Associates in Cardiovascular Disease

Americans Still Eat Too Much Salt

Despite repeated warnings about the health effects of a high-salt diet, Americans haven’t cut back – at all.

A new study found that salt consumption is the same today as it was nearly 50 years ago, an amount well above current U.S. guidelines.

Eating too much salt can increase blood pressure – and boost the risk for heart disease and stroke.

Long-term study

Harvard researchers analyzed 38 studies that involved a total of 26,000 people and that spanned more than four decades – from 1957 to 2003. They focused on the amount sodium that people had in their urine. This test is the best way to check salt consumption, because 40 percent of salt is sodium.

You need sodium for proper body functioning. But most fresh foods – vegetables, fruits, and meats, for instance – already contain sodium as a natural ingredient. There’s no need to add any.

More processed food

Because people eat more processed foods today than in 1957, the researchers thought they would find that salt intake had increased over time. But decade after decade, people consumed about 3,700 mg of sodium a day.

That’s more than half again the maximum amount of sodium recommended. Current guidelines say adults should consume no more than 2,300 mg (about one teaspoon) a day. For people who have or are at risk for high blood pressure, the upper limit is 1,500 mg a day.

Since the 1980s, the federal government has advised Americans to cut back on salt to reduce the risk for high blood pressure and cardiovascular disease.

The study, published in the American Journal of Clinical Nutrition, also notes that although salt intake has remained constant for almost 50 years, rates of high blood pressure and heart disease have increased in the last two decades.

Rising obesity rates, however, may play a more critical role in hypertension than salt intake, the researchers note.

Personalize the right amount

The study’s main message, says David McCarron, M.D., lead author of an accompanying journal editorial, is that the intense effort to get people to limit their salt intake hasn’t worked.

It may be that people need a set amount of salt and are hard-wired to seek it, he says. To wit:

• Dr. McCarron led a 2009 study that looked at urine samples of 19,151 people in 33 countries over a 24-year period. The average daily sodium intake was 3,726 mg a day, even across diverse groups of people and diets, and without change over time.

• In a 12-year study of more than 13,000 people from Switzerland, people averaged around 3,680 mg a day.

In light of these studies, the editorial says, guidelines should limit salt for those at risk for high blood pressure and heart disease rather than issue a broad, one-amount-fits-all recommendation.

Always talk with your health care provider to find out more information.

Peripheral Artery Disease Treatment Improved

A new approach to clearing plaque from arteries is helping doctors treat patients who require a procedure called balloon angioplasty.

Balloon angioplasty is among the standard treatments for peripheral artery disease (PAD). In the U.S., about 8 million people have peripheral artery disease, and about half have no symptoms.

PAD is frequently found in people with coronary artery disease because atherosclerosis, which causes coronary artery disease, is a widespread disease of the arteries.

Disease requires careful management

In PAD, plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue.

Symptoms include painful cramping in the hips, thighs, or calves when walking, climbing stairs, or exercising.

To correct this problem, a doctor inserts a catheter into an artery and guides it to the blockage, then opens the artery by inflating a balloon at the tip of the catheter.

The doctor typically uses a stent to keep the artery open. A stent is a tiny metal “scaffold” that is left open inside the artery to it from reclosing.

Inflating the balloon can knock loose particles of plaque, which travel down the leg. A large particle can block blood flow, a condition called distal embolization. In the most severe cases, distal embolizations can require leg amputation or even be fatal.

Some doctors have used a filter device to prevent debris from escaping, but using this filter isn’t yet approved by the FDA.

New device increases safety for patient

The new report shows that the device that was studied opens the artery just like a standard angioplasty balloon.

After the artery is opened, the doctor deflates the balloon. The negative pressure sucks up the debris, which is trapped inside as the balloon retracts.

Researchers report their findings in the medical journal Endovascular Today.

In two clinical trials totaling 123 patients, the device had a success rate of 97 to 99 percent and consistently outperformed filter devices typically used to capture debris particles, report the study authors.

Robert Dieter, M.D., of the Loyola University Health System, and Dr. Aravinda Nanjundappa, M.D., of West Virginia University, say they expect to see a shift by doctors to using this new method now that it has been approved by the FDA.

