1.) Are You at Low Risk for Heart Disease? Probably Not
A new study released yesterday sounds pretty shocking: Fewer than 10 percent of Americans qualify as being at low risk for heart disease. Just 7.5 percent of us (to be exact) have none of the following risk factors that put our hearts in danger: being overweight (a body mass index above 25), being a smoker, having high cholesterol (above 200 mg/dL) or high blood pressure (above 120 mm Hg/80 mm Hg), or having diabetes, according to the study, which was published in the journal Circulation. That’s a decrease from 15 years ago, when 10.5 percent of us fell into the low-risk category. So the news here is that we’re going backward despite the fact that experts know a lot more today about preventing heart disease than they did a decade or two ago.
Starting in the late 1970s, when quitting smoking first came into fashion, an increasing number of us fell into the low-risk category. Blame the backsliding on our ever expanding waistlines. “Increasing adiposity is likely to be a major driver,” write Harvard Medical School researchers in an editorial that accompanied the study. This is just the tip of the iceberg, they warn. As the growing number of overweight kids reach adulthood, “low-risk” Americans will become an endangered species. And, yes, this will certainly drive up healthcare costs and the price tag of reform.
Women, though, fare better than men. More than 10 percent of us have no risk factors for heart disease, compared with fewer than 5 percent of men. We can thank our bodies’ production of the female hormone estrogen, which protects our hearts before menopause and is thought to explain why we develop heart disease, and accompanying risk factors, about a decade later than men, on average.
The question is: What can we do to keep our risk from creeping up as we age and our estrogen levels plummet?
For starters, young women need more encouragement not to smoke. Nearly 30 percent of those ages 25 to 44 are smokers compared with just 11 percent of folks over 65. Many women start smoking in their teens in the mistaken belief that it will help them control their weight. They then don’t want to quit for fear of gaining weight. While women typically gain about 5 to 10 pounds after quitting, there’s no question that smoking is a far greater risk to your heart health than being overweight, especially if you’re over 35 and take oral contraceptives.
Exercise can help offset the quitter’s weight gain, but a recent Temple University study found another surprising method that works: body image therapy. Former smokers who took a body image workshop, in which they talked about issues they had with their bodies, wound up, on average, losing a few pounds. They followed the book Body Image: A Handbook of Theory, Research, and Clinical Practice
by Thomas F. Cash, Ph.D, and Thomas Pruzinsky, Ph.D., and attended group discussions every week. If you’re not into joining a support group, try to encourage a few friends to read the book along with you and discuss its themes like the influence of waiflike magazine models and how to retrain the brain to think differently about perceived body flaws. Over time, you’ll find yourself thinking about your body in a more positive light, and this can actually help dissuade you from overeating. (Contrary to what you might think, it’s the self-loathing that causes us to binge—usually after an episode of self-punishing starvation.) In fact, nonsmokers, too, can benefit from an improved body image to help ward off the midlife spread.
In addition to not smoking, we need to double our efforts to keep the scale steady as we age. We can do this by increasing our activity levels and cutting down on supersize portions. Check out this slide show for more tips.
http://health.usnews.com/
2.) Number of Americans at low risk of stroke, heart disease dropping, study finds
After nearly a quarter century of improvement, the number of Americans at low risk for heart disease and stroke has dropped substantially, raising fears about the future health of the country and the financial burden it faces, according to research published Monday.
The study found that only 7.5% of Americans between the ages of 25 and 74 could be considered at low risk, according to the latest national data. At its peak in the early 1990s, that number had reached 10.5% following dramatic improvements from the early 1970s.
Doctors attributed the country’s recent deteriorating heart health to an energy imbalance – too many calories and too little exercise – that has become a way of life for many Americans.
“We are starting to lose the battle against heart disease because as a society we are too overweight,” said James Stein, a professor of cardiovascular medicine at the University of Wisconsin School of Medicine and Public Health. “It’s a tragedy that despite all of our medical advances and scientific understanding of this disease, our lifestyles are getting the worst of us.”
The news comes at a time when the country is debating a national health care plan as a way to slow spiraling medical costs. Because so few people are low risk, there is a huge potential for reducing heart disease and its cost through prevention efforts. But moving most adults into the low-risk group is a distant and challenging goal, the study authors wrote.
