The Heart

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Recalled 'weight history' can predict heart failure risk

Asking older adults how much they weighed in the past can help to predict their risk of heart failure, according to recent research.
senior woman receiving heart from women's hands
New research found that asking seniors how much they weighed in their 20s and 40s accurately predicted heart failure risk.

Ideally, doctors treating older people would have ready access to accurate weight histories from lifelong medical records.

In reality, however, medical records tend not to accompany people as they change their primary care doctors.

After studying more than 6,000 older adults, researchers from the Johns Hopkins School of Medicine in Baltimore, MD, concluded that just asking older individuals how much they weighed when they were 20 and 40 years old could help predict their risk of heart failure.

"Self-reported lifetime weight," they write in a report of the study that features in the Journal of the American Heart Association, "is a low-tech tool easily utilized in any clinical encounter."

While unlikely to be as accurate as clinically recorded weight, they found that self-reported weight, over and above current body mass index (BMI), could be a good predictor of heart failure risk.

Obesity and heart failure

Previous studies have shown that the more years that individuals spend with obesity, the more likely they are to have a higher risk of heart failure.

"That is why," explains senior study author Dr. Erin D. Michos, who is an associate professor of medicine, "measuring a person's weight at older ages may not tell the whole story about their risk."

There is mounting evidence that individuals who have only recently developed obesity are overall in less danger compared with counterparts who have a history of obesity, she adds.

Heart failure, also known as congestive heart failure, is a severe condition. It develops when heart muscle gradually weakens and stiffens until it cannot pump enough oxygen- and nutrient-rich blood to the body's organs and tissues.

The Centers for Disease Control and Prevention (CDC) estimate that around 5.7 million people have heart failure in the United States, where the condition contributed to 1 in 9 deaths in 2009.

Around half of those diagnosed with heart failure do not live more than 5 years following diagnosis.

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A practical way to obtain weight history

In the routine assessment of heart disease and heart failure risk, doctors bring together measures of cholesterol, blood pressure, diet, BMI, and family history of cardiovascular disease.

Dr. Michos notes that while it is useful to have the current BMI measure when making such an assessment in older adults, having a weight history would be even more helpful.

So, she and her team set out to investigate if there might a practical way of obtaining a weight history that is good enough to inform routine clinical assessment.

They used data from the Multi-Ethnic Study of Atherosclerosis (MESA) on 6,437 people living in six different states in the U.S. The individuals, of which 53 percent were female, had joined the study during 2000-2002 when their average age was 62 years.

Regarding ethnic composition, the cohort was around 39 percent white, more than 26 percent African-American, 22 percent Hispanic, and just over 12 percent Chinese-American.

At the start of the study, the participants had filled in questionnaires that asked them about their weight when they were 20 and 40 years old.

During an average follow-up of 13 years, there was a total of five in-person visits that included weight measurement.

The investigators converted the weight measurements into BMI by dividing the weight in kilograms by the square of the height in meters. They classed BMIs under 25 as normal, between 25 and under 30 as overweight, and 30 and above as being in the obesity range.

Weight history tied to heart failure risk

During the follow-up, 290 individuals had developed heart failure. Another 828 had experienced heart attacks, strokes, or other conditions due to arterial plaque buildup, or had died because of one of these conditions.

Dr. Michos says that, as they expected, there was a link between the weight measures that came from the follow-up visits and the risk of developing heart failure.

For every 5 kilograms per square meter of extra BMI, the risk of developing heart failure went up by 34 percent. This was after accounting for other possible risk factors, such as smoking, age, exercise, diabetes, and blood pressure.

However, further analysis also revealed that reporting having had obesity at age 20 was linked to an above threefold risk of heart failure. Reporting having had obesity at age 40 was tied to a twofold risk.

These risks were in comparison to those who reported having BMIs in the normal range at those two ages.

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Doctors should ask about weight history

The team notes that self-reporting can be subject to bias from imperfect memory, but they suggest that most older adults have a reasonable ability to recall how much they weighed when they were younger.

They propose that just asking about weight history can be a help. And yet, while it is an easy thing to incorporate into routine clinical assessments, most doctors don't ask the question.

Dr. Michos calls for further research on how best to include self-reported weight history in clinical practice and electronic health records.

"Our findings emphasize the importance of lifelong maintenance of a healthy weight, as greater cumulative weight from young adulthood is more risky to heart health."

Dr. Erin D. Michos

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Mediterranean diet reduces cardiovascular risk by a quarter

A recent study has put the Mediterranean diet to the test once more, attempting to unpick the molecular mechanisms that produce its benefits.
Mediterranean diet couple dinner
More good news for advocates of the Mediterranean diet.

Inspired by the traditional eating patterns of people from Greece, Italy, and Spain, the Mediterranean diet can seemingly do no wrong.

In a nutshell, the diet is rich in plants and olive oil but low in meat and sugary products.

Over the years, studies have concluded that this eating pattern lowers the risk of various health issues, including coronary heart disease and stroke.

Studies have even concluded that the Mediterranean diet might extend lifespan in older adults as well as reduce the risk of Parkinson's and Alzheimer's.

Evidence is mounting for its health benefits, but scientists still do not know exactly how these benefits come about.

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The Mediterranean black box

A new study published in JAMA Network Open asks the following question: "Is the Mediterranean diet [...] associated with lower risk of cardiovascular disease (CVD) events in a [United States] population, and, if so, what are the underlying mechanisms?"

As corresponding study author Dr. Samia Mora explains, "While prior studies have shown benefit for the Mediterranean diet on reducing cardiovascular events and improving cardiovascular risk factors, it has been a black box regarding the extent to which improvements in known and novel risk factors contribute to these effects."

To investigate, the scientists took data from the Women's Health Study. Lead study author Shafqat Ahmad, Ph.D., led researchers from Brigham and Women's Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health — all in Boston, MA.

In all, they had access to the health records and dietary habits of 25,994 women, all of whom were healthy at the start of the study. The researchers followed them for a maximum of 12 years.

The researchers measured the levels of 40 biomarkers, including lipids, inflammation, glucose metabolism, and lipoproteins. They split the participants into three groups — low, middle, and upper intake — depending on how strictly they adhered to the Mediterranean diet.

They were particularly interested in cardiovascular events, such as stroke and heart attack. They found that:

In the low intake group, 4.2 percent of women had a cardiovascular event. In the middle intake group, 3.8 percent of women had a cardiovascular event. In the upper intake group, 3.8 percent of women had a cardiovascular event.
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This marks the first long-term study in a U.S. population to explore the impact of the Mediterranean diet on CVD. The authors conclude:

"[H]igher [Mediterranean diet] intake was associated with approximately one-quarter lower risk of CVD events over a 12-year follow-up period."

The authors also note that this effect size is equivalent to that present in people who take statins, which are common drugs that doctors prescribe to lower cardiovascular risk.

Mediterranean metabolites

Next, they dived into the metabolic data to see if they could find any patterns. They discovered that variation in metabolites related to inflammation accounted for 29 percent of the reduction in CVD risk.

Glucose metabolism and insulin resistance accounted for 27.9 percent, body mass index (BMI) for 27.3 percent, and blood pressure for 26.6 percent.

The team also noted relationships between a number of other metabolites, including lipids, but these were less pronounced.

Dr. Mora says, "In this large study, we found that modest differences in biomarkers contributed in a multifactorial way to this cardiovascular benefit that was seen over the long-term."

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Once again, the Mediterranean eating pattern seems to have come up trumps; and now we know that its benefits are most likely due to the way it interacts with inflammation pathways, glucose metabolism, and insulin resistance.

Of course, there are some limitations to the study. For instance, as the authors explain, CVD risk could have been influenced by as-yet-unknown metabolic factors that the scientists did not measure in this study.

Also, the dietary information that they analyzed relied on the participants keeping a food diary, which comes with a potential for human error. However, the size of this study and the detailed information about biomarkers make this a relatively reliable research endeavor.

As evidence in favor of the Mediterranean diet mounts, its popularity is sure to continue climbing.

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Red meat raises heart disease risk through gut bacteria

Scientists have uncovered further evidence of how a diet rich in red meat interacts with gut bacteria to raise the risk of heart disease.
two hands cutting red meat with knife and fork
A diet rich in red meat may affect heart disease risk by triggering the production of certain metabolites in the gut.

They found that people who ate red meat as their main source of protein for 1 month had levels of trimethylamine N-oxide (TMAO) that were two to three times higher than those in people who got their protein primarily from white meat or non-meat sources.

Gut bacteria produce TMAO as a byproduct when they feed on certain nutrients during digestion.

Previous studies have implicated high circulating levels of TMAO in the development of artery-blocking plaques and raised risk of heart-related conditions.

In the recent research, scientists at the Cleveland Clinic in Ohio uncovered two mechanisms through which a diet rich in red meat raises TMAO levels.

It appears that not only does frequent consumption of red meat enhance gut bacteria production of TMAO, but it also reduces elimination of the compound through the kidneys.

The European Heart Journal has published a report on the study and its findings.

"This is the first study of our knowledge," says senior study author Dr. Stanley L. Hazen, who chairs the Department of Cellular and Molecular Medicine in the Cleveland Clinic's Lerner Research Institute, "to show that the kidneys can change how effectively they expel different compounds depending on the diet that one eats — other than salts and water."

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TMAO as a predictor of heart disease risk

In previous work, Dr. Hazen and his team had found that TMAO alters blood platelets to raise the risk of thrombosis, or blood clots.

Their work revealed that TMAO modifies calcium signaling in blood platelets. In addition, it showed that platelets respond differently to blood-clotting triggers when blood levels of TMAO are high.

The team proposed that the compound could be a powerful predictor of the risk of heart attack, stroke, and death — even when cholesterol and blood pressure levels are healthy.

Others have since replicated the findings and, like Dr. Hazen and his team, have continued to investigate TMAO and its impact on health.

Research from the University of Leicester in the United Kingdom, for example, demonstrated that people with acute heart failure fared worse if they had higher circulating levels of TMAO.

Clinical trials are also underway to test TMAO as a predictive marker of heart disease risk.

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Red meat diet compared with other diets

The recent study assigned 113 individuals to follow three tightly controlled diets in a random order for 4 weeks each with a "washout diet" preceding the changeover.

The diets differed according to their main source of protein. In the red meat diet, 12 percent of the daily calories came from lean red meat in the form of pork or beef, while in the white meat diet, these calories came from lean white poultry meat.

