be re-treated every decade or two if the atherosclerosis begins to develop again."

"Once you know what causes something, you can come up with a hammer for it and eliminate it. We're not the first ones to think of this idea. This would be the culminating study of decades of research by thousands of people."

Dr. Jennifer G. Robinson

Dr. Robinson continues, "But I'm excited about this, and I think it's really time to pursue this hypothesis."

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How atherosclerosis affects your health

Atherosclerosis, wherein plaque builds up in the arteries, can prevent oxygen-rich blood from traveling through the blood vessels to supply the rest of the body.

Plaque is made up of different substances in the blood, such as fat, cholesterol, and calcium. Over time, this plaque begins to harden, and when it does, it narrows the arteries.

This means that a person does not get as much oxygen-rich blood as they need, which can have serious consequences, including heart attacks and strokes. It can also lead to death.

There are some risk factors for atherosclerosis that people can try to control themselves, including unhealthy blood cholesterol levels. High levels of LDL and low levels of high-density lipoprotein, or "good," cholesterol are among the leading causes of the disease.

Other risk factors include high blood pressure, smoking, insulin resistance, diabetes, being overweight, and a lack of physical activity. An unhealthful diet can also be a factor, particularly for people who eat a lot of foods that are high in saturated fats, trans fats, cholesterol, sodium, and sugar.

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Potential study limitations

A new way to combat early-onset atherosclerosis would be welcome, especially as heart disease is so widespread and a leading cause of death for people in the United States. The Centers for Disease Control and Prevention (CDC) note that about 1 in 4 deaths are a result of heart disease.

However, Dr. John Wilkins, a cardiologist and assistant professor at Northwestern University Feinberg School of Medicine in Chicago, IL — who has conducted studies on B lipoproteins but was not involved in this study — thinks that it might be difficult to convince healthy adults to take medications to keep atherosclerosis at bay.

He also notes that this type of clinical trial may be hard to do as it would involve tracking people for 20 or 30 years, which could prove difficult.

Overall, the study is promising, and as Dr. Robinson says, it could lead to big changes in how doctors and their patients fight heart disease in the future. Reducing or eliminating atherosclerosis in people is an excellent goal, and while a clinical trial has not started yet, it is definitely a good place to start.

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Atrial fibrillation increases the risk of dementia

New evidence suggests that atrial fibrillation, in which the heart has an irregular beat, is linked to an increased risk of dementia. This knowledge, however, also indicates a potential preventive strategy, researchers show.
person holding heart figurine
An irregular heartbeat speeds up the rate at which cognitive function deteriorates, but there may be an easy way to address this.

In a new study paper published yesterday in the journal Neurology, researchers at the Karolinska Institute and Stockholm University, which are in Sweden, explain that atrial fibrillation (A-fib) is linked with an increased risk of developing dementia.

In A-fib, the heart's atria — or the chambers that receive blood and then send it to the ventricles, which pump it out to the rest of the body — beat irregularly.

Because of this, blood can pool inside the heart and form clots, which may later circulate to the brain, leading to a stroke.

The new study has found that A-fib also increases the risk of another health problem as people age — namely, dementia. However, this warning also comes with an encouraging solution, the authors explain.

"Compromised blood flow caused by atrial fibrillation may affect the brain in a number of ways," as study co-author Chengxuan Qiu explains.

"We know [that] as people age, the chance of developing atrial fibrillation increases, as does the chance of developing dementia," Qiu says, adding:

"Our research showed a clear link between the two and found that taking blood thinners may actually decrease the risk of dementia."

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A-fib is linked with faster cognitive decline

In the new study, the investigators analyzed data collected from 2,685 participants with an average age of 73. All of these participants were followed for an average period of 6 years.

The team interviewed each person and administered a medical exam at baseline and then again after 6 years for participants younger than 78, or once every 3 years in the case of participants older than 78 at the beginning of the study.

None of these volunteers had dementia at baseline, though 9 percent of all the participants (243 individuals) had been diagnosed with A-fib.

Over the follow-up period, 11 percent of the total number of participants (279 individuals) developed A-fib, and 15 percent of the cohort (399 individuals) received a diagnosis of dementia.

After analyzing the data, the researchers revealed that the cognitive function — including thinking capacity and memory — of participants with A-fib tended to deteriorate more rapidly than in the case of people with healthy cardiovascular systems.

Also, people with A-fib had a 40 percent higher chance of developing dementia when compared with their healthy peers.

Of the 2,163 participants without A-fib, 10 percent (278 individuals) were diagnosed with dementia throughout the course of the study.

As for the 522 people with A-fib, 23 percent (121 individuals) developed dementia.

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Blood thinners may counteract risk

However, the team also saw that participants with A-fib who took blood thinners to prevent blood clots actually had a 60 percent lower risk of developing dementia, compared with those who did not take this medication.

Of the 342 people who did not take blood thinners, 22 percent (76 people) developed dementia, while among the 128 participants who did take blood thinners, only 11 percent (14 people) developed the neurodegenerative condition.

At the same time, the researchers also note that participants who took antiplatelet drugs — which prevent clots from forming in the arteries — did not have a lower risk of dementia.

"Assuming that there was a cause-and-effect relationship between using blood thinners and the reduced risk of dementia," explains Qui, "we estimated that about 54 percent of the dementia cases would have been hypothetically prevented if all of the people with atrial fibrillation had been taking blood thinners."

"Additional efforts should be made to increase the use of blood thinners among older people with atrial fibrillation," the researcher advises.

The investigators nevertheless admit that their study faced some limitations, such as the fact that it did not distinguish among different subtypes of A-fib, or that certain participants with A-fib may not have been diagnosed accordingly due to lack of symptoms.

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Newly discovered molecule could treat heart failure

In heart failure, the heart is unable to pump blood effectively throughout the body. One key factor in the development of this condition is calcium dysregulation. A newly discovered molecule that may be able to address this issue could become the next therapeutic target for this heart condition.
heart concept illustration
Will a newly discovered molecule become the next therapeutic target for heart failure?

The heart can contract, relax, and pump blood through the veins effectively, partly due to a process called "calcium cycling." This process allows calcium to circulate in and out of cells.

This cycle is sometimes impaired by a person's age, which can also affect the rate or potency with which the heart muscle pumps out blood.

Calcium dysregulation may therefore lead to the development of heart failure.

So far, researchers have focused on developing therapies targeting a molecule known as SERCA, whose role is to transport calcium ions, ensuring the relaxation of the heart muscle.

In heart failure, SERCA does not function properly, which has led some scientists to look into the possibilities of developing a gene therapy that would increase SERCA expression.

Now, however, specialists from the University of Texas Southwestern in Dallas, and from Loyola University Chicago in Illinois, have discovered a micropeptide, which they named "dwarf open reading frame" (DWORF). The scientists believe that DWORF could pave the way to better treatments for heart failure.

"Our lab recently discovered a micropeptide called [DWORF], which binds directly to SERCA and enhances its activity," explains the lead author of this new study, Catherine Makarewich.

"In this study, we explored the therapeutic potential of high levels of DWORF, as a way to increase SERCA activity and improve heart contractility in heart failure."

Catherine Makarewich

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DWORF's impact on heart function

Makarewich and team first found that DWORF displaces a molecule called phospholamban (PLN), which inhibits SERCA activity.

This suggested that scientists might be able to use DWORF to help boost SERCA activity, thus allowing the heart to regain its ability to contract and relax effectively.

In the current study, whose findings appear in the journal eLife, the researchers worked with mice that they genetically engineered to express higher levels of DWORF, higher levels of PLN, or higher levels of both DWORF and PLN in the heart.

By comparing genetically engineered rodents with normal ones, the scientists noticed that the mice with higher DWORF levels had better calcium cycling than regular mice.

At the same time, the mice engineered to express higher PLN levels had poorer calcium cycling compared with the controls. Finally, in the mice with high levels of both molecules, DWORF prevented the impact of PLN.

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'An attractive candidate' for new therapies

In order to consolidate these findings, the researchers also assessed the effects of DWORF in a mouse model of dilated cardiomyopathy, in which the heart becomes enlarged and unable to pump blood efficiently.

Regular mice with dilated cardiomyopathy had poor function of the left heart ventricle, the part of the heart that pumps oxygenated blood towards the body.