Always talk with your doctor to find out more information.

Fat in Arteries Can Worsen Cardiovascular Problems

Some people with abnormal fatty deposits in their arteries are at higher risk than others for heart attack, stroke, and cardiovascular death, a new study shows.

The fatty condition, referred to as atherothrombosis, puts people at increased risk for heart attack and stroke stemming from reduced blood flow from the artery blockage.

The large, multi-center study is reported in the Journal of the American Medical Association (JAMA) and was presented at a recent meeting of the European Society of Cardiology in Sweden.

SECTION HEADER

Dr. Deepak L. Bhatt, of Harvard Medical School, and his team studied 45,000 patients who were enrolled in the Reduction of Atherothrombosis for Continued Health (REACH) study.

Detailed information was gathered at the start, with additional annual follow-up at one, two, three, and four years.

The researchers found that patients with abnormal fatty deposits in an artery were at highest risk if they had a prior history of heart attack or other emergencies linked to an artery blockage.

They also discovered that of the participants studied, 81 percent had hypertension, 70 percent had high cholesterol levels in the blood, and nearly 16 percent had narrowing of the arteries in numerous locations.

In fact, 48 percent of the patients had prior heart attacks, unstable angina, or other problems related to the artery blockage. About 28 percent of those patients had such an event within the previous year.

Studies Provide Clues to Help Physicians

During the follow-up period, 5,481 patients experienced cardiovascular events that included 2,315 with cardiovascular death.

The researchers also found that 1,228 people with myocardial infarction (heart attack), 1,898 with stroke, and 40 with both a myocardial infarction and stroke occurring on the same day.

Among patients with atherothrombosis, those with a prior history of ischemic events at the beginning had the highest rate of new ischemic events, while patients with stable coronary, cerebrovascular, or peripheral artery disease had a lower risk.

Patients without known atherothrombosis, but with risk factors only, had the lowest risk of new ischemic events.

The researchers say this information can help physicians identify patients with various stages of atherothrombosis who are at high risk of future heart and vascular problems.

Always consult your physician or other healthcare provider for more information.

CPR Using Chest Compressions Alone Effective

Performing only chest compressions to help keep the blood flowing during a heart attack can be as effective as standard cardiopulmonary resuscitation, or CPR, that includes mouth-to-mouth breathing, says a new study.

The technique forces air into the lungs, which can help a heart attack victim survive three to five minutes long – possibly enough time until emergency medical services arrive.

If a person has not been well-trained in CPR and sees someone having what appears to be a heart attack, it is okay to only use only chest compressions.

Two new studies, appearing in the New England Journal of Medicine, found that when bystanders were instructed by emergency dispatchers to give either standard CPR or chest-compression-only CPR, survival rates were similar between the two techniques.

Experts hope that by making the procedure easier and removing the mouth-to-mouth contact that more bystanders might be willing to attempt CPR.

“Bystander CPR can double your chances of survival, but the biggest thing is getting more people to try it,” explains the lead author of one of the studies, Dr. Thomas Rea, medical director of the Emergency Medical Services Division of Public Health for Seattle and King County in Washington.

“Only one in three people who need it get bystander CPR,” says Dr. Rea. “If we can make it less complicated, it may enable more people to perform CPR.”

Start with Compression, Others Can Bring Defibrillator

Rescue breathing can be difficult, especially for someone who is not trained in the technique, says Dr. Rea. Even in people who are trained, but do not often have the chance to practice rescue breathing, it can be hard to do.

Dr. Dana Peres Edelson, director of clinical research at the emergency resuscitation center at the University of Chicago Medical Center, says, “Even for myself as a physician, because I don’t do mouth-to-mouth on a regular basis, it’s hard to do.”

Dr. Edelson says that when you see a seemingly healthy adult suddenly drop, call 911 and then begin chest compressions. Emergency dispatchers can provide instructions on where to place your hands.

If someone else is available to help, she says to have them call 911 and to go look for an automatic external defibrillator (AED). AEDs are now present in many public places, such as malls, schools, and stadiums.

“Push hard, push fast, and don’t stop unless you have to give a breath or use a defibrillator,” says Dr. Edelson. “If you do stop, keep the pause as brief as possible.”

