Category Archives: Heart Disease

Fat or Fit: Which Is Healthier?

Posted on August 25, 2012 | Comments Off on Fat or Fit: Which Is Healthier?

Men live longer if they improve or maintain their fitness level over time, according to research out of the Cooper Clinic in Dallas, Texas. Part of that improved longevity stems from reduced risk of death from cardiovascular disease such as heart attack and stroke.

Compared with men who lose fitness with aging, those who maintained their fitness had a 30% lower risk of death; those who improved their fitness had a 40% lower risk of death. Fitness was judged by performance on a maximal treadmill exercise stress test.

Body mass index over time didn’t have any effect on all-cause mortality but was linked to higher risk of cardiovascular death. The researchers, however, figured that losses in fitness were the more likely explanation for higher cardiovascular deaths. In other words, as men age, it’s more important to maintain or improve fitness than to lose excess body fat or avoid overweight.

Steve Parker, M.D.

Reference: Lee, Duck-chul, et al. Long-term effects of changes in cardiorespiratory fitness and bodly mass index on all-cause and cardiovascular disease mortality in men. Circulation, 124 (2011): 2,483-2,490

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Huge U.S. Study Confirms Health and Longevity Benefits of the Mediterranean Diet

Posted on July 27, 2012 | 4 comments

This is a reprint of my very first blog post, from December 24, 2007, at the old Advanced Mediterranean Diet Blog. 

We now have results of the first U.S. study on mortality and the Mediterranean dietary pattern.  380,000 people, aged 50-71, were surveyed on their dietary habits and scored on their conformity to the Mediterranean diet.  They were visited again 10 years later.  As you would expect, some of them died.  12,105 to be exact: 5985 from cancer, 3451 from cardiovascular disease, 2669 from other causes.  However, the people with the highest adherence to the Mediterranean diet had better survival overall, and specifically better odds of avoiding death from cardiovascular disease and cancer.  Compared to the people with low conformity to the Mediterranean diet, the high conformers were 15-20% less likely to die over the 10 years of the study.  The study authors, funded by the National Institutes of Health, noted eight similar studies in Europe and one in Australia with similar results.

Once again, my promotion of the Mediterranean diet is vindicated by the scientific literature.  I’m not aware of any other diet that can prove anywhere near this degree of health benefit.  If you are, please share. 

Reference: Mitrou, Panagiota N., et al.  Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population,  Archives of Internal Medicine, 167 (2007): 2461-2468.


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Posted in Cancer, Heart Disease, Longevity

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Overweight Youth Point To Increase In Heart Disease

Posted on July 24, 2012 | Comments Off on Overweight Youth Point To Increase In Heart Disease

No doubt you have noticed the expanding girths of  U.S. yoots.  What are the health implications?  Research published in the New England Journal of Medicine suggests a disturbing answer.

Heavy youths tend to stay heavy as they age.  Researchers looked at the incidence of overweight adolescents in the year 2000 and then estimated the prevalence of obesity in the year 2020.  Thirty to 44% of 35-year-olds in 2020 are expected to be obese.

Using computer simulation, investigators estimated that by 2035 the prevalence of coronary heart disease will increase by 5 to 16% because of the increased obesity.  In other words, the increasing obesity in these young and middle-aged adults will result in over 100,000 excess cases of coronary heart disease.

That is, if current trends continue.  But I see nothing on the horizon likely to alter that societal trend in the near future.  I’m doing my part.  How about you?

Steve Parker, M.D.

References:  Bibbins-Domingo, K, et al.  Adolescent Overweight and Future Adult Coronary Heart Disease.  New England Journal of Medicine, 357 (2007): 2,371-2,379.

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Posted in Coronary Heart Disease, Heart Disease, Overweight & Obesity

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It’s Not Too Late to Get Healthier, Even if Middle-Aged

Posted on July 23, 2012 | Comments Off on It’s Not Too Late to Get Healthier, Even if Middle-Aged

Are your eventual health problems a matter of fate by the time you reach middle age?