In the non-meat diet, 12 percent of the daily calorie intake came from "legumes, nuts, grains, [and] isoflavone-free soy products."

In all three diets, protein accounted for 25 percent of the daily calories, and the remaining 13 percent of this protein came from "eggs, dairy, and vegetable sources."

After 4 weeks on the red meat diet, "the majority of" the individuals had raised levels of TMAO in their blood and urine.

On average, compared with levels during the white meat and non-meat diets, blood levels of TMAO during the red meat diet were up to three times higher. For some individuals, the levels were 10 times higher. Urine samples revealed a similar pattern.

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Reduced kidney efficiency

The study also yielded an unexpected result. While on the red meat diet, the study participants' kidneys were less efficient at expelling TMAO.

However, in the 4 weeks after ceasing the red meat diet, their blood and urine levels of TMAO fell.

Dr. Hazen says that the findings show that people can reduce their risk of heart-related problems by changing what they eat.

Gut production of TMAO was lower and kidney elimination was higher when the individuals followed the white meat or non-meat protein diet.

This suggests, says Dr. Hazen, that these types of diet are more healthful for the heart and body.

"We know lifestyle factors are critical for cardiovascular health, and these findings build upon our previous research on TMAO's link with heart disease."

Dr. Stanley L. Hazen

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Statins: Risk of side effects is low, say experts

For most people who take statins to lower cholesterol, the risk of side effects is low compared to the benefits, according to a recent scientific statement.
pills and stethoscope against a pink and blue background
New research suggests that the benefits of statins outweigh the risks.

The American Heart Association (AHA) statement applies to those who — according to current guidelines — are at risk of heart attack and ischemic strokes, which are strokes arising from blood clots.

Statins are drugs that reduce low-density lipoprotein (LDL) cholesterol by blocking an enzyme in the liver.

Around a quarter of adults over the age of 40 years old in the United States use statins to reduce their risk of heart attack, ischemic stroke, and other conditions that can develop when plaque builds up in arteries.

However, up to 1 in 10 of individuals taking statins stop using them because they assume that the drug is responsible for symptoms that they experience, although that may not be the case.

"Stopping a statin," says Dr. Mark Creager, who is director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, NH, and former president of the AHA, "can significantly increase the risk of a heart attack or stroke caused by a blocked artery."

The journal Arteriosclerosis, Thrombosis, and Vascular Biology carries a full report on the research that went into the statement.

Within guidelines, 'benefits outweigh risks'

The statement's authors say that trials have proved that statins have had a major effect on reducing heart attacks, strokes, other cardiovascular diseases, and associated deaths.

Further to this, they reviewed a large number of studies and clinical trials that have evaluated the safety and potential adverse effects of statins.

"Over 30 years of clinical investigation," the authors write, "have shown that statins exhibit few serious adverse effects."

They point out that, apart from a few exceptions, it is possible to reverse the adverse effects of statin use. This should be compared, they argue, with the fact that heart attacks and stroke damage the heart or brain permanently, and they can kill.

They list the exceptions as "hemorrhagic stroke and the possible exception of newly diagnosed diabetes mellitus and some cases of autoimmune necrotizing myositis."

"Thus," they conclude, "in the patient population in whom statins are recommended by current guidelines, the benefit of reducing cardiovascular risk with statin therapy far outweighs any safety concerns."

According to the AHA, the current guidelines recommend the use of statins for the following groups:

Those who have experienced heart attack, stroke, transient ischemic attacks, or who have a history of cardiovascular conditions such as angina and peripheral artery disease. Adults aged 40–75 years old whose LDL cholesterol is in the 70–189 milligrams per deciliter (mg/dl) range and whose risk of having a heart attack or stroke in the next 10 years is 7.5 percent or above. Adults aged 40–75 years of age who have diabetes and whose LDL cholesterol is in the range 70–89 mg/dl. Anyone aged 21 years and older with a very high LDL cholesterol level of 190 mg/dl and above.
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'Muscle aches and pains'

People using statins who report side effects most often mention "muscle aches and pains."

However, the research that the statement's authors reviewed reveals that fewer than 1 percent of people who use statins "develop muscle symptoms that are likely caused by statin drugs."

Uncertainty about the causes of any aches and pains, coupled with the fact that they are taking statins, may prompt people to make a link where none exists.

The AHA say that if individuals stop taking their statins for this reason, they may be doing more harm than good by raising their risk of a cardiovascular event.

They urge healthcare providers to "pay close attention to their patients' concerns and help them assess likely causes." They could, for instance, check for blood markers of muscle damage. If they are normal, this could reassure their patients.

Another option is to check vitamin D levels, as insufficiency amounts can also cause muscle aches and pains.

Risk of diabetes and hemorrhagic stroke

There is a slight chance that statins might raise the risk of diabetes, especially in those at higher risk. These include individuals with obesity or whose lifestyle is largely sedentary.

The statement suggests that the absolute risk of being diagnosed with diabetes as a result of using statins is around 0.2 percent per year.

For those who already have diabetes, there could be a slight increase in the amount of glucose in the blood, as their HbA1c measure may reflect.

However, the increase is very small and should not prevent the use of statins, note the AHA.

The research that the statement reviewed did not find that statins increase the risk of a first hemorrhagic stroke, which is a type of stroke that occurs when a blood vessel ruptures.

People with a history of hemorrhagic stroke, on the other hand, may have a slightly higher risk of a further one if they use statins. However, this risk is very small and the overall benefits of statin use in reducing strokes and "other vascular events" outweighs it.

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Risk of other side effects

The statement's authors also looked at evidence that statin use might increase the risk of other conditions. These included damage to peripheral nerves, other neurological effects, damage to the liver, cataracts, and ruptures to a tendon.

They found, however, "little evidence" to support the idea that using statins raised the risk of these conditions.

In rare instances, there could be a side effect called rhabdomyolysis, which is a type of muscle injury that can lead to acute kidney failure. A sign of this can be passing dark urine, so if this happens people should stop taking their statins and see their doctor, say the AHA.

From the reviewed evidence, the statement suggests that rhabdomyolysis is a side effect in less than 0.1 percent of people taking statins.

"In most cases, you should not stop taking your statin medication if you think you are having side effects from the drug — instead, talk to your healthcare provider about your concerns."

Dr. Mark Creager

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Excess belly fat common in those with high heart risk

Excess waist fat is common in many people with a high risk of heart disease and stroke, according to a recent European study.
middle aged man doing squats
New research finds that two-thirds of people at high risk of developing cardiovascular disease have excess belly fat.

The study, called EUROASPIRE V, is a survey of cardiovascular disease prevention and diabetes. It forms part of a European Society of Cardiology research program.

The findings featured recently at the World Congress of Cardiology & Cardiovascular Health in Dubai in the United Arab Emirates.

They revealed that nearly two-thirds of individuals at high risk of cardiovascular disease had excess abdominal fat.

The results also showed that:

Only 47 percent of those taking drugs to reduce high blood pressure were achieving a target of under 140/90 millimeters of mercury, or under 140/85 for those who reported having diabetes. Among individuals using lipid-lowering medication, only 43 percent had reached the low-density lipoprotein (LDL) cholesterol target of under 2.5 millimoles per liter. Many who were not in receipt of treatment for high blood pressure and high LDL cholesterol had those conditions. Only 65 percent of individuals receiving treatment for type 2 diabetes had attained the target blood sugar of under 7.0 percent glycated hemoglobin (HbA1c).

"The survey," says Kornelia Kotseva, chair of the EUROASPIRE Steering Committee and a professor at Imperial College London in the United Kingdom, "shows that large proportions of individuals at high risk of cardiovascular disease have unhealthy lifestyle habits and uncontrolled blood pressure, lipids, and diabetes."

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Individuals with high heart risk

The recent study focuses on "apparently healthy individuals in primary care at high risk of developing cardiovascular disease, including those with diabetes."

Altogether, 78 primary care practices from 16, mainly European, countries took part in the research, which took place during 2017–2018.

They recruited individuals who were under 80 years of age and had no history of coronary artery disease or other conditions arising from atherosclerosis.

However, assessments had shown that they were at high risk of developing cardiovascular disease due to one or more of the following: high blood pressure, high cholesterol, or diabetes.

The researchers used medical records to identify those eligible for the study and invited them for an interview and clinical exam.

The interviewers asked questions about diet, exercise, smoking, and other lifestyle factors.

The analysis included a total of 2,759 people. Of these:

64 percent had central obesity, which is a measure of excess abdominal fat. 37 percent were in the overweight category for body mass index (25.0–29.9 kilograms per square meter). 18 percent were current smokers. 36 percent were achieving the typical guideline physical activity level of at least 30 minutes on 5 days of the week.

The researchers defined central obesity as having a waist size of at least 88 centimeters (34.7 inches) for women and at least 102 centimeters (40.2 inches) for men.

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'GPs need to be more proactive'

Prof. Kotseva urges primary care practitioners to be proactive about looking for cardiovascular risk factors.

They need to probe beyond the risk factors that they are already aware of and "always investigate smoking, obesity, unhealthy diet, physical inactivity, blood pressure, cholesterol, and diabetes," she argues.

Individuals often don't realize that they should be receiving treatment. They may visit their doctor for diabetes care and not know that they also have high blood pressure.

"In our study, many participants with high blood pressure and cholesterol were not being treated," notes Prof. Kotseva.

She suggests that the findings highlight a need for more investment and policy that focuses on prevention.

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The recent news follows that of earlier research that featured at the European Society of Cardiology Congress in April 2018 in Ljubljana, Slovenia.

In that study, researchers from the Mayo Clinic in Rochester, MN concluded that excess belly fat is "bad for the heart," even in individuals whose BMI is in the normal range.

They advised doctors not to assume that having normal BMI means that there is no heart-related issue in an otherwise healthy individual.

A BMI in the normal range does not necessarily indicate normal fat distribution. It is important to measure central obesity as well, to get a better picture of heart risk.

"These data make it clear that more efforts must be made to improve cardiovascular prevention in people at high risk of cardiovascular disease."

Prof: Kornelia Kotseva

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What too much sleep can do to your health

New research finds that both insufficient and excessive sleep may raise the risk of cardiovascular problems and premature death.
person in bed waking up with their hand on their face
New research finds that sleeping too much can raise the risk of early death and cardiovascular problems.

