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  1. Statins 'do not work' for half of people prescribed them, study reports "Statins are not effective at lowering cholesterol levels for half of patients," the Daily Mirror reports. Statins are a widely used and well-established medicine for lowering cholesterol. A large body of evidence has shown that statins are effective in reducing so-called "bad cholesterol", which in turn can reduce the risk of heart disease and stroke. A new study assessed GP records for more than 160,000 patients in the UK who'd had a cholesterol check in the 2 years after they started statins. Half of patients did not have an adequate response to statins: their cholesterol levels had reduced by less than 40%. These patients had a slightly higher risk of future cardiovascular problems than those who'd had a good response. But this does not mean statins do not work. We do not have enough information about the people who did not respond to statins, such as whether they took the medicine as prescribed. And those who did not respond to statins tended to be on lower doses than responders. Whether some people could be less responsive to statins needs to be looked into. The study also highlights the need for doctors to monitor a patient's response and change their medication if needed. People prescribed statins should not stop taking them. This could increase their risk of having a heart attack or stroke. You should speak with your doctor if you have concerns. Find out more about preventing complications from high cholesterol Where did the story come from? This study was carried out by researchers from the University of Nottingham and was funded by the same institution. The article was published in the peer-reviewed journal Heart. The UK media reported the study accurately and included some helpful commentary from independent experts. What kind of research was this? This cohort study looked at a large number of people who were prescribed statins to see the effect this had on their cholesterol levels. A randomised controlled trial (RCT) is the best way to directly look at the effects of a medicine, where you can compare the effects of a treatment like statins with no treatment or with another cholesterol-lowering medicine. But a practical drawback is that RCTs can be both expensive and time consuming to carry out. Cohort studies are often used to assess the effects of medication because they allow you to study many more people than you can usually include in a RCT and follow them for longer periods of time. The disadvantage is that you cannot account for differences between people who do and do not respond to statins. What did the research involve? The study used the GP records database (UK Clinical Practice Research Datalink) to identify 183,213 patients who started taking statins between 1990 and 2016. Eligible patients had to have at least 2 cholesterol measures taken: 1 in the 12 months before taking statins and 1 in the 24 months after starting statins. The researchers excluded anyone who'd experienced cardiovascular problems, such as a heart attack or stroke, before starting statins. This left them with data for 165,411 patients (47% women), who had an average age of 62. They looked at the number of patients who'd failed to achieve at least a 40% reduction in their low density lipoprotein (LDL) "bad" cholesterol. This is the adequate treatment response currently recommended in national guidelines. They also looked at whether there were any cardiovascular events like a heart attack or stroke. The researchers adjusted for various confounding factors that may influence the results, such as: age baseline cholesterol levels how long the patients were on statins use of other medications blood pressure history of smoking alcohol use socioeconomic status What were the basic results? They found half of the patients assessed (51%, 84,609) did not achieve an adequate 40% reduction in their LDL cholesterol levels. Non-responders were more likely to have been prescribed lower strength statins. For example, 29% of non-responders were taking low dose and 66% medium dose, compared with 18% low dose and 76% medium dose among responders. Non-responders had a slightly higher risk of future cardiovascular problems than responders (adjusted hazard ratio 1.22, 95% confidence interval [CI] 1.19 to 1.25), though the actual difference was fairly small. Over the course of 10 years on statins, 22.6% of non-responders would experience a cardiovascular problem, compared with 19.7% of responders. How did the researchers interpret the results? The researchers concluded: "Optimal lowering of LDL cholesterol is not achieved within 2 years in over half of patients in the general population initiated on statin therapy, and these patients will experience significantly increased risk of future [cardiovascular disease]." Conclusion This valuable study made use of a large number of general practice records to look at the cholesterol response of hundreds of people taking statins. It shows that half of people on statins are not achieving the required 40% reduction in their LDL cholesterol levels. This is of some concern and highlights a need for doctors to look into this further to find out why this might be the case. For example, it could be that statins do not work so well for certain people. But there are a few points to consider. The researchers adjusted for many factors that could influence the results, but we do not know