High Triglycerides increase risk - April 2009

Did you know...Elevated Triglyceride levels can increase your risk?

Among US adults, high triglyceride levels are becoming epidemic.  Researchers recently reviewed data on 5,610 Americans in National Health and Nutrition Examination Survey, and found that approximately one-half had elevated triglyceride levels.

Triglycerides are a type of fat that circulate in the bloodstream. High triglyceride levels have been associated with heart attack and stroke.

What Does CPC recommend?

Triglycerides are measured along with cholesterol as part of a fasting blood test. Normal triglyceride levels are below 150. If your triglyceride level is high, you might consider taking the following steps.

• Lose weight. Even a small weight loss will help to lower triglycerides and cholesterol.
• Lead a more active lifestyle– daily exercise will help you lower triglycerides.
• Eat healthy. Follow a diet that is low in saturated fats and contains little to no trans fats. Eat plenty of high fiber foods like oatmeal, whole grains and fruit. You should be sure to limit sugar intake. Make sure that your meals include foods rich in Omega-3 like salmon, fish oils and flax seed.
• Eat fewer carbohydrates, especially simple sugars like soda and sweets.

The studies presented above, in order of presentation are authored by: Dr. Earl S. Ford, with the U.S. Centers for Disease Control and Prevention, the lead author of a report in the March 23, 2009 Archives of Internal Medicine. Dr Samrat Yeramaneni, Jewish Hospital Cholesterol Center, Cincinnati, OH, the lead researcher in studies funded by the National Heart Lung and Blood Institute of the National Institutes of Health.

Vounteering to improve your health - March 2009

Did you know...Volunteering at school could improve your health?

The Experience Corps program in Baltimore, Maryland, designed a health intervention to increase physical activity in older adults and simultaneously improve the academic outcomes of children. Previously inactive older adults were placed in public elementary schools as classroom volunteers and followed for over three years.  Older African-American women who spent 15 hours a week or more helping out in classrooms were significantly more physically active than their peers who didn't engage in volunteer activity. 

Dr. Erwin Tan of the Johns Hopkins Center on Aging and Health and his team compared the study participants to 150 women of similar socioeconomic status, age, and health who were not engaging in volunteer activities, and found the volunteers consistently burned 50 percent more calories per week in physical activity.

Experience Corps now places older people, aged 65 to 86 in public elementary schools in 20 US cities, including Baltimore. .

What Does CPC recommend?

There is compelling evidence supporting the benefits of increased regular physical activity – even light activity - in older adults.  Social research strongly supports that older people have the potential to make substantial contributions to our society.  As our population gets older and lives longer, programs like this one that help older people become more active while helping others will be increasingly important. The findings support the popular idea that people of all ages can benefit from regular exercise and interacting with one another.   Maybe you know someone who is resistant to the concept of exercise, but who might benefit from “going back to school”?

The study cited above was published in The Journals of Gerontology, Jan.29, 2009.

Keeping Resolutions - February 2009

Did you know...Some resolutions are more effective than others?

According to recent research, certain ways of setting intentions (otherwise known in January as making New Year resolutions) to change behavior work better than others. To explore this, a study in Germany enrolled approximately 250 middle aged women who wanted to increase their physical activity. Half received education and counseling about physical activity and the other half received the same education and counseling but were also taught a method called “self-regulation”. The self-regulation group was able to maintain twice the level of physically activity 4 months afterwards!

So what is self-regulation? Here’s how it works regarding physical activity: write down the following four items: (1) your most important current wish regarding physical activity (for example, biking to work); (2) the most positive outcome of realizing the wish (such as, getting into better shape) and events and experiences associated with this positive outcome; (3) the most critical obstacle (such as getting up too late to bike to work) together with events and experiences associated with this obstacle; and (4) plans for dealing with the obstacles. To plan for the obstacles answer the following three questions: (1) When and where does the obstacle occur and what can I do to overcome or circumvent the obstacle? (2) When and where is an opportunity to prevent the obstacle from occurring and what can I do to prevent it? (3) When and where is a good opportunity for me to act on my wish and what would this action be?

For example, you could counter the obstacle of getting up too late to exercise with: If I get up too late, I’ll skip the morning news, so I can still exercise. Participants used a diary to record their self regulation techniques and were encouraged to use the technique mentally throughout the day.

What Does CPC recommend?

First, you have to be mentally ready to make changes. Self regulation techniques turn favorable conditions (readiness to change and a positive attitude) into immediate and lasting behavior change. Then, for the self-regulation technique to work, two conditions must be met: You need to expect that you can make the change you want, and you need to be able to name and imagine a positive outcome from making the behavior change. The authors of this study note that once people learned how to apply the tool described above, they were able to implement it on their own. While self-regulation steps might seem awkward at first, CPC believes that being purposeful and continuing to practice the steps will allow you to achieve the results you want. What do you want to change or achieve this year?

This study was published in: American Journal of Preventive Medicine 2009;36(1)

Treating "Normal" Cholesterol Levels - January 2009

Did you know…Treating some persons with "normal" cholesterol levels may prevent heart disease?

A new study, the JUPITER trial (Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin), conducted by researchers at Brigham and Women's Hospital in Boston and colleagues, showed that a widely used cholesterol-lowering drug appears to protect against heart attacks and stroke in people who do not have high cholesterol.  The study participants receiving the drug did have high levels of C-reactive protein (CRP), which is a marker for the inflammation process leading to blockage of the arteries.

People with increased levels of CRP (which can be measured by a simple blood test), have a higher risk for cardiovascular events. About half of all heart attacks and strokes occur in apparently healthy people with lower LDL (“bad cholesterol”) levels. The medication (a “statin”) used in the study lowers both the CRP and the LDL cholesterol.

