The Heart

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Diabetes: Switching to common drugs raises risk of complications

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Do omega-3 supplements really benefit the heart?

Every day, millions of people from all over the world take fish oil supplements in the hope that they will protect them from heart disease. But do these golden capsules really work? A large systematic review investigates.
fish oil supplements on blue background
Should we believe the hype around these little golden capsules?

Omega-3 is a kind of fat found in fish, seafood, certain nuts, and plant oils.

More specifically, omega-3 fatty acids are of three main types: alpha­linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).

ALA is an essential fatty acid, which means that the human body cannot produce it on its own and has to get it from food.

Flaxseed, soybean, and canola oils, as well as chia seeds and walnuts, all contain ALA.

DHA and EPA — also called long-chain omega-3s — can both be found in fatty fish such as salmon, mackerel, tuna, herring, and sardines, as well as in other kinds of seafood.

Studies have shown that those who consume fish regularly as part of a healthful, balanced diet are at a lower risk of heart problems. But the National Institutes of Health (NIH) explain that research is unclear as to whether these benefits come from fish or omega-3 in particular.

While the jury is still out on the matter, millions of people in the United States have turned to omega-3, or fish oil supplements, due to their alleged heart health benefits.

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In fact, as a survey carried out by the NIH reports, "Fish oil was the most popular natural product used by adults in the United States in 2012," with about 18.8 million U.S. individuals taking it.

But are the supplements actually worth the hype? A new review by researchers at Cochrane, an independent organization that evaluates existing medical research, assesses the benefits of the supplements by looking at the evidence available.

Lee Hooper, the lead author of the meta-analysis, is an expert systematic reviewer and reader in research synthesis, nutrition, and hydration from the Norwich Medical School at the University of East Anglia in the United Kingdom

The findings are now published in the Cochrane Library.

Reviewing almost 80 clinical trials

Hooper and colleagues reviewed 79 randomized trials, summing up 112,059 participants. The trials assessed the cardiovascular effects of taking omega-3 supplements and compared them with those of normal or lower intake of omega-3.

In most studies, some participants were given fish oil supplements, while others took placebos.

Other studies had prompted participants to increase their omega-3 intake over the course of 1 year, while other participants were asked to keep it the same.

The majority of the trials that assessed the effect of ALA intake gave participants in the intervention group omega-3-enriched foods such as margarine, or foods naturally rich in ALA, including walnuts. The control group had a normal, non-enriched diet.

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Supplements have 'little or no effect'

The review found that taking long-chain omega-3 supplements had "little or no effect" on death risk from any causes, death risk from cardiovascular problems, or death risk from coronary heart disease.

The supplements are also reported to have had "little or no effect" on the risk of cardiovascular events, stroke, or irregular heartbeat.

As for ALA, increasing intake from walnuts or fortified products such as margarine "probably makes little or no difference to all-cause or cardiovascular deaths or coronary events but probably slightly reduce[s] cardiovascular events, coronary mortality, and heart irregularities," the authors conclude.

However, this reduction is so slight that 1,000 people would have to increase their ALA intake in order for one of them to benefit, say the researchers.

This is based on "moderate- and high-quality evidence." Conversely, "Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias," write the authors.

Finally, the effects of ALA on stroke risk remain unclear because the evidence was considered to be "of very low quality."

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Diet may help, but supplements do not

Hooper comments on the results, saying, "We can be confident in the findings of this review which go against the popular belief that long-chain omega-3 supplements protect the heart."

"The review provides good evidence," she adds, "that taking long-chain omega-3 (fish oil, EPA, or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause."

"The most trustworthy studies consistently showed little or no effect of long-chain omega-3 fats on cardiovascular health," Hooper emphasizes. "On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts."

In an expert reaction to the review, Tim Chico — who is a professor of cardiovascular medicine and an honorary consultant cardiologist at the University of Sheffield in the U.K. — says, "Although diet plays an important role in preventing heart disease, this is complex and unlikely to relate much to any single element of the diet."