Two Studies Show Similar Results

Dr. Rea and his colleagues studied dispatcher-assisted bystander CPR. Adults who needed CPR were assigned to receive either traditional CPR or chest-compression-only CPR.

The second study was similarly designed, but conducted in Sweden. Both groups of researchers concluded that compression-only CPR with instructions from emergency dispatchers was likely to be as effective as traditional CPR, possibly even slightly more so.

The findings do not apply to emergency workers and others who are well-trained in CPR, says Dr. Rea.

There are some times when rescue breathing is necessary. Dr. Edelson says that it is recommended that children generally receive rescue breathing, as well as anyone who was choking or looked like they were having trouble breathing before they became unconscious.

But, she notes, that lay people might not be able to discern who needs rescue breathing or not, so she advises, “If you haven’t been trained in CPR, just start doing chest compressions as fast as you possibly can.”

Dr. Rea agrees. “You can make a life-and-death difference by providing chest compressions. You don’t have to be perfect; all you can do is provide benefit. Your actions can save a life.”

Always consult your physician or other healthcare provider for more information.

Anxiety Disorders May Increase Heart Attack and Stroke Risk

Anxiety disorders may increase the risk of heart attack, stroke, heart failure, and death in people with heart disease, a new study suggests.

Researchers have studied depression in patients with coronary heart disease, but relatively few studies have examined the role of anxiety.

The study on anxiety was reported in the journal Archives of General Psychiatry.

Many factors may account for the increase in risk linked with anxiety, says study author Elisabeth J. Martens, Ph.D., of Tilburg University in the Netherlands.

Anxiety a Common Problem

Anywhere from 24 percent to 31 percent of patients with heart disease also have symptoms of anxiety, Dr. Martens notes.

Anxiety may be linked with surges in “fight or flight” hormones called catecholamines that may be related to heart risks.

Or it is possible that people with anxiety may be more likely to seek medical care when they have symptoms of a cardiovascular event (although researchers noted this would not explain the higher rates of death).

Or a common underlying factor may increase the risk of both anxiety and heart events.

The research included over 1,000 people with stable coronary heart disease who were assessed for anxiety disorder at the start of the study and then followed for an average of 5.6 years.

During that time, there were a total of 371 cardiovascular events (heart attacks or other incidents that may cause damage to the heart).

The yearly rate of cardiovascular events was 9.6 percent among the 106 patients with generalized anxiety disorder and 6.6 percent among the other 909 patients.

Anxiety Link to Heart Problems Considerable

After adjusting for a number of factors – such as other health problems, heart disease severity, and medication use – the researchers concluded that generalized anxiety disorder was associated with a 74 percent increased risk of cardiovascular events.

“These findings have implications for clinical practice and research,” notes Dr. Martens, since the evaluation and treatment of anxiety might now “be considered as part of the comprehensive management of patients with coronary heart disease.”

The research team adds that scientists need research programs to help understand the impact of anxiety disorders on medical prognosis, including that of heart disease, and to develop evidence-based approaches to patient care.

Always consult your physician or other healthcare provider for more information.

Lack of Exercise at Young Age Raises Hypertension Risk

High blood pressure, or hypertension, increases significantly with low levels of physical activity and fitness, a study of young adults shows.

The study in the journal Hypertension found that about one-third of all high blood pressure cases could be prevented with increased physical fitness.

“Those who were the least physically fit, as determined by the amount of time on a treadmill and self-report, were more likely to develop hypertension,” says study author Mercedes Carnethon, Ph.D., at Northwestern University.

Because high blood pressure does not generally have warning signs or symptoms, it has been called “silent killer” because many people do not realize they have it.

High blood pressure can be detected in a quick, painless manner by having a blood pressure measurement performed by a physician or other healthcare professional. Blood pressure checks should be performed regularly, at least once a year or more often, if recommended by a healthcare provider.

Long-Term Study Uses Treadmill, Questionnaires

For the study, researchers asked if levels of physical activity and fitness as a young adult affect risk of developing high blood pressure later in life.

To answer that question, 4,618 men and women between 18 and 30 years old were recruited for a 20-year study of cardiovascular disease risk factors. Study volunteers completed a treadmill test and a physical activity questionnaire when the study began. In addition, their overall health was assessed at six follow-up appointments over 20 years.

