Posts Tagged "Heart attack"

Men who slept badly were twice as likely to suffer a heart attack and up to four times as likely to have a stroke compared with those who slept well, according to a Russian study presented at EuroHeartCare.

“Sleep disorders are very closely related to the presence of cardiovascular diseases. However, until now there has not been a population based cohort study examining the impact of sleep disorders on the development of a heart attack or stroke,” lead investigator Valery Gafarov, MD, PhD, professor of cardiology at the Russian Academy of Medical Sciences in Novosibirsk, said in a press release.

The study included 657 men ages 25 to 64 with no history of cardiovascular disease or diabetes. They were enrolled in 1994 as part of the World Health Organization’s MONICA (multinational monitoring of trends and determinants in cardiovascular disease) project.

Sleep quality was assessed at baseline with the MONICA-psychosocial interview sleep disturbances scale. Incidence of new cases of myocardial infarction (MI) and stroke were determined at 5 years, 10 years, and 14 years of follow-up. The investigators used Cox proportional regression models to estimate hazard ratios.

Compared with men who rated their sleep as “good,” those who rated it “poor” or “very bad” had more than twice the risk of experiencing MI at 5 years.

This increased risk for MI was also seen at 10 years and at 14 years of follow-up.

Nearly two-thirds (63%) of the men experiencing their first MI described their sleep as “poor” or “very bad.”

Compared with men who rated their sleep as “good,” those who rated it “poor” or “very bad” had nearly quadruple the risk of stroke at 5 years.

Source: Medpage Today

The risk of developing cancer is significantly higher in survivors of an acute MI compared to the general population, according to a large Danish national registry study.

“Greater focus on long-term cancer risk is warranted in MI survivors. This could potentially have implications on future patient care for MI patients, outpatient follow-up strategies, and distribution of health care resources,” Morten Winther Malmborg said at the annual meeting of the American College of Cardiology.

He presented a nationwide cohort study including 3,005,734 Danish adults with no baseline history of MI or cancer who were followed for up to 17 years in the comprehensive Danish National Patient Registry. During the study period, 125,926 of these individuals had a nonfatal MI.

The subsequent incidence of cancer in the MI survivors was 167 cases per 10,000 person-years compared with 95 per 10,000 person-years in the control group, reported Mr. Malmborg, a fourth-year medical student at the University of Copenhagen.

Source: Family Practice News

Living decades with high cholesterol greatly increases the risk for heart disease, according to a recent study that bolsters a push by some doctors for regular cholesterol testing and perhaps early drug treatment of people in their 30s and 40s.

About 37% of young adults have never had their cholesterol checked, according to the Centers for Disease Control and Prevention. And when elevated cholesterol levels are found, doctors typically won’t prescribe a drug until patients are in their 50s or 60s. By then, significant damage from years of cholesterol buildup has been done, the new research indicates.

“If we wait until people are in their 50s and 60s to be thinking about high cholesterol, it is probably too late,” said Ann Marie Navar-Boggan, a cardiology fellow at Duke Clinical Research Institute in Durham, N.C., and lead author of the study, which was published in the journal Circulation in January. The risk of developing heart disease increases by 39% for every 10 years a person lives with high cholesterol, the research found.

Heart disease can be prevented through healthier eating, more exercise and weight loss, though many patients find it difficult to make the necessary lifestyle changes. Although statins have been proved to lower cholesterol and reduce the risk of heart attack, the safety and effectiveness of taking the drugs for several decades hasn’t been closely studied. In short-term studies, some people experience side effects to statins including muscle pains.

Source: WSJ

The Presidential Healthcare Center Provides Advanced Cardiovascular Screening.

Cardiovascular disease (CVD) is the top killer in women and is largely preventable. The call for women to reduce their risk comes from the European Society of Cardiology (ESC) today on International Women’s Day.