The Centers for Disease Control and Prevention (CDC) report that a third of the United States population does not get enough sleep.

The CDC also warn that sleep deprivation raises the risk of various chronic conditions such as diabetes, cardiovascular disease, obesity, and depression.

But, according to new research appearing in the European Heart Journal, sleeping too much may affect health just as negatively as sleeping too little.

Chuangshi Wang, a doctoral candidate at McMaster University in Ontario in Canada, and Peking Union Medical College at the Chinese Academy of Medical Sciences in China, is the lead author of the new paper.

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Wang and colleagues examined the sleeping habits of more than 116,000 people aged between 35 and 70 years who had enrolled in the Prospective Urban Rural Epidemiology (PURE) study.

In their analysis, the researchers also included information about the participants' socioeconomic status, lifestyle habits, physical activity, diet, use of various medications, and family history of chronic conditions.

Overall, 4,381 people died and 4,365 people had a heart attack or stroke during the 8-year follow-up period of the PURE study.

The analysis by Wang and her team revealed that people who regularly slept more than the recommended 6–8 hours a night were more likely to die prematurely or develop cardiovascular disease.

More specifically, the risk of premature death or cardiovascular conditions was 5 percent higher for people who slept 8–9 hours than for people who slept the recommended amount.

Those who slept 9–10 hours were 17 percent more likely to die or develop heart and blood vessel conditions. Similarly, people who regularly slept more than 10 hours were 41 percent more likely to die prematurely or develop cardiovascular problems.

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Also, the study found a 9 percent higher risk of the outcomes mentioned above among those who slept 6 hours or less. However, the authors caution that this increase was not statistically significant.

Wang comments on the findings, saying, "Our study shows that the optimal duration of estimated sleep is six to eight hours per day for adults."

"Given that this is an observational study that can only show an association rather than proving a causal relationship, we cannot say that too much sleep per se causes cardiovascular diseases," she cautions.

"However, too little sleep could be an underlying contributor to death and cases of cardiovascular disease, and too much sleep may indicate underlying conditions that increase risk."

Corresponding author Dr. Salim Yusuf, who is the principal investigator of the PURE study, and a professor of medicine at McMaster, also comments on the findings.

"The general public should ensure that they get about six to eight hours of sleep a day. On the other hand, if you sleep too much regularly, say more than nine hours a day, then you may want to visit a doctor to check your overall health."

Dr. Salim Yusuf

"For doctors," continues Dr. Yusuf, "including questions about the duration of sleep and daytime naps in the clinical histories of your patients may be helpful in identifying people at high risk of heart and blood vessel problems or death."

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What is a pescatarian diet?

In the pescatarian diet, a person's main source of animal protein comes from fish and other seafood, such as shrimp.

Eating a diet consisting mainly of plant-based foods has a variety of health benefits, which the addition of fish and fish products may enhance.

However, some types of fish may absorb mercury from their environment, so certain people may need to limit their intake.

In this article, we look at the potential health benefits of a pescatarian diet and what people can eat on this kind of diet.

Health benefits of the pescatarian diet The pescatarian diet has many health benefits. Below, we cover some of these benefits. Heart health Pescatarian diet salmon
Eating fish provides omega-3 fatty acids, some of which are integral for healthy living.

Eating fish, especially fatty fish, provides increased long-chain omega-3 fatty acid intake. An omega-3 fatty acid is an unsaturated fat that can be beneficial to people, and some omega-3s are integral for healthy living.

People who eat fish have lower blood pressure, a lower risk of abnormal heart rhythms, and fewer fatal heart attacks than those who do not include fish in their diet.

Apart from fish, the pescatarian diet consists mainly of plant foods. According to one 2017 analysis, people who have a diet high in vegetables and other plant foods have a reduced risk of coronary heart disease.

The study authors say that the heart health benefits of a plant-based diet include improved blood lipids and lower blood pressure.

The same research concludes that a vegetarian diet could reverse atherosclerotic plaques when combined with exercise and stress management.

Atherosclerosis occurs when plaque builds up in the arteries. This causes the arteries to harden, narrow, and restrict the blood flow.

Cancer

A pescatarian diet may also protect people against colorectal cancers, or cancers that affect the colon and rectum.

According to a 2015 study, colorectal cancers are the second leading cause of cancer deaths in the United States.

The study used data from a cohort of over 77,650 people and found that the pescatarian diet had a strong protective effect against colorectal cancers.

Diabetes and inflammation

Following a plant-based diet can reduce the risk of type 2 diabetes and metabolic syndrome.

Metabolic syndrome includes conditions such as insulin resistance, high blood pressure, and obesity.

There is also evidence that omega-3s present in fatty fish may reduce inflammation, though this evidence comes from trials of supplements.

Plant-based diets are high in anti-inflammatory and antioxidant agents, such as flavonoids. These are natural compounds present in plants. Flavonoids have a range of anti-inflammatory and antidiabetic properties.

A 2016 study, again looking at different dietary patterns among more than 77,000 people in the U.S., found that people following a pescatarian diet had the highest flavonoid intake of all those taking part.

Thank you for supporting Medical News Today Environmental and animal welfare benefits Some people choose vegetarian diets because they disagree with factory farming practices or killing animals for food. For people concerned about animal welfare, the pescatarian diet may be a little more suitable. This is because some scientists argue that fish cannot feel pain. A 2015 study concluded that although fish can experience psychological stress, they lack the neural network necessary to experience pain. The pescatarian diet may also appeal to those who want to eat foods from what they perceive to be sustainable farming practices. Is a pescatarian diet sustainable? Pescatarian diet fish farming
While some see farming fish as a solution to over-fishing, it can still damage water ecosystems. The pescatarian diet is more sustainable than factory farming of mammals or birds, but it does have some environmental issues. Some people believe that the farming of pigs and ruminants, such as cattle, sheep, and goats, can harm the environment. Both groups emit greenhouse gases, with ruminants producing methane gas and pigs producing ammonia. On a global scale, these gases contribute to global warming. Also, large-scale deforestation for grazing and agriculture makes the greenhouse gas issue worse. Although fish do not produce greenhouse gases, fishing and fisheries represent a challenge to water ecosystems. For example, eating wild line-caught fish is not necessarily better for the environment than eating farmed fish, and the trawlers used to catch trawler-caught fish can affect ocean ecosystems in many ways. Some people see farming fish as a solution to over-fishing and depleted fish stocks, and the practice has grown rapidly over the past few years. However, in certain circumstances, fish farming can: damage water ecosystems introduce invasive species use wild fish for feed cause overcrowding cause disease The pescatarian diet may also be expensive or difficult to maintain when people live some distance from coastlines or fresh waterways. Some people may also find it hard to access sustainably sourced tinned fish. What can someone following the pescatarian diet eat? Listed below are some suggestions for sources of fish that a person on a pescatarian diet can eat: canned sardines canned salmon canned tuna fish sticks frozen salmon, trout, and herring frozen shrimp fresh fish, such as salmon, pollock, catfish, and sardines fresh shellfish, such as shrimp, clams, and scallops Other foods to include are: fruit vegetables cereals and whole grains, including oats, bulgar wheat, amaranth, corn, and rice food containing grain products pseudo grains, such as quinoa and buckwheat, which are gluten-free legumes, including kidney beans, pinto beans, and peas legume products, including tofu and hummus nuts and nut butters seeds, such as flaxseeds, hemp seeds, and chia eggs and dairy, if lacto-ovo-vegetarian If a person follows a strict pescatarian diet and avoids consuming eggs and dairy, they might need to check their calcium intake and consider taking supplements. Thank you for supporting Medical News Today 1-day meal plan Here, we give examples of recipes for meals that a person might consider when choosing a pescatarian diet: Breakfast Pescatarian diet sardines on crosti
Sardines are an excellent source of protein and omega-3s. Sardines on crostini Sardines are an excellent source of omega-3s. Using spinach to make a pesto spread on the crostini provides a source of vitamin C and vitamin A. The vitamin C helps increase the amount of iron a person absorbs. This recipe uses canned sardines, but it is also possible to use fresh sardines or anchovies. Starting the day with protein increases the feeling of fullness, and the pesto adds healthful greens that are a source of iron. Lunch Classic baked falafel Tahini is good source of plant protein and omega-3s. Chickpeas are also a good source of plant protein and fiber. Add a healthful Mediterranean salad to this recipe to create a filling lunch. Dinner Roasted salmon with shallot grapefruit sauce Salmon provides omega-3s essential fatty acids. Strong-flavored fish go very well with citrus fruits such as grapefruit. The addition of grapefruit to this recipe also adds vitamin C and fiber, and it counts toward the 2 servings of fruit that a person should eat per day. Disadvantages of a pescatarian diet Heavy metal and pollutants in marine fish is a global issue. With 92 percent of fish consumed by humans being marine fish, mostly from coastal fisheries, there is a risk of contamination. Mercury is present in the atmosphere and bodies of water and, because of this, nearly all fish may be a source of mercury. For most people, the mercury present in fish is not a risk, explain the U.S. Food and Drug Administration (FDA). However, they advise women considering becoming pregnant, women who are pregnant, nursing mothers, and young children not to eat specific fish. Fish to avoid include: shark sword fish king mackerel tilefish Fish low in mercury include: canned light tuna salmon pollock shrimp catfish Thank you for supporting Medical News Today Summary A pescatarian diet may be healthful and carries health benefits, as long as people avoid fish with high levels of mercury. However, this diet may not be as sustainable as some people think. Plant-based diets can help a person maintain a healthy weight, and they also may help with weight loss when necessary. A pescatarian diet may also be more healthful than some diets that rely on calorie deficits to reduce weight. People may find that canned tuna and sardines, as well as smoked fish, are the easiest foods to obtain and eat. These are full-flavored options, but frozen white fish and fish sticks are more delicately flavored options. Where possible, people may wish to try to buy fresh fish from sustainable sources. A useful website that can help is Seafood Watch.
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Snoring can worsen heart function, especially in women

Both snoring and obstructive sleep apnea could lead to earlier impairment of cardiac function in women, according to a new study.
Woman snoring
A recent study unlocks the health issues linked to snoring.

"Snoring" refers to a sleeping pattern in which a person breathes while emitting a snorting or grunting sound.

The National Sleep Foundation suggest that 90 million people in the United States snore.

Snoring might become more dangerous as people age, and it can also lead to heart disease.