The JUPITER trial studied almost 18,000 men and women with LDL cholesterol levels less than 130 milligrams per deciliter (130 is considered "borderline high") and CRP levels of 2 milligrams per liter or higher (considered average risk).  Men were 50 years or older, while women were 60 or older, with no history of cardiovascular disease, no diabetes and no uncontrolled hypertension, though many had pre-diabetes. The statin drug reduced LDL cholesterol by 50% and CRP levels by 37%.  The results showed that the statin treatment reduced the risk of a heart attack, stroke, death and heart procedures by 44%.  This translates to treating 25 subjects for 5 years to prevent a cardiovascular event. 

What Does CPC recommend?

Measuring CRP may help to more accurately estimate risk for heart disease and may be most important to measure in persons at moderate risk of developing heart disease. In the 2003 statement the American Heart Association and the Centers for Disease Control and Prevention concluded that measurement of CRP is not useful for broad screening of the entire American adult population or those with heart disease. For those at high risk, treatment should already be aggressive and include a statin. Rather, at a physician’s discretion, it was suggested that checking CRP levels may be useful for people at moderate risk, to help decide whether or not a statin could be used as a preventive measure against heart disease. An unanswered question that remains: does lowering normal cholesterol values with a statin provide a benefit irrespective of the level of CRP? Future studies may answer this question.

The study referenced above is published in:  New  England Journal of Medicine 2008;359:2195-207, by authors Paul M Ridker, M.D., et al.

Five Fab Foods - December 2008

Did you know…Five Foods Can Lower Your Cholesterol?

Research supports adding the following 5 foods to your diet to improve your cholesterol: 

Oatmeal and oat bran contain soluble fiber, which lowers LDL, the "bad" cholesterol, by reducing absorption of cholesterol in your intestines.  Ten grams or more of fiber a day decreases LDL and total cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. Adding fruit, such as a banana, adds about 4 more grams of fiber. Other whole grain breakfast cereals are a good source of fiber, as well as kidney beans, apples, pears, barley and prunes.

Walnuts and almonds can significantly reduce cholesterol. Rich in polyunsaturated fatty acids, they also help keep blood vessels healthy and elastic. All nuts are high in calories, so a handful (no more than about 10) will do. Instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

Fish and omega-3 fatty acids lower cholesterol and also help reduce blood pressure and risk of blood clots. In people who have already had heart attacks, omega-3 fatty acids significantly reduces the risk of sudden death.  Eat at least 2 servings of fish a week. The best fish are mackerel, trout, herring, sardines, albacore tuna and salmon. You can take an omega-3 or fish oil supplement, but you need to take at least 2 grams per day to get a beneficial effect.

Olive oil can lower your "bad" (LDL) cholesterol and may increase your “good” (HDL) cholesterol. The Food and Drug Administration recommends using about 2 tablespoons of olive oil a day to get its heart-healthy benefits. To add olive oil to your diet, saute vegetables in it, add it to a marinade, mix it with vinegar as a salad dressing, or use olive oil when basting meat. Avoid "light" olive oil, which is more processed and lighter in color, not fat or calories.

Plant sterols or stanols are substances found in plants that help block the absorption of cholesterol.  Margarines, orange juice and yogurt drinks fortified with plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce servings of plant sterol-fortified orange juice a day. The American Heart Association recommends foods fortified with plant sterols for people with levels of LDL cholesterol over 160 mg/dL.

What Does CPC recommend?

These fabulous five foods have been shown by research to improve cholesterol levels.  Taking small steps in our daily life can make big changes over time.  Be sure to check your cholesterol level at least once every five years, and more often if it is elevated.  And then enjoy the 5 power foods in your diet for the best heart healthy score!

From MayoClinic.com, May 2008:  Cholesterol:  The top 5 foods to lower your numbers

Five Healthy Behaviors - November 2008

Did you know…Five healthy behaviors can help you live longer?

Quick – can you name them? And the more of these you do, the more significantly you reduce your risk of cancer and heart disease.

The five healthiest behaviors are: 1. don’t smoke 2. maintain a healthy weight 3. be physically active 4. eat a healthy diet 5. have a moderate intake of alcohol

Women in the Nurses Health Study who incorporated four out of five behaviors lowered their overall risk of premature death by 55 percent. This study followed 77,782 women over 24 years. Obese women were three times more likely to die of heart disease than women with a normal weight. Women who exercised at least five hours per week had 50% less heart disease than women who were more sedentary. People who had four of the unhealthy behaviors (smoked cigarettes, were overweight, sedentary, and a low healthy-diet score) raised their chance of having heart disease sevenfold, and more than doubled their risk of cancer.

Drinking a light amount of alcohol lowered heart disease risk (1 drink per day for women, up to 2 drinks per day for men) but heavy alcohol use increased cancer risk.

A healthy weight is a “BMI” (body mass index) of 18.5-24.9. To find your BMI, go to this website.

Combining the healthy lifestyle behaviors has a substantially greater impact than any single behavior. Even modest lifestyle changes such as 30 minutes of moderate physical activity can have a large impact on avoiding premature death.

What Does CPC recommend?

It’s essential to understand that you can take control of your health. The most important factors that influenced health in this study were smoking and obesity. By exercising regularly, eating a diet rich in fruits and vegetables, and avoiding tobacco products you can substantially improve your health. Why is good health important to you?

The research cited above was published in: British Medical Journal, Sept. 18, 2008. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. Van Dam RM et al.

Food Diary - October 2008

Did you know…People who keep a food diary may lose more pounds?

In a weight-loss study of nearly 1,700 overweight adults, those who recorded their intake in a food diary every day lost twice as much weight over six months as those who did not keep a diary.  The findings suggest that using a tracking tool such as a diary may increase dieting success.

"The more food records people kept, the more weight they lost," stated Dr. Jack Hollis, lead researcher on the study.  "It seems that the simple act of writing down what you eat encourages people to consume fewer calories." Dr. Hollis is a researcher at Kaiser Permanente's Center for Health Research in Portland, Oregon.