Dr. Susanna Price, ESC spokesperson and consultant cardiologist at the Royal Brompton Hospital in London, UK, said:

“CVD is still largely considered a man’s problem with breast cancer commonly perceived as the greater issue for women. However, CVD is the top killer of women in Europe, resulting in 51% of deaths compared to 3% caused by breast cancer.” (1)

She added: “Women’s risk of heart disease tends to be underestimated by both the public and the medical profession because of the perception that estrogen protects them. In reality this just delays the onset of CVD by 10 years. (2) The result is that women’s risk factors are left untreated, leaving them more vulnerable to heart attack, heart failure and sudden cardiac death when the protection fades after menopause.”

Despite these misconceptions, the facts are that:

-CVD is the main cause of death in women in all countries of Europe (3)

-CVD causes 51% of deaths in women and 42% of deaths in men in Europe (1)

-CVD kills 51% of women in Europe and breast cancer causes 3% of deaths (1)

-The risks of smoking are higher in women because women metabolize nicotine faster, especially those taking oral contraceptives (2)

-Type 2 diabetes doubles CVD risk in men but more than triples the risk in women (4)

-Women are more likely to be severely disabled after a stroke than men (5).

Source: European Society of Cardiology

Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking.

We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort.

During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure, intestinal ischemia, hypertensive heart disease, infections, various respiratory diseases, breast cancer, and prostate cancer. Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased.

A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated.

Source: The New England Journal of Medicine

Cardiovascular screenings are a cost-effective way to identify middle-aged athletes who may risk heart attacks or strokes by participating in high-intensity sports, a new study suggests.

“I would suggest that all middle-aged athletes should be screened at least once, particularly men over 40 and women over 50,” said the study’s lead author, Dr. Andrea Menafoglio, a cardiologist at Ospedale San Giovanni in Bellinzona, Switzerland.

While the benefits of regular exercise are well known, vigorous physical exertion can be life-threatening for older athletes who may not realize that they have an underlying heart condition. Guidelines in Europe and the U.S. urge cardiovascular risk evaluations for middle-aged athletes, but researchers say the recommendations aren’t universally followed because widespread implementation hasn’t proved effective or affordable.

To see if widespread screening could detect hidden symptoms and risks for heart disease at a reasonable price, Menafoglio and colleagues at three hospitals in Switzerland evaluated 785 athletes between the ages of 35 and 65.

Each of the athletes reported spending at least two hours a week participating in high-intensity sports such as running, cycling, triathlon, football, swimming, tennis, climbing, or cross-country skiing.

The initial evaluation included a personal and family history, a physical exam, and a resting electrocardiogram, or ECG. For each participant, the researchers also estimated the risk of death from cardiovascular disease within the next 10 years based on gender, age, cholesterol level, blood pressure, and smoking habits.

Overall, the cost of screening averaged $199 per athlete (about 160 euros), because most athletes didn’t need any testing beyond the initial evaluation.

About one in seven athletes needed additional screening. Extra tests found some cases of previously unimagined diabetes, hypertension, high cholesterol, and mild heart valve disease.

Overall, the screenings caught previously undetected cardiovascular abnormalities in about 3 percent of participants and a high cardiovascular risk profile in about 4 percent.

Just three athletes had abnormalities that made it too dangerous for them to continue their exercise routines.

Source: Reuters Health

“The Presidential Healthcare Center can design a personalized exercise prescription for you.”

In an analysis of cohort studies, a history of kidney stones was associated with an increased risk for coronary heart disease (CHD) and stroke. The data suggest that the risk may be higher in women than men.

The studies included close to 50,000 patients with kidney stones and 3.56 million controls. Results found kidney stone history to be associated with a 19% greater risk for CHD and a 40% greater risk for stroke. Additionally, women showed a statistically significant increased risk for myocardial infarction, while men did not.

The researchers noted that a lack of studies separately evaluating for effect modification by sex, along with other limitations, could explain the risk difference among men and women. Though, they added that several recent studies have shown a gender difference in kidney stone-related CHD and stroke risk.

One was reported in JAMA in July 2013.

The prospective study included 45,748 men and 196,357 women in the U.S. without a history of CHD at baseline, including 19,678 who reported a history of kidney stones. Two cohorts of women and one of men were followed for up to 24 years.