There are different types of sleep apnea, but the most common is called obstructive sleep apnea (OSA). At least 18 million U.S. adults have sleep apnea.

This condition affects breathing patterns while sleeping, causing a person to stop breathing and start again repeatedly. About half of people who snore loudly have OSA.

When OSA occurs, the muscles in the throat that are responsible for keeping the airway open actually prevent the flow of air.

According to a new study presented recently at the annual meeting of the Radiological Society of North America — held in Chicago, IL — snoring and OSA may lead to earlier impairment of cardiac function in women than in men.

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Sleep apnea and heart disease?

It is unclear whether or not sleep apnea directly causes heart disease, but some specialists believe that people with sleep apnea are at risk of developing hypertension, or high blood pressure.

Many people who have sleep apnea also have co-existing diseases. This is one of the reasons why it is harder to establish a direct link between sleep apnea and heart disease.

According to the American Heart Association (AHA), some people living with sleep apnea and high blood pressure who received treatment for sleep apnea also saw their blood pressure drop. Such findings show a possible link between hypertension and sleep apnea.

OSA is also associated with obesity, which is a risk factor for heart disease.

Obesity contributes to sleep apnea, and the sleep deprivation that sleep apnea causes can give rise to further obesity, in the long-term. As a person gains more weight, the throat muscles that keep the airway open relax, and sleep apnea becomes more serious.

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Women who snore may be at greater risk

The researchers analyzed data associated with cardiac parameters in relation to diagnosed OSA and self-reported snoring using data from the UK Biobank.

The UK Biobank is an international health resource, open to researchers, that aims to improve the prevention, diagnosis, and treatment of diseases.

The data were of 4,877 participants who had received a cardiac MRI scan. The scientists divided them into three groups: those with OSA, those with self-reported snoring, and those with neither.

When the researchers compared the snoring group with the group without sleep disorders, they found a striking difference in the left ventricular mass in women compared with men.

Increased left ventricular mass means that the heart needs to work harder to fulfil the body's needs.

These patterns in people who self-reportedly snore may be an indication of undiagnosed OSA.

"We found that the cardiac parameters in women appear to be more easily affected by the disease and that women who snore or have OSA might be at greater risk for cardiac involvement."

Researcher Dr. Adrian Curta

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OSA may be vastly underdiagnosed

The researchers also found that the number of diagnosed OSA cases in the study was extremely low, suggesting that OSA may be underdiagnosed across the board.

Dr. Curta, a radiology resident at Munich University Hospital in Germany, urges people who snore to get screened for OSA and those with OSA to seek treatment.

"I would encourage people who snore to ask their partner to observe them and look for phases during sleep when they stop breathing for a short while and then gasp for air," says Dr. Curta.

He continues, "If unsure, they can spend the night at a sleep lab where breathing is constantly monitored during sleep and even slight alterations can be recorded."

The team now hopes to conduct more research to fully understand the sex differences linked to snoring and OSA.

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Infections could trigger cardiovascular disease

Researchers find a higher risk of coronary events during the 3 months after an infection. The body's immune response, they suggest, may explain why infections "trigger" heart attack and stroke.
woman sneezing
Scientists encourage everyone to have their flu shots this year, as simple influenza viruses may trigger cardiovascular events.

The term cardiovascular disease (CVD) covers a range of conditions: from heart attack and heart disease to stroke, hypertension, and heart failure.

As many as 84 million people in the United States are living with one of the conditions above, and 2,200 people die every day as a result.

Several factors may raise the risk of cardiovascular conditions. Some of these factors are modifiable, such as smoking, high cholesterol, and high blood pressure. Other factors, such as sex, race, age, and family history, cannot be modified.

However, there are also a number of "acute" risk factors, or triggers, that can lead to CVD. Some research has linked urinary infections and pneumonia, for instance, with the risk of having heart attacks and stroke.

A new study, published in the Journal of the American Heart Association, zooms in on the link between infections and adverse cardiovascular events.

Dr. Kamakshi Lakshminarayan, a neurologist and associate professor of epidemiology at the University of Minnesota in Minneapolis, is the senior author of the study.

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Studying infections and coronary events risk

Dr. Lakshminarayan and colleagues examined 1,312 people who had had a coronary event such as a heart attack, or myocardial infarction, and compared them with 727 people who had had an ischemic stroke.

The study included both outpatients and people who were hospitalized to receive treatment for their infection.

The researchers looked for infections that these people developed up to 1–2 years before the cardiovascular event. The most commonly reported infections were urinary tract infections, pneumonia, and respiratory infections.

Overall, the study found that approximately 37 percent of the participants with heart disease had developed an infection in the 3 months leading up to the coronary event. Among people with stroke, this number was almost 30 percent.

In the first 2 weeks after having an infection, the risk of a stroke or a heart attack was the highest.

Though the analysis found this link among both inpatients and outpatients, people who received care in the hospital were more likely to have a coronary event.

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Immune response may elicit coronary events

Although the study was observational, the scientists speculate on the mechanism that may explain the results.

During an infection, explains Dr. Lakshminarayan, the body's immune system produces more white blood cells to fight it off. However, this immune response also makes small blood cells, called platelets, stickier.

In a healthy body, the role of platelets is to bind to a damaged blood vessel and create a blood clot. This is very useful for accidental cuts, for example, but too many platelets, or platelets that are too sticky, can raise the risk of blood clots.

"The infection appears to be the trigger for changing the finely tuned balance in the blood and making us more prone to thrombosis, or clot formation," says Dr. Lakshminarayan. "It's a trigger for the blood vessels to get blocked up and puts us at higher risk of serious events like heart attack and stroke."

"One of the biggest takeaways is that we have to prevent these infections whenever possible [...] and that means flu shots and pneumonia vaccines, especially for older individuals."

Dr. Kamakshi Lakshminarayan

In an accompanying editorial, Juan Badimon — who was not involved in the research — explains why the risk of a coronary event may have been higher in the hospitalized group. He says that for these people, the infection might have been more severe.

"And if the infection is that severe, we can assume a stronger inflammatory response will result in a higher cardiovascular risk," he said in an interview.

Badimon is a professor of medicine and the director of the atherothrombosis research unit at Mount Sinai School of Medicine's Cardiovascular Institute in New York City, NY.

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Exercise may prevent heart attacks in otherwise healthy people

New research published in the European Heart Journal suggests that even people with no signs of cardiovascular disease should exercise to prevent a heart attack. Cardiorespiratory fitness can be a predictor of future problems, warn the researchers.
woman exercising on a treadmill
Even fit and healthy people should exercise regularly to keep heart disease at bay.

Heart disease remains the leading cause of death among men and women in the United States, responsible for the deaths of around 610,000 people each year.

Coronary artery disease is the most common form of heart disease, which often results in a heart attack.

However, even healthy people might be at risk of a heart attack, new research points out.

Even if someone has no signs of cardiovascular problems, low cardiorespiratory fitness may predict future heart disease. For this reason, healthy individuals should exercise regularly to keep heart disease at bay.

Jon Magne Letnes, Ph.D., of the Norwegian University of Science and Technology (NTNU) in Trondheim, is the lead author of the new paper.

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Studying cardiorespiratory fitness levels

Letnes and colleagues analyzed the cardiorespiratory fitness of 4,527 "healthy and fit" individuals who enrolled in the large HUNT3 study in 2006–2008.

As part of the study, the participants ran on a treadmill while wearing an oxygen mask and a heart rate monitor. The researchers measured the participants' cardiorespiratory fitness, which is the body's ability to supply the muscles with sufficient oxygen during a workout.

The standard measure of cardiorespiratory fitness is VO2max — that is, "the maximum amount of oxygen the body can use during a specified period of usually intense exercise." This depends on a person's weight, as well on the health and strength of their respiratory system.

The scientists also had access to data about the participants' smoking status, alcohol intake, family history of heart disease, physical activity, body mass index (BMI), blood pressure, and cholesterol levels.

Letnes and team followed the participants for almost 9 years.

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'Exercise as preventive medicine'

Over the 9-year follow-up period, only 147 (3.3 percent) of the participants developed heart disease, died from it, or required coronary artery bypass graft. This is a surgical procedure that unclogs the arteries and releases the blood flow to the heart.

However, Letnes and colleagues also found that better cardiorespiratory fitness correlated with a decreased cardiovascular risk — including the risk of a heart attack — throughout the study period.

Bjarne Nes, a researcher at the NTNU and the corresponding author of the study, sums up the findings, saying, "We found a strong link between greater fitness and reduced risk of a coronary event during the 9 years of follow-up in a very healthy sample of adults."

"In fact, the participants who were in the 25 [percent] of those with the highest cardiorespiratory fitness had nearly half the risk compared [with] those in the 25 [percent] with the lowest fitness levels."

Bjarne Nes

More specifically, the risk of experiencing heart problems dropped by 15 percent with every metabolic equivalent. This is a unit of measurement that expresses the "cost of physical activities as a multiple of the resting metabolic rate."

"This indicates that greater cardiorespiratory fitness protects against both chronic and acute heart and blood vessel problems," says Nes. "Even a small increase in fitness could have a large impact on health."

The study's lead author adds that the study should "encourage the use of exercise as preventive medicine. A few months of regular exercise may be an efficient way of reducing the cardiovascular risk."

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What an exotic fish can do for human heart health

People with heart failure experience heart cell loss that can damage the heart muscle to such an extent that they need a transplant. One species of exotic fish, the tetra fish, has the amazing ability to repair its own heart. Can we apply this mechanism to healing human hearts?
tetra fish
The tetra fish can regenerate heart tissue following heart damage.

The tetra fish is a type of freshwater fish hailing from regions of South America and southern North America. Many tetra species are popular with aquarium owners due to their unique coloring and the fact that they are fairly easy to keep.

A new study suggests that they are now also popular with researchers, although for an entirely different reason. Most species of tetra fish are able to heal their own hearts following heart damage.

Dr. Mathilda Mommersteeg, an associate professor at the University of Oxford in the United Kingdom, recently led a team of researchers who were striving to understand how tetra fish are able to regenerate heart tissue.

The team looked at two different subspecies of tetra fish, Astyanax mexicanus, that are native to Mexico. One of these subspecies lives in rivers, is beautifully colored, and can heal its own heart.