A food diary was just one of several strategies employed in this study of overweight and obese subjects (BMI=25-45 kg/m2). Men and women in the study regularly attended group sessions with nutrition and behavioral counselors, who encouraged them to cut calories, eat more fruits and vegetables and exercise regularly.  Participants were asked to keep daily records of food and beverage intake, as well as how many minutes they spent exercising.  After six months, study participants had lost an average of 13 pounds, with a majority of people losing at least 9 pounds.

Overall, people who regularly kept a food diary tended to be more successful weight losers than those who had not kept a diary.  Also, the more participants exercised, the greater their weight loss on average.

What does CPC recommend?  Maintaining a healthy and successful diet requires dedication and planning.  Keeping a food diary does not have to take a lot of time. Simply listing the foods you eat each day can help you become more aware of habits and make changes for the better.  Try writing down quantity as well, for even more self-awareness.  A single serving of fruit is about the size of a tennis ball; a 3-oz. portion of meat is the size of a computer mouse; an ounce of cheese is the size of a domino.  An 8-oz. cup is about the size of a fist, and an ounce of butter is about the size of a quarter.  Paying attention to our behavior is the first step in changing it.  Now, go ahead and chart a new and healthy course: “Write on!”  Remember that diet works best with regular aerobic exercise!

The research described above was published in:
American Journal of Preventive Medicine, August 2008.

Coffee - September 2008

Did you know…Many beliefs abut coffee are untrue?

Recently, the Center for Science in the Public Interest published a comprehensive appraisal of scientific reports about caffeine.   The following popular beliefs are analyzed in their report findings. 

Coffee is a diuretic.  False: Studies show that people who drank up to 550 milligrams (mg) of caffeine produced no more urine than when drinking caffeine-free fluids. Above 575 mg, caffeine was a diuretic.  Caffeinated drinks with less than 550 mg are hydrating and, like water, contribute to the body’s daily water needs.

Coffee increases your risk of heart attack.  False:  Analysis of 10 studies of more than 400,000 people found no increase in heart disease among daily coffee drinkers.  There is little evidence that coffee and/or caffeine in typical dosages increases the risk of heart attack.  In fact, among 27,000 women followed for 15 years in the Iowa Women’s Health Study, those who drank 1-3 cups a day reduced their risk of cardiovascular disease by 24 percent, although this benefit diminished as the quantity of coffee rose.

Coffee raises your blood pressure.  True, for a little while:   Caffeine induces a small, temporary rise in blood pressure. But in a study of 155,000 nurses, women who drank coffee for a decade were no more likely to develop hypertension than noncoffee drinkers. A Johns Hopkins study that followed more than 1,000 men for 33 years found that coffee drinking played little overall role in the development of hypertension.

Caffeine intake causes bone loss. Slightly true:  Studies have found only a slight reduction in calcium absorption and no effect on calcium excretion.  Caffeine’s negative effect on calcium can be offset by as little as one or two tablespoons of milk. Consuming the currently recommended amount of calcium will negate caffeine’s effect on bone health.

Caffeine causes weight loss. False:  Caffeine speeds up metabolism, with 100 mg burning an extra 75-100 calories a day, but no long-term benefit to weight control has been shown. In fact, in a study of more than 58,000 men and women followed for 12 years, those who increased their caffeine consumption gained more weight than those who didn’t.

I just feel better when I drink it.  True:  Consuming up to 200 mg improves sense of well-being, happiness, energy, alertness and sociability, although higher amounts sometimes cause anxiety and stomach upset.  The drug improves alertness and reaction time. In the sleep-deprived, it improves memory and the ability to perform complex tasks. In sport activity, caffeine enhances endurance and performance.

What does CPC recommend?  There are health benefits to caffeine intake.  However, the most benefit seems to be obtained by limiting your intake to under about 500mg per day.  As with most things in life, moderation is key.  Many of the formerly held concerns about caffeine have been disproven through research, so go ahead, order a latte!

Diet - August 2008

Did you know…The top 3 diets all produce similar results?

A 2-year study comparing the low-fat diet, the Mediterranean diet, and the low-carbohydrate (carb) diet shows that all 3 had similar results.  Among 272 study participants who completed the study, the average weight loss ranged from 7 to 12 lbs.  All the diets improved “good cholesterol” (HDL), blood pressure and waist circumference.  But each diet had specific benefits that may help people decide which is best for them. 

The low-fat diet consisted of 30% calories from fat, 1500 calorie restriction for women and 1800 calories for men.  Low-fat grains, vegetables, fruits, and legumes were encouraged, with limits on sweets and high-fat snacks.  This diet had the highest adherence rate over the 2 year period, at 90%.

The Mediterranean diet was rich in vegetables and fruit, low in red meat, substituting fish and poultry instead.  Calories were restricted as in the low-fat diet, and fat in the diet came from olive oil and nuts.  The benefits of this diet were:  favorable changes in blood glucose and insulin levels in diabetics, the greatest amount of weight loss in women (an average of 13.6 lbs.), and greatest improvement in blood pressure. C-reactive protein, a marker for heart disease, decreased significantly.

The low-carb diet limited carbs to 20 grams daily in first 2 months and gradually increased to a 120 gram limit per day.  Protein, fat and calories were not restricted.  Benefits of this diet were:  the greatest amount of weight loss in men, greatest improvement in the “good cholesterol” HDL, and the greatest decrease in triglycerides.  C-reactive protein decreased significantly in this diet also. 

What does CPC recommend?
Losing extra weight improves blood pressure, cholesterol and glucose levels, which lowers risk of diabetes and heart disease.  No one diet appears to be optimal for weight loss and there are good components among each of the 3 diets in this study. If you need to lose weight, and don’t like restricting calories, the low-carb diet may be the choice for you.  If diabetes is in your family, the Mediterranean diet may be the best choice. CPC discourages diets high in saturated and trans fats and those that are so extreme they are difficult to sustain. Resources for the diets are listed below.  A balanced diet with healthful components has benefits beyond weight reduction, so here’s to healthy losing!  