The study found that women with a history of kidney stones had about an 18% increased risk for CHD and a 48% increased risk compared with women who had never had a kidney stone.

An even larger study from Alberta, Canada, reported in March of this year, showed similar differences in risk by gender.

The study included close to 3.2 million people registered in Alberta’s universal healthcare system between 1997 and 2009 who were followed for a median of 11 years.

The study showed that people who had at least one kidney stone had a 40% higher risk for heart attack, a 63% higher risk for blockage of blood flow to the heart and other organs, and a 26% higher risk for stroke. The magnitude of increased risk appeared more pronounced for women than men.

Both studies were included in the newly-published meta-analysis.

Gary C. Curhan, MD, who was a co-author on both, said the new data make a strong case for a real gender difference in cardiovascular disease risk associated with kidney stone history.

Curhan is a professor of medicine at Harvard Medical School and a renal disease specialist at Brigham and Women’s Hospital, Boston.

“The risk certainly seems to be higher in women than men, but I would not say the risk is zero in men.” “These two studies give us more confidence that this association is real. The next step is to try and answer the question ‘Why is there a difference?'”

Source: medpage Today

We Americans work hard. Weekends are more like workends. We sleep with our smartphones. And we think vacations are for wimps. So we don’t take them. Or take work along with us if we do.

But what if taking vacation not only made you healthier and happier, as a number of studies have shown, but everyone around you? And what if everybody took vacation at the same time? Would life be better, not just for you, but for the entire society?

Yes, argues Terry Hartig, an environmental psychologist at Uppsala University in Sweden. Yes, indeed.

When people go on a relaxing vacation, they tend to return happier and more relaxed. (The operative word here being relaxing, not frenzied whirlwind.) Traffic? A smile and nod instead of flipping the bird. An upset at the office? A deep breath and a focus, not on the drama, but on the task at hand.

And those mellow, good vibes, he said, spread “like a contagion” to everyone you come in contact with. “Even people you don’t know personally,” he said. Send everyone away on vacation at the same time, and that contagion takes off through the population like a viral happiness pandemic.

Hartig calls it “collective restoration.”

To test his theory, Hartig and his colleagues studied monthly anti-depressant prescriptions in Sweden between 1993 and 2005. In a recently published study, they found that the more people took vacations at the same time, the more prescriptions dropped exponentially. That was true for men and women, and for workers as well as retirees.

Summer, by far, was the happiest time – or at least saw the steepest declines in anti-depressant prescriptions. It’s no surprise why: Since 1977, Swedish law has mandated that every worker have five weeks of paid vacation every year. And workers can take four consecutive weeks off in the summer.
“It’s like there’s this national agreement that it’s vacation time, and work will be left aside,” Hartig said. So instead of working and being distracted and busy, people get outside. They do things they like and enjoy. They see friends, play with their children, visit their aging parents, or finally have time for that cup of tea with a friend who’s been blue.

The benefits, Hartig said, are huge. Not only is the society measurably happier, but workers are more rested and productive, relationships are closer and people are healthier. “Depression is a very costly disease,” he said. (Depression costs the U.S. economy an estimated $23 billion a year in lost productivity.)

Europeans, with their 20 and 30 days of paid vacation every year, live longer and spend less on health care than Americans, Hartig said.

But that kind of widespread, vacation-induced health and euphoria is unlikely to hit the United States anytime soon. “Collective restoration,” Hartig said, is only possible if the entire population can coordinate time off. And the only way to do that, he argues, is through national policy.

The US is the only advanced economy with no national vacation policy. (Unless you count Suriname, Nepal and Guyana.) One in four workers, typically in low-wage jobs, have no paid vacation at all. Those that do, get, on average, 10 to 14 days a year.

American workers don’t take all their vacation days, leaving, by some estimates, 577 million unused days on the table every year. And even when they do, many say they take work along with them. (All those unused days add up to $67 billion in lost travel spending and 1.2 million jobs, according to a recent report by Oxford Economics, an economic forecasting group.)
Kathy Simons was one of them. Even though she knew better. Simons directs the Work-Life Center at MIT. She knows almost better than anyone how taking a break from work not only improves your mood, but your health: One long-term study found that men who don’t take vacations are 30 percent more likely to have heart attacks than those who do. For women, it’s 50 percent. Women who fail to take vacation are more likely to suffer from depression.