Just over 1,000 people in the study developed high blood pressure, which was defined as having blood pressure that is higher than 140/80 millimeters of mercury (mm Hg) or having been prescribed medication to treat high blood pressure.

Even after adjusting for other known heart disease and high blood pressure risk factors – such as smoking, age, race, sex, cholesterol, and diet – the researchers found that lower levels of physical activity and fitness were associated with an increased risk of high blood pressure.

Dr. Carnethon says this study is especially helpful because it did not rely solely on self-report of physical activity, but relied on an objective measure of physical activity – the treadmill test.

If people moved more and were able to increase their fitness level, the researchers estimate that about 34 percent of hypertension cases could be prevented.

Old Habits Are Hard to Change

The reason sedentary behavior in young adults translated to a higher risk of elevated blood pressure later in life, says Dr. Carnethon, was probably because the sedentary behavior did not change as people grew older.

“The results of this study aren’t too surprising, but what I think is impressive is the amount of hypertension that can be prevented, says Dr. Goutham Rao, at Children’s Hospital of Pittsburgh.

“For example, in white women, the difference between low levels of fitness and high levels of fitness is a fivefold higher risk in the low level group,” he says. “The magnitude of the difference was surprising.”

“Hypertension is largely controllable or reversible,” explains Dr. Rao. “The good news is that there’s no point at which you can not benefit from increased activity.” But, he says, it is better to start younger because people who are active in their youth are more likely to stay active as adults.

One in three Americans has hypertension, according to the Centers for Disease Control and Prevention (CDC). High blood pressure is a risk factor for heart disease, stroke, and kidney disease.

Regular physical activity is one way that a person can help keep blood pressure at normal levels. The CDC recommends at least 30 minutes of moderate physical activity on most days of the week.

Always consult your physician for more information.

Heart Risk Prediction May Improve with Calcium CT Scan

Using a computed tomography (CT) test to measure calcium in coronary arteries helps predict a person’s future heart disease, a new study finds.

Still in question, however, is whether or not it is worth the cost and risk due to radiation exposure.

“This kind of evidence gives encouragement to go on and do additional testing, but it shouldn’t convince us that this test should be done routinely,” says Dr. Philip Greenland, at Northwestern University in Chicago and a co-author on a report in the Journal of the American Medical Association (JAMA).

CT Scan Uncovers Extra Risk

CT uses x-rays to get a detailed picture of heart structure. Some experts are concerned about using it to diagnose heart disease because x-ray exposure may increase the risk of cancer.

The new study of nearly 6,000 healthy Americans was done to see whether the technique could provide extra help to physicians assessing risk. This would be in addition to looking at known risk factors such as high blood pressure, high cholesterol, and obesity.

The study began in July 2000 and ran through May 2008. It used two models to predict the five-year risk of a heart attack, resuscitated cardiac arrest, or death from coronary heart disease: the traditional risk factors or those risk factors plus the coronary artery calcium score.

At nearly six years, the participants had experienced 209 coronary heart disease problems and 122 “major events” – heart attacks, deaths from coronary heart disease, or cardiac arrest followed by resuscitation.

The second model, which used the regular risk factors plus the calcium CT, was able to predict an additional 23 percent of participants who would go on to experience a harmful cardiovascular event.

But, the question remains if added predictive power makes a difference in terms of saving lives and reducing unnecessary treatment.

Dr. Greenland says, “What we can say here is that additional testing looks like it improves prediction. Whether it improves clinical outcome requires a different kind of study.”

Next Steps: What Is Best in the Long Run?

The first steps toward such a study have been taken. Dr. Greenland is discussing a possible new study with the National Heart, Lung, and Blood Institute (NHLBI).

This could involve tens of thousands of people and cost millions of dollars, says Dr. Andrew J. Einstein, director of cardiac computed tomography research at Columbia University Medical Center in New York City.

The study would aim at finding whether more intensive treatment of traditional risk factors would improve survival of people classified as high risk by the coronary artery calcium score.

“No study has compared patients who had intensive preventive therapy with those who didn’t and see if it makes a difference in terms of the number of heart attacks people have,” explains Dr. Einstein. “That study would be the ideal.”