A study from the Medical University of South Carolina asked whether middle-aged folks could improve their health and longevity by making healthful changes in lifestyle.  15,708 study participants, ages 45-64, were surveyed with regards to four “healthy lifestyle” components, namely:

  • five or more fruits and vegetables daily
  • regular exercise
  • healthy weight range (BMI 18.5-29.9)
  • no current smoking

When first surveyed, 8.5% of the participants had all four of the healthy lifestyle components.  When surveyed six years later, 8.4% of the remainder had adopted these four healthy lifestyle features.  Overall death rate and cardiovascular disease events were monitored over the next four years.  Compared to the study participants who did not adopt a healthy lifestyle, the new adopters had a 40% lower incidence of death from all causes and 35% less cardiovascular disease events.

So middle-aged people can improve their longevity and avoid cardiovascular disease by making healthy lifestyle changes.  These improvements are very significant in degree and comparable to, if not better than, results seen with many expensive medications and invasive medical procedures.

Why not make some changes today?

Steve Parker, M.D.

References: King, Dana E., et al.  Turning Back the Clock: Adopting a Healthy Lifestyle in Middle Age.  American Journal of Medicine, 120(2007): 598-603.

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Posted in Exercise, Heart Disease, Longevity, Stroke

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Berry Science

Posted on July 21, 2012 | Comments Off on Berry Science

The Mediterranean diet was originally found to be a healthy diet by comparing populations who followed the diet with those who didn’t.  The result?  Mediterranean diet followers had less cardiovascular disease, less cancer, and longer life.

Over the last 15 years, researchers have been clarifying exactly how and why this might be the case.  A study from Finland is a typical example.

The traditional Mediterranean diet has an abundance of fresh fruit, including berries.  Berries are a rich source of polyphenols and vitamin C, substances with the potential to affect metabolic and disease processes in our bodies.

The Finnish researchers studied 72 middle-aged subjects, having half of them consume moderate amounts of berries, and half consume a placebo product over 8 weeks.  Compared with the placebo group, the berry eaters showed inhibited platelet funtion, a 5% increase in HDL cholesterol (the “good” cholesterol), and a 7-point drop in systolic blood pressure.

What does platelet function have to do with anything?  Platelets are critical components of blood clots.  Blood clots can stop life-threatening bleeding, but also contribute to life-threatening heart attacks and strokes.  Inhibition of platelet function can decrease the occurence of blood clots that cause heart attacks and strokes.  That’s why millions of people take daily aspirin, the best known platelet inhibitor.

Cardiovascular disease is a group of conditions that include high blood pressure, heart attacks, poor circulation, and strokes.  Berry consumption in this small Finnish study resulted in favorable changes in blood pressure, HDL cholesterol, and platelet function.  These changes would tend to reduce the occurence and severity of cardiovascular disease.

So berries don’t just taste good, they’re good for us.  If price is a concern, focus on the berries that are in season or use frozen berries.

Steve Parker, M.D.

Reference: Erlund, I., et al, Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol.  American Journal of Clinical Nutrition, 87 (2007): 323-331.

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How to Prevent Heart Attacks in Women

Posted on July 19, 2012 | Comments Off on How to Prevent Heart Attacks in Women

Researchers studied 24,444 Swedish women over the course of 6.2 years, analyzing dietary patterns, healthy lifestyle choices, and body weight.  Information on the women was obtained mostly by surveys at the start and end of the study.  The women were aged 48 to 83 at the start of the study and were free of diabetes mellitus, cardiovascular disease, cancer, and coronary artery disease.

Heart attacks in the study cohort were identified in the Swedish Hospital Discharge Registry and the Cause of Death Registry.  Over the course of six years there were 308 heart attacks.