Mice with dilated cardiomyopathy that were also engineered to have higher levels of DWORF, however, showed better function of the left heart ventricle.

Conversely, rodents with the same heart problem but with no DWORF at all displayed even poorer left ventricle function than the controls.

Makarewich and team also noted that mice with high DWORF levels did not show some of the usual physiological signs of cardiomyopathy, such as enlarged heart chambers, thinning of the chamber walls, and a higher volume of heart muscle cells.

Also, the mice with high DWORF levels did not develop a buildup of scar tissue in the heart, which is another characteristic of cardiomyopathy.

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"Previous attempts to restore SERCA to protect against heart failure have been unsuccessful because they have focused on increasing levels of SERCA itself," notes the study's senior author, Eric Olson.

Based on the current findings, however, he thinks the team may have identified a more viable therapeutic target in DWORF.

"We believe that increasing levels of DWORF instead may be more feasible and that the small size of the DWORF molecule could make it an attractive candidate for a gene therapy drug for heart failure," Olson adds.

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Just how harmful is it to have 1 drink per day?

Many enjoy a glass of wine or beer during dinner, believing that this little alcohol couldn't possibly affect them. A new study is, however, warning that even one small drink per day can influence our health.
glass of wine
It is not safe to have even one glass of wine with your meal, finds a new study.

In August, we covered a large-scale review that drew an unequivocal conclusion: it's not, in fact, safe to drink any amount of alcohol.

Senior author Dr. Emmanuela Gakidou referred to the idea that one or two drinks are safe for health as "a myth."

She said that her and her colleagues' research found that any level of drinking is tied to an increased risk of early death, cancer, and cardiovascular events.

Now, researchers from Washington University School of Medicine in St. Louis, MO, have discovered even more about just how harmful it can be to have even as little as one drink per day.

The new study focused on the impact of alcohol on light drinkers specifically, so its findings — now published in the journal Alcoholism: Clinical & Experimental Research — are relevant to a large segment of the population.

"It used to seem like having one or two drinks per day was no big deal, and there even have been some studies suggesting it can improve health," says first author Dr. Sarah M. Hartz.

"But now we know that even the lightest daily drinkers have an increased mortality risk," she cautions.

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Even light drinking heightens death risk

The authors of the recent study analyzed data collected from 434,321 participants, aged 18–85. Of these, 340,668 (aged 18–85) were recruited via the National Health Interview Survey, and 93,653 (aged 40–60) provided health information as outpatients at Veterans Health Administration sites.

Dr. Hartz and team found that people who had one or two drinks four or more times weekly had a 20 percent higher risk of premature death, compared with those who drank only three times per week or less often. This increased death risk, the study authors add, remains consistent across all age groups.

"A 20 percent increase in risk of death is a much bigger deal in older people who already are at higher risk," notes Dr. Hartz.

"Relatively few people die in their 20s, so a 20 percent increase in mortality is small but still significant," she adds.

"As people age, their risk of death from any cause also increases, so a 20 percent risk increase at age 75 translates into many more deaths than it does at age 25."

Dr. Sarah M. Hartz

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The risks outweigh any potential benefits

One study published earlier this year suggested that people who drink just a little — one drink each day, at most — appear to have lower cardiovascular risk than both people who drink more and people who shun alcohol entirely.

Dr. Hartz and team's research, however, reveals that the health hazards that even people who drink lightly face outweigh any potential benefits.

When the scientists assessed the risk for heart disease and cancer, they saw that, on the whole, though drinking a little did help protect the heart in some cases, daily consumption — even when light — increased a person's risk of cancer.

"Consuming one or two drinks about four days per week seemed to protect against cardiovascular disease, but drinking every day eliminated those benefits," explains Dr. Hartz.

"With regard to cancer risk, any drinking at all was detrimental," she warns.

However, Dr. Hartz also believes that in the future, health practitioners may want to develop more highly personalized guidelines for their patients.

Therefore, healthcare providers might advise people at risk of developing heart problems to drink on occasion. Conversely, they may encourage those who are at risk of cancer to give up drinking entirely.

"If you tailor medical recommendations to an individual person," explains Dr. Hartz, "there may be situations under which you would think that occasional drinking potentially could be helpful."

"But overall," she reports, "I do think people should no longer consider a glass of wine a day to somehow be healthy."

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Could we use gene mutations to treat diabetes and heart disease?

Genes that control one aspect of our health can also influence others. Now, a recent study has revealed such a link between mutations of three genes that control cholesterol and a lower risk of certain cardiovascular conditions and type 2 diabetes.
dna structure with red patch
Scientists find a link between gene mutations, cholesterol, heart health, and diabetes.

Researchers at the Stanford University School of Medicine as well as the Veteran Affairs Palo Alto Health Care System, both in California, have led an investigation that linked genetic information on 300,000 veterans to their electronic health records.

It focused on three gene variants, or mutations, that change the way their associated genes behave.

Studies of gene mutations usually uncover how they damage health or give rise to disease, but in this study, the gene variants are all linked to positive effects.

Veterans who carried any one of these three gene variants not only had better levels of blood cholesterol, but also — depending on the gene — a lower risk of developing type 2 diabetes, coronary heart disease, or abdominal aortic aneurysm.

The investigators suggest that their findings — which now feature in the journal Nature Genetics — offer valuable information for developing drugs to treat the conditions associated with the three genes.

The genes are: ANGPTL4 for type 2 diabetes, PCSK9 for abdominal aortic aneurysm, and PDE3B for coronary heart disease.

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The 'power of numbers'

For a genetic study such as the recent one to give significant results, it must draw on the "power of numbers."

The Million Veteran Program (MVP), which was set up in 2011, offers such an opportunity. Its aim is to explore the relationship between genetic variation and health in military veterans in the United States.

The MVP gave the researchers access to genetic information on 297,626 — including 57,332 black and 24,743 Hispanic — veterans for whom there were also electronic health records containing measures of their cholesterol.

By bringing the MVP data together with "data from the Global Lipids Genetics Consortium," the team was able to identify 188 genetic markers of cholesterol that were already known about and 118 that were not.

Then, by applying an approach called a phenome-wide association study, the team picked out the cholesterol-associated gene variants that were also associated with other health factors or conditions in the MVP data.

The result was that variants in ANGPTL4, PCSK9, and PDE3B appeared not only to favor beneficial cholesterol levels but were also linked to a lower risk of developing type 2 diabetes, abdominal aortic aneurysm, and coronary heart disease, respectively.

These associations were previously unknown; the PCSK9 variant was already known to lower risk of heart disease, but this was the first study to tie it to a lower risk of abdominal aortic aneurysm.

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'Good case' for new drugs

The researchers believe that their results "make a good case" for developing drugs that "mimic the effects" of the gene variants.

They acknowledge that there already exists a drug called cilostazol, which mimics the effect of the PDE3B mutation on cholesterol, for treating vascular conditions. However, they advise against using it to treat heart disease on the basis of the recent genetic study alone.

"The genetics," explains senior study author Dr. Themistocles L. Assimes, an assistant professor of medicine in Stanford University's Division of Cardiovascular Medicine, "help suggest that this drug can decrease the risk of heart disease by lowering triglycerides, but it's not proof."

He urges people to wait until the approved drugs have been thoroughly tested for other desired effects in large randomized clinical trials before using them for those purposes.

"We've been misled before by drugs that had effects on cholesterol, but they turned out to be cosmetic," he adds.

"Better cholesterol profiles can look great, but if the drug doesn't affect the outcome you're aiming for [...] then it's useless."

Dr. Themistocles L. Assimes

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Why sudden cardiac arrests no longer peak in the morning

New research, published in the journal Heart Rhythm, discovers that due to recent cultural shifts in our work schedules and daily stressors, sudden cardiac arrests no longer tend to occur in the mornings.
person holding their chest
Sudden cardiac arrest can occur any time of the day, says a new study.

Until now, the consensus has been that a range of cardiovascular events, such as angina, heart attacks, and stroke, tend to happen mostly in the early hours of the morning.

A possible explanation for this phenomenon is that in the morning, the sudden pressures of daily activities put a strain on people's cardiovascular system.

Just waking up, in fact, releases the activity of certain hormones, such as cortisol, that raise blood pressure, heart rate, and glucose levels, as well as narrow blood vessels and prompt our hearts to pump harder.