It is estimated that heart disease and stroke cost the nation $234 billion a year. Nearly 17 million Americans have heart disease and nearly 7 million have suffered a stroke.
Part of a dwindling group
Jason Rzepka, 37, of Pewaukee is a member of the small and shrinking group of Americans who are at low risk for developing cardiovascular disease. He doesn’t smoke or have diabetes; has good cholesterol and blood pressure numbers; and maintains a healthy weight.
Rzepka, who works as a surgical technician at Froedtert Hospital in Wauwatosa, said he has seen what happens when people don’t take care of themselves.
The father of two said he works out several times a week and eats a low-fat diet.
“We don’t keep snacks or cookies in the house,” he said. “For me to splurge would be to have a granola bar.”
The study, published in Circulation: Journal of the American Heart Association, analyzed data from large national health surveys taken every five years beginning in the early 1970s. The most recent survey data was obtained between 1999 and 2004, and it involved about 9,400 people.
To be considered at low risk for cardiovascular disease a person must meet five criteria: a non-smoker; never diagnosed with diabetes; not overweight (body mass index of less than 25); total cholesterol of less than 200 milligrams per deciliter and not using a cholesterol-lowering drug; and blood pressure of less than 120/80.
One of the biggest declines in cardiovascular health was in women. Between 1998 and 2004, 15.5% of women were in the low risk group. That number dropped to 10.5% between 1999 and 2004.
The 25- to 44-year-old age group also saw a significant decline from 17.2% to 12.1%.
Men, older people and minorities had the fewest people in the low-risk category.
“These are clearly not welcome developments,” said lead author Earl Ford, medical officer of the U.S. Public Health Services at the Centers for Disease Control and Prevention in Atlanta.
Other studies had shown that being at low risk can reduce the chances of developing cardiovascular disease between 60% and 90%. That translates into another six to 10 years of life expectancy.
Only smoking has seen a consistent improvement over the last 25 years, according to the study.
Weight a big contributor
The decline in the number of people with a healthy body weight was the biggest contributor to the shrinking low-risk group, dropping from about 50% of adults in the 1970s to 32% between 1999 and 2004.
Blood pressure, cholesterol and diabetes also were headed in the wrong direction, but to a smaller degree, the study said.
“There has been a decline in how we are taking care of ourselves,” said Mark Obermyer, an internal medicine and pediatric specialist with Froedtert Hospital and the Medical College of Wisconsin.
Obermyer said many people who maintained a healthy lifestyle as young adults don’t realize that as they get older metabolic changes occur that require them to do a little more in order to remain at low risk for heart disease.
“What we used to do doesn’t cut it anymore,” he said.
An editorial that accompanied the study noted that there had been major declines in deaths from heart disease between 1980 and 2002, largely due to new therapies. However, the growing number of people who are overweight and have high blood pressure and diabetes suggests that the mortality rate may increase.
The editorial said more needs to be done to support better nutrition and physical activity for children.
If not, “medical costs will continue to burgeon and displace investments in education, parks and other public infrastructure,” the editorial said.
http://www.jsonline.com
3.) Study: More Americans at Higher Risk of Heart Disease
Epidemiologists love to crunch numbers — and Americans, on the whole, love to ignore them. Even the most health-conscious among us soon grow numb to the storm of statistics warning us about rising levels of obesity or falling levels of exercise or all the other numerical indicators that tell us how unwell we’re getting. But on Sept. 14, a team of researchers released a new finding that should cause even the most data-weary folks alarm.
According to a paper published Monday in Circulation, a journal of the American Heart Association, fewer than 8% of all Americans can now be considered at low risk for heart disease. No one needs a statistician’s help to know that that means more than 92% of us are not as healthy as we could be, and that’s worth paying attention to.
The study was actually the latest in a series of studies, all of which have been part of a program known as the National Health and Nutrition Examination Surveys (NHANES). Administered by the Centers for Disease Control and Prevention (CDC), the program is a four-decade attempt to evaluate the country’s health by conducting surveys and physical exams with a rotating sample group of about 10,000 Americans. The first NHANES study was conducted from 1971 to 1975, the second from 1976 to 1980, the next from 1988 to 1994, and the most recent — from which the heart-disease findings are only now being released — from 1999 to 2004.