enough about the individuals to be sure there are not any differences between responders and non-responders that could have affected the results. For example, we do not know whether the participants took the medication as prescribed. Those who did not respond to statins did have a higher risk of further cardiovascular problems. But the absolute size of the difference was still fairly small: only a 3% risk increase over the course of 10 years. Notably, those who did not respond were on lower doses, but the study cannot tell us that specific statins or particular doses "do not work" because we do not know enough about why doctors prescribed as they did. Importantly, the results of this study do not apply to people who have been prescribed statins after a previous heart attack or stroke: they will nearly always be prescribed higher dose statins. The study highlights the need for doctors to review the cholesterol response in people who take statins. National guidelines recommend that people who have been started on statins should have their cholesterol rechecked after 3 months. If they have not achieved at least a 40% reduction in LDL cholesterol, the guidelines recommend: checking that the person is taking the medication as prescribed promoting general healthy living advice through diet and exercise considering increasing the dose It's important that people do not stop taking statins without speaking to their doctor, as this could increase their risk of having a heart attack or stroke. https://www.nhs.uk/news kalip
  2. Pig brains partially revived hours after death—what it means for people In a feat sure to fire up ethical and philosophical debate, a new system has restored circulation and oxygen flow to a dead mammal brain. Scientists have restored cellular function in 32 pig brains that had been dead for hours, opening up a new avenue in treating brain disease —and shaking our definition of brain death to its core. Announced on Wednesday in the journal Nature, researchers at the Yale University School of Medicine devised a system roughly analogous to a dialysis machine, called BrainEx, that restores circulation and oxygen flow to a dead brain. The researchers did not kill any animals for the purposes of the experiment; they acquired pig heads from a food processing plant near New Haven, Connecticut, after the pigs had already been killed for their meat. And technically, the pig brains remained dead—by design, the treated brains did not show any signs of the organised electrical neural activity required for awareness or consciousness. “Clinically defined, this is not a living brain,” says study co-author Nenad Sestan, a neuroscientist at the Yale University School of Medicine. The new system instead kept the brains in far better shape than brains left to decompose on their own, restoring functions such as the ability to take in glucose and oxygen for up to six hours at a time. Researchers say that the technique could give a major boost to studies of human health by providing a rich testbed for studying brain disorders and diseases. The brain constitutes only about 2 percent of the human body, yet it is responsible for all of the body's functions. Learn about the parts of the human brain, as well as its unique defences, like the blood brain barrier. “We're really excited about this as a platform that could help us better understand how to treat people who have had heart attacks and have lost normal blood flow to the brain,” adds Khara Ramos, director of the Neuroethics Program at the U.S. National Institute of Neurological Disorders and Stroke. “It really enhances our ability to study cells as they exist in connection with each other, in that three-dimensional, large, complicated way.” Even so, the finding opens up considerable ethical questions, a conversation that the researchers themselves welcome. “This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain,” says Nita Farahany, a bioethicist at the Duke University School of Law who wrote a commentary about the study for Nature. “It [also] challenges a lot of the fundamental assumptions that we had in neuroscience, like that once there is a loss of oxygen to the brain, it’s an irreversible march toward organismal death,” she adds. “That turns out not to be true—and because that’s not true, there's some pretty profound ethical and legal issues that are raised as a result.” Defining death Death is final, but the number of truly irreversible medical outcomes has shrunk over time. For millennia, people were considered dead when they stopped breathing and their hearts ceased to beat. But then modern medicine intervened. The invention of mechanical ventilators allowed failing bodies to be kept alive for longer, and decades of improvements to heart surgery and transplants mean that even a stopped heart might not necessarily be the end. But the brain remains a finicky patient. Mammal brains such as ours are high-performance machines; they demand a constant stream of oxygen-rich blood to work to their fullest. If blood flow is cut off, we lose consciousness after just a few seconds. Within five minutes, the brain's stores of vital molecules such as glucose and ATP—the body's universal currency for chemical energy—run out. The brain then enters a death spiral that, up to now, scientists considered irreversible: Nerve cells' delicate chemistries get thrown out of whack, a build-up of carbon dioxide makes the brain's blood more acidic, and leaks of a powerful neurotransmitter