Fish belonging to the other subspecies, known as the "blind cave tetra," populate the waters of the Pachón cave in Mexico. These fish have not only lost their color and their eyesight, neither of which serves them in the darkness of the cave, but they no longer have the ability to regenerate heart tissue.

In a recent study, Dr. Mommersteeg's team has compared the genetic profiles of the two types of tetra fish in order to understand what genetic features may be responsible for the self-healing abilities.

The findings of the study, which the British Heart Foundation supported, appear in the journal Cell Reports.

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The gene that drives heart repair

Dr. Mommersteeg's team analyzed and compared the genetic profiles of both kinds of fish. In doing so, they identified three areas on their genomes that were relevant to the ability to regenerate damaged heart tissue.

In further analyzing these genetic areas, the researchers were also able to identify the genes that were the most important for heart regeneration.

When they compared the activity of these genes in the river tetra and the blind cave tetra following heart damage, the scientists saw that two genes, lrrc10 and caveolin, had increased activity only in the river tetra.

"A real challenge until now was comparing heart damage and repair in fish with what we see in humans. But, by looking at river fish and cave fish side by side, we've been able to pick apart the genes responsible for heart regeneration," says Dr. Mommersteeg.

Previous research in mice has shown that lrrc10 is linked to a heart condition called dilated cardiomyopathy, in which the heart becomes excessively enlarged and is no longer able to pump blood properly. The results of further studies have suggested that lrrc10 plays a key role in heart cell contraction and expansion.

To confirm that this gene is also involved in the regeneration of damaged heart tissue, the researchers behind the current study turned to zebrafish, another freshwater species that is popular among aquarists. Like the tetra fish, zebrafish also have the ability to regenerate heart tissue if necessary.

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New hopes for future treatments

In the second part of their study, the researchers blocked lrrc10 gene expression in zebrafish. These animals became unable to effectively repair heart damage. This, the researchers say, indicates that lrrc10 is indeed responsible for heart regeneration.

"It's early days, but we're incredibly excited about these remarkable fish and the potential to change the lives of people with damaged hearts," Dr. Mommersteeg remarks.

In the future, the research team hopes to learn more about the mechanisms behind the ability to heal damaged heart tissue. They want to use this knowledge to repair heart tissue in people facing problems with this organ, such as heart failure.

Heart failure often occurs due to a heart attack, during which the heart muscle becomes damaged and progressively loses cells, which scar tissue replaces. This process can render the heart unable to function correctly, and, as a result, many people with severe heart failure require a heart transplant.

However, if tetra fish can teach us how to heal the heart, transplants may become less of a necessity in the future.

"These remarkable findings show how much there is still to learn from the rich tapestry of the natural world," says Prof. Metin Avkiran, an associate medical director at the British Heart Foundation.

"It's particularly interesting that the ability of the river fish to regenerate its heart may arise from an ability to suppress scar formation. We now need to determine if we can exploit similar mechanisms to repair damaged human hearts."

Prof. Metin Avkiran

"Survival rates for heart failure have barely changed over the last 20 years, and life expectancy is worse than for many cancers. Breakthroughs are desperately needed to ease the devastation caused by this dreadful condition," he adds.

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Heart attacks increasingly common in young women

New research finds a worrying trend in the incidence of heart attacks in recent decades. The results indicate that young women are more likely than young men to need hospitalization for heart attacks, as well as to develop other cardiometabolic conditions.
young woman holding her chest
More and more young women develop heart disease, and doctors should pay more attention to women, say the authors of a new study.

Cardiovascular disease — an umbrella term that covers different types of conditions that affect the heart or blood vessels, including coronary heart disease, stroke, congenital heart defects, and peripheral artery disease causes about 1 in 3 deaths in the United States.

Also, cardiovascular disease accounts for almost 836,546 deaths each year, making it the "leading killer of both women and men" in the U.S.

However, there are sex differences in the prevalence of some cardiovascular events, such as coronary heart disease — a cardiovascular condition that can ultimately lead to heart attacks.

An established body of research has shown that coronary heart disease is more prevalent among men at any age, which may have led to the common perception that "heart disease is a man's disease."

However, more recent studies have started to point out an "alarming" trend, which is a steady increase in the number of young women who die of coronary heart disease.

Now, new research, presented at the American Heart Association's Scientific Sessions meeting in Chicago and subsequently published in the journal Circulation, adds to the mounting evidence that heart attacks are increasingly common among young women.

Dr. Sameer Arora, a cardiology fellow at the University of North Carolina School of Medicine, Chapel Hill, is the lead author of the study.

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Heart attacks no longer an old man's disease

Dr. Arora and colleagues examined data on almost 29,000 people aged 35–74 years old who doctors admitted to hospital for acute myocardial infarction between 1995 and 2014.

The researchers found that the proportion of young patients who doctors admitted to the hospital for a heart attack "steadily increased, from 27 [percent] in 1995–1999 to 32 [percent] in 2010–2014."

The study also found that this increase was even more substantial in women. Namely, 21 percent of the heart attack hospital admissions were of young women at the beginning of the study, but this proportion jumped to 31 percent by the end.

Additionally, the research revealed that young women were less likely than young men to receive cardiovascular treatments, such as antiplatelet drugs, beta blockers, coronary angiography, or coronary revascularization.

Finally, young women were at a higher risk of hypertension, diabetes, and chronic kidney disease compared with young men.

The study's lead author comments on the findings, saying, "Cardiac disease is sometimes considered an old man's disease, but the trajectory of heart attacks among young people is going the wrong way [...] It's actually going up for young women."

"This is concerning," continues Dr. Arora. "It tells us we need to focus more attention on this population."

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A 'wake-up call to male physicians'

Dr. Arora explains why cardiologists and other healthcare professionals need to pay more attention to women's cardiovascular health.

"Traditionally, coronary artery disease is seen as a man's disease, so women who come to the emergency department with chest pain might not be seen as high-risk," he says.

"Also, the presentation of heart attack is different in men and women. Women are more likely to present with atypical symptoms compared to men, and their heart attack is more likely to be missed."

Dr. Ileana L. Piña, a cardiologist and professor of medicine and epidemiology at the Montefiore Medical Center in New York City, also chimes in on the findings.

She says that the results are "another wake-up call to physicians, especially male physicians" to take better care of women's heart health.

"The number one killer of women is not breast cancer or uterine cancer; the number one killer of women is heart disease [...] And, until we pay attention to this, these kinds of figures are going to keep coming up."

Dr. Ileana L. Piña

Dr. Piña, who was not involved in the research, says that traditional gender roles, which continue to prevail, may stop women from looking after their health.

"It's hard when a woman is working two jobs and taking care of the family, too," Dr. Piña says.

"[Women will] do anything for their families, but they often leave themselves for last. We need to teach women to change their health attitude and take care of themselves," she warns.

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Vitamin D, fish oil supplements of little benefit to heart health

Two new randomized trials challenge the view that vitamin D and fish oil supplements hold any real benefit in the fight against chronic conditions, such as cancer and heart disease.
man taking fish oil supplements
Do fish oil supplements really protect the heart?

The results of the first and second trial were presented at Scientific Sessions, held by the American Heart Institute (AHA) in Chicago, IL, and published in the New England Journal of Medicine.

Vitamin D and fish oil supplements have lately been the subject of much hype in the medical research community, mass media, and among the general public, due to their alleged benefits in combatting cancer and heart disease.

For example, recent studies in mice found that vitamin D benefits heart cells and suggested that the vitamin may prevent cardiovascular blockages.

Other studies identified persistent links between a lack of vitamin D and the development of breast cancer and bowel cancer.

Experts also believe that omega-3 fatty acids — which are in seafood, some nuts, and seeds — benefit the heart. The AHA, for example, recommend an intake of at least 2 servings of fish every week for optimal cardiovascular health.

As a result, many Americans have turned to omega-3 fish oil supplements to stave off heart disease. A survey carried out by the National Institutes of Health (NIH) found that almost 19 million Americans are taking fish oil supplements.

But do vitamin D and fish oil supplements really work?

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Vitamin D, fish oil no better than placebo

The two new studies were randomized, placebo-controlled trials led by Dr. JoAnn E. Manson, the chief of the division of preventive medicine at the Brigham and Women's Hospital in Boston, MA.

The trials examined the effect of a daily intake of vitamin D and omega-3-containing fish oils on the prevention of heart disease and cancer.

The studies involved almost 26,000 healthy adult participants, 20 percent of whom were African-American. None had a history of heart disease or cancer. The men in the study were at least 50 years old, and the women were at least 55.

Some participants took a daily dosage of 2,000 international units of vitamin D and 1 gram of fish oil.

Other participants received the same dosage of vitamin D plus a placebo, and others took the same daily dosage of fish oil with a placebo. The final group received two dosages of placebos.

Dr. Manson and the team followed the participants for 5 years. By the end of the study period, they had found no overall benefits.

In the first trial, they conclude:

"Supplementation with [omega-3] fatty acids did not result in a lower incidence of major cardiovascular events or cancer than placebo."

In the second trial, they surmise that "Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo."

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Does fish oil stave off heart attacks?

Dr. Manson and the team did find a link between fish oil and a lower risk of heart attacks, particularly among people who did not eat fish regularly, as well as among African-Americans.

Overall, fish oil supplements reduced the risk of a heart attack by approximately 28 percent. Among African-Americans, fish oil supplements lowered this risk by 77 percent, compared with participants who took only a placebo.

Finally, the researchers found that no supplement involved in the trial led to severe side effects, such as bleeding, excessive calcium, or gastrointestinal problems.

The New England Journal of Medicine also published an editorial related to the trials. In it, authors Dr. John F. Keaney and Dr. Clifford J. Rosen warn that the trials' "positive" results regarding fish oil supplementation and heart attack risk "need to be interpreted with caution."

They continue, noting that other large randomized trials of omega-3 fatty acids do not support these findings.

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How does a doctor diagnose atrial fibrillation?

Atrial fibrillation is a heart disorder that causes an irregular heart rhythm known as arrhythmia. It can often make the heart beat faster, which can reduce the blood supply to the rest of the body. Early diagnosis helps reduce the risk of severe complications, such as stroke or heart failure.

A doctor may perform one or more tests to diagnose atrial fibrillation (A-fib).

The doctor will look for signs of A-fib as well as any underlying conditions that might be causing arrhythmia and possible complications.

Sometimes a doctor will refer someone to a cardiologist, who is a specialist in heart disease.