For that portion of the survey, the investigators focused on people in the 25-to-74 age group and evaluated five different risk factors for cardiovascular disease: blood pressure, cholesterol, smoking history, obesity and diabetes. To be considered at low risk, subjects had to have a blood pressure reading of 120/80 mm Hg or lower without the aid of medication and a cholesterol level below 200 mg/dL, also without drugs. They had to be nonsmokers or at least former smokers, not be overweight or obese, and never have been diagnosed with diabetes. “From a prevention point of view, it’s important that Americans achieve as many of these goals as possible,” says the CDC’s Dr. Earl S. Ford, the lead author of the study.
That’s why it’s troubling that so few of us did. In the latest NHANES, just 7.5% of adults were considered low risk in all five areas. That’s a significant dip from the 10.5% in the 1988-94 survey — which was already a decidedly poor score. Within the adult population, there is no particular demographic slice that’s doing particularly well, but some are clearly faring better than others. Among women in the current study, 10.5% were considered low risk (a decrease from 15.5% in the previous survey), compared to just 4.8% of men (down from 5.7%). In the 25-to-44 age group, 12.1% came in at low risk, compared to 3.5% of 45-to-64-year-olds and just 0.8% in the 65-to-74 demographic. Whites, among whom 8.2% were at low risk of heart disease, did better than Mexican Americans (5.3%), and both did better than African Americans (4.6%). The racial gaps have much to do with socioeconomic disparities and unequal access to health care, but there are also genetic factors at play, with certain groups having a higher susceptibility to certain conditions.
Bad as the current numbers are, they are actually not historic lows. In the 1971-75 survey, just 4.4% of the entire sample group was considered low risk; that percentage climbed to 5.7% in the next survey before peaking in the third one. The trend was reversed this time around. “Until the 1990s, we were headed in a positive direction,” says Ford. “But then it took a turn.”
Surprisingly — and encouragingly — rising heart-disease risk does not necessarily translate to rising heart-disease deaths. Last year, the American Heart Association announced that since 1999, deaths from coronary heart disease fell a remarkable 25.8%. There are a lot of reasons for that happy development, but the leading ones are better drugs and technology, closer adherence to evidence-based practice guidelines and the simple precaution of getting people in cardiac distress to the hospital fast.
All the same, the best way not to need the hospital at all is not to get sick, and even the greatest advances in treatment will amount to little if we can’t bring the risk factors under control. The most important factors to attack, the Circulation paper explains, are not cholesterol or tobacco use. Both continue to drop, and with recent federal action to boost cigarette taxes and allow the Food and Drug Administration to regulate tobacco for the first time, the decline in smoking may actually accelerate. (Indeed, last year, the share of Americans who use tobacco fell below 20% for the first time in modern memory.)
The real problems are blood pressure, obesity and diabetes, all of which are relentlessly on the rise. Worse, there’s a time bomb in the trend lines. According to a 2008 survey by the CDC, 32% of American children are now overweight or obese, a number that at least appears to have plateaued after a long period of steady increase but one that’s shocking all the same. Once those children reach the 25-to-74 demographic, their heart-disease risk could cause the national numbers to explode. “As these children grow up, I expect to see a decrease in the number of people who qualify as low risk,” says Dr. Seema Kumar, a pediatric endocrinologist and medical director of the Weight Management Program for Children at the Mayo Clinic in Rochester, Minn. “Our obese children are at high risk of becoming obese adults; some of them are already developing high blood pressure, high cholesterol and diabetes.”
The answer to much of this — as is so often the case — is better diet, more exercise and early detection. Such preventive measures form one of the cornerstones of the ongoing health-care debate — one of the few points on which nearly all sides can agree. The authors of the new study call for physicians to be reimbursed for heart-disease-prevention measures like working with their patients to develop weight-loss and smoking-cessation plans and to be allowed enough breathing room in their schedules to let them do good cardiac assessments. Schools and workplaces, the paper argues, should also be in on the prevention game. Since both are places where large numbers of people congregate, they are also places where simple measures like blood-pressure screenings could do the most good.
“Much potential exists to reverse ominous trends in cardiovascular health,” the authors write, “but this is unlikely to occur without making prevention of overweight and obesity a national priority.” There’s no way of knowing when Americans who have heard this refrain again and again will take notice — and take action — but when 92% of us are affected, now seems like a very good time.
http://www.time.com/
4.)Heart Disease a Risk Factor for Most Americans
It seems that most of us Americans now have at least a low-risk for heart disease. Many of us are at even higher risks – overweight, out-of-shape, hypertensive, or diabetic.