called glutamate quickly become toxic. Soon, enzymes that break down nerve tissue come online, and the brain's smaller structures and blood vessels rupture and break. The more researchers understood this process, the more they incorporated it into the definition of death itself. In 1968, a committee of doctors assembled by Harvard University put forth a landmark definition of “irreversible coma,”what we now call “brain death”: a total lack of responsiveness, the inability to breathe on one's own, a total lack of reflexes, and no signs of large-scale electrical activity in the brain. Now, the American Academy of Neurology maintains a checklist that clinicians use to judge brain death in patients. But there have been hints of greater brain resilience. Some parts of brain cells, such as the mitochondria that process chemical energy, still work up to 10 hours after death. In cats and macaques, researchers have successfully made brains recover after a full hour cut off from blood by carefully restoring circulation. And in humans, some medical case studies point to a brain that can bounce back. In 2007, researchers reported that a woman suffering from acute hypothermia—with a body temperature less than 65 degrees Fahrenheit—made a full neurological recovery. Working, but not aware Sestan and his colleagues, led by Zvonimir Vrselja and Stefano Daniele, resolved to test a complex mammal brain's ability to recover, so they devised what they call the BrainEx system. BrainEx consists of computer-controlled pumps and filters that send a nourishing solution through a dead, surgically exposed brain, with an ebb and flow that mimics the body's natural circulation. The proprietary solution is based on haemoglobin, the oxygen-ferrying protein in red blood cells, and is made to show up in ultrasound scans, so researchers can track its flow through the brain. Yale University has filed a patent for the system on behalf of its creators, but all of BrainEx's parts and procedures will be freely available to non-profit and academic researchers. The team took steps to ensure that the brains would not “wake up” in any way, let alone have awareness of the procedure's trauma. Though none of the brains in the experiment showed any sign of awareness, researchers stood at the ready to administer anaesthesia and lower the brains' temperatures, just in case. What's more, the team added compounds in the solution to block neural activity, which served the extra goal of resting the brains' cells to give them better odds of healing. “It was in fact never a goal—and even sort of the opposite of a goal—of the research to have consciousness restored,” says study co-author Stephen Latham, director of the Yale Interdisciplinary Centre for Bioethics. First, the team checked to see whether BrainEx could restore circulation in the brain, even in its tiniest blood vessels. It does. Researchers also confirmed that the brain's blood vessels were in good enough shape that they could dilate in response to medications. Next, the researchers checked how well BrainEx preserved the overall structure of brain tissue. For the most part, BrainEx-treated brains looked comparable to brains in living animals or untreated brains an hour after death, and they were far more intact than untreated brains examined 10 hours after death. Brain areas that are especially sensitive to oxygen loss, such as the hippocampus, also preserved well under BrainEx, as did the structures of individual neurons. And as they monitored the chemical differences in the solution flowing into and out of the brain, researchers found that the brain was making CO2 and using up glucose and oxygen—signs of brain-wide metabolism restarting. Though researchers ensured that the experimental brains wouldn't have large-scale activity, they took small slices of brain tissue to test whether individual hippocampus neurons could still fire after treatment. They could. “[That result was] the most surprising aspect to me as a working neuroscientist,” says Allen Institute for Brain Science director Christof Koch, who wasn't involved with the study? “They were still capable of generating the spikes that are the universal idiom of fast electrical communication. It means that in principle, those neurons seem capable of neural activity.” Ethics of animal research The BrainEx team is acutely aware of the ethical implications of its work, which is why they have consulted with leading neuroscientists and ethicists for years. The Neuroethics Working Group, a consortium convened by the U.S. National Institutes of Health's BRAIN Initiative, which funded the research, has been consulting with Sestan since 2016. The researchers also presented their work at a 2017 bioethics conference at Duke University and at a 2018 NIH workshop. “Cutting-edge science needs cutting-edge ethics,” says Ramos, who serves as the Neuroethics Working Group's executive secretary. “There is an existing, robust framework of laws and policies that our funded researchers are expected to follow, but the development and application of new neuro-technologies may require us to examine those ethical standards, and for those standards to evolve.” For one, the technique opens up questions about the ethical use of non-human animals in experiments. As it stands, two sets of rules apply, one for live animals and another for dead animal tissues, since live animals can experience pain or distress. But which rules apply to BrainEx-treated brains from dead