Tag Archives: heart attack

Legumes Linked to Lower Risk of Heart Disease

Posted on July 16, 2014 | Comments Off on Legumes Linked to Lower Risk of Heart Disease

Ischemic heart disease, specifically. That’s heart attacks, mostly. I had written that in the first edition of The Advanced Mediterranean Diet, but hadn’t seen much supportive evidence since then (2007). Here it is at AJCN.

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Frequent Nuts Consumption Linked to 50% Lower Risk of Fatal Heart Attack

Posted on February 17, 2014 | Comments Off on Frequent Nuts Consumption Linked to 50% Lower Risk of Fatal Heart Attack

JAMA Internal Medicine has the details. Frequent consumption would be at least four times a week. 

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Taking Care of Your Gums May Help Your Heart

Posted on November 3, 2013 | Comments Off on Taking Care of Your Gums May Help Your Heart

…according to an article at University Herald.

The idea is that nasty bacteria around your gums somehow cause arterial inflammation in your heart arteries, which could lead to heart attacks. I’ve written about this before.

A quote from the article:

The researchers followed 420 adults as part of the Oral Infections and Vascular Disease Epidemiology Study (INVEST), a randomly sampled prospective cohort of Northern Manhattan residents. Participants were examined for periodontal infection. Overall, 5,008 plaque samples were taken from several teeth, beneath the gum, and analyzed for 11 bacterial strains linked to periodontal disease and seven control bacteria. Fluid around the gums was sampled to assess levels of Interleukin-1β, a marker of inflammation. Atherosclerosis in both carotid arteries was measured using high-resolution ultrasound.

Over a median follow-up period of three years, the researchers found that improvement in periodontal health-health of the gums-and a reduction in the proportion of specific bacteria linked to periodontal disease correlated to a slower intima-medial thickness (IMT) progression, and worsening periodontal infections paralleled the progression of IMT. Results were adjusted for potential confounders such as body mass index, cholesterol levels, diabetes, and smoking status.

Thickening of the arterial lining is linked to higher rates of heart attack and stroke.

It remains to be seen whether alteration of gum bacteria and periodontal disease via oral self-care and dental care will reduce cardiovascular risk going forward. Stay tuned.

Read more at http://www.universityherald.com/articles/5322/20131101/brushing-your-teeth-could-prevent-heart-disease.htm#rvx294vC7VKJ6Qu3.99

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Heart Attacks: It All Boils Down to LDL-P

Posted on October 7, 2013 | 2 comments

…according to Drs. Thomas Dayspring and JamesUnderberg. By LDL-P, they mean LDL cholesterol particle number. I don’t know if these guys are right or not. I bet it’s more complicated than LDL particle number.

Most heart attacks (aka myocardial infarctions) indeed seem to be caused by acute rupture of an atherosclerotic plaque that’s been present for years. Two key questions are:

  1. What causes the plaque?
  2. Why causes them to rupture?

Underberg and Dayspring write:

The only absolute requirement for plaque development is the presence of cholesterol in the artery: although there are additional heart risk factors like smoking, hypertension, obesity, family history, diabetes, kidney disease, etc., none of those need to be present. Unfortunately, measuring cholesterol in the blood, where it cannot cause plaque, until recently has been the standard of risk-testing. That belief was erroneous and we now have much better biomarkers to use for CV risk-assessment. The graveyard and coronary care units are filled with individuals whose pre-death cholesterol levels were perfect. We now understand that the major way cholesterol gets into the arteries is as a passenger, in protein-enwrapped particles, called lipoproteins.

Particle entry into the artery wall is driven by the amount of particles (particle number) not by how much cholesterol they contain. Coronary heart disease is very often found in those with normal total or LDL-cholesterol (LDL-C) levels in the presence of a high LDL particle number (LDL-P). By far, the most common underlying condition that increases LDL particle concentration is insulin resistance, or prediabetes, a state where the body actually resists the action of the sugar controlling hormone insulin. This is the most common scenario where patients have significant heart attack risk with perfectly normal cholesterol levels. The good news is that we can easily fix this, sometimes without medication. The key to understanding how comes with the knowledge that the driving forces are dietary carbohydrates, especially fructose and high-fructose corn syrup. In the past, we’ve often been told that elimination of saturated fats from the diet would help solve the problem. That was bad advice. The fact is that until those predisposed to insulin resistance drastically reduce their carbohydrate intake, sudden deaths from coronary heart disease and the exploding diabetes epidemic will continue to prematurely kill those so afflicted.

***

 And for goodness’ sake, if you want to live longer, start reducing the amount of dietary carbohydrates, including bread, potatoes, rice, soda and sweetened beverages (including fruit juices), cereal, candy – the list is large).

Underberg and Dayspring don’t mention don’t mention LDL particle size, such as small/dense and large/fluffy; the former are thought by many to be much more highly atherogenic. Is that outdated?

Whoever figures out the immediate cause of plaque rupture and how to reliably prevent it will win a Nobel Prize in Medicine.

Read the whole enchilada.

Steve Parker, M.D.

About Dayspring and Underberg:

Thomas Dayspring MD, FACP, FNLA   Director of Cardiovascular Education, The Foundation for Health Improvement and Technology, Richmond, VA. Clinical Assistant Professor of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School.

James Underberg MD, FACP, FNLA   Clinical Assistant Professor of Medicine in the Division of General Internal Medicine at NYU Medical School and the NYU Center for Cardiovascular Disease Prevention . Director of the Bellevue Hospital Primary Care Lipid Management Clinic.

