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Interesting items related to CVD

Published 1.25.2017
Cardiovascular disease (CVD) is a topic of increasing interest for me as I age and of occasional coverage here. Fortunately, no one in my immediate family is dealing with the disease at present, and I hope to keep it that way. Please note: I am not any kind of medical professional. Absolutely nothing presented here should be taken as medical advice. Now that the standard (additional) disclaimer is in place, what follows are a few interesting links related to CVD.

Stress and CVD

Stress is often listed as a risk factor for CVD, and researchers are learning that the damage from stress starts in the brain.

The report, published in The Lancet, is the first to link regional brain activity with cardiovascular disease, and the first to suggest a possible mechanism to explain the relationship between chronic stress and myocardial infarction and stroke.

They had seen this effect in mice, now they’ve seen in men. N.B.: That's a John Steinbeck reference, not sexism They use PET/CT scans on people who were having them for other reasons and had no CVD. Then they followed them, assessing Amygdalar activity, bone-marrow activity, and arterial inflammation.

Amygdalar activity was associated with increased bone-marrow activity (r=0·47; P<0·0001), arterial inflammation (r=0·49; P<0·0001), and risk of cardiovascular disease events (standardized hazard ratio 1·59, 95% CI 1·27–1·98; P<0·0001), and this finding remained significant after multivariate adjustments.

It’s not news that stress causes heart damage, the news is that we are beginning to find out how.

Using diabetes drugs to treat CVD?

Cardiologists have noticed that using drugs to lower blood glucose improves outcomes for heart disease. As elevated blood sugar is damaging to the body systemically, I’m not sure why this result is a surprise. Decrease the thing causing the damage (high blood glucose levels) and see less damage. The particular study was looking at the effects of liraglutide, which is branded Victoza. Of coures, this suggests that making the life changes that will bring blood glucose levels down are also could for heart health— there’s nothing new or surprising in that statement either. Of course, popping a pill is easier than changing habits.

Imbibing and CVD

Alcohol consumptions increase the risk for Afib, which is cardiologist speak for a fluttery, briefly irregular beating heart, and not only at binge level intakes. Once you have the condition, continuing to drink makes it worse. Heavy drinking is not required to develop the condition.

And after a diagnosis of Afib, "those who continue to consume alcohol have higher rates of progression from paroxysmal to persistent Afib, more Afib recurrences following pulmonary vein isolation, and potentially higher rates of adverse outcomes, such as thromboembolism," Peter M. Kistler, MBBS, PhD, of Baker IDI Heart and Diabetes Institute in Australia, and colleagues wrote in the Dec. 13 issue of the Journal of the American College of Cardiology.
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"Habitual drinking at moderate levels, as well as binge drinking, predisposes to Afib, with an increase in Afib recurrence in those who continue to drink. Although a small amount of alcohol is considered cardioprotective, these benefits do not extend to Afib," the authors wrote in what they dubbed a "sobering" review.

Still, the definitive association is with heavy drinking, defined as two drinks or more a day. A drink is an ounce of alcohol, so one beer, one shot or one five ounce glass of wine would all qualify. There's a surge during the holidays, when money people over-indulge.

Patients commonly present to emergency departments nationwide with "holiday heart syndrome," or Afib precipitated by alcohol, they noted. One study found that while "many patents develop Afib at the time of intoxication, others may present 12 to 36 hours later," they added -- with a quarter of patients showing recurrences at 1 year with subsequent binges.

Although heavy habitual alcohol consumption and binge drinking are closely associated with Afib, three large meta-analyses have also shown a link between light-to-moderate alcohol consumption and the condition, according to the authors.

Granted this is an association based on pooled observational studies. The effect isn’t apparent in smaller data groupings. So perhaps it is nothing to panic over. However, as someone who enjoys an adult beverage (or two) on a regular basis, it did make me sit up and notice.

Football damages hearts

Here's another reason to avoid (American) football. I have stuck to my resolution not to watch any football this season, and it’s proved easier than I would have thought possible at the beginning.

Linemen are more likely to suffer from hypertension and associated secondary cardiac remodeling than other football players and other young adults are, according to a study online in JACC: Cardiovascular Imaging.

This is just further justification for a decision I am already completely comfortable with. I can’t say that it amounted into increased productivity or book reading though as I'd hoped when I announced my decision.

Saturated Fat still a factor

Saturated fat is still thought to be bad for the heart. The results were observational, so causation can't be proven.

The BMJ paper was based on 24 to 28 years of follow-up of 73,147 women in the Nurses' Health Study and 42,635 men in the Health Professionals Follow-up Study. In this report, the investigators focused on the role of individual saturated fatty acids (SFAs) and found a strong correlation with all the main SFAs and coronary heart disease. They calculated that replacing 1% daily energy intake of SFAs -- including lauric acid, myristic acid, palmitic acid, and stearic acid -- with an equivalent number of calories from polyunsaturated fats, whole grain carbohydrates, or plant proteins would lead to a 6% to 8% reduction in the risk of coronary heart disease.

Of course the BMJ (and MedPage) gives critics their say too. From an email sent to MedPage:

"Epidemiologic studies are observational studies. This means that people who tend to eat high (or low) saturated fats tend to also do other things that may reduce or increase risk of heart disease. For example, in this study, those who ate more saturated fat also ate more protein from animals, 'refined' carbohydrate, and trans fats. They also ate less fiber, fruits and vegetables, and whole grain carbohydrates. They were more likely to smoke. Though the authors carefully controlled for many of these confounders in their analyses, the risk of what we call residual confounding is always present."



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