The research cited above is found in:  The New England Journal of Medicine, July 17, 2008, Volume 359:229-241
Information on the diets can be found in :
Low-fat diet:  American Heart Association guidelines
Mediterranean diet:  Eat, Drink and Be Healthy; The Harvard Medical School guide to healthy eating by Willett & Skerrett
Low-carb diet:  Atkins’ New diet Revolution, by RC Atkins

Stroke and Depression - July 2008

Did you know…It may be lifesaving to treat depression after a stroke?

While it is crucial to focus on cardiovascular health after a stroke, new research is illustrating the importance of including mental health follow up as well. Researchers at the University of Western Australia report that approximately half of stroke survivors develop symptoms of depression in the first two years following a stroke. Stroke patients with depression have greater problems with activities of daily living, more serious deficits in their thinking and problem solving, and higher mortality rates than stroke patients without depression.(1) Another study found that depressed stroke patients returned to work at about half the rate of non-depressed stroke patients, even with comparable functional abilities.(2)

To prevent this post-stroke depression, a recent study at the University of Iowa treated non-depressed patients with recent stroke, with either an antidepressant medication, a placebo (sugar pill), or problem-solving therapy. The group treated with the antidepressant showed significantly less depression over a 12 month period. The problem- solving therapy group experienced only slightly less depression than the placebo-treated group.(3)

What Does CPC recommend?

If someone you know has suffered a stroke, be watchful for signs of depression. Medical providers should ask stroke patients about depression. Not every stroke patient experiences depression or will need an antidepressant, but it is important to note that those who do experience post-stroke depression can be significantly helped with antidepressant therapy. Improving mood is an important component of health, and may improve their medical prognosis as well. Most importantly, take steps to prevent a stroke by knowing your blood pressure and cholesterol numbers. Lifestyle changes, such as exercise, diet and smoking cessation, can help reduce blood pressure -- and minimize the risk of stroke.

The research reported above is published in: 1. Starkstein SE, Mizrahi R, Power BD. Antidepressant therapy in post-stroke depression. Expert Opinion on Pharmacotherapy. 2008 May;9(8):1291-8. 2. Glozier N, Hackett ML, Parag V, Anderson CS; Auckland Regional Community Stroke (ARCOS) Study Group. The influence of psychiatric morbidity on return to paid work after stroke in younger adults: the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke. 2008 May;39(5):1526-32. 3. Robinson RG, Jorge RE, Moser DJ, Acion L, Solodkin A, Small SL, Fonzetti P, Hegel M, Arndt S. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA. 2008 May 28;299(20):2391-400.

Anxiety

Did you know…Managing stress can help you avoid a heart attack?

We already know that blood pressure, cholesterol, smoking and diabetes are major risk factors for heart disease, but emotional stress may be another component of risk. A recent multi-center study (1) followed 735 men without heart disease for about 12 years, to determine the effect of anxiety levels on risk of heart disease. Those with the highest anxiety levels had the most heart attacks. The study took into account blood pressure, cholesterol and other contributors to heart disease, and found that high anxiety had almost as much influence as traditional heart disease risk factors.

Another study (2) in men and women evaluated anxiety and stress in people who already had heart disease. This study found that high levels of anxiety increase the risk of a second heart attack or death.

What Does CPC recommend?

Studies indicate that high levels of stress and anxiety contribute to heart disease. People who are experiencing stress overload may notice some of the following signs: anxiety or panic attacks, a feeling of being constantly pressured, hassled, and hurried, irritability and moodiness, physical symptoms, such as stomach problems, headaches, allergic reactions, such as eczema or asthma, problems sleeping, drinking too much, smoking, overeating, or doing drugs, sadness or depression.

Learning effective ways to lower anxiety and stress levels will improve your quality of life. Although relaxation strategies have not been definitively shown to reduce the risk of heart attack, CPC recommends we all strive to live a more relaxed life. Find a vigorous physical activity like walking, swimming, jogging or biking. Letting go of tension in your body will help you feel better. Regular aerobic exercise has been shown to improve other risk factors for heart disease as well. Many resources are available to learn how to lower stress on the NIH website Medline Plus. Take time to take time out, and be healthier for it!

The studies cited above were published in: 1. Journal of the American College of Cardiology, January 15, 2008, Shen BJ, et al. 2. Journal of the American College of Cardiology, May 22, 2007, Shibeshi WA, et al.

Coronary Calcium Scans - May 2008

Did you know…Coronary Calcium Scans are not for everyone?

A coronary calcium scan (also known as a heart scan or EBCT) is a test that can help show whether you have coronary artery disease. Coronary artery disease, the most common form of heart disease and the leading cause of heart attacks, occurs as plaque clogs your arteries. This plaque is made of fat and cholesterol, which over time calcifies. Coronary calcium scans detect the calcifications.

Currently, heart disease risk is measured by evaluating blood pressure, cholesterol levels and tobacco use, along with age and gender to calculate a 10-year risk score. A recent study by the National Heart, Lung, and Blood Institute shows that calcifications can improve the accuracy of predicting heart disease. In this study, over 6,700 Americans from diverse ethnic groups (White, Black, Chinese, Hispanic) were followed for about 4 years. Those who had the highest calcium scores were nearly 10 times more likely to have a heart attack than those with the lowest scores (1).

However, this test may not be for everyone. A coronary calcium scan costs $300 to $600, and most insurance companies do not cover them. People who are non-smokers with healthy cholesterol and blood pressure levels are not likely to benefit from having this test done because it is not known what a high calcification score means in the absence of elevated cholesterol or other evidence of plaque. Also, the test can give falsely positive results (concluding a person is at high risk for heart disease when in fact they are not) leading to unnecessary, invasive, anxiety-producing diagnostic testing such as cardiac catheterization.