"Previous experience has shown that although some types of diet are linked to lower risk of heart disease, when we try to identify the beneficial element of the diet and give it as a supplement it generally has little or no benefit."

Prof. Tim Chico

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Large study reviews the cardiovascular benefits of walnuts

In recent years, studies have started pointing to nuts as a way to boost heart health, but most of them were observational with a limited sample size. Now, a systematic review of clinical trials spanning 25 years has confirmed that when it comes to cardiovascular health, nuts are the go-to food.
walnuts
It's official: walnuts are great for your heart.

At Medical News Today, we've been unpacking the health benefits of nuts, one study at a time.

This delicious snack may be key for heart health and healthy aging, slashing the risk of stroke or coronary heart disease.

But the benefits of nuts do not stop here; some studies suggest that a handful of nuts may help us live longer, improve our memory, and strengthen our brain.

Now, scientists led by Marta Guasch-Ferré — a research associate in the Department of Nutrition at the Harvard TH Chan School of Public Health in Boston, MA — have carried out a large-scale review of numerous studies covering the link between nut consumption and heart health.

These "natural health capsules," as Guasch-Ferré called them in a study that MNT reported on last year, may do wonders for our cardiovascular system.

This is the main takeaway of the new review, which has been published in the American Journal of Clinical Nutrition.

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Walnut-enriched diets protect the heart

This review updates the results of a previous meta-analysis that was published in 2009. It included 13 clinical trials.

Now, Guasch-Ferré and team have assessed the trials published since that point; this amounted to 26 randomized trials, summing up 1,059 participants with ages between 22 and 75.

Among the study participants, some were living with conditions such as high cholesterol, type 2 diabetes, metabolic syndrome, or obesity.

The scientists evaluated the benefits of a diet rich in walnuts and compared it with low-fat, Western, Mediterranean, and Japanese diets.

Walnut-enriched diets provided a more significant reduction in cholesterol levels and other markers of cardiovascular health when compared with these control diets.

More specifically, a diet rich in walnuts had a 3.25 percent greater reduction in total cholesterol levels, a 3.73 percent greater decrease in low-density lipoprotein (LDL) cholesterol, and a 5.52 percent greater reduction of triglycerides.

Also, levels of apolipoprotein B — which is the main protein found in LDL, or "bad," cholesterol — were lowered by 4.19 more percentage points than in control diets.

"Incorporating walnuts into the diet improved blood lipid profile without adversely affecting body weight or blood pressure," conclude the authors.

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Strengths and limitations of the study

Walnuts' benefits may be down to their rich polyunsaturated, or "healthful," fat content, including essential omega-3 fatty acids, as well as to their wide variety of antioxidants.

Dr. Michael Roizen, the chief wellness officer in the Department of Preventive Medicine at the Cleveland Clinic in Ohio, weighs in on the findings.

"This updated review further strengthens the case that enjoying walnuts is a great (and tasty) way to add important nutrients to your diet while supporting the health of your heart."

Dr. Michael Roizen

But the review does have some caveats. The samples in most of the studies reviewed were fairly small, which may weaken the findings.

Also, some trials used a considerable amount of walnuts, which may be hard to stick to in a day-to-day setting, say the researchers.

Still, they highlight the fact that great benefits were noticed with even smaller amounts of walnuts — that is, fewer than 28 grams per day.

Finally, the research was funded by the California Walnut Commission, an agency of the State of California that works together with the Secretary of the California Department of Food and Agriculture to develop the nut market and support health research.

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What causes a bounding pulse?

A bounding pulse is when a person feels their heart beating harder or more vigorously than usual.

People are often worried that a bounding pulse is a sign of a heart problem. However, anxiety or panic attacks cause many cases and will resolve on their own.