The study authors noted a greatly reduced incidence of heart attacks in women with the following characteristics:

  1. high consumption of fruits, vegetables, whole grains, legumes, and fish
  2. moderate consumption of alcohol
  3. avoidance of overweight, especially abdominal fat (waist-hip ratio < 0.85)
  4. physically active (at least 40 minutes daily of walking or bicycling and 1 hour weekly of leisure-time exercise
  5. non-smokers

Women meeting these criteria had a 92% lower risk of having a heart attack!  Such women were only 5% of the cohort, however.  I suspect the physical activity criterion knocked a lot of women out of the super heart-healthy subset.

The authors conclude that “most [heart attacks] in women may be preventable by consuming a healthy diet and moderate amounts of alcohol, being physically active, not smoking, and maintaining a healthy weight.”

I see little reason to doubt that these findings apply to the typical woman in the U.S. or Europe, and not just to Swedes.  The traditional Mediterranean diet of the mid-20th century fulfills the dietary prescription for a healthy heart.  The Advanced Mediterranean Diet incorporates these healthy diet and lifestyle choices while simultaneously working to control weight.

Steve Parker, M.D.

Reference:  Akesson, Agneta, et al.  Combined Effect of Low-Risk Dietary and Lifestyle Behaviors in Primary Prevention of Myocardial Infarction in Women.  Archives of Internal Medicine, 167 (2007): 2,122-2,127.

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Posted in Alcohol, Coronary Heart Disease, Exercise, Heart Disease

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Eye-Popping Statistics

Posted on July 8, 2012 | Comments Off on Eye-Popping Statistics

I often talk to people interested in improving their health or losing weight via lifestyle modification, mostly changes in diet and exercise.  Many of them are motivated by health-related facts.  Here is a smattering of facts I compiled in 2008 (so some are outdated), starting out worrisome and ending hopeful: 

  • 65% of U.S. adults are overweight or obese.  Half are overweight, half are obese. 

  • 12% of deaths in the U.S. are due to lack of regular physical activity – 250,000 deaths yearly.

  • 11% of U.S. adults have diabetes mellitus.

  • 24 million in the U.S. have diabetes.  Another 57 million have pre-diabetes, a condition that increases your risk for diabetes.

  • 23% of U.S. adults over 60 have diabetes. 

  • 85% of people with type 2 diabetes are overweight.

  • 200,000 yearly deaths in the U.S. are due to obesity.

  • Excess body fat causes 14 to 20% of all cancer-related deaths in the U.S.

  • 550,000 people die yearly of cancer in the U.S. 

  • Obesity-related cancers in men: prostate and colorectal.  Obesity-related cancers in women: endometrial (uterine), cervix, ovary, breast.  Both sexes: kidney, esophageal adenocarcinoma.

  • 20% of us in the U.S. will die of cancer.

  • Lifetime risk of developing invasive cancer in the U.S. is four in 10 (a little higher in men, a little lower in women).

  • At least one-half of high blood pressure cases are caused by excess body fat.  Every 20 pounds of excess fat increases blood pressure by two to three points.

  • Peak aerobic power (a measure of physical fitness) decreases by 50% between age 20 and 65.

  • Middle-aged and older people through regular exercise can increase their aerobic power by 15 to 20%, equivalent to a 10 or 20-year reduction in biological age. 

  • Regular aerobic exercise reduces blood pressure by 8 to 11 points.  

  • Have you already had a heart attack?  If so, regular exercise reduces the odds of fatal recurrence by 25% and adds two to three years to life.

  • The Mediterranean diet is associated with lower incidence of cancer (colon, breast, prostate, uterus), cardiovascular disease (e.g., heart attacks), and dementia (both Alzheimers and vascular types). 

  • High fruit and vegetable consumption protects against cancer of the lung, stomach, colon, rectum, oral cavity, and esophagus.  The protective “dose” is five servings a day.

  • Coronary artery disease is the cause of heart attacks and many cases of sudden cardiac death.  Legume consumption lowers the risk of coronary artery disease.  The protective dose is four servings of legumes a week. 

  • Whole grain consumption is associated with reduced risk of coronary artery disease (e.g., heart attacks), lower risk of death, lower incidence of type 2 diabetes and several cancers.  The protective dose is three servings a day. 