Cancer risk and cost are also parts of the equation. Dr. Greenland says a well-controlled computed tomography scan gives about twice the radiation exposure as a mammogram.

A new large-scale trial could show whether the added risk is justified by the number of lives saved, and the same is true of the cost, estimated to run between $200 and $600 per scan.

Always consult your physician for more information.

Heart Disease Plus ED May Raise Risk for Death

A new study published in Circulation shows that men with both cardiovascular disease and erectile dysfunction (ED) have a higher risk for a host of heart problems, including death.

ED Is Often Caused by Other Health Conditions

Up to 30 million men in the U.S. are affected by ED. Although it’s more common among older men, it is not a normal part of aging. Most often, ED is caused by diseases that damage nerves, arteries, smooth muscles, and fibrous tissues. Health conditions such as heart disease and high blood pressure are often to blame.

Researchers collected data on 1,519 men with heart disease from around the world. Based on a questionnaire given at the start of the study, slightly more than half of the men had ED that ranged from mild to severe.

ED Raises Heart Health Risks

After an average of more than four years, 11 percent of men with moderate to severe ED died from any cause during the study period, compared with only 6 percent of men with mild or no ED. Also, men with ED were more likely to have a heart attack or stroke, be hospitalized for heart failure, or die of a heart problem. Risk for these outcomes increased with the severity of ED.

Experts think that ED likely raised risk for complications or death among participants because it’s linked with endothelial dysfunction, or problems with the cells that line blood vessels. Endothelial dysfunction also occurs in hardening of the arteries and the buildup of sticky plaque that can cause heart attack and stroke.

A Happy Mind May Equal a Healthy Heart

People who experience joy, happiness, excitement, enthusiasm, and contentment have what’s called a positive affect. It’s been linked with living longer and a having a lower risk for diabetes and high blood pressure. Now, a study published in the European Heart Journal suggests that it might also lower your risk for heart problems.

Happiness Linked to Heart Health

For 10 years, researchers followed more than 1,700 people who were all at least 18 years old. None had heart disease when the study began. Researchers interviewed participants and rated them on a five-point scale according to how much positive affect they displayed. A value of one on the scale was “no positive affect” and a value of five was “extreme positive affect.” The group also was evaluated for symptoms of depression, hostility, and anxiety.

During the study period, 145 people developed heart disease. After researchers accounted for factors that could increase risk for heart problems, such smoking and high blood pressure, the data showed that the happier people were, the less likely they were to develop heart disease. In fact, risk for heart disease dropped 22 percent for every point higher on the five-point scale.

People with symptoms of depression had a slightly higher risk for heart disease. But no link was found between heart disease and feelings of hostility or anxiety.

Better Lifestyle Habits May Be the Cause

Researchers think that positive affect might protect against heart disease because it’s linked with better sleep and higher odds of quitting smoking.

This study is the first to look into a possible link between happiness and heart disease. Researchers are now looking into whether boosting people’s happiness levels can improve their heart health and lower the risk for heart disease. However, known and well-established strategies such as exercising, not smoking, eating a heart-healthy diet, and maintaining normal blood pressure and cholesterol levels have been shown to help prevent heart disease.

Even Mild Lung Disease Hurts the Heart

Past evidence has shown that severe chronic obstructive pulmonary disease (COPD) can damage the heart. But a new study published in the New England Journal of Medicine shows that even mild COPD affects heart function.

COPD is the fourth-leading cause of death in the U.S. Emphysema and chronic bronchitis are two forms of COPD. Both cause narrowed airways, which make it hard to breathe, and a persistent cough.

A Look at Heart and Lung Function

Researchers assessed heart and lung function of more than 2,800 volunteers who were 61 years old on average and free from heart disease. All were part of an ongoing study about the early stages of heart, lung, and blood diseases.

Based on results from computed tomography (CT) and magnetic resonance imaging (MRI) scans, the researchers found that about 15 percent of the study participants had emphysema. Their hearts performed more poorly in pumping blood than those without emphysema.

As the severity of lung disease increased, blood flow from the heart decreased. This was true even in mild cases of disease, which suggests that early-stage COPD affects the heart. Also, the effects of lung disease on heart function were most severe in smokers.