But for five years, Simons didn’t take a vacation. She loves her work, had some big projects take off, and didn’t feel she could afford to be away from the office. “But I really got pretty exhausted,” she said. It took worried friends to finally push her to get away with her husband to Cape Cod for a few days. They rode bikes, turned off computers, spent time outside and, she said “got transported, and sort of awed by nature again.”

She came back to the office relaxed, while everyone around her looked stressed. So did her happiness wear off on them, as Hartig theorizes?

“I do think my good mood is contagious,” she said. “But honestly, re-entry is hard because you’re so out of sync with what’s going on around you. In so many work environments, co-workers don’t ask where you’re going on vacation. They only want to know when you’re coming back. It would be a heck of a lot easier to take vacation if we didn’t have to do it alone.”

Because while you’re being awed by a sunrise in a kayak, somewhere in the back of your mind, you know your co-workers are getting ready for a busy day, that stuff is piling up on your desk and you almost dread the emails flooding into your inbox.
The closest that Americans may come to collective restoration, Hartig said, is the quiet week between Christmas and New Years, when large swaths of the population leave the office behind.

William Howard Taft didn’t want Americans to have to go on vacation alone. In 1910, he proposed giving American workers two to three months of paid vacation every year. The naturalist John Muir said better than compulsory schooling, the U.S. should consider compulsory vacationing. In 1938, Congress proposed the 40-hour work week, a minimum wage and two weeks of paid vacation. In both instances, the vacation proposals died.

Now, perhaps with dollar signs, not collective restoration in mind, the travel and tourism industry has launched the Vacation Equality Project and, with slick ads and petition drives, is pushing Congress for a guaranteed minimum amount of paid vacation.

John de Graaf, executive director of the Take Back Your Time organization who has been working on the campaign, said it’s a tough sell in the United States, where vacation is seen as an “extraneous luxury” of little benefit to anyone.

“People don’t experience very much vacation in the United States, so they’re inclined not to understand its value,” he said. “In fact, people are in so much debt that, if given the choice of time or money, people will choose money, which is why they unions tell me they won’t fight for time off.”

DeGraaf just finished work on a video for public television that noted that 20 years ago, 80 percent of the families visiting Yosemite National Park stayed overnight. Today, the average visit, usually in the car, frantically snapping pictures out the window, is five hours. Likewise, the U.S. Travel Association notes that family vacations in 1975 typically lasted one week. In 2010, it was 3.8 days.

The one place in America that comes the closest to Hartig’s dream of collective restoration, with everyone taking off at the same time, is, ironically enough, Washington, DC.

President Obama is heading off for 15 days with his family on Martha’s Vineyard. Members of Congress will scatter for August recess, as will many of the staffers who serve them and the lobbyists who buttonhole them. Washington DC will become a veritable ghost town. (In August, there is no traffic!)

So, come September, will our nation’s leaders be basking in the glow of collective restoration? Will calmer, more relaxed Republicans drop their lawsuit against Obama? Will lawmakers’ good moods mean progress on a host of unfinished business?

Or, is that just too much to expect from a few weeks off, even at the same time, when mid-term elections are just around the corner?

Source: Associated Press

Stress has long been thought to trigger heart attacks, but the mechanism is unknown. Now, researchers think that bacteria could play a role. A study published today in suggests that stress hormones can break up mats of bacteria growing on the fatty plaques in arteries, releasing the plaques and causing strokes or heart attacks.

Researchers have suspected for years that bacteria infect the plaques of hardened arteries. The plaques form a surface on which bacteria can attach and grow in masses called biofilms, held together in a scaffold. To test this, a team led by bacteriologist David Davies of Binghamton University in New York analyzed arteries from 15 patients with cardiovascular disease. Using fluorescent tags that mark bacterial DNA, they discovered at least 10 species of bacteria clustered tightly around the plaques, including the biofilm-forming Pseudomonas aeruginosa.