Likewise, if a heart scan shows a person’s arteries are free of calcification, it doesn't necessarily mean they don't have heart disease. The plaque that builds up in one’s arteries becomes calcified over a long period of time. It is possible for an individual to have significant non-calcified plaque in their arteries that the scan won't detect. Knowledge of a low calcium score may lead some who are at risk to be falsely reassured and less likely to make needed lifestyle changes.

For someone at high risk (for example, with high cholesterol levels, high blood pressure, and age 65 or older), heart scan results wouldn’t alter a doctor’s appropriately aggressive treatment plan. However, if an individual is in need of motivation to make changes, and can afford to have the test, it might be beneficial. Another recent study showed that people with higher calcium scores - who see the calcifications on their scan -are more motivated to make needed lifestyle changes such as exercise and eat healthy diets (2).

What Does CPC recommend?

Once you know your cholesterol and blood pressure levels, you or your doctor can calculate your 10-year risk using the CPC cardiovascular risk assessment tool at www.health-e-solutions.org. The American Heart Association states that coronary calcium scans may be helpful in individuals who are at moderate risk for a heart attack (a 10 to 20 percent chance of having a heart attack within the next 10 years) to help guide treatment. Finally, if an individual needs motivation to make lifestyle changes, a scan may help that person “see” the impact of unhealthy arteries. Coronary calcium scans are an interesting technique for predicting heart attacks, but it is best to talk first to your doctor to see if it is right for you.

The research cited above was published in: 1. New England Journal of Medicine, March 27, 2008. 2. American Journal of Cardiology, April 1, 2008

Low Fat Dairy - April 2008

Did you know…Low fat dairy products may benefit women more than calcium supplements?

Getting enough calcium is essential to bone health, and may impact heart health, but the source of calcium may be as important as the amount.

Researchers at Washington University in St. Louis* reported that women who get their calcium mostly from food have higher bone densities than those who get their calcium mostly from supplements. The researchers analyzed women by three groups: those getting at least 70% of their calcium from food, those getting at least 70% from supplements, and those whose calcium intake was distributed more evenly between supplements and dietary sources. Women getting most of their calcium from food consumed on average only 830 mg per day, but had much higher bone density than the women getting most of their calcium from supplements, who got1,033 mg per day. Women who consumed both dietary calcium and supplements had the highest bone density—and also, at 1,620 mg per day, the highest calcium intake.

Other studies have shown adverse effect from calcium supplementation. New Zealand investigators* studied 1471 postmenopausal women who took a daily calcium supplement or placebo, for 5 years; Twice as many women in the calcium group experienced heart attacks compared with the placebo group. The results of this study suggest that calcium supplementation does not lower cardiovascular risk in postmenopausal women but, instead, could raise it.

Finally, another recent study* among 28,886 women showed that those who regularly consume low-fat milk or yogurt may have a lower risk of developing high blood pressure over a 10-year period. Calcium supplements, higher-fat milk and dairy products conferred no such benefit in preventing hypertension.

What Does CPC recommend?

U.S. dietary guidelines call for three servings of foods rich in calcium per day. These studies support getting most of your calcium from a balanced and varied diet. Be sure you get at least 1,200 to 1,500 mg of daily calcium—including vegetable sources—as well as adequate vitamin D (800-1000IU per day). Good sources of dietary calcium are listed here, as well as lactose levels for those who are lactose intolerant. A diet rich in vegetables and non-fat or low-fat dairy products is a winning ticket!

FOOD	Calcium (mg)	Lactose (g)
Yogurt, plain, low-fat, 8oz.	415	5
Soymilk, fortified, 8oz.	240	0
Milk, skim or fat-free, 1 cup	306	11
Milk, 1% milkfat, 1 cup	290	11
Cheese, swiss, 1 oz.	270	1
Cheese, mozzarella, 1 oz.	207	1
Cheese, cheddar, 1 oz.	204	1
Cottage cheese, 1/2 cup	75	1-2
Sardines, canned, w/bones, 3 oz.	325	0
Salmon, canned, w/bones 3 oz.	205	0
Tofu, *firm, 4oz.	163	0
Broccoli, raw, 1 cup	90	0
Collards, frozen, cooked, 1 cup	357	0
Orange, 1 medium	50	0
Pinto beans, 1/2 cup	40	0
Kale, frozen, cooked, 1 cup	179	0
Bok choy, fresh, cooked, 1 cup	158	0

The research cited above was published in: 1. American Journal of Clinical Nutrition, May 2007; 2. BMJ 2008 Feb 2; 3. Hypertension, April 2008. *Tofu made with calcium sulfate. Source: www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a301.pdf.

Hypertension Quiz - March 2008

Did you know…You can prevent high blood pressure?

See if you know the right answers to the following hypertension facts quiz…

Answers

Double Duty Drug - February 2008

Did you know…Lowering risk of heart disease with a “statin” medication may also lower your risk of cancer?

This seems too good to be true. Cardiovascular disease is the number one killer of both men and women in the U.S. and Colorado. Cancer is the second leading cause of death. But the results of the following study show cancer rates reduced by about 25 percent in those taking cholesterol-lowering drugs called “statins”. Read on!

A large study conducted in the Veterans Affairs (VA) Boston Healthcare System analyzed data from VA databases. The study compared two groups: 26,000 patients who used blood pressure medications but no cholesterol-lowering medicine and 27,000 patients who had used statins for at least two years. Most of the patients were men (96%), average age 66 years, all were cancer-free at study entry, and average follow-up was five years.

The incidence of cancer was 9.4% among the statin-treated, and 13.2% among those not statin-treated, a significant difference. The study accounted for effects from smoking, age, weight, other diseases, cholesterol levels, and colon cancer screening, and found that the risk of developing cancer was reduced by about 26% in the statin-treated group. There was also a significant “dose response”, showing higher drug doses correlated with lower cancer mortality rates. Cancer reduction was shown in colorectal cancer (35% lower risk), lung cancer (30% lower risk) and prostate cancer (10% lower risk).