The good news is that we can significantly reduce our risk of premature death and common illnesses such as high blood pressure, cancer, diabetes, coronary artery disease, and dementia.  How?  Weight management, diet modification, and physical activity.     

Steve Parker, M.D.

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Posted in Diabetes, Exercise, Heart Disease, Longevity, Overweight & Obesity, Stroke

Evidence In Favor of Healthfulness of Whole Grains

Posted on July 2, 2012 | 3 comments

I bought a sack of potatoes the other day.  The advertising on the sack proclaimed   these potatoes as “Gluten-Free!”.  As if other potatoes have gluten (they don’t).

In these days of gluten-free this and gluten-free that, the health benefits of grains—especially wheat—are being questioned.

A 2008 review article in a scientific journal confirmed the association between high whole grain intake and reduced incidence of cardiovascular disease.  Heart disease and strokes (subsets of cardiovascular disease) are the first and fourth leading causes of death, respectively, in the U.S.

The article authors, Philip Mellen, Thomas Walsh, and David Herrington, reviewed the scientific literature on the subject and found seven pertinent published observational studies.  Study participants were divided into those with high average whole grain intake (2.5 servings per day) and those with low average intake (0.2 servings a day, or 1 serving every 5 days).  Compared with low intake, participants with high intake had 21% lower risk of cardiovascular disease events, such as heart disease, stroke, and death from cardiovascular disease.

Refined grain intake, such as standard white bread, was not associated with cardiovascular disease one way or the other.

The authors conclude, “There is a consistent, inverse association between dietary whole grains and incident cardiovascular disease…and clinicians should redouble efforts to incorporate clear messages on the beneficial effects of whole grains into public health and clinical practice endeavors.”

I’ll be the first to admit that observational studies don’t prove that whole grains reduce the risk of cardiovascular disease.  They identify an association that should lead to additional testing of the hypothesis.  I don’t see any proof on the foreseeable horizon.

If heart attacks and strokes ran in my blood lines (genes), I’d try to incorporate two or three daily servings of whole grain into my diet, assuming I had no good reasons to avoid grains.

That being said, I’m also convinced that many can live long health lives without grains.

Steve Parker, M.D.

References and resources:

Mellen, Philip, et al.  Whole grain intake and cardiovascular disease: A meta-analysis.  Nutrition, Metabolism & Cardiovascular Diseases, 18, (2008): 283-290.

The Whole Grains Council.  Learn more about the benefits of various whole grains and how to find whole grain products.  Many recipes here, plus links to hundreds of recipes at other websites.

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Huge Study Confirms Health and Longevity Benefits of Mediterranean Diet

Posted on June 27, 2012 | Comments Off on Huge Study Confirms Health and Longevity Benefits of Mediterranean Diet

Italian researchers reported in the September 11, 2008, online issue of the British Medical Journal what is already known:

“Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinsons’s disease and Alzheimer’s disease (13%).  These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.”

Methodology

Researchers, mostly at the University of Florence, performed a meta-analysis of 12 other published studies that looked at the effects of a Mediterranean-style eating pattern on health and longevity.  [Meta-analyses are popular, in part, because they are cheap.  This study required no specific funding.]

Most, if not all, of these 12 studies were observational, and involved 1,574,299 participants.  Six of the 12 studies were in Mediterranean countries, the others were in the U.S., northern Europe, and Australia.  Study participants were followed between 3.7 and 18 years.

The researchers devised their very own Mediterranean diet scale based on study participants’ intake of various foods.  Participants were given a point if they had higher than average intake of vegetables, fruits, legumes, cereals, fish, and red wine during meals.  They were given a point if they had lower than average intake of red meat, processed meats, and dairy products.  Due to differences among the 12 studies, “the total adherence scores…varied from a minimum of 0 points indicating low adherence to a maximum of 7-9 points reflecting high adherence to a Mediterranean diet.”