However, given the new pressures of modern life — such as instant communication, the prevalence of smartphones, apps, and the online medium in general — the timing of our daily stressors may have changed.

So, do these changes have a bearing on certain cardiovascular events and the time of day in which they occur? New research suggests so.

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Zooming in on sudden cardiac arrests

Scientists from the Cedars-Sinai Medical Center in Los Angeles, CA — led by Dr. Sumeet Chugh, a professor of medicine — set out to investigate when the peak times for sudden cardiac arrests during the day are.

As Dr. Chugh and team explain, contrary to popular belief, sudden cardiac arrest is quite different to a heart attack. Unlike in a heart attack, during sudden cardiac arrest, the heart stops beating suddenly. Death occurs if medical assistance is not given within minutes.

A heart attack, on the other hand, occurs when blood flow to the heart is partially blocked, which does not usually cause the heart to stop beating.

As the study authors mention, around half of all cardiovascular deaths in the United States result from sudden cardiac arrest, and up to 350,000 cases occur each year, making the condition a significant concern for public health.

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'Stress is likely a major factor'

Dr. Chugh and his team studied data available from the Oregon Sudden Unexpected Death Study, which began in 2002.

For the analysis, the investigators looked at the data collected from emergency medical reports in 2004–2014. During this time, 1,535 adults had sudden cardiac arrests and died as a result.

Of these people, note the authors, only 13.9 percent died between 12 a.m. and 6 a.m. Contrary to older research and an ensuing widespread belief, the study found no evidence of a higher prevalence of sudden cardiac arrests on Mondays.

"While there are likely several reasons to explain why more cardiac arrests happen outside of previously identified peak times, stress is likely a major factor," explains Dr. Chugh.

"Because sudden cardiac arrest is usually fatal, we have to prevent it before it strikes," he adds.

"We now live in a fast-paced, 'always on' era that causes increased psychosocial stress and possibly, an increase in the likelihood of sudden cardiac arrest."

Dr. Sumeet Chugh

Dr. Chugh also shares some directions for future research, explaining, "Our next steps are to conclusively determine the underlying reasons behind this shift, then identify public health implications as a result."

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Does 'bad' cholesterol deserve its bad name?

"Misleading statistics, exclusion of unsuccessful trials, and [...] ignoring numerous contradictory observations" are at the root of a half-century-long assumption that may be entirely wrong, says new research.
heart shape with foods in it
Heart health may not have much to do with cholesterol levels.

In the case of good vs. bad cholesterol, things are less clear-cut than we'd like them to be.

An increasing number of studies suggest that high-density lipoprotein (HDL) cholesterol, or the "good" kind, may not be so good after all.

A recent study found an unsettling association between HDL cholesterol and mortality in men.

Another one found that HDL cholesterol levels correlated with a higher risk of heart disease among women.

Now, new research has shone a critical light on "bad," or low-density lipoprotein (LDL), cholesterol.

Researchers led by Dr. Uffe Ravnskov, Ph.D. — a former medical practitioner and independent researcher based in Lund, Sweden — set out to analyze the findings of three large reviews that maintain that LDL cholesterol gives rise to atherosclerosis and cardiovascular disease (CVD) and that statins prevent CVD.

The results were published in the journal Expert Review of Clinical Pharmacology.

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Why high LDL cholesterol is not the culprit

Dr. Ravnskov and his team started with philosopher Karl Popper's criterion for the falsifiability of scientific claims, according to which a scientific theory can never be proven true, but it can be shown to be false. So, they set out to see if the bad cholesterol hypothesis could be falsified.

The hypothesis that high LDL cholesterol is the main cause of heart disease is invalid, explain the researchers, "because people with low levels become just as atherosclerotic as people with high levels and their risk of suffering from CVD is the same or higher."

"The usual argument in support of the lipid hypothesis," they continue, "is that numerous studies of young and middle-aged people have shown that high [total cholesterol] or LDL [cholesterol] predict future CVD."

"This is correct, but association is not the same as causation," write the scientists. Not only are the studies unable to prove causality, but the statistical methods are also flawed, they say.

The authors go on to point to a range of other potential causes of CVD that the reviews analyzed did not account for, such as mental stress, inflammation, and infections.

Dr. Ravnskov and colleagues conclude:

"Our search for falsifications of the cholesterol hypothesis confirms that it is unable to satisfy any of the Bradford Hill criteria for causality, and that the conclusions of the [...] three reviews are based on misleading statistics, exclusion of unsuccessful trials, and by ignoring numerous contradictory observations."

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People should make an informed decision

Study co-author Prof. David Diamond, of the University of Southern Florida in Tampa, comments on the findings, saying, "There have been decades of research designed to deceive the public and physicians into believing that LDL causes heart disease, when in fact, it doesn't."

"The research that has targeted LDL is terribly flawed," he goes on to explain. "Not only is there a lack of evidence of causal link between LDL and heart disease, the statistical approach statin advocates have used to demonstrate benefits has been deceptive."

The researchers aim "to share this information with people, so they can make an informed decision when they're considering taking cholesterol lowering medication."

In the paper, the authors disclose that Dr. Ravnskov — along with a few other co-authors — have previously published books that criticize the idea that LDL cholesterol causes heart disease.

Dr. Ravnskov is the director of The International Network of Cholesterol Skeptics, and in 2007, he was awarded the Leo-Huss-Walin Prize for Independent Thinking.

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What is perindopril?

Highlights for perindopril

Perindopril oral tablet is available as a generic drug. It doesn't have a brand-name version. Perindopril comes only in the form of a tablet you take by mouth. Perindopril oral tablet is used to treat hypertension (high blood pressure). It's also used to lower the risk of death or heart attack in people with stable coronary artery (heart) disease. Important warnings FDA warning: Use during pregnancy This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous. You shouldn't take this drug if you're pregnant or planning to become pregnant. It can harm or end your pregnancy. Talk to your doctor about other ways to lower your blood pressure if you become pregnant. If you get pregnant while taking perindopril, tell your doctor right away. Other warnings Angioedema (swelling) warning: This drug can cause sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines. This can be fatal. Tell your doctor right away if you have swelling in these areas or abdominal pain. You'll be taken off of perindopril and possibly given medication to reduce the swelling. Angioedema can happen at any time while you're taking perindopril. Low blood pressure warning: Perindopril can cause hypotension (low blood pressure), especially during the first few days of treatment. Tell your doctor if you feel lightheaded or have any fainting spells. Your risk of low blood pressure may be higher if you: don't drink enough fluids sweat heavily have diarrhea or are vomiting have heart failure are on dialysis take diuretics (water pills) Cough warning: Perindopril may cause a persistent, dry, nonproductive cough. It will go away once you stop taking this medication. What is perindopril? Perindopril is a prescription drug. It comes as an oral tablet. Perindopril isn't available as a brand-name drug. It's only available as a generic drug. Generic drugs usually cost less than brand-name versions. Perindopril may be used as part of a combination therapy. That means you need to take it with other drugs. Why it's used Perindopril oral tablet is used to treat hypertension (high blood pressure). Reducing your blood pressure lowers your risk of complications, such as stroke or heart attack. Perindopril is also used to lower your risk of death or heart attack if you have stable coronary artery disease. How it works Perindopril belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. Perindopril works by helping your blood vessels relax and widen. This lowers your blood pressure. Thank you for supporting Medical News Today

Perindopril side effects

Perindopril oral tablet doesn't cause drowsiness, but it can cause other side effects.