What Does CPC recommend?

Many people have been prescribed a statin by their doctor. Common statin names are Lipitor, Mevacor, Pravachol, Crestor, and Zocor. Statins reduce not only cholesterol but also cardiovascular disease. However, many people don’t keep taking them. Why not?

Studies show that many people think statins are a temporary, rather than a lifelong commitment. Also, the medication label warns that severe muscle aches may indicate a very rare but serious side effect. This warning has the effect of scaring many away- who doesn’t have a worrisome muscle ache? Finally, if a person does not perceive their risk of a heart attack very strongly, they may be less committed to continuing the medication.

More studies are certainly needed to evaluate whether statins can prevent cancer. But CPC strongly recommends that if you have been prescribed a statin to lower your cholesterol, it’s a healthy and heart-wise step to take.

The studies cited above were published in: Journal of the National Cancer Institute, e-published January 8, 2008. “The Association Between Statins and Cancer Incidence in a Veterans Population.”; Cardiovascular Drugs and Therapy, August 21, 2007. “Predictors of adherence to statins for primary prevention.”

Whole Grains - January 2008

Did you know…Eating whole grains reduces many health risks?

Eating whole grains and fiber-rich food may reduce the risk of heart disease, diabetes, diverticulitis, constipation, cataracts and even pancreatic cancer.

A recent study showed that a high intake of fiber reduced the risk of pancreatic cancer by 35%. Another study showed that avoiding high glycemic index foods – foods that are quickly digested such as white bread and potatoes- and eating whole grains instead, reduces the risk of cataracts by 77 %. A Harvard study of over 40,000 men showed that a high fiber diet lowered heart disease risk by 40%. Cereal fiber, found in whole grains, seemed particularly beneficial. This study and a second study in women showed a reduction in the risk of diabetes when whole grains were increased in the diet.

So what are some of these fantastic whole grains?

Common whole grains are whole wheat, whole rolled oats, wild rice, brown rice, pearl barley and popcorn. Less common whole grains include: amaranth, buckwheat, bulgur, kamut, millet, quinoa, spelt, whole grain cornmeal and whole rye.

When shopping, look for foods that list “whole grain” as the first ingredient. Breads should have at least 2 grams of fiber per serving, and cereals should have at least 5 grams per serving. “Pumpernickel” is not a whole grain, and is made from rye and wheat flours, but not usually whole grain. Similarly, “multigrain” and “stone ground” might be refined or enriched, but are not whole grain.

What Does CPC recommend?

Although the above studies are observational and are not conclusive, the CPC believes the data are compelling and recommends that you eat > 20 grams of fiber each day. We recommend that you eat 2-3 servings of whole grains, 2 cups of fruit, and 2.5 cups of vegetables per day. Other good sources of fiber are legumes (lentils, kidney beans, black beans, black-eyed peas, and garbanzo beans), nuts and seeds. High glycemic index foods to avoid include potatoes, white bread, white rice, refined cereals, white pasta and sugar.

The studies cited above were published in: American Journal of Epidemiology, Nov 15, 2007. Whole grains and risk of pancreatic cancer in a large population-based case-control study in the San Francisco Bay Area, California American Journal of Clinical Nutrition, Nov 2007. Carbohydrate nutrition, glycemic index, and the 10-y incidence of cataract. JAMA, 1996. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. American Journal of Clinical Nutrition 2004. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.

Peripheral Artery Disease - December 2007

Did you know…Peripheral artery disease is increasing, especially among women?

Peripheral artery disease (PAD) is blockage of the blood vessels in the legs. Currently 8 -12 million people in the United States have the disease. PAD occurs when fatty deposits cause the arteries to narrow and blood flow to the legs is restricted. PAD is a signal for higher risk of heart attack and stroke, but few doctors screen patients for it because the screening test is not reimbursed under Medicare.

A study led by Dr. Andrew Sumner in Allentown, PA. analyzed the results from three studies involving participants aged 40 and over with no prior history of cardiovascular disease. The study found that the prevalence of PAD among adults 40 years and older with no symptoms increased from 3.7 % to 4.6% between 1999 and 2004. Further analysis of the data showed a significant increase in women, from 4.1% to 6.3%. PAD is most common in those age 70 and older, but the disease increases in prevalence as people age from 40 years old on up.

Many people with PAD do not have classic symptoms, such as leg pain with exertion that is relieved by rest. Over half of PAD patients have no symptoms at all.

The test for diagnosing PAD is called an “ankle-brachial index”, which includes a series of blood pressure measurements taken in the arms and legs. Treatment for PAD involves regular exercise as well as aggressive modification of cardiovascular risk factors such as high blood pressure, high cholesterol, diabetes, and cigarette smoking.

What Does CPC recommend?

PAD predisposes you to heart disease and stroke, and is very common in older adults. If you are between the ages 50-69 and smoke or have diabetes, ask your doctor to be tested for PAD. If you are over 70 years old, if you have leg pain with exercise, or you have a history of heart disease or stroke, you should be tested for PAD. CPC believes that smoking cessation, a regular exercise program, and medications to lower blood pressure and cholesterol are essential in patients with PAD.

The research cited above was presented at the American Heart Association annual meeting in Orlando, FL, Nov. 2007. In addition, the following research study was a resource for this article: PARTNERS=PAD Awareness, Risk and Treatment New Resources for Survival. Hirsch AT, et al. JAMA 2001;286:1317-1324.

Marital Stress - November 2007

Did you know…A hostile relationship is a risk factor for heart disease?

Three recent studies show that marital stress, negative close relationships, and argument style can impact heart health even as much as cholesterol level or blood pressure.