People may notice their heartbeat feels stronger in their chest or when they feel for their pulse in the neck or wrist. They might also notice an irregular heartbeat or heart palpitations.

In this article, we look at the causes and symptoms of a bounding pulse. We also discuss ways that people can treat or prevent it from happening.

Causes of a bounding pulse Bounding pulse
A person experiencing anxiety will often feel their heartbeat increase.

A range of medical conditions can cause a bounding pulse. If the symptoms do not go away on their own, people should see a doctor to find out what is causing the symptoms.

Some of the most common conditions linked to pulse rate changes include the following:

Anxiety or panic attacks

Anxiety can cause the heart to beat more strongly and more rapidly. Anxiety is a temporary state, and a person's heartbeat will return to normal when their fear or worry go away.

In cases of extreme anxiety, people might experience a panic attack. Panic attacks usually come on quickly and reach their peak within minutes. In some cases, they can feel like a heart attack, which can add more anxiety.

According to the Anxiety and Depression Association of America (ADAA), the symptoms of a panic attack include:

heart palpitations, or an irregular heartbeat a pounding heart a rapid heartbeat chest pain or discomfort shortness of breath fear of losing control or dying

Panic attacks are not a sign of any underlying medical condition. Nevertheless, if a person experiences severe anxiety or panic attacks, they should speak to their doctor.

Dehydration

Dehydration can disrupt the balance of electrolytes in the body. A person's heart may beat more rapidly to try and correct these imbalances.

A bounding pulse linked to dehydration is more common in people doing intense exercise, experiencing heat-related exhaustion, and those with metabolic disorders that affect their ability to absorb electrolytes.

Fever

People may feel their heart beating more quickly or vigorously when they have a fever.

A person's body heats up when it is trying to fight off an infection, which means the heart has to work harder. This also occurs when people exercise or spend too much time in hot climates.

Some people also become more sensitive to changes in their heart rate when they are sick or have a fever, so they are more likely to notice changes in their heartbeats.

Drugs

Some drugs and medications can cause the heart to beat faster. Some that may cause this effect include:

caffeine and nicotine prescription medications, including Ritalin and other ADHD treatments illicit substances, including cocaine

Hormonal imbalance

Hormones are the body's chemical messengers. Changes in hormone levels can change the heart rate.

Thyroid diseases, such as hyperthyroidism, which causes the body to produce too much thyroid hormone, are a common cause of hormone imbalances.

People who experience a pounding heart and other symptoms, such as exhaustion or unexplained weight gain or loss, may have a thyroid condition.

Allergic reactions

Mild allergic reactions should not cause changes in people's heartbeats. However, a severe allergic reaction, such as anaphylactic shock, can produce a rapid, bounding pulse.

Anaphylaxis usually happens within a few minutes of exposure to an allergen.

People experiencing anaphylaxis may have:

rapid, pounding heartbeat trouble breathing swollen throat or tongue

Electrical faults in the heart

The heart uses electrical signals to know when to pump and when to relax.

A problem with the heart's electrical system can cause any of the organ's four chambers to beat at an irregular rate, or to pump too fast and too hard. This can create the sensation of a bounding pulse.

One of the most common symptoms of an electrical problem is called paroxysmal supraventricular tachycardia (SVT). It often happens during exercise or stress and does not usually mean a person has a serious health problem.

Heart disease

A racing, bounding heart rate may be a sign of heart disease.

Heart disease is more likely in people with cardiovascular risk factors, such as:

smoking cigarettes a family history of heart disease being overweight

When the arteries are clogged, the heart has to beat harder to pump blood through the body. This damages the heart and may cause chest pain. It can also cause some people to experience a faster heart rate.

Problems with the heart valves

Aortic insufficiency, sometimes called aortic regurgitation, is where the heart valves do not close properly. This means that the heart cannot pump the blood as well as it should.

Heart disease and some other health problems, such as a bacterial infection, can weaken the heart and cause problems with the heart valves.