More common side effects

Some of the more common side effects that can occur with use of perindopril include:

If these effects are mild, they may disappear within a few days or a couple of weeks. If they're more severe or don't disappear, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency. Serious side effects and their symptoms can include the following:

Breathing problems. Symptoms can include: trouble breathing or swallowing hoarseness Swelling (angioedema). Symptoms can include: swelling of your face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs Very low blood pressure. Symptoms can include: Low white blood cell count. This can increase your risk of infections. Symptoms can include: Heart problems. Symptoms can include: irregular or rapid heart rate Liver damage. Symptoms can include: yellowing of your skin and the whites of your eyes nausea vomiting pain in the upper right part of your abdomen fatigue elevated liver enzymes High potassium levels. In most cases, your potassium levels will decrease on their own. However, some people may have dangerously high levels of potassium while taking this drug. Your risk is higher if you have kidney disease, diabetes, or are taking diuretics (water pills). Your doctor may do blood tests to check your potassium levels.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Perindopril may interact with other medications Perindopril oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you're taking. To find out how this drug might interact with something else you're taking, talk to your doctor or pharmacist. Examples of drugs that can cause interactions with perindopril are listed below. Sacubitril Taking perindopril with sacubitril, which is used with valsartan to treat high blood pressure and heart failure, raises your risk of angioedema (serious swelling). You should not use perindopril within 36 hours of using sacubitril. Nonsteroidal anti-inflammatory drugs (NSAIDs) Taking NSAIDs with perindopril can increase your risk of kidney problems. Your risk may be higher if you're a senior, have kidney problems, or are dehydrated. Examples of these drugs include: Diuretics (water pills) Taking diuretics with perindopril can sometimes increase your risk of low blood pressure. Examples of these drugs include: hydrochlorothiazide furosemide bumetanide chlorthalidone torsemide indapamide Potassium-sparing diuretics, potassium supplements, and salt substitutes Taking these drugs with perindopril can increase your risk of high potassium levels in your blood. Examples of these drugs include: spironolactone triamterene amiloride potassium-containing salt substitutes Blood thinner Taking heparin with perindopril can increase your risk of high potassium levels in your blood. Blood pressure medications Taking these drugs with perindopril can increase your risk of high potassium levels. It can also lower your blood pressure too much and cause decreased kidney function. Examples of these drugs include: aliskiren losartan valsartan olmesartan candesartan benazepril captopril enalapril lisinopril Mood stabilizer Taking lithium with perindopril may increase the amount of lithium in your body. Drugs to prevent organ transplant rejection Taking these drugs with perindopril raises your risk of angioedema (swelling), a severe allergic reaction. Examples of these drugs include: temsirolimus sirolimus everolimus In addition, taking cyclosporine with perindopril can increase your risk of high potassium levels in your blood. Gold Using injectable gold (sodium aurothiomalate) with perindopril may increase your risk of a nitritoid reaction. Symptoms of this condition can include flushing (warming and reddening of your face and cheeks), nausea, vomiting, and low blood pressure. Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking. Perindopril warnings This drug comes with several warnings. Allergy warning Perindopril can cause a severe allergic reaction. Symptoms can include: trouble breathing swelling of your throat or tongue hives If you develop these symptoms, call 911 or go to the nearest emergency room. Don't take this drug again if you've ever had an allergic reaction to it. Taking it again could be fatal (cause death). Warnings for people with certain health conditions For people with angioedema: If you have a history of hereditary or idiopathic angioedema that's not related to previous use of drugs similar to perindopril (ACE inhibitors), you may have a higher risk of angioedema while taking perindopril. For people with liver failure: Your body may not clear this drug out of your system as well as it should. This could cause higher levels of perindopril in your body, leading to more side effects. For people with kidney problems: Perindopril may decrease how well your kidneys work. Your doctor may have you stop taking this drug if your kidney function gets worse while you're taking it. For people with lupus: Perindopril can lower your white blood cell counts. This raises your risk of infections. This is more likely to occur if you have lupus. If you have lupus and take this drug, tell your doctor any time you have a fever or sore throat. For people with scleroderma: Perindopril can lower your white blood cell counts. This raises your risk of infections. This is more likely to occur if you have scleroderma. If you have this condition and take this drug, tell your doctor any time you have a fever or sore throat. Warnings for other groups For pregnant women: Perindopril is a category D pregnancy drug. That means two things: Research in humans has shown adverse effects to the fetus when the mother takes the drug. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother. Talk to your doctor if you're pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to your pregnancy. This drug should be only used if the potential risk to the fetus is acceptable given the drug's potential benefit. If you become pregnant while taking this drug, call your doctor right away. For women who are breastfeeding: It isn't known if perindopril passes into breast milk. If it does, it may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication. For seniors: Your body may process drugs more slowly than it used to. A normal adult dosage may cause levels of this drug to be higher than normal in your body. You may need a lower dosage or a different dosage schedule. For children: This drug hasn't been studied in children. It shouldn't be used in children younger than 18 years. How to take perindopril All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on: your age the condition being treated how severe your condition is other medical conditions you have how you react to the first dose Drug form and strengths Generic: Perindopril Form: oral tablet Strengths: 2 mg, 4 mg, 8 mg Dosage for hypertension (high blood pressure) Adult dosage (ages 18–64 years) Typical starting dosage: 4 mg taken once per day. Typical dosage: 4–8 mg taken once per day or split into two divided doses. Dosage increases: Your doctor may change your dosage based on your blood pressure. Maximum dosage: 16 mg per day. Child dosage (ages 0–17 years) This drug hasn't been studied in children. It shouldn't be used in people younger than 18 years. Senior dosage (ages 65 years and older) Typical starting dosage: 4 mg taken once per day or split into two divided doses. Dosage increases: Your doctor will increase your dosage slowly to reduce your risk of side effects. If your doctor increases your dosage above 8 mg per day, they should carefully monitor your blood pressure. Dosage for stable coronary artery (heart) disease Adult dosage (ages 18–64 years) Typical starting dosage: 4 mg taken once per day for two weeks. Dosage increases: Your doctor may increase your dosage up to 8 mg taken once per day if tolerated. Child dosage (ages 0–17 years) This drug hasn't been studied in children. It shouldn't be used in children younger than 18 years. Senior dosage (ages 65–70 years) Typical starting dosage: 4 mg taken once per day for two weeks. Dosage increases: Your doctor may increase your dosage up to 8 mg taken once per day if tolerated. Senior dosage (ages 71 years and older) Typical starting dosage: 2 mg taken once per day in the first week, and 4 mg taken once per day in the second week. Dosage increases: Your doctor may increase your dosage up to 8 mg taken once per day if tolerated. Special dosage considerations For people with kidney disease: For people with mild to moderate kidney disease, the starting dosage is 2 mg taken once per day. The maximum dosage is 8 mg taken once per day. If you have severe kidney disease, you shouldn't use this drug. Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you. Thank you for supporting Medical News Today Take as directed Perindopril oral tablet is used for long-term treatment. It comes with serious risks if you don't take it as prescribed. If you stop taking the drug suddenly or don't take it at all: Your high blood pressure will stay high. This may lead to serious complications, such as a heart attack or stroke. If you miss doses or don't take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, it needs to be taken on a regular basis. If you take too much: You could have dangerous levels of the drug in your body. This may cause you to have more side effects. These can include: very low blood pressure, which may cause dizziness or fainting kidney problems high potassium levels If you think you've taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away. What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects. How to tell if the drug is working: Your blood pressure should be lower. Important considerations for taking perindopril Keep these considerations in mind if your doctor prescribes perindopril for you. General You can take perindopril with or without food. You can crush or cut the tablet. Storage Store perindopril at room temperature between 68°F and 77°F (20°C and 25°C). Store this away from light. Don't freeze this drug. Don't store this medication in moist or damp areas, such as bathrooms. Refills A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription. Travel When traveling with your medication: Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag. Don't worry about airport X-ray machines. They can't harm your medication. You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you. Don't put this medication in your car's glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold. Self-management Your doctor may tell you to check your blood pressure at home in between appointments. You may need to buy a blood pressure monitor to do this. Clinical monitoring You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. They will check you for signs of swelling. They may also check issues that may include your: kidney function electrolyte levels lithium levels (if you're also taking lithium) blood pressure Availability Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it. Hidden costs You may need to buy a blood pressure monitor to check your blood pressure at home. Prior authorization Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription. Are there any alternatives? There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you. Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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Why a regular bedtime may benefit your heart and metabolism

New research — which is now published in the journal Scientific Reports — examines and highlights the importance of regular bedtimes for optimal heart and metabolic health.
clock on bedside table
Going to bed at the same time each night may keep both your heart and metabolism healthy.

The cardiometabolic health risks linked to sleep deprivation are numerous.

These health risks include weight gain, insulin resistance, type 2 diabetes, high blood pressure, and heart disease.

Going to bed and waking up at the same time every day, however, is also vital for health.