In this article, we look at some of the tests and procedures doctors use to confirm a diagnosis of A-fib, as well as identifying possible causes and complications of the condition.

Medical history A-fib diagnosis cardiogram
A doctor will diagnose A-fib after taking a medical history and carrying out some tests, including a cardiogram.

Firstly, a doctor will ask an individual about their medical history to determine whether they have any risk factors for A-fib.

They will ask about eating habits, exercise routine, whether a person smokes tobacco or uses illicit drugs, and how often they drink alcohol.

They will also ask if there is a family history of A-fib, as people with a family member who has the disorder have an increased risk of having A-fib themselves.

The medical history might help a doctor identify whether a person has any potential signs of A-fib, or symptoms of other conditions that could be causing A-fib.

Thank you for supporting Medical News Today Physical examination The most obvious physical sign of A-fib is an irregular heart rhythm. The doctor will also check how fast the heart is beating by taking a person's pulse. The speed of their pulse indicates their heart rate. The doctor can also listen to the rhythm and rate of the heart with a stethoscope. A doctor will look for other physical indications of a problem with heart function. They will check for signs of any complications of A-fib, such as heart failure. The doctor will check for signs of any conditions that can cause or contribute to A-fib, such as hyperthyroidism, which is an overactive thyroid. Testing There are several tests that doctors can perform to diagnose A-fib, find the cause of A-fib, or identify any complications of it. Electrocardiogram: This records the electrical activity of the heart, and doctors commonly use it for diagnosing A-fib. When someone has A-fib, the ECG will identify an "irregularly irregular" rhythm, which means the heartbeat is random and irregular, with no pattern at all. This is a typical sign of A-fib. stress test
An exercise stress test can help demonstrate heart activity while under duress. Holter monitoring: This is a portable ECG monitor that a person wears to record their heart rhythm and rate over a more extended period while they carry out their daily activities. A person usually wears it for 24 to 48 hours. It is an effective way to document A-fib that occurs intermittently or has no symptoms. Event recorder: Similar to a Holter monitor, a person wears an event recorder for weeks or even months. The individual wearing the monitor pushes a button to start recording whenever they experience symptoms. This allows the doctor to examine the heart rate and rhythm when the symptoms occur and make an accurate diagnosis. This is an effective test for someone who only has the arrhythmia intermittently. However, a person must experience symptoms to know when to start recording, which is not always the case. Echocardiogram: This test uses a device called a transducer that sends sound waves to produce a moving picture of the heart, helping to highlight any blockages, such as blood clots. When a doctor places the transducer on the outside of the chest, it is called a transthoracic echocardiograph (TTE). If the transducer sits on a scope that a doctor then inserts into the esophagus, it is known as a transesophageal echocardiograph (TEE). A TEE produces a clearer image. Some other tests that look for causes or complications of A-fib include: Blood tests: These help identify potential causes of A-fib, such as hyperthyroidism. They can also highlight whether a person has other conditions that may affect A-fib, such as anemia or problems with kidney function. Chest X-Ray: This creates an image of the chest, including the heart and lungs. An X-ray can highlight whether a person has any heart problems, such as heart failure that has caused fluid to build up in the lungs or enlarged the heart. A stress or exercise test: The doctor conducts an ECG while the person engages in a physical activity, such as running on a treadmill. This test can show if A-fib is reducing blood supply to the heart. Tilt-table test: A doctor may perform a tilt-table test if an ECG or Holter monitor do not reveal arrhythmia but the person still experiences symptoms, such as fainting or dizziness. The test checks a person's heart function and blood pressure as the table moves them from a prone to an upright position. If the test shows low blood pressure changes when a person is in an upright position, this may indicate that the brain is not receiving enough blood. Electrophysiology: If a doctor diagnoses a person with arrhythmia, they may recommend an electrophysiologic test. This is an invasive test that involves threading a catheter through a blood vessel into the chambers of the heart. The catheter stimulates the heart and records where the abnormal impulses come from, how fast they are, and which important conduction pathways they bypass. Once a doctor has determined what is causing the arrhythmia, they can recommend treatments to try to correct it. Thank you for supporting Medical News Today Takeaway A-fib can lead to serious complications, but several tests are available to confirm the diagnosis and detect complications. A doctor will ask about a person's medical history, including exercise routine and diet. They will also perform a physical examination, checking for signs and complications of both A-fib and any underlying conditions. They might also perform several tests, including an ECG, take an X-ray of the chest, measure heart activity during exercise, or provide a take-home device to measure heart rate and rhythm over an extended period. Once a doctor has diagnosed arrhythmia, treatments are available to try to stop it. Q: Does A-fib ever go undetected after visiting a doctor for a diagnosis A: A doctor should be able to detect A-fib when they listen to your heart or take your pulse because they can hear and feel the irregular heartbeat. In the unlikely event that a doctor orders an electrocardiogram (ECG) or echocardiogram without listening to your heart, these tests would pick up any signs of A-fib. A doctor cannot identify A-fib if they do not check your heart or pulse. If you experience any symptoms of potential A-fib, such as a fast heartbeat, dizziness, confusion, or chest pains during activity, your doctor will check your heart or pulse. A doctor will not automatically check your heart if you go to see them for something unrelated to your heart, such as a mild skin rash. This means A-fib could remain undetected. Nancy Moyer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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What is atrial fibrillation?

Atrial fibrillation is an abnormal heart rhythm, also known as an arrhythmia. Blood flow from the top chambers of the heart to the bottom chambers varies from beat to beat, and the heart cannot pump blood to the rest of the body efficiently.

The Centers for Disease Control and Prevention (CDC) estimate that between 2.7 and 6.1 million people currently have A-fib.

Age is a key risk factor for developing the disorder. According to the CDC, 9 percent of people over the age of 65 years have A-fib in the U.S., but only two percent under 65 years have it.

The heartbeat usually starts from one spot in the right atrium, the upper-right chamber of the heart. However, people with A-Fib have a heartbeat that triggers from multiple spots, which means both atria and the ventricles, or lower chambers, beat at their own pace.

The arrhythmia may or may not produce symptoms. Recognizing and treating A-Fib early in its development can greatly improve the chances of avoiding complications.

Symptoms chest pain man
Chest pain is a symptom of A-fib, if symptoms occur at all.

A-Fib may not cause any symptoms at all, and, when there are symptoms, they may only occur intermittently.

Often the heart rate is higher than usual with AFib, but this depends on how many signals get from the atria to the ventricle.

Common symptoms include:

palpitations, or the feeling of an irregular heartbeat breathlessness, particularly when lying flat chest pain or pressure low blood pressure dizziness, light-headedness, and fainting

People who do not have symptoms will not be aware of A-fib, so it goes untreated. The first sign of A-fib might be a complication, such as a stroke or heart failure.

Keep a close eye on the symptoms and when they occur or change in severity. Make a note of them for your doctor. This will help them make the diagnosis and decide on the best treatment.