Aortic insufficiency can cause:

a bounding pulse chest pain weakness swelling fatigue

Shock

Shock is a medical condition where the heart does not pump enough oxygen-rich blood around the body. This can happen when a person has one of the following:

too little blood in their body a problem with their heart's pumping mechanism widened blood vessels

Shock can cause the heart to beat faster to compensate. People may go into shock following a severe injury, especially one that causes organ damage or heavy bleeding. A racing heart following an injury is always a medical emergency.

Symptoms During an episode of bounding pulse, a person may experience the following: sudden increase in pulse rate, such that the heart feels as if it is beating very fast feeling like the heart is beating very hard anxiety about the heart heart palpitations or an irregular heart rate Some people also experience dizziness or light-headedness. These signs are often due to anxiety. Anxiety can increase a person's pulse and make the bounding feeling more intense. This change in pulse can make people feel even more anxious. Finding ways to manage anxiety, such as deep breathing or meditation, may help to break this cycle. Thank you for supporting Medical News Today When to see a doctor Bounding pulse can be cause for medical treatment
Seek medical help if chest pain is not linked to exercise and does not reduce with rest. A bounding pulse does not necessarily mean a person has a medical condition, and it usually goes away on its own. People who frequently experience a bounding pulse should consult a doctor, especially if the symptom is not due to anxiety. If a person has other symptoms, it is vital to see a doctor quickly, as a bounding pulse associated with other signs may point to a further medical issue. People should seek emergency medical help if a bounding pulse happens along with: chest pain or pressure not associated with exercise and not improving after rest intense jaw or shoulder pain, especially along with chest pain confusion or changes in consciousness a history of heart disease, stroke, or heart attack starting new medication exposure to a recent allergen, such as a bee sting sweating profusely heavy bleeding or a recent injury spotting during pregnancy a head injury Diagnosis To find out the cause of a bounding pulse, a doctor will ask about a person's symptoms and medical history. The doctor may seek the following information: when the changes in pulse rate began whether a bounding pulse has happened before what triggers the bounding pulse other symptoms, such as an irregular heartbeat or ectopic beats risk factors for heart issues, including family history of heart problems A doctor may then order tests to measure the speed and regularity of a person's heartbeat. An electrocardiogram (ECG or EKG) is one of the most common heart tests. It measures heart rhythms over time. Blood testing may also help rule out some causes, such as thyroid disease. Treatment A person with a bounding pulse does not usually require treatment. However, people may need treatment for an underlying medical condition if that is causing their symptoms. Treatment varies depending on the medical condition involved, but it may include medication, lifestyle changes, and ongoing medical monitoring. A doctor may recommend regular stress tests to test how the heart responds to physical stress. When anxiety causes changes in the pulse, people can try various ways to reduce their stress levels. These may include: using deep breathing exercises when anxiety arises learning ways to manage a panic attack practicing meditation or mindfulness Some people may also benefit from anti-anxiety medication and should speak to a doctor about the best options. Thank you for supporting Medical News Today Prevention Regular exercise can reduce risk of bounding pulse
Regular exercise will help to keep the heart healthy. The best ways to prevent a bounding pulse depend on the cause. When anxiety causes these symptoms, people can prevent pulse changes by avoiding triggers or developing stress-management techniques. When chronic health conditions cause a bounding pulse, people should speak to their doctor about the best ways to control their symptoms. A number of strategies can prevent heart health issues if people are concerned about these or they have a risk of cardiovascular disease. According to the American Heart Association, people can keep their heart healthy by using the following tips: maintaining a healthy body weight eating a balanced, nutrient-rich diet exercising regularly managing chronic health conditions keeping anxiety and stress under control limiting foods linked to heart health issues, including sodium and red meat eating heart-friendly foods, such as non-fried fish, whole grains, and fruits and vegetables Outlook For most people, a bounding pulse is temporary and will resolve on its own. Anxiety is often the cause. If a person frequently experiences a pounding heartbeat, they should speak with their doctor to find the causes and triggers. Heart health issues are usually treatable, and treatment can be more effective when people catch the problems early. People should speak to a doctor about any heart rate changes that persist or cause worry.
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Full-fat dairy may actually benefit heart health

Popular belief has it — and even some governmental authorities on nutrition agree — that we should avoid full-fat dairy products due to their high content of saturated fats. But, a new study boldly challenges these claims.
illustration of dairy products
Full-fat dairy products may actually be good for cardiovascular health.