(This version of a Mediterranean diet score is problematic.  Curiously, olive oil – the predominant source of fat in the traditional Mediterranean – is not in the score.  Olive oil is a key characteristic of the Mediterranean diet.  Furthermore, the study authors also state that dairy products are “presumed not to form part of a Mediterranean diet.”  Most experts would argue that cheese and yogurt are a significant part of the Mediterranean diet, if only in low amounts.  I also doubt that participants in the 12 original studies  were surveyed whether they drank red wine – as contrasted with white – and whether it was with meals or not.  I admit I did not read each of the 12 component studies.  The underlying cause of this idiosyncratic definition of the Mediterranean diet is that the 12 original studies themselves used different definitions of the Mediterranean diet.  The meta-analysts had to pigeonhole the data.  There are a handful of respected Mediterranean diet scores in existence, but the authors of this study couldn’t apply them across the board due to database inconsistency or inadequacy.)

Results

“The cumulative analysis of 12 cohort studies shows that a two point increase [emphasis added] in the score for adherence to a Mediterranean diet determines a 9% reduction, in overall mortality, a 9% reduction in mortality from cardiovascular diseases, a 6% reduction in incidence of or mortality from neoplasm [cancer], and 13% reduction in incidence of Parkinson’s disease and Alzheimer’s disease.”

The only one of the 12 original studies focused on Alzheimer’s disease, and it showed a 17% reduction in participants with high adherence to the Mediterranean diet.  The two studies that focused on Parkinson’s disease revealed a 7% reduction in men, and 15% reduction in women.  These reduced incidence figures, again, apply to a two-point increase in Mediterranean diet adherence score.

Discussion

The authors indicate that their report is the first ever meta-analysis of the data associating the Mediterranean diet with reduced mortality and chronic disease in the general population.  Congratulations, guys!

The authors’ idiosyncratic Mediterranean diet score is unusual and won’t be widely adopted.  However, the 12 studies comprising the meta-analysis did have reasonable Mediterranean diet characteristics.

Combining Alzheimer’s data with Parkinson’s data doesn’t make sense to me, nor did the authors try to explain it.   You could lump them into the category of “neurodegenerative diseases,” but they aren’t the only ones by any means.  The single Alzheimer’s study, by the way, was quite small compared to the two Parkinson’s studies.

Nearly all the popular media stories reported the findings as I did in my first paragraph above, which may be  misleading.  The specific improvements in mortality and various disease rates is per two-point increase in Mediterranean diet score.  For example, consider the 9% reduction in overall mortality.  If a population increased its Mediterranean score by four points, would overall mortality be reduced by 18%?  I’ve read this study four times and cannot answer my own question.  But I suspect that the answer is “yes.”  So the news here may better than it seems at first blush.

In other words: If a population’s score goes from 5 to 7, the death rate is reduced by 9%.  If that same population then moved its score from 7 to 9, would mortality improve another 9%?  I think so, but this study as written does not make it clear.

I’m starting to see why the popular media simplified the study findings.  The reporting on this study is amazingly uniform.  They must have all gotten the same news release.

Of course, “populations” don’t die or get cancer, heart attacks, strokes, Alzheimer’s, or Parkinson’s disease.  Individuals do that.  If I as an individual had a low Mediterranean diet score, I’d try to improve my score by at least two points.  A good place to start would be a review of the Mediterranean diet.

Steve Parker, M.D.

Reference:  Sofi, Francesco, et al.  Adherence to Mediterranean diet and health status: Meta-analysis.  British Medical Journal, 337; a1344.  Published online September 11, 2008.  doi:10.1136/bmj.a1344

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Posted in Alzheimer Disease, Cancer, Coronary Heart Disease, Dementia, Heart Disease, Longevity

Feeling Tired and Easily Fatigued? It May Be Your Medication

Posted on June 12, 2012 | Comments Off on Feeling Tired and Easily Fatigued? It May Be Your Medication

“Dr. Parker tells me to exercise but I’m always exhausted!”

Especially if you’re a woman taking a statin drug.

-Steve

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