A study from last year reported that "social jet lag" — that is, the difference in sleep and waking times between the weekend and the weekdays — can also raise the risk of heart disease.

Previous studies have also suggested that obesity and diabetes may be on the cards for those who hit the snooze button on weekends.

Now, new research from the Duke University Medical Center in Durham, NC, adds to the mounting evidence suggesting that regular bedtimes are key to a person's heart health and the good functioning of their metabolism.

Jessica Lunsford-Avery, Ph.D. — an assistant professor in psychiatry and behavioral sciences from the Duke University Medical Center — led the new study.

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Lunsford-Avery and team examined the sleeping patterns of almost 2,000 adults aged 54–93, who had no history of sleep disorders.

The volunteers all wore sleep tracking devices that picked up on the slightest variations in bedtime patterns. The adults wore the devices for 7 days and kept a sleep diary.

The researchers examined the link between bedtime patterns and markers of cardiometabolic risk, and they calculated a 10-year projected risk of heart disease, obesity, hypertension, and type 2 diabetes markers, such as high blood sugar and hemoglobin A1.

Overall, volunteers with irregular bedtimes had a higher body mass index (BMI), higher levels of blood sugar, higher blood pressure, and higher levels of hemoglobin A1C, and they were more likely to have a heart attack or stroke in the following decade than individuals with regular sleeping patterns.

Also, the volunteers who went to bed and woke up at varying times had a higher risk of depression and stress than their more disciplined counterparts.

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"[S]leep irregularity may represent a target for early identification and prevention of cardiometabolic disease," conclude the authors. However, they also point out that their study is observational and cannot say anything about causality.

"From our study," reports Lunsford-Avery, "we can't conclude that sleep irregularity results in health risks, or whether health conditions affect sleep. Perhaps all of these things are impacting each other."

"Perhaps there's something about obesity that disrupts sleep regularity," she states. "Or, as some research suggests, perhaps poor sleep interferes with the body's metabolism which can lead to weight gain, and it's a vicious cycle."

"With more research," says Lunsford-Avery, "we hope to understand what's going on biologically, and perhaps then we could say what's coming first or which is the chicken and which is the egg."

Either way, the new findings help establish who is at risk of developing serious cardiometabolic conditions.

"Heart disease and diabetes are extremely common in the United States, are extremely costly and also are leading causes of death in this country. To the extent we can predict individuals at risk for these diseases, we may be able to prevent or delay their onset."

Jessica Lunsford-Avery, Ph.D.

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Inflammation keeps heart attack and stroke at bay

Scientists have discovered that, as far as arteries are concerned, inflammation can be both good and bad. In its well-known bad role, it can aid atherosclerosis, the plaque-forming process that clogs up arteries and raises the risk of heart attacks and strokes.
plaque in artery
Inflammation affects the plaque-forming process in the arteries.

New research, however, has also revealed that during the advanced stages of atherosclerosis, inflammation helps to keep the plaques stable, which reduces the risk of heart attacks and strokes.

The study was done at the University of Virginia (UVA) at Charlottesville and now features in the journal Nature Medicine.

These findings have important implications for drugs that treat advanced atherosclerosis by reducing inflammation.

The investigators draw attention to the "high-profile drug" canakinumab, which is undergoing trials for the treatment of advanced atherosclerosis.

Based on their results, they suggest that, should it receive federal approval, the drug should only be given to "a select group of patients."

"What our data suggest," says senior study author Gary K. Owens, a professor of cardiovascular research at UVA, "is that you need to be extremely cautious in starting to give this drug more broadly to lower-risk patients."

"If you give it to the wrong person, it could do the opposite of what you intended," he warns.

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Atherosclerosis and plaques

The Centers for Disease Control and Prevention (CDC) estimate that each year in the United States, around 795,000 people have a stroke and 790,000 have a heart attack.

Most strokes and heart attacks are the result of the complex process of atherosclerosis.

The process builds up plaques in the inside walls of arteries, or blood vessels that supply the heart and other organs and tissues with oxygen and nutrients. The plaques are made of calcium, fats, cholesterol, and other bloodborne substances.

As atherosclerosis progresses, these plaques harden and cause the affected arteries to narrow and impede blood flow.

This increases the risk of heart attack if the artery nurtures heart muscle, or stroke if it is one that feeds the brain.

The traditional view is that the body deposits potentially harmful substances in the plaques and after this they do not change much and enter a dormant state. The "fibrous caps" that seal the plaques are thought to be inert, serving like patches on tires.

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Plaque caps are constantly changing

By working with cell cultures and mice, however, Prof. Owens and his colleagues revealed that the caps are far from inert and can change rapidly and dramatically over time; they are constantly "remodeling."

They noticed that treatment with a drug that blocked an inflammation promoter weakened the cap structure, causing the plaque to rupture more readily.

The scientists suggest that reducing inflammation at the wrong time sends a signal that the job of sealing the plaque is done.

"This study," reports first author Ricky Baylis, who is a student in Prof. Owens's laboratory, "seems to indicate that the fibrous cap, as a structure, is actually much more plastic than previously thought."

Though at first this might appear to be a problem, Baylis says that it may actually present "a much greater opportunity to strengthen the caps to prevent heart attacks and strokes."

Prof. Owens reckons that studies similar to theirs should lead to better design of drugs that target the "bad parts of inflammation" while preserving and even promoting the "good parts" so as to "increase the stability of atherosclerotic lesions."

"[W]e believe our data suggest that if you suppress inflammatory response without first removing or reducing the cause of the inflammation [...] that this could become dangerous and have unintended consequences."

Prof. Gary K. Owens

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Can a heart treatment lower depression and anxiety?

Many people who have atrial fibrillation experience symptoms of mood disorders, such as anxiety and depression. Do particular treatments for this condition help resolve such symptoms? A new study suggests they might.
woman in distress
A-fib is tied to psychological distress, but one treatment for this heart condition can also improve the psychological symptoms.

Atrial fibrillation (A-fib) is a common condition characterized by an irregular heart rhythm.

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

Studies show that about a third of people with this heart condition also have symptoms of depression and anxiety.

Starting from this evidence, researchers from Australia decided to look into how various treatments for A-fib might influence a person's levels of psychological distress.

The results of the study — the senior author of which is Jonathan Kalman, of the Royal Melbourne Hospital — were published earlier this week in the Journal of the American Heart Association.

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Which treatment improves mental health?

The researchers worked with a cohort of 78 participants who had received some form of treatment for A-fib. The team monitored the participants' levels of depression and anxiety and evaluated and took into consideration their personality traits.

Of the total number of participants, 20 had received ablations, a type of procedure through which the heart tissue that produces the irregular heartbeat is removed or destroyed.

The remaining 58 participants chose to take drugs to regulate heart rate and prevent the formation of blood clots.

At the beginning of the study, 35 percent of the participants said that they lived with symptoms of severe anxiety and psychological distress. A further 20 percent reported suicidal ideation.

After a year from the beginning of the study, those who opted for an ablation tended to report lower levels of depression and anxiety compared with those who took drugs as therapy.

More of the people who had received ablations also reported no longer having suicidal thoughts. Specifically, the number of individuals with suicidal ideation fell from six to one among those participants.

Kalman believes that the new findings "[demonstrate] that effective treatment of atrial fibrillation markedly reduces psychological distress."

"This psychological impact," he adds, "is not well appreciated by many heart specialists and is important to take into consideration" — particularly when deciding on the most appropriate treatment for A-fib.

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Psychological distress and chronic conditions

The participants' personality types appeared to have a bearing on whether or not they experienced psychological distress and suicidal ideation.

Individuals who displayed a type D personality were more at risk of anxiety and depression. This personality type is characterized by a predisposition to stress, anger, and pessimism, which has also been tied to poorer outcomes when experiencing a heart condition.

Thirty-five of the total number of participants had type D personalities. Dr. Dimpi Patel, a researcher specializing in the mind-heart link — who is based at the New Hanover Regional Medical Center in Wilmington, NC — explains that the association between heart conditions and psychological distress is important, albeit understudied.

"Patients need to be aware," notes Dr. Patel, "that physical ailments can and do have psychological manifestations, and both must be acknowledged and managed to ensure a good quality of life and perhaps even prevent worse outcomes."

While the new research offers fresh evidence that heart and mind health are closely interlinked, Dr. Patel explains that this association is likely to occur in many more conditions than just A-fib.