If these biofilms are tightly attached to plaques, they may have an effect on cardiovascular disease, Davies says. Plaques in blood vessels are normally stable, but if they break up and enter the bloodstream, they can trigger blood clots that lead to heart attacks or strokes.

To test this idea, the researchers grew P. aeruginosa in artificial arteries made of silicone tubing and waited for the bacteria to form biofilms. They then flooded the tubes with the stress hormone noradrenaline, which caused the biofilms to break up.

The authors say that stress hormones in the blood trigger the body’s cells to release iron into the bloodstream. The iron causes bacteria such as P. aeruginosa to produce enzymes that sever the polymer bonds that hold the bacteria together in the biofilm matrix and attach the bacteria to the plaque. The plaque is broken up as collateral damage, Davies says. Although he says that much more research in animals and humans is needed, the work “introduces a completely unexpected potential culprit” in the mystery of how plaques trigger heart attacks, he adds.

“It’s quite an intriguing hypothesis,” says microbiologist Primrose Freestone of the University of Leicester, UK. But she adds that the amount of noradrenaline that the authors used in the experiment is much higher than would be present in a human body.

Still, Freestone says, it is possible that noradrenaline levels are somewhat higher at the site of the plaque. And she says that the project could serve as a “springboard” for researchers to think more about the role of bacteria in cardiovascular disease.

Emil Kozarov, a microbiologist at Columbia University in New York, agrees that the idea is interesting. But he says that he would like to see whether noradrenaline breaks up plaques in mice injected with the biofilm bacteria, and whether noradrenaline disperses biofilms formed by other bacterial species.

Davies says that he plans to model the process in mice. He and his team are also planning to determine whether the arteries of healthy people contain biofilm-forming bacteria.

Source: Scientific American

Switching over to daylight saving time, and losing one hour of sleep, raised the risk of having a heart attack the following Monday by 25 percent, compared to other Mondays during the year, according to a new U.S. study released on Saturday.

By contrast, heart attack risk fell 21 percent later in the year, on the Tuesday after the clock was returned to standard time, and people got an extra hour’s sleep.

The not-so-subtle impact of moving the clock forward and backward was seen in a comparison of hospital admissions from a database of non-federal Michigan hospitals. It examined admissions before the start of daylight saving time and the Monday immediately after, for four consecutive years.

In general, heart attacks historically occur most often on Monday mornings, maybe due to the stress of starting a new work week and inherent changes in our sleep-wake cycle, said Dr. Amneet Sandhu, a cardiology fellow at the University of Colorado in Denver who led the study.

“With daylight saving time, all of this is compounded by one less hour of sleep,” said Sandhu, who presented his findings at the annual scientific sessions of the American College of Cardiology in Washington.

A link between lack of sleep and heart attacks has been seen in previous studies. But Sandhu said experts still don’t have a clear understanding of why people are so sensitive to sleep-wake cycles.

“Our study suggests that sudden, even small changes in sleep could have detrimental effects,” he said.

Sandhu examined about 42,000 hospital admissions in Michigan, and found that an average of 32 patients had heart attacks on any given Monday. But on the Monday immediately after springing the clock forward, there were an average of eight additional heart attacks, he said.

The overall number of heart attacks for the full week after daylight saving time didn’t change, just the number on that first Monday. The number then dropped off the other days of the week.

People who are already vulnerable to heart disease may be at greater risk right after sudden time changes, said Sandhu, who added that hospital staffing should perhaps be increased on the Monday after clocks are set forward.

“If we can identify days when there may be surges in heart attacks, we can be ready to better care for our patients,” he said.

The clock typically moves ahead in the spring, so that evenings have more daylight and mornings have less, and returns to standard time in the fall. Daylight saving time was widely adopted during World War I to save energy, but some critics have questioned whether it really does so and whether it is still needed.

Researchers cited limitations to the study, noting it was restricted to one state and heart attacks that required artery-opening procedures, such as stents. The study therefore excluded patients who died prior to hospital admission or intervention.

Source: Reuters