Thank you for supporting Medical News Today Complications A-fib can cause potentially life-threatening health issues. Blood clots Blood can pool in the atria if the heart is not beating regularly. Blood clots can form in the pools. A segment of a clot, called an embolus, might break off and travel to different parts of the body through the bloodstream and cause blockages. An embolus can restrict blood flow to the kidneys, intestine, spleen, brain, or lungs. A blood clot can be fatal. Stroke A stroke occurs when an embolus blocks an artery in the brain and reduces or stops blood flow to part of the brain. The symptoms of a stroke vary depending on the part of the brain in which it occurs. They can include weakness on one side of the body, confusion, and vision problems, as well as speech and movement difficulties. Stroke is a key cause of disability in the U.S. and the fifth most common cause of death, according to the CDC. Heart failure A-fib can lead to heart failure, especially when the heart rate is high. When the heart rate is irregular, the amount of blood flowing from the atria to the ventricles varies for each heartbeat. The ventricles may therefore not fill up before a heartbeat. The heart fails to pump enough blood to the body, and the amount of blood waiting to circulate the body instead builds up in the lungs and other areas. A-fib can also worsen the symptoms of any underlying heart failure. Cognitive problems A study in the Journal of the American Heart Association showed people with AFib have a higher long-term risk of cognitive difficulties and dementia that have no link to reduced blood flow in the brain. Risk factors Certain factors increase the risk of developing AFib. These include: Age: The older a person is, the higher the risk of AFib becomes. elderly couple
Age is an important factor in the development of A-fib. Hypertension: Long-term high blood pressure can add strain to the heart and increase the risk of A-fib Pulmonary embolism: A blood clot in the lung increases the risk of A-fib. Heart disease: People with the following conditions have a higher risk of A-fib: Excessive alcohol consumption: Men who have more than two drink a day and women who have more than one drink daily are at increased risk of A-fib . Family members with AFib: A family history of the disease increases the risk of getting it. Other chronic conditions: Other long-term medical problems, including thyroid problems, asthma, diabetes, and obesity, may contribute to the risk of AFib. Sleep apnea: People with this condition, especially when it is severe, have a higher risk of developing AFib. Surgery: A-fib commonly occurs directly after receiving heart surgery. Thank you for supporting Medical News Today Prevention Controlling the factors that increase the risk of AFib may help prevent it. Manage the diet: A heart-healthy diet can help prevent AFib and other heart diseases. The DASH diet, which the American Heart Association (AHA) promotes, has shown protective effects on heart health. Abstaining from harmful substances: Tobacco, alcohol, and some illicit drugs, like cocaine, can damage the heart. With or without a diagnosis of A-fib, eliminating tobacco and mood-altering substances and moderating alcohol is vital for protecting the heart. This is also important in a person who already has A-fib. Stress management: Stress can increase blood pressure and heart rate, which makes the heart work harder. Managing stress levels can help to prevent the progression and development of A-fib. Breathing exercises, mindfulness, meditation, and yoga can all help reduce stress. Exercise: A physically active lifestyle has profound effects on cardiac health and can help strengthen the heart, reducing the risk of AFib and other heart conditions. Treatment The treatment of A-Fib aims to improve symptoms and reduce the risk of complications. For some people, converting the heart back to a normal rhythm is the best option. For others, the doctor deems it better to leave the irregular rhythm in place and prescribe medication to control a high heart rate and prevent the formation of blood clots. In addition to recommending a healthy lifestyle, a doctor will determine the most appropriate treatment depending on symptoms, other conditions they have, and overall health. Medications For AFib, medications are used to control the heart rate, prevent clots from forming. Sometimes medications or a procedure is used to try to restore a regular rhythm. Preventing clots When a doctor thinks the best option is to let someone stay in AFib, they may prescribe anticoagulant medications, or blood-thinners. These medications make it harder for blood to clot. However, stopping bleeding becomes more difficult in a person who takes these medications. The doctor will weigh the risk of developing a clot against the risk of falling and causing a bleed in the brain. Pacemaker
The surgeon might install a pacemaker to moderate heart rhythm. These medications include: warfarin direct-acting oral anticoagulants (DOACs), including rivaroxaban, apixaban, and edoxaban Elderly people with an increased risk of falling often use aspirin but also have a high risk of forming a clot. Aspirin reduces clotting factor but not to the same extent as other medications, so any bleeding is easier to manage. People taking warfarin or other anti-clotting agents should advise any medical professional treating them of their current medications, especially if they will be having a procedure or surgery or have been in an accident. While taking anticoagulants, make sure the doctor knows about any planned or existing pregnancy or any signs of bleeding, such as: very large bruises nausea and light-headedness vomiting blood coughing up blood unusually heavy menstrual flow gums that bleed regularly bloody or black stool blood in the urine sudden back pain that is very severe Take blood thinners exactly as the doctor advises for the best chance of preventing a clotting-related complication and avoiding excessive thinning of the blood. Managing heart rate If the heart rate is high, bringing it down is important to avoid heart failure and reduce the symptoms of A-Fib. Several medications can help by slowing conduction of the signals that tell the heart to beat. These include: beta-blockers, such as propranolol, timolol, and atenolol calcium-channel blockers, such as diltiazem and verapamil digoxin Normalizing heart rhythm Instead of putting a person on blood thinners and heart rate-controlling medicine, doctors may try to return the heart rhythm to normal using medication. This is called chemical or pharmacologic cardioversion. Medications called sodium channel blockers, such as flecainide and quinidine, and potassium channel blockers, such as amiodarone and sotalol, are examples of medications that help to convert A-fib to regular heart rhythm. Procedures When a person does not tolerate A-fib medication needed for someone who has an irregular heart rhythm or doesn't respond to pharmacologic cardioversion, surgical and non-surgical procedures can be used to control the heart rate or try to convert to a regular rhythm to help prevent complications from A-fib. Options for converting A-fib to a regular rhythm include: Electrical cardioversion: The surgeon delivers an electric shock to the heart, which briefly resets the abnormal rhythm to a regular beat. Before carrying out cardioversion, they will often perform an echocardiogram by inserting a scope down the throat to produce an image of the heart to make sure no clots are present in the heart. If they find a clot, a doctor will prescribe anticoagulant medication for several weeks to dissolve it. Cardioversion will then be possible. Catheter ablation: This destroys the tissue that is causing the irregular rhythm, returning the heart to a regular rhythm. The surgeon may need to repeat this procedure if the A-fib returns. The surgeon sometimes destroys the area in which the signals travel between the atria and ventricles. This stops the A-fib, but the heart can no longer send a signal to orchestrate a beat. In these instances, the surgeon will then fit a pacemaker. Surgical ablation: The heart tissue that is causing the irregular rhythm can also be removed in an open-heart surgery called a maze procedure. A surgeon will often carry out this procedure alongside a heart repair. Pacemaker placement: This device instructs the heart to beat regularly. A surgeon will sometimes place a pacemaker in a person with intermittent A-fib that only occurs intermittently. When a doctor feels that another condition is responsible for the A-fib, such as hyperthyroidism or sleep apnea, they will treat the underlying condition alongside the arrhythmia. Thank you for supporting Medical News Today Takeaway A-fib is a disorder that causes an irregular heart rhythm. It occurs more often after the age of 65 years and may or may not cause symptoms. The condition can lead to a stroke when blood pools in the heart and forms a clot that travels to the brain. Lifestyle adjustments that can help to prevent A-fib include a heart-healthy diet, limiting alcohol intake, not smoking, and getting regular exercise. There are two treatment options. A doctor might allow an irregular rhythm to continue but control the heart rate and prescribe an anticoagulant to help prevent a stroke. Alternatively, the doctor might try to convert the irregular rhythm back to a regular one with medication or a procedure. Q: If A-Fib does not show symptoms, how can I take steps to stop it before it causes complications? A: The first step is recognizing you have it. Without symptoms, you won’t know you have A-fib unless your doctor finds it while listening to your heart during an examination or while testing for a different health issue. Increase the odds of finding A-fib by regularly visiting your doctor for ongoing or preventative care. Once you have AFib, unless it stops spontaneously on its own, the only way to avoid complications is through appropriate treatment. Nancy Moyer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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What are the types of atrial fibrillation?

Atrial fibrillation is a type of arrhythmia, or irregular heartbeat, that often causes the heart to beat at an abnormally fast rate. Doctors need to determine which type of atrial fibrillation a person has to choose the best treatment option for them.

The three main types of atrial fibrillation (A-fib) are paroxysmal, persistent, and long-term persistent. Doctors also categorize A-fib as either valvular or nonvalvular.

In some cases, A-fib may not cause any symptoms, so a doctor might only discover it when testing for other conditions. In some people, it will present with symptoms. The presence of symptoms is not a factor in the classification of A-fib.

In this article, we discuss the different types of A-fib.

Paroxysmal atrial fibrillation arrhythmia
There are several types of A-fib that differ in the length of episode.

A paroxysm is a sudden episode of a disease or symptom.

In paroxysmal A-fib, the irregular rhythm starts suddenly and resolves without treatment within 7 days. The episode may only last a few seconds before it stops on its own.

A person with this type of A-fib will have no noticeable symptoms and may not require treatment to control their heart rhythm. However, a doctor will often prescribe anticoagulation medications to make it harder for the blood to form clots. These drugs may help prevent a stroke.

Episodes occur intermittently at irregular intervals in paroxysmal A-fib.

Approximately half of all cases of A-fib are paroxysmal.

Thank you for supporting Medical News Today Persistent atrial fibrillation The episodes in persistent A-fib are continuous and last for more than 7 days. While these episodes may resolve without treatment, a person with persistent A-fib often needs to receive medication or undergo a procedure to restore their heart rhythm. They may take medication to slow the heart rate. Usually, a doctor also issues anticoagulants to prevent blood clots. Medications that help control the heart rate include beta-blockers and calcium channel blockers. In addition to antiarrhythmic medications, there are several procedures that a doctor may use to restore a regular heartbeat in people with persistent A-fib. These include cardioversion, which involves issuing a small electric shock, and catheter ablation, in which the surgeon destroys the heart tissue that is responsible for the irregular rhythm. Long-term persistent atrial fibrillation This type of A-fib was formerly called permanent A-fib. When medications, cardioversion, catheter ablation, and other methods are unable to convert A-fib back to a normal rhythm, and it seems unlikely that this conversion will be possible, doctors refer to the condition as long-term persistent A-fib. People with this diagnosis will have agreed with their doctor to stop attempting the conversion. However, a doctor might still issue medication to control a person's heart rate and prevent blood clots. Thank you for supporting Medical News Today Nonvalvular and valvular A-fib If A-fib is nonvalvular, this means that a heart valve issue, such as mitral stenosis or a replacement valve, is not the cause of the condition. Conversely, in people with valvular A-fib, an issue with a heart valve is responsible for the arrhythmia. Any of the three types of A-fib can be either valvular or nonvalvular. It is vital that doctors determine whether or not the heart valves are responsible for a person's A-fib before deciding on a treatment plan. Newer medications for preventing blood clots are available, but the United States Food and Drug Administration (FDA) has not approved them as a safe and effective treatment for nonvalvular A-fib. Takeaway Atrial fibrillation is an arrhythmia. There are several different types of A-fib, which vary in the length of arrhythmia episodes and in how they respond to treatment. Paroxysmal A-fib lasts for between a few seconds and 7 days, while persistent A-fib lasts for more than 7 days. Long-term persistent A-fib is continuous and does not respond to treatment. Doctors also classify A-fib as valvular or nonvalvular according to whether or not the heart valves are causing the arrhythmia. Q: How do I know which type of A-fib I have? A: Doctors classify A-fib according to how long an episode lasts. Each type of A-fib may or may not cause symptoms, and you might not know that you have this condition if you do not experience any symptoms.If your episodes last for only a few seconds or up to 7 days, the A-fib is paroxysmal. Episodes lasting longer than 7 days indicate persistent A-fib. When A-fib does not respond to attempts to convert it to a regular rhythm, it is called long-term persistent A-fib. Nancy Moyer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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What happens during atrial fibrillation?

Atrial fibrillation or A-fib is a condition where the heart has an irregular rhythm. It is caused by a malfunction in the conduction of electricity in the upper chambers or atria of the heart.

A range of conditions that can cause changes in the electrical conduction system of the heart or the muscle around it can contribute to the disorder.

Lifestyle choices, including an inactive lifestyle, smoking, and consuming alcohol in large amounts, can trigger episodes of A-fib.

In this article, we explore the factors that can contribute to triggering A-fib or a person developing the condition.

Heart tissue changes heart tissue
Changes in heart tissue can lead to the abnormal rhythms characteristic of A-fib.

When a person's heart is in its normal sinus rhythm, a signal is sent from a spot in the right atrium, called the sinoatrial (SA) node.

This signal travels down specific conduction pathways and spreads uniformly through the atria first and then the two lower chambers of the heart known as the ventricles.

This process causes the heart to squeeze and pump out blood in a sequence that equates to one heartbeat.

The signal occurs and is conducted through the heart in a stepwise, uniform way so that the heart beats regularly.

In A-fib, the SA node does not work correctly, so the signal to start a heartbeat comes from elsewhere in the atrium.

In this scenario, the signal cannot travel down the usual conduction paths, so it travels all over the heart tissue, chaotically. This causes the heartbeat to be irregular.