"It is important to note that psychological distress, depression, anxiety and, at times, suicidal ideation are not exclusive to atrial fibrillation, but to many chronic diseases such as diabetes, chronic obstructive pulmonary disease, and congestive heart failure."

Dr. Dimpi Patel

"Physicians have an obligation," she adds, "to broaden their approach in managing any chronic illness to include emphasis on the psychological well-being of their patient. To me, it is simply practicing good and compassionate medicine."

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Three daily servings of dairy may keep your heart healthy

A large observational study recently published in the journal The Lancet examines the link between the consumption of whole-fat dairy and cardiovascular health.
dairy products
Dairy products may benefit cardiovascular health, says new research.

The United States Department of Agriculture and American Heart Association (AHA) both recommend that adults do not exceed three servings of low-fat dairy per day.

The high content of saturated fat found in dairy products, they warn, may raise the levels of "bad" cholesterol, which poses a threat to cardiovascular health.

However, new research is challenging these guidelines.

For instance, a recent study has suggested that the fatty acids found in whole-fat dairy may have a protective role against heart disease and stroke.

Now, a large-scale observational study has reviewed the dietary habits of over 130,000 people in 21 countries across five continents and found that whole-fat dairy correlates with a lower risk of mortality and cardiovascular disease.

Dr. Mahshid Dehghan — from McMaster University in Ontario, Canada — is the lead author of the new research.

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Whole-fat dairy lowers mortality risk

Dr. Dehghan and colleagues used food questionnaires to collect self-reported data on the eating habits of 136,384 people over a follow-up period of 9.1 years. The people surveyed were aged between 35 and 70, and the dairy products they consumed were milk, yogurt, and cheese.

For the purposes of the study, a portion of dairy comprised either a glass of milk of 244 grams, a cup of yogurt of 244 grams, a 15-gram slice of cheese, or a 5-gram teaspoon of butter.

Based on these intakes, the team divided the volunteers into four groups: those who consumed no dairy, those whose intake did not exceed one serving per day, those who consumed one to two servings daily, and the "high-intake" group, who consumed over two daily servings — or 3.2 servings, on average — every day.

The study revealed that people in the high-intake group were less likely to die from any cause, less likely to die of cardiovascular disease, and less likely to have a stroke or develop major heart disease.

Also, within the group that regularly consumed full-fat dairy only, the researchers found that the more whole-fat dairy was consumed, the lower the risk of mortality and cardiovascular issues.

"Our findings support that consumption of dairy products might be beneficial for mortality and cardiovascular disease, especially in low-income and middle-income countries where dairy consumption is much lower than in North America or Europe."

Dr. Mahshid Dehghan

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Should dietary guidelines be changed?

Although this is an observational study that cannot confirm causality, the results suggest that some saturated fats in whole-fat dairy could benefit cardiovascular health, as do some vitamins and calcium. Does this mean that the current dietary guidelines should be changed?

Previous research that found similar results suggested that the guidelines do need revising. However, a linked commentary written by Jimmy Chun Yu Louie, at the University of Hong Kong, and Anna M. Rangan, from the University of Sydney in Australia, explains why that may not be such a good idea yet.

"The results from the [...] study seem to suggest that dairy intake, especially whole-fat dairy, might be beneficial for preventing deaths and major cardiovascular diseases," they write.

"However, as the authors themselves concluded, the results only suggest the 'consumption of dairy products should not be discouraged and perhaps even be encouraged in low-income and middle-income countries.'"

"[The study] is not the ultimate seal of approval for recommending whole-fat dairy over its low-fat or skimmed counterparts," they add. "Readers should be cautious, and treat this study only as yet another piece of the evidence (albeit a large one) in the literature."

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Health benefits of hemp seeds

Many people consider hemp seeds to be a superfood. The seeds have a rich nutritional profile and provide a range of health benefits.

Although hemp seeds come from the Cannabis sativa plant, they do not produce a mind-altering effect.

These small, brown seeds are rich in protein, fiber, and healthful fatty acids, including omega-3s and omega-6s. They have antioxidant effects and may reduce symptoms of numerous ailments, improving the health of the heart, skin, and joints.

In this article, we look at the various benefits of hemp seeds and provide tips for adding them to the diet.

Nutritional benefits of hemp seeds These seeds are full of nutritious compounds, including: 1. Protein Benefits of hemp seeds
Hemp seeds are a complete source of protein, providing all nine essential amino acids.

Hemp seeds contain almost as much protein as soybeans. In every 30 grams (g) of seeds, or about a tablespoon, there are 9.46 g of protein.

These seeds are a complete source of protein, meaning that they provide all nine essential amino acids.

Amino acids are the building blocks for all proteins. The body cannot produce nine of these acids, so a person must absorb them through the diet.

Relatively few plant-based foods are complete sources of protein, making hemp seeds a valuable addition to a vegetarian or vegan diet.

Hemp seeds are especially rich in an amino acid called arginine, which has benefits for heart health.

2. Unsaturated fats

The health benefits of polyunsaturated fats, especially omega-3 fatty acids, are becoming increasingly well known.

Hemp seeds are a great source of essential fatty acids, such as alpha-linolenic acid (ALA), which is an omega-3.

The body cannot produce essential fatty acids, and the body must absorb them from the diet. They are crucial for long-term health.

The ratio of omega-3s to omega-6s is also important.

In general, people tend to eat too many omega-6s and too few omega-3s, but adding hemp seeds to the diet may help to promote a balance.

According to results of a 2015 animal study, incorporating hemp seeds and hemp seed oil to hens' diet led to eggs with increased levels of omega-3s in the yolks and a more healthful omega-3 to omega-6 ratio.

Also, hemp seeds are low in saturated fats and contain no trans fats.

3. Fiber

Much of the fiber in a hemp seed lies in its outer hull, or shell. If possible, purchase hemp seeds with the hulls intact.

However, even without the shells, hemp seeds are a god source pf fiber, with three tablespoons containing approximately 1.2 g of fiber.

Consuming enough fiber every day can:

4. Minerals and vitamins

Hemp seeds contain an impressive array of vitamins and minerals and are especially rich in:

They are also a good source of iron, zinc, and B vitamins, including:

niacin riboflavin thiamine vitamin B-6 folate Thank you for supporting Medical News Today Health benefits of hemp seeds Alongside the nutritional benefits, some research suggests that hemp seeds have a wide range of positive health effects. They may: 5. Protect the brain Benefits of hemp seeds brain
The CBD compound found in hemp seeds may help with neurological conditions. A study published in the journal Food Chemistry found that hemp seed extract has antioxidant effects in lab tests. These effects may result from the seeds' cannabidiol (CBD) content. Results of a review from 2018 suggest that CBD and other compounds in the seeds may have neuroprotective, anti-inflammatory, effects and may also help to regulate the immune system. The review suggests that, because of these potential properties, CBD may help with neurological conditions, including: 6. Boost heart health The medical community believes that omega-3 fatty acids improve the health of the heart and reduce the risk of issues such as arrhythmias and heart disease. Hemp seeds contain high levels of omega-3s and a healthful ratio of omega-3 to omega-6 fatty acids. The seeds also contain high levels of arginine, an amino acid that turns into nitric oxide. Nitric oxide is essential for artery and vein dilation, and it helps keep blood vessel walls smooth and elastic. Lowering blood pressure, eating a healthful diet, and participating in varied forms of exercise may help to decrease the risk of heart failure. 7. Reduce inflammation The amount of omega-3s in hemp seeds and the seeds' healthful omega-3 to omega-6 ratio can together help to reduce inflammation. In addition, hemp seeds are a rich source of gamma linolenic acid (GLA), a polyunsaturated fatty acid which may also have anti-inflammatory effects. Some studies on animals suggest that GLA can act as a potent anti-inflammatory. However, recent studies in humans suggest that the acid is not always effective. A review in The European Journal of Pharmacology states that humans process GLA in a very complicated way, which may explain why the studies in humans produce more varied results than those on animals. When looking at these studies, it is important to note that researchers usually use high concentrations of hemp seed extracts and that eating the seeds may produce less dramatic effects. Reducing inflammation may help manage the symptoms of chronic diseases, such as: 8. Improve skin conditions Atopic dermatitis (AD) and acne can both result from chronic inflammation. The anti-inflammatory compounds in hemp seeds may help. Among other possible dietary causes, acne may be linked to a deficiency in omega-3s. The high omega-3 content in hemp seeds may help to manage and reduce acne symptoms. A 2018 review explored the effects of dietary changes on skin diseases. While the authors found evidence that eating more omega-3s may improve symptoms of acne, determining the extent of the effects will require more research. The authors also note that prebiotics and plant fibers may help to manage symptoms of AD. Hemp seeds are a rich source of plant fiber. 9. Relieve rheumatoid arthritis Rheumatoid arthritis is an autoimmune condition. It causes the immune system to attack its own tissues, which leads to inflammation in the joints. In 2014, research conducted in human cells suggested that hemp seed oil could have anti-rheumatic effects. However, a 2018 review found a lack of conclusive evidence to suggest that cannabinoids could effectively treat rheumatic diseases. The authors noted that more research is needed. Nutritional profile of hemp seeds Hemp seeds contain plenty of protein, healthful fatty acids, and fiber. According to the United States Department of Agriculture (USDA), 3 tablespoons of hemp seeds contain 116 calories and the following nutrients: Protein 9.47 g Carbohydrates 2.60 g Fat 1.20 g Total fatty acids 14.62 g Monounsaturated fatty acids 1.62 g Polyunsaturated fat 11.43 g Saturated fatty acids 1.38 g Hemp seeds are also a healthful source of vitamin E and minerals, such as calcium, iron, magnesium, potassium, and zinc. Thank you for supporting Medical News Today How to add hemp seeds to the diet Benefits of hemp seeds cereal
People can add hemp seeds to smoothies and cereal. When considering the results of studies, it is important to note that researchers often use hemp seed extract, rather than whole hemp seeds. People can purchase shelled, ground, or split seeds. To remove the seeds' hard outer shells at home, a person can use a mortar and pestle or a food processor. Whole seeds act as a bulking agent, and they also add fiber to the diet, which can aid digestion. Try incorporating hemp seeds into the diet by: sprinkling whole or ground seeds on cereal or yogurt adding the seeds to smoothies baking with hemp seeds and others rich in omega-3s making hemp milk at home using whole seeds sprinkling hemp seeds, along with other seeds or nuts, on a salad People can find hemp seeds in some supermarkets, health food stores, and online. Online stores also offer other hemp products, such as hemp milk, which may be fortified with extra nutrients, and hemp protein powder, which is a plant-based alternative to whey protein powder. Risks Although hemp seeds come from the cannabis plant, they ideally contain no tetrahydrocannabinol (THC), which is the active ingredient in cannabis. Hemp seeds will not produce a mind-altering effect. However, athletes and others who undergo drug testing should be aware that consuming hemp products can, in some cases, lead to failed urine tests. The level of THC in any hemp-based product depends on the suppliers and the manufacturing process. In Canada, the production of hemp seeds is tightly regulated to prevent cross contamination of THC from the cannabis plant. A legal principle in the U.S. prohibits people from growing hemp seeds with THC concentrations higher than 0.3 percent. The U.S. government also strictly regulates the importation of hemp seeds and hemp-based products. Thank you for supporting Medical News Today Takeaway Hemp seeds have a rich nutrition profile. They contain high levels of antioxidants, fatty acids, minerals, and vitamins. The shells add fiber to the diet, and grinding the seeds helps the body to absorb more of the other nutrients. Some research has suggested links between hemp seeds and health benefits, but these studies tend to use extracts with high concentrations. While there are potential health benefits to consuming hemp seeds, avoid eating excessive amounts. There is evidence that some seeds contain levels of THC that exceed the legal limit. The most healthful choice is to eat a varied diet that contains a wide range of nutrients.
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Walking may prevent heart failure in senior women

New research examines the effect of walking on two subtypes of heart failure in aging women. The findings were published in the Journal of the American College of Cardiology: Heart Failure.
senior woman walking
Senior women, walking could do wonders for your hearts.

According to recent estimates, almost 5 million people in the United States have congestive heart failure.

Over half a million cases are diagnosed each year.

Despite its name, "heart failure" does not mean that the heart has stopped working completely, explain the American Heart Association (AHA).

In congestive heart failure, the heart is not pumping blood as well as it should be.

Heart failure occurs in two main ways: either the muscles of the heart weaken, or they become stiff and lose their elasticity.

Although the condition affects people of all ages, it is more prevalent among seniors over the age of 60. The AHA recommend that people at risk avoid smoking, exercise more, and eat heart-healthy foods.

A new study delves deeper into one of these potential strategies for prevention. Researchers from the University of Buffalo in New York set out to investigate how walking affects two heart failure subtypes: reduced ejection fraction heart failure, and preserved ejection fraction heart failure.

Michael LaMonte, a research associate professor of epidemiology at the University of Buffalo School of Public Health and Health Professions, led the study.

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Studying walking and heart failure in women

Reduced ejection fraction heart failure occurs when the heart's left side pumps less blood into the body than normal.

Specifically, the normal ejection fraction — which measures how much blood is pumped out of the left ventricle into the body in one heartbeat — is over 55 percent. In reduced ejection heart failure, this rate drops to 40 percent or under.

In preserved ejection fraction heart failure, this rate may be over 50 percent and thus appear to be normal. However, if the heart muscles are too thick or stiff, the initial amount of blood that the ventricles can hold may already be too small for what the body needs.

As LaMonte and team explain, the first form of heart failure has a poorer outlook, whereas the second form is more common in seniors and tends to affect women and ethnic minorities in particular.

The researchers examined the link between physical activity levels as reported by 137,303 people who registered in the Women's Health Initiative, a long-term study of postmenopausal women.

Then, the scientists zoomed in on a subgroup of 35,272 women who lived with either one of the two subtypes of heart failure.

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Why walking is 'particularly important'

For each additional 30–45 minutes of daily physical activity, the risk of developing heart failure was reduced by 9 percent for heart failure in general, by 8 percent for preserved ejection fraction heart failure, and by 10 percent for reduced ejection fraction heart failure.

Crucially, while walking and physical activity correlated inversely with heart failure risk, the intensity of the physical activity did not have any effect; this suggests that the amount of activity is what matters.

"The finding that walking showed a protective association with heart failure and its subtypes is particularly important in a public health context. This is especially relevant given that walking is by far the most commonly reported physical activity in older adults."

Michael LaMonte

"This is the first study to report physical activity levels are related to a lower risk of developing heart failure with reduced ejection fraction in older adults, particularly in women," highlights LaMonte.

"This is pretty important from a public health standpoint, given the poor prognosis this type of heart failure has once it's present," he adds.

"Because heart failure is much more common after age 60," he says, "and because its treatment is very challenging and costly, the possibility of preventing its development by promoting increased physical activity levels, and specifically walking, in later life could have an important impact on the overall burden of this disease in an aging society."

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Common painkiller poses risk to heart health

One of the most widely used painkillers may pose a threat to cardiovascular health. This is the main takeaway of new research, recently published in The BMJ.
Common painkillers may hide major risks, says a new study.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to alleviate pain.

In fact, according to the National Institutes of Health (NIH), about 30 million people in the United States take NSAIDs each year.

While NSAIDs are commonly recommended to treat inflammatory conditions, headaches, and fever, the drugs are thought to have some cardiovascular risks.

However, due to ethical concerns, these risks cannot be evaluated in clinical trials.

The European Society of Cardiology therefore carried out an extensive review of existing research that concluded that nonaspirin NSAIDs should not be prescribed to individuals at high risk of heart disease, nor should they be sold over the counter without issuing an "appropriate warning of their frequent cardiovascular complications."

Now, a new study focuses on one NSAID in particular: diclofenac. Scientists led by Morten Schmidt, at Aarhus University Hospital in Denmark, set out to investigate the cardiovascular risks of taking this common painkiller, which some rank as "the most widely used [...] NSAID in the world."

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Schmidt and team examined 252 national studies for information on over 6.3 million Danish people over a period of 20 years in 1996–2016. On average, the participants were aged 46–56.

During the study period, the researchers examined the cardiovascular risks of taking up diclofenac and compared them with the risks of starting paracetamol, ibuprofen, or naproxen.