Tim Smith, a professor of psychology at the University of Utah found that the more hostile a woman is during an argument, the greater the extent of her atherosclerosis (hardening of the arteries). If the husband was also hostile, the women had particularly high levels of calcification. Husbands who displayed controlling behavior – or whose wives displayed such behavior –were more likely to have severe atherosclerosis than other men.

Janice Kiocolt-Glase, professor and director of the Division of Health Psychology at Ohio State University College of Medicine, studies stress in the human immune system. She has found that marital conflict and stress cause sustained high levels of pro-inflammatory cytokines, which have been linked to a variety of diseases as well as heart disease.

A British study found that constant bickering increases the risk of heart disease by one third. About 9000 British civil servants were asked about the emotional quality and practical support provided in their closest relationship. The study found that relationships that were perceived to be negative, stressful, or dysfunctional had a strong impact on later cardiovascular problems.

What Does CPC recommend?

Pay attention to your relationships. Disagreements are an unavoidable fact, but the way we talk during disagreements gives us an opportunity to do something healthy. Chronic stress and negative emotions have a big impact not only on your happiness, but also on your health. Through counseling, reading and talking one can learn how to improve stressful relationships or set limits in them. Healthy arguing can lead to greater intimacy, so work at understanding your partner for a deeper and more satisfying relationship.

The studies cited above were published in: Journal of Behavioral Medicine. 2007 30, 1-10. Hostility, anger, and marital adjustment: concurrent and prospective associations with psychosocial vulnerability. Baron KG, Smith TW, Butner J, Nealey-Moore J, Hawkins MW, & Uchino BN Arch Gen Psychiatry. 2005 Dec;62(12):1377-84. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL, Glaser R. Arch Intern Med. 2007 Oct 8;167(18):1951-7.Negative aspects of close relationships and heart disease. De Vogli R, Chandola T, Marmot MG.

Go Fish - October 2007

Did you know…Higher intake of foods rich in omega-3 fatty acids may protect children against Type 1 Diabetes?

A team of researchers here at the University of Colorado Health Sciences Center have been studying the development of Type 1 Diabetes in children through an ongoing observational study of families who are at risk. Jill Norris and her team have followed 1770 children since 1992, who are at increased risk because they have a family member with Type 1 Diabetes. Children whose families reported dietary intake of omega-3 fatty acids were half as likely to develop Type 1 Diabetes, as those who did not.

What Does CPC recommend?

Omega-3 fatty acids benefit the heart of healthy people, and those at high risk of cardiovascular disease. While Dr. Norris states that it is too early to recommend dietary intake of omega-3’s for the prevention of Type 1 Diabetes, it is still an important part of a healthy diet.

We recommend eating fish (particularly fatty fish) at least two times a week. Fish is a good source of protein and doesn’t have the high saturated fat that meat products do. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids. Other excellent sources of omega-3 fatty acids are flax seeds, walnuts, soybeans, halibut, shrimp, tofu, snapper, scallops and winter squash.

For women of childbearing age, nursing mothers, and young children, we recommend two servings of fish per week. For these individuals, eating fish with higher mercury levels (eg, shark, swordfish, golden bass, and king mackerel) should be avoided; albacore tuna should be limited to 6 oz per week.

The research cited above was published in: Norris JM, Yin X, Lamb MM, Barriga K, Seifert J, Hoffman M, Orton HD, Baron AE, Clare-Salzler M, Chase HP, Szabo NJ, Erlich H, Eisenbarth GS, Rewers M. Omega-3 polyunsaturated fatty acid intake and islet autoimmunity in children at increased risk for type 1 diabetes. JAMA. 2007 Sep 26;298(12):1420-8.

Manpower - September 2007

Did you know…Most men overestimate their level of health while avoiding preventive measures?

A recent survey conducted by the American Academy of Family Physicians of 2,282 men and women about their health behaviors uncovered the following:

This survey shows the paradox between perceived health among men and actual healthy behaviors. Men in this survey spent an average of 19 hours a week watching television, and more than four hours a week watching sports, but only about one-third exercise on a regular basis. Fortunately, 78 percent of the men with a spouse or significant other surveyed say their spouse or significant other has some influence over their decision to go to the doctor.

What Does CPC recommend?

Men and women should make health a priority. Many men are unaware that simple screening tests and lifestyle changes can dramatically improve quality of life and cardiovascular risk factor control. A visit to a family doctor or internist can address physical, emotional and health concerns and provide medical guidance to keep in the best of health.

Rather than trying to reduce television watching, CPC recommends adding more exercise. At least 30 minutes per day on most days of the week is recommended. Start with 10 or 20 minutes a day and add 5 minutes to the daily routine each week to make exercise part of your lifestyle.

Although men view themselves as “Brave hearts”, the CPC wants men to focus on “healthy hearts.”

This survey was conducted online within the United States by Harris Interactive® on behalf of the American Academy of Family Physicians between April 30 and May 2, 2007.

No more fasting blood tests? Woo-hooo ! - August 2007

Did you know…Eating before your cholesterol test could actually tell you more about your risk for heart disease than if you fast?

Two studies, one in Denmark and the other in the United States found that people who have very high triglyceride levels after a meal are much more vulnerable to having a heart attack. In the course of these two studies, approximately 39,000 individuals were followed for at least 11 years.

The Danish study found that women were five times more likely to have a heart attack and men twice as likely to have a heart attack if they had high triglyceride levels following a meal. The American study showed similar results, and also showed that the triglyceride elevation disappeared about four hours after eating, and thus would not show up in a fasting blood test!

Triglycerides are made directly from the fat and sugar in our diet. They are the first fats that come into the bloodstream after we eat, and then they are processed by the body into a variety of blood fats (cholesterol).

What Does CPC recommend?