Whole-fat dairy does not raise cardiovascular risk. Conversely, some fats present in certain dairy products might even keep stroke and heart disease at bay.

This is the main takeaway of a recent study led by Dr. Dariush Mozaffarian, from the Friedman School of Nutrition Science and Policy at Tufts University in Boston, MA.

With their findings, Dr. Mozaffarian and team challenge not only popular opinions, but also the stance of governmental organizations such as the United States Department of Agriculture (USDA) and the U.S. Department of Health & Human Services.

The two bodies advise people to avoid full-fat dairy due to its impact on cholesterol levels. The saturated fats found in whole-fat dairy products, warn the USDA, raise levels of low-density lipoprotein (LDL) cholesterol, also known as the "bad" kind of cholesterol.

In time, high LDL cholesterol may lead to cardiovascular conditions such as atherosclerosis or coronary artery disease.

However, the new study turns the idea that full-fat dairy is bad for you on its head. The surprising findings were published in the American Journal of Clinical Nutrition.

Marcia Otto, who is an assistant professor in the Department of Epidemiology, Human Genetics, and Environmental Sciences at the University of Texas Health Science Center at Houston, is the first and corresponding author of the paper.

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Dairy fat may prevent heart disease, stroke

To study the effect of dairy on mortality risk and cardiovascular health, Dr. Mozaffarian and team examined over 2,900 U.S. seniors, aged 65 and above.

The researchers measured the participants' blood plasma levels of three fatty acids contained by dairy products at the beginning of the study in 1992, 6 years later, and then 13 years later.

Associations with "total mortality, cause-specific mortality, and cardiovascular disease (CVD) risk" were examined.

During the 22-year follow-up period, 2,428 of the participants died. Of these deaths, 833 were due to heart disease.

However, none of the three fatty acids examined correlated with the risk of total mortality. In fact, high circulating levels of heptadecanoic fatty acid were associated with a lower risk of death from heart disease.

Also, adults with higher levels of fatty acids overall were 42 percent less likely to die from stroke, revealed the analysis.

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Dietary guidelines should be revised

According to the study's corresponding author, the findings suggest that current dietary guidelines need to be amended.

The 2015–2020 Dietary Guidelines for Americans issued by the Office of Disease Prevention and Health Promotion recommend the consumption of "fat-free and low-fat (1 percent) dairy, including milk, yogurt, cheese, or fortified soy beverages (commonly known as 'soymilk')."

However, Otto disagrees. "Consistent with previous findings," she says, "our results highlight the need to revisit current dietary guidance on whole fat dairy foods, which are rich sources of nutrients such as calcium and potassium."

"These are essential for health not only during childhood but throughout life, particularly also in later years when undernourishment and conditions like osteoporosis are more common," adds the researcher.

"[D]airy fat, contrary to popular belief, does not increase [the] risk of heart disease or overall mortality in older adults. In addition [...], the results suggest that one fatty acid present in dairy may lower risk of death from cardiovascular disease, particularly from stroke."

Marcia Otto

She adds, "Consumers have been exposed to so much different and conflicting information about diet, particularly in relation to fats," and she highlights the fact that "a growing body of evidence" suggests that dairy fat is actually good for you.

"It's [...] important to have robust studies, so people can make more balanced and informed choices based on scientific fact rather than hearsay," Otto concludes.

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