Steve Parker, M.D.

h/t Dr. Axel Sigurdsson

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Posted in Coronary Heart Disease, Diet-Heart Hypothesis, Heart Disease

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High Adiponectin May Not Protect Against Stroke and Heart Disease After All

Posted on March 19, 2013 | Comments Off on High Adiponectin May Not Protect Against Stroke and Heart Disease After All

I’ve written in the past about adiponectin, a hormone-like protein that may help protect against disease.  Obese folks have less of it.  However, a new study published in Obesity Reviews found no protection against stroke and coronary heart disease (like heart attacks) in people with higher levels of adiponectin.

Read the abstract.

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Exercise Reduces Risk of Death by 20% in Heart Attack Patients

Posted on January 13, 2013 | Comments Off on Exercise Reduces Risk of Death by 20% in Heart Attack Patients

“If exercise is a miracle drug, as it has been recently described, then it is a drug that is not prescribed enough for the prevention of cardiovascular disease. And if exercise is a “central and indispensable component” of a strategy in the primary prevention of coronary artery disease, then it is even more valuable in secondary prevention, according to a new viewpoint in the Journal of the American Medical Association.”

Read the rest at HeartWire.

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Berry Science, or Berriology

Posted on September 18, 2012 | 2 comments

Mmm, mm, good! And they’re low carb

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 dieters enjoyed longer lifespans and less heart disease, cancer, strokes, diabetes, and dementia.

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 provides an abundance of fresh fruit, including berries.  Berries are a rich source of vitamin C and polyphenols, 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 strokes and heart attacks.  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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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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Alcohol Consumption Linked to Lower Rates of Death and Heart Attack

Posted on April 10, 2012 | Comments Off on Alcohol Consumption Linked to Lower Rates of Death and Heart Attack

Canadian and U.S. researchers report that moderate alcohol consumption seems to reduce 1) the incidence of coronary heart disease, 2) deaths from coronary heart disease, and 3) deaths from all causes. Reduction of death from all causes is a good counter-argument to those who say alcohol is too dangerous because of deaths from drunk driving, alcoholic cirrhosis, and alcohol-related cancers such as many in the esophagus.

Remember, we’re talking here about low to moderate consumption: one drink a day or less for women, two drinks or less a day for men. That’s a max of 12.5 alcohol for women, 25 g for men. No doubt, alcohol can be extremely dangerous, even lethal. I deal with that in my patients almost every day. Some people should never drink alcohol.

The recent meta-analysis in the British Medical Journal, which the authors say is the most comprehensive ever done, reviewed all pertinent studies done between 1950 and 2009, finally including 84 of the best studies on this issue. Thirty-one of these looked at deaths from all causes.

Compared with non-drinkers, drinkers had a 25% lower risk of developing coronary heart disease (CHD) and death from CHD. CHD is the leading cause of death in develop societies.

Stroke is also considered a cardiovascular disease. Overall, alcohol is not linked to stroke incidence or death from stroke. The researchers did see strong trends toward fewer ischemic strokes and more hemorrhagic strokes (bleeding in the brain) in the drinkers. So the net effect was zero.

Compared with non-drinkers, the lowest risk of death from any cause was seen in those consuming 2.5 to 14.9 g per day (one drink or less per day), whose risk was 17% lower. On the other hand, heavy drinkers (>60 g/day) had 30% higher risk of death.

In case you’re wondering, the authors didn’t try to compare the effects of beer versus wine versus distilled spirits.

On a related note, scientists at the Medical University of South Carolina found that middle-aged people who took up the alcohol habit had a lower risk of stroke and heart attack. Wine seemed to be more effective than other alcohol types. They found no differences in overall death rates between new drinkers persistent non-drinkers, perhaps because the study lasted only four years and they were following only 442 new drinkers.

This doesn’t prove that judicious alcohol consumption prevents heart attacks, cardiac deaths, and overall deaths. But it’s kinda lookin’ that way.

Steve Parker, M.D.

Reference: Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, & Ghali WA (2011). Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ (Clinical research ed.), 342 PMID: 21343207

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Coronary Artery Disease Declining In U.S.

Posted on March 28, 2012 | Comments Off on Coronary Artery Disease Declining In U.S.

The U.S. Centers for Disease Control and Prevention reported last year that the prevalence of self-reported coronary heart disease declined from 6.7% of the population in 2006, to 6% in 2010. Figures were obtained by telephone survey. Coronary heart disease, the main cause of heart attacks, remains the No.1 cause of death in the U.S.

Self-reports of heart disease may not be terribly reliable. However, I remember an autopsy study from Olmstead County, Minnesota, from 2001 that confirmed a lower prevalence of coronary heart disease there. I wrote about that at the NutritionData.com Heart Health Blog, but those posts may not be around much longer.

The CDC report mentioned also that mortality rates from coronary heart disease have been steadily declining for the last 50 years.

Improved heart disease morbidity and mortality figures probably reflect better control of risk factors (e.g., smoking, high blood pressure), as well as improved treatments. I’ve never seen an estimate of the effect of reduced trans fat consumption.

Obesity is always mentioned as a risk factor for heart disease, yet obesity rates have skyrocketed over the last 40 years. You’d guess heart disease prevalance to have risen, but you’d have guessed wrong. In view of high obesity rates, some pundits have even suggested that the current generation of Americans wil be the first to see a decrease in average life span.

The American Diabetes Association offers a free heart disease risk calculator, if you’re curious about your own odds. My recollection is that the calculator works whether or not you have diabetes.

Steve Parker, M.D.

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