While the standard of care is still to have cholesterol testing completed after a 12 hour fast, it may be worth asking your doctor to have a test performed after a meal, if you have any other risk factors for heart disease. Other risk factors for heart disease include high blood pressure, diabetes, and smoking. Blood tests performed at health fairs may be an opportunity to try out a non-fasting cholesterol test.

Most cholesterol tests performed at health fairs include total cholesterol, LDL, HDL and triglyceride levels. Elevated triglyceride levels following a meal that are higher than 300 mg/dl (or higher than 150 mg/dl if fasting) should be brought to your doctor’s attention. Note that if you plan to also evaluate your glucose level, the test should be done in a fasting state instead of after eating a meal.

The research cited above was published in:

Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007 Jul 18;298(3):299-308. Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA. 2007 Jul 18;298(3):309-16.

Dangers of abnormal fasting blood sugar - July 2007

Did you know…Impaired fasting glucose may increase your risk of heart disease as much as diabetes?

Researchers led by Elizabeth Bar of the International Diabetes Institute, Melbourne followed 10,429 people in the Australian Diabetes, Obesity and Lifestyle Study for approximately five years. At the beginning of the trial, all participants underwent an oral glucose tolerance test and cholesterol tests.

After five years, people who had diabetes had a 2.6 times higher risk of dying from cardiac problems than healthy people. Those with impaired fasting glucose (considered "pre-diabetes") had a 2.5 times higher risk.

Diabetes and pre-diabetes together accounted for almost two-thirds of all deaths from heart disease.

Impaired fasting glucose is defined as a fasting blood sugar level that is higher than normal (upper limit of normal is100 mg/dL) but less than what is considered to be the cutoff for diabetes (126 mg/dL ). Impaired fasting glucose is thought to be pre-diabetes, because it indicates that the body is failing to metabolize blood sugar efficiently.

What Does CPC recommend?

It's well known that diabetes increases the risk of cardiovascular disease and early death, but now we know that pre-diabetes is also a strong contributor.

A single blood test showing an abnormal fasting glucose does not necessarily mean that you have impaired fasting glucose, or are pre-diabetic. However, this test result should be followed up by an appointment with your care provider. If you are diagnosed with pre-diabetes, there are dietary and lifestyle modifications that could reverse this disorder. Considering the important study results above, it is essential to act quickly to lower your risk of heart disease.

The research cited above was published in:

Barr EL, Zimmet PZ, et al. Risk of Cardiovascular and All-Cause Mortality in Individuals With Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance. The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation. 2007 Jun 18

Eat More Lose More - June 2007

Did You Know...Losing weight on a diet that prescribes foods works better than diets that restrict food?

In a recent study at Penn State University, over 600 men and women were counseled regarding weight loss techniques. One group was given a calorie restriction plan and another group was given the DASH diet which emphasizes getting 9 to 12 daily servings of fruits and vegetables, and 2 to 3 servings of low-fat dairy products. Those who were given the DASH diet actually ate more food by weight -a consequence of getting more fruits and vegetables and also lost the most weight. The DASH diet also was richer in vitamins, minerals and higher in fiber.

The DASH diet was originally designed to help lower blood pressure. And speaking of blood pressure, the Women’s Health Initiative studying over 60,000 women, found that women with even mildly elevated blood pressure (prehypertension) were at greater risk for heart attack and stroke. Therefore, the DASH diet may be helpful for both weight loss and simultaneously reducing risk of heart disease by lowering blood pressure.

What Does CPC recommend?

A diet rich in fruits, vegetables, fiber and low in saturated fat is proven to be heart healthy. Add mono- and polyunsaturated fats (those that are liquid at room temperature-like olive oil and canola oil), include nuts and two servings of fish per week in your diet, and you are on your weigh to a better and healthier body.

Your lowest risk of heart disease and stroke occurs at a systolic blood pressure (top number) below 120 and a diastolic (bottom number) below 80 mm Hg.

Eat and be healthy!

The research sited above was published in Ledikwe JH, Rolls BJ, et al. Reductions in dietary energy density are associated with weight loss in overweight and obese participants in the PREMIER trial. Am J Clin Nutr. 2007 May;85(5):1212-21.

Hsia J, Margolis KL, et al Prehypertension and cardiovascular disease risk in the Women's Health Initiative. Circulation. 2007 Feb 20;115(7):855-60.

DASH diet: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

To Stent or Not to Stent...
That is the Question - May 2007

Did You Know...

Compared with optimal medical therapy, implanting stents into coronary arteries did not provide further protection from future heart attacks. More is not always better, it seems, regarding the treatment of stable coronary artery disease. What your mother told you: eat right, get lots of exercise, watch your blood pressure and cholesterol, and take all of your medications as prescribed is the right message. Research sponsored by the Department of Veterans’ Affairs and the Canadian Institute of Health proved just that.

About 2300 patients with stable coronary artery disease received treatment with either “optimal medical therapy” alone, or optimal medical therapy plus placement of a stent to improve blood flow to the heart. Patients were followed for an average of 5 years. Those who received a stent did not live any longer, nor did they suffer fewer cardiac events, such as stroke or heart attack, than those who received optimal medical therapy alone. In fact, there were 9 fewer cardiac events in the medical therapy group!

What Does CPC recommend?

“Optimal medical therapy” for coronary artery disease patients includes medication to get blood pressure and cholesterol levels into healthy ranges, medications such as statins, ACE-inhibitors and Beta-blockers, as well as blood thinners such as aspirin and clopidogrel. In addition, lifestyle modification such as smoking cessation, exercise, and weight loss are key. These approaches take time and commitment but are well worth it.

Please be aware that this research applies only to patients with stable coronary artery disease. People who are having a heart attack or unstable angina generally benefit from having a stent placed. In these “unstable” patients time is of the essence, to improve blood flow to the heart.

The research cited above was published in: N Engl J M. 2007 Apr 12;356(15):1572-4 Optimal medical therapy with or without PCI for stable coronary disease.