Earl S. Ford, MD, MPH, of the CDC’s Division of Adult and Community Health at the National Center for Chronic Disease Prevention in Atlanta, and colleagues published a report online yesterday in Circulation, Journal of the American Heart Association which looked at data from four national surveys of adults ages 25 to 74 to estimate the proportion of Americans who have a low risk factor burden.
The researchers found that Americans considered at low-risk for heart disease now make up less than 8% of the population. The age-adjusted prevalence of low risk factor burden increased from 4.4% [in 1971 to 1975] to 10.5% [in 1988 through 1994], before decreasing to 7.5% [in the most recent national survey].
The pattern was the same for men and women. Whites were more likely to be living heart-healthy lives than were blacks except for the period from 1976 to 1980, when there was no racial difference in low-risk factor burden.
Low risk of heart disease means the person is unlikely to develop cardiovascular disease or risk factors for cardiovascular disease. This person will have a total cholesterol less than 200 mg/dL and therefore not need lipid-lowering medications. This person’s blood pressure will have a systolic measurement <120 mm Hg and diastolic <80 mm Hg and therefore not need antihypertensive medications. This person will have a body mass index <25 kg/m2. This person will not be a diabetic and will not be a smoker.
The researchers suggest that a societal effort is needed to encourage healthy eating and physical activity to lower the risk factors not only for heart disease, but also for other conditions. They suggest adaptations to towns and cities that favor pedestrians and cyclists. Such initiatives should start in schools and the work place, and will require good collaboration between politicians and doctors for success.
Sources:
Ford ES, et al “Trends in the Prevalence of Low Risk Factor Burden for Cardiovascular Disease Among United States Adults” Circulation 2009; 120:000-000
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5.) How Air Pollution Causes Heart Disease
It’s well known that measures such as exercise, a healthy diet and not smoking can help reduce high blood pressure, but researchers at the University of Michigan Health System have determined the very air we breathe can be an invisible catalyst to heart disease.
Inhaling air pollution over just two hours caused a significant increase in diastolic blood pressure, the lower number on blood pressure readings, according to new U-M research.
The study findings appear in the current issue of Hypertension, a publication of the American Heart Association.
Nearly one in three Americans suffer from hypertension, a significant health problem that can lead to heart attack, heart failure, stroke, and other life-threatening problems.
“Although this increase in diastolic blood pressure may pose little health risk to healthy people, in people with underlying coronary artery disease, this small increase may actually be able to a trigger heart attack or stroke,” says Robert D. Brook, M.D., lead author and assistant professor of medicine in the Division of Cardiovascular Medicine at the University of Michigan Health System.
In the study, researchers hoped to identify which air pollutants are harmful and how the pollutants work to damage the cardiovascular system.
Eighty-three people in Ann Arbor and Toronto were involved in testing and breathed air pollution, concentrated by a mobile air quality research facility, that was similar to what would be found in an urban environment near a roadway.
“We looked at their blood vessels and then their responses before and after breathing high levels of air pollution,” explains Robert Bard, M.S., co-author and clinical research manager at U-M.
Ozone gases, a well-known component of air pollution, were not the biggest culprit. Rather, small microscopic particles about a 10th of the diameter of a human hair caused the rise in blood pressure and impaired blood vessel function, tests showed. The blood pressure increase was rapid and occurred within 2 hours, while the impairment in blood vessel function occurred later but lasted as long as 24 hours.
It’s believed these fine particles deposit deep into the lungs and certain components may gain entrance to the blood stream, or cause an inflammatory response throughout the body. There is also evidence that functions in the body’s nervous system are also disrupted.
The research is the latest in the relatively new field of environmental cardiology which looks at the association between air pollution and heart disease. Brook says the findings support efforts to maintain current ambient air quality standards set by the Environmental Protection Agency.
“It really bolsters and strengthens the importance of maintaining air quality for human health,” says Brook.
There are practical ways to avoid exposure to high levels of air pollution, such as avoiding unnecessary travel or commutes and not exercising during rush hour, or near busy roadways, Brook says. In modern society, the burning of fossil fuels is the primary source for air pollution.
“If air pollution levels are forecasted to be high, those with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity,” he says.
http://www.emaxhealth.com/
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