Thank you for supporting Medical News Today Characteristics and conditions A number of factors can increase the risk of having A-fib. It occurs more frequently in men and after they reach the age of 65 years old. Conditions that increase the risk for A-fib include: These factors increase the risk of having A-fib, although people can also experience the irregular rhythms of A-fib without having any them. Triggers In one type of A-fib known as paroxysmal A-fib, the episodes can be very short and come and go. Some lifestyle choices can trigger an episode of this type of A-fib. Possible triggers include: large amounts of caffeine, such as in coffee or energy drinks, especially if a person is unused to it large amounts of alcohol, particularly during binge drinking emotional or situational stress recreational stimulant drugs, such as cocaine and methamphetamine smoking tobacco products A-fib is more likely to happen when a person has an infection, such as pneumonia, and in the days following surgery, especially heart or lung surgery. Thank you for supporting Medical News Today Takeaway Changes in electrical signaling in the heart and surrounding tissues that control the heartbeat are at the root of A-fib. Many medical conditions can increase the risk of having A-fib, especially those that involve the heart. Other diseases can also increase the risk, including COPD, hyperthyroidism, and high blood pressure. Triggers can set off episodes of A-fib, including stress and excessive caffeine. If people have concerns about an irregular heartbeat, they should arrange to see their doctor as soon as possible. Q: How do I treat or manage A-fib if the doctor cannot find the cause? A: The treatment for A-fib depends on the type of A-fib you have, not the factors that may be increasing your risk of getting it. If you do have a condition that puts you at increased risk of A-fib, treating that condition may reduce the number of episodes of A-fib you have. Depending on the type of A-fib you have and what your symptoms are, one of two choices of treatment are available. Your doctor will either try to convert back to a regular rhythm or prescribe medications to control the heart rate along with medication to prevent blood clots from forming. Nancy Moyer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Heart attack: Some risk factors affect women more

Some of the main factors that can predispose a person to heart attack include smoking cigarettes, having high blood pressure and high cholesterol, being overweight, and having diabetes. Whom do these risk factors affect the most, however?
womans heart concept illustration
How do risk factors for heart attack impact men vs. women? A new study weighs in.

During a heart attack, or myocardial infarction, the heart stops functioning normally.

This is because its blood supply is cut off, often by a blood clot.

According to the Centers for Disease Control and Prevention (CDC), someone in the United States experiences a heart attack every 40 seconds, and each year, around 790,000 people go through such an event.

The current stance is that men are more at risk of heart attack compared with women, while women's risk increases after going through menopause.

However, researchers from the George Institute for Global Health at the University of Oxford in the United Kingdom have now conducted a study that indicates that women may be more affected by certain risk factors for heart attack than men.

In the study paper, which now appears in The BMJ, the team reports that a smoking habit, diabetes, and high blood pressure render women even more vulnerable than men to heart attacks.

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The researchers analyzed the data of 471, 998 participants, of whom 56 percent were women. The participants were aged 40–69, and they had no history of cardiovascular disease.

In the first instance, the investigators' findings were not surprising. They confirmed that both men and women are at heightened risk of heart attack if they smoke, have diabetes, have high blood pressure, or have a body mass index (BMI) of over 25, which indicates an unhealthy weight or potential obesity.

Also unsurprisingly, men who smoked 20 or more cigarettes per day had more than twice the risk of experiencing a heart attack compared with men who had never smoked. However, the surprise came when the researchers looked at the data of female participants.

Women who smoked had a more than three times higher risk of heart attack than women who had never smoked. The researchers refer to this as "excess risk."

Women with high blood pressure and diabetes (both type 1 and type 2) also had an increased risk. However, the excessive increase in risk did not apply to women with a high BMI.

More specifically, the researchers found that high blood pressure was tied to an over 80 percent increase in relative risk in the case of women compared with men.

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With type 1 diabetes, women had an almost thrice as high relative risk of heart attack as men, and for type 2 diabetes, women had a 47 percent higher relative risk.

"Overall, more men experience heart attacks than women. However, several major risk factors increase the risk in women more than they increase the risk in men, so women with these factors experience a relative disadvantage," explains lead researcher Dr. Elizabeth Millett.

When looking at how the risk of heart attack changed with age, the researchers found that the hazards associated with smoking and high blood pressure decreased with age for both men and women.

Yet the excess risk associated with women remained consistent, regardless of age.

"These findings highlight the importance of raising awareness around the risk of heart attack women face, and ensuring that women as well as men have access to guideline-based treatments for diabetes and high blood pressure, and to resources to help them stop smoking."

Dr. Elizabeth Millett

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Broken heart syndrome: How complications affect death risk

New research finds that people who develop cardiogenic shock as a complication of broken heart syndrome have an increased risk of death, both in the short-term and in later years.
senior having a heart attack
Broken heart syndrome may feel very similar to a heart attack.

Stressful life events can sometimes put a strain on the heart, quite literally.

A large-scale study from 2018, for example, has confirmed that psychological distress caused by anxiety or depression can boost a person's risk of a heart attack and stroke.

The link between depression and cardiovascular disease is not new. Recently, however, researchers have identified biochemical pathways behind the association, and stress appears to play a key mediating role.

One adverse cardiovascular event that can result from intense stress is broken heart syndrome, a rare condition that mimics the symptoms of a heart attack. It tends to affect women more commonly than men.

People with broken heart syndrome — also called takotsubo cardiomyopathy or stress-induced cardiomyopathy — experience sudden, intense chest pain, along with shortness of breath. Although this can feel similar to a heart attack, the syndrome does not cause blocked arteries.

Instead, part of the heart enlarges and does not pump correctly. Some researchers believe that stress-induced hormones, produced in response to extremely stressful emotions, such as intense grief, anger, or surprise, cause this effect.

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Although broken heart syndrome can be life-threatening, most people fully recover within weeks.

However, 1 in 10 people develop complications such as cardiogenic shock — which occurs when the heart cannot pump enough blood to the rest of the body.

New research has examined the risk of premature mortality among people who developed cardiogenic shock as a result of broken heart syndrome.

The leader of the team was Dr. Christian Templin, Ph.D., the head of acute cardiac care at University Hospital Zurich's University Heart Center in Switzerland.

He will present the findings at Scientific Sessions 2018, held by the American Heart Association (AHA) in Chicago, IL.

The new study will also appear in Circulation, the journal of the AHA.

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Dr. Templin and the team accessed information from the largest database relevant to broken heart syndrome: the International Takotsubo Registry.

The researchers studied information about 198 people who developed cardiogenic shock as a result of the syndrome. They compared this with data from 1,880 people who had the syndrome but not the complication.

The average age of the former group was 63.4 years, while that of the latter was 67.2 years.

Results revealed that, in people who developed cardiogenic shock, physical stress was more than twice as likely to have caused broken heart syndrome.

The stressful event may have been an asthma attack or a surgical procedure, for example.

Also, the patients with cardiogenic shock were more likely to die in the hospital and more likely to have died within 5 years of developing the syndrome.

Specifically, 23.5 percent of the study population with cardiogenic shock died in the hospital, compared with only 2.3 percent of those who had not developed the complication.

An arrhythmia, an abnormality in the heart's left ventricle, and a history of diabetes or smoking were also more prevalent in the group with cardiogenic shock. Diabetes and smoking are common risk factors for heart disease.

Finally, the results showed that the patients with cardiogenic shock were more likely to survive the initial episode if they received cardiac mechanical support.

The study's lead author comments on the findings, saying, "The history and parameters that are easily detectable on admission to the hospital could be helpful to identify broken heart syndrome patients at higher risk of developing cardiogenic shock. For such patients, close monitoring could reveal initial signs of cardiogenic shock and allow prompt management."

"For the first time, this analysis found [that] people who experienced broken heart syndrome complicated by cardiogenic shock were at high risk of death years later, underlining the importance of careful long-term follow-up, especially in this patient group."

Dr. Christian Templin, Ph.D.

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A natural pigment can help decrease cardiovascular risk

According to new evidence, anthocyanin — a pigment present in a variety of fruits and vegetables — could help lower the risk of cardiovascular disease when ingested in high quantities.
assortment of berries
A plant pigment may help keep cardiovascular problems at bay, find the authors of a recent systematic review.

Cardiovascular diseases affect the well-being of many people across the globe. In the United States alone, around 84 million people have some type of cardiovascular problem.

According to the World Health Organization (WHO), cardiovascular diseases are "the number one cause of death globally," and one key strategy for lowering cardiovascular risk is to encourage people to follow healthful diets.

Plenty of fruits and vegetables should be a dietary staple when it comes to looking after heart and blood vessel health, as these foods are filled with essential nutrients.

However, some specific fruits and vegetables may help keep cardiovascular diseases at bay. This is what the authors of a new systematic review featured in the journal Critical Reviews in Food Science and Nutrition have concluded.

The investigators — based at Northumbria University in Newcastle-upon-Tyne, United Kingdom — focused on studies looking at the beneficial properties of anthocyanins, which are natural pigments that lend many fruits and vegetables their reddish, purple, or bluish colors.

Some types of fruit with high anthocyanin content include acai berries, blackberries, raspberries, blueberries, some cherries, and some grapes. Eggplants, some sweet potatoes, and red cabbage also contain this pigment.

Anthocyanins are also a class of flavonoids, which are natural antioxidants that act at the cell level and have a protective effect against cellular degeneration.

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The researchers identified and analyzed 19 prospective cohort studies looking at the effect of anthocyanins on the health of the heart and the circulatory system.

In total, these studies presented data collected from over 602,000 individuals from across the U.S., Europe, and Australia, and their authors monitored participants for periods between 4 and 41 years.

In the new review, the team focused on how dietary anthocyanin intake compared with the incidence of heart disease and cardiovascular events, including stroke, heart attacks, and death due to heart disease-related causes.

They found that individuals who had the highest anthocyanin intake had a 9 percent lower risk of developing coronary heart disease and an 8 percent lower risk of death due to heart disease, when compared with peers who integrated the fewest anthocyanin sources in their diets.

"Our analysis is the largest, most comprehensive evaluation of the association between dietary anthocyanin intake and the risk of cardiovascular disease," notes study co-author Prof. Glyn Howatson, from the Department of Sport Exercise and Rehabilitation at Northumbria University.

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"Evidence has been growing in recent years to suggest that these natural plant compounds might be especially valuable for promoting cardiovascular health," he adds.

However, the researchers also warn that the benefits that anthocyanins seem to provide may not apply across populations. This is because, when the scientists tried differentiating the links between the pigment and cardiovascular risk based on location, they noticed that the association only remained significant for groups based in the U.S.

Thus, the researchers suggest that anthocyanins may be particularly relevant for cardiovascular health in the context of North American dietary habits.

This review, the authors also disclose, received financial support from the Cherry Marketing Institute, a nonprofit organization funded by U.S.-based tart cherry growers and processors.

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