After accounting for potentially confounding factors, the researchers found that within 30 days of taking up diclofenac, the rate of major cardiovascular problems — such as arrhythmia, ischemic stroke, heart failure, and heart attack — was much higher compared with other NSAIDs.

Specifically, the risk of such adverse cardiovascular events was 50 percent higher among those who started taking diclofenac, compared with those who did not take it. Compared with taking paracetamol or ibuprofen, taking diclofenac raised cardiovascular risk by 20 percent.

Additionally, write the authors, "Diclofenac initiation [...] increased the risk of upper gastrointestinal bleeding [...] by approximately 4.5-fold compared with no initiation [and] 2.5-fold compared with initiation of ibuprofen or paracetamol."

The cardiovascular threat also increased with the risk at baseline. In other words, the higher the risk of heart problems when the patients started taking the drug, the higher the risk of actually developing heart problems over the course of the treatment.

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"Diclofenac poses a cardiovascular health risk compared with non-use, paracetamol use, and use of other traditional nonsteroidal anti-inflammatory drugs," explain the authors.

Although the study is observational, they say — which means that no conclusions can be drawn about causality — the large sample size and the quality of the research is sufficiently "strong evidence to guide clinical decision-making."

"Treatment of pain and inflammation with NSAIDs," explain the authors, "may be worthwhile for some patients to improve quality of life despite potential side effects."

"Considering its cardiovascular and gastrointestinal risks, however, there is little justification to initiate diclofenac treatment before other traditional NSAIDs."

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Is there a link between acid reflux and palpitations?

Palpitations are irregular heartbeats that can occur sporadically or frequently. Although palpitations have many direct causes, gastroesophageal reflux disease (GERD), the long-term and frequent occurrence of acid reflux, is unlikely to be one of them. However, acid reflux shares some of the same triggers as palpitations and may also lead to them indirectly.

The primary symptom that acid reflux does cause is a burning pain in the chest and upper abdomen, which occurs due to stomach acid leaking back into the food pipe.

In this article, we look at heart palpitations in more detail, including the common causes of palpitations and how they might relate to acid reflux.

What are palpitations? Heart palpitations represented by model fo a heart over a stethoscope.
A palpitation is an irregular heartbeat.

Palpitations are irregular heartbeats that can make a person feel as though their heart has skipped a beat. The heart may also feel like it is fluttering in the chest.

Other people with heart palpitations may feel that their heart is beating harder than usual or beating too fast in comparison to its regular rate.

Much of the time, heart palpitations are harmless, and people can think of them as a speed bump in the heart's natural rhythm.

Other times, heart palpitations may signal a problem with the heart or other organs.

Some people experience heart palpitations regularly while others may only have them on rare occasions.

Acid reflux and causes of heart palpitations While acid reflux will not usually be a direct cause of heart palpitations, it may lead to them indirectly. For instance, if a person with GERD feels stressed or anxious about their symptoms, this may lead to palpitations. Several factors may also trigger both acid reflux and heart palpitations. When this happens, it is easy to confuse the causes. For example, alcohol consumption may cause palpitations in some people, and it can also trigger GERD symptoms. Likewise, too much caffeine may sometimes trigger GERD symptoms, and the effects of caffeine can also cause skipped heartbeats or palpitations. Eating too much, or eating a particularly heavy meal, may also cause both heart palpitations and acid reflux in some people. Thank you for supporting Medical News Today Other causes of heart palpitations Other possible causes of palpitations can include: illegal drugs, such as cocaine or methamphetamine smoking tobacco smoking marijuana pregnancy some stimulating medications electrolyte imbalance, such as low potassium levels low blood sugar sickness Some medical conditions may cause palpitations, including: Symptoms of heart palpitations Man touching chest in doctors office explaining heart problem
A fast heartbeat is a potential symptom of heart palpitations. The symptoms of heart palpitations can vary from person-to-person, but may include: a fast or racing heartbeat the heart pounding in the chest or beating very hard a fluttering sensation in the chest a feeling of the heart skipping a beat a "flip-flopping" sensation in the chest, as though the heart has turned over These sensations are due to either premature atrial contractions (PACs) or premature ventricular contractions (PVCs). Both of these are extra beats in the heart that happen just before the regular heartbeat, causing the person to feel an odd sensation. Severe symptoms are also possible alongside heart palpitations. These may include: chest pain breathing difficulty cold sweats feeling dizzy or fainting tightness, pain, or pressure in the shoulder, neck, or jaw When they occur together with heart palpitations, these symptoms may signify a heart condition or medical emergency. Anyone experiencing these symptoms should seek emergency medical attention. Diagnosing heart palpitations To diagnose heart palpitations, doctors will first perform a physical exam and ask about any symptoms. It may be beneficial for people with heart palpitations to keep a daily journal of their symptoms to discuss with the doctor at the appointment. The doctor may do some physical checks, such as listening to the heart with a stethoscope or checking the thyroid gland for swelling. Much of the time, they will also order one or more tests to examine the heart in more detail. Possible tests include: Electrocardiogram (ECG) An ECG records impulses in the heart. Doctors may order an ECG to track the rhythm and beats of the heart and check for irregularities. Holter monitor If a simple ECG does not capture any irregularities, doctors may have the person wear a Holter monitor. A Holter monitor is a portable ECG that records the heart for an extended continuous period, potentially 24 hours or more. This may be helpful for people who only have palpitations in specific situations, such as when lying down or after a meal. Event recorder If palpitations are less frequent, a doctor may ask the individual to wear an event recorder. An event recorder only records the heart when prompted. The user pushes a button when they feel the palpitation, and the recorder picks it up for the doctor to examine later. People may wear event recorders for much longer than Holter monitors, sometimes keeping them on for up to several weeks. Ultrasound Doctors will sometimes order an ultrasound of the chest, called an echocardiogram, to view the heart and see how it is looking and working. Blood tests Some blood tests may help diagnose underlying causes, such as anemia or thyroid problems. Thank you for supporting Medical News Today Treatment for heart palpitations Woman drinking from mug with headphones in relaxing to mindfulness or meditation app
Meditation and deep breathing exercises may help treat stress-related palpitations. Doctors usually only treat heart palpitations related to more severe heart conditions. The treatment can vary in each case, and doctors will thoroughly discuss all of the person's options with them. For common heart palpitations, a doctor may recommend lifestyle changes. If palpitations seem to occur around the same time as GERD symptoms, it is likely to be because of the meal the person just ate. They may be consuming meals that are too large, or their body may be sensitive to a specific food that they are eating. People can often identify trigger foods by keeping a daily journal of what they eat and any symptoms that they experience. Treating palpitations can sometimes be as simple as removing these foods from the diet. Avoiding the excessive consumption of tobacco, alcohol, and marijuana is also likely to help some people. For stress-related palpitations, doctors may recommend that people relieve stress by incorporating some of the following activities into their weekly routines: meditation yoga tai chi deep breathing exercises mild-to-moderate exercise Doing at least one of these activities regularly may help reduce stress, which can cause palpitations in some people. What to do when you experience palpitations Palpitations may be a sign of an underlying condition, even in cases where stress triggers them. Anyone experiencing heart palpitations along with other serious symptoms should seek emergency medical care. These symptoms include: chest, back, or shoulder pain tightness in the jaw shortness of breath How to stop palpitations There are a couple of techniques that people can try to stop palpitations when they are occurring. These methods stimulate the vagus nerve, which may help control the heartbeat: Valsalva maneuver. Pinch the nose and close the mouth. Try to breathe out of the nose for a couple of seconds to create a feeling of pressure in the head. Cold water. Splash cold water on the face for 30 seconds or dunk the head in cold water. This may stimulate a response in the body, slowing down the heart rate. Bearing down. Bearing down is the act of clenching the muscles in the stomach and closing the anal sphincter while pushing down as if initiating a bowel movement. This action has the same result as the Valsalva maneuver. These techniques may work temporarily, but it is vital not to ignore the underlying cause of palpitations. Long-term treatment should be a top priority for people with this symptom. Takeaway While GERD or acid reflux is unlikely to cause heart palpitations directly, symptoms associated with GERD may trigger palpitations in some people. Anyone who is unsure about their symptoms should talk to a doctor, and any severe symptoms indicate that emergency medical care is necessary.
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