animals, especially if there is a chance, they could be partially reawakened? “There's this kind of gaping hole in our protections of animal research subjects, [since] we now have this part-revived, slightly-alive category with the potential—and, as of yet, not fully understood potential—for recovery of function,” says Farahany, who is also a member of the Neuroethics Working Group. “If you're seeking to revive pig brains, or other animal brains, does that mean that that becomes an animal research subject, rather than dead tissue?” Experts add that the ethical trade-off here hinges on BrainEx's ability to further research into human disease—or even save people from brain death. “We cannot willy-nilly impose, just for our curiosity, pain or agony on another creature unless there's a very good motive and the appropriate experiments,” Koch says. “Can this be used to rescue brains? Not just gee-whiz, let's see what happens here.” Experts also say that BrainEx's ethical implications extend to the next logical question: Would it work on humans? On a technical level, Koch says that would not be a major leap, since both pigs and humans have large, complexly folded brains. But Koch and every other outside expert contacted by National Geographic urged caution in moving toward human trials. On even broader horizons, future versions of BrainEx could complicate the process of organ donation by blurring the lines of brain death, note Case Western Reserve University bioethicists Stuart Youngner and Insoo Hyun in an accompanying commentary published in Nature. But Kevin Cmunt, CEO of Gift of Hope, one of the United States's largest organ donation networks, doesn't see BrainEx as a major disruption. He says that in many cases, organ donors who are declared brain-dead have suffered oxygen loss well beyond the study's time window, or substantial physical trauma. (Other researchers are creating human-pig chimeras to advance organ transplant options.) “I think that in the vast majority of brain-dead donors, this intervention would not be material,” he says. “There may be a small subset of cases where [brainEx] could impact the opportunity for donation, but I think it's relatively small.” And if BrainEx does appear in clinics, Cmunt adds that it would be incorporated into the list of interventions before declaring someone brain-dead or deciding to end life support. The promise of brain recovery could even improve organ donations by giving medical professionals an even greater imperative to maintain circulation. Then, if the patient is declared brain-dead even after treatment with BrainEx, their organs could be more viable for donation than they would be otherwise. “I don't necessarily see this as a conflict,” Cmunt says. “These treatments would certainly be a part of care, just like hypothermia protocols are a part of care, and other things that we try to do to stop damage to organs and brains.” Only the beginning At its most profound, the discussion around BrainEx shows how gains in knowledge and improvements in treatments have shifted the definition of death itself. “Imagine you're standing in the clinic, your dad is declared brain-dead, and you've just read this paper. You ask the surgeon, Well, what does brain-dead mean? He says it's irreversible loss of brain function, and you say, Well, wait a minute, there was this paper—doesn’t that mean that 'irreversible' today may not be 'irreversible' tomorrow?” Koch says. BrainEx's space on the border of life and death echoes science fiction—and at its most lurid, people may well think of Frankenstein and the prospect of resurrecting the dead. But Farahany cautions that we are still many miles away from that feat. “It is definitely has a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there,” she says. “They did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility.” https://www.national...hic.com/science kalip
  3. Will You Get Fat? Genetic Test May Tell As obesity becomes epidemic among Americans, many could over- or underestimate their odds for piling on the pounds. But a new genetic "score" might take the guesswork out of all of that, researchers say. Using information on more than 2 million gene variants linked to body weight, the scientists created a so-called polygenic score that may help quantify a person's obesity risk. The investigators found that adults who scored in the top 10% weighed 30 pounds more, on average, than adults who scored in the bottom 10%. And they were 25 times more likely to be severely obese. "We're not saying this is destiny," said researcher Dr. Amit Khera of the Broad Institute and Massachusetts General Hospital, in Boston. "Any one person's weight results from an interaction of genes and environment." But severe obesity, in particular, appears to have a strong genetic influence. That's not exactly a surprise. But Khera said a clearer understanding of the importance of genes might help lessen some of the stigma around severe obesity. So does this mean doctors will start presenting parents with their baby's obesity-risk score? Probably not any time soon. Ruth Loos, a researcher who was not involved in the study, was sceptical about the value of the genetic score. Weight and obesity are about 50% genetic and 50% lifestyle choices and environment, according to Loos, director of the Genetics of Obesity and Related Metabolic Traits Program at Mount Sinai, in New York City. The score used in this study, she said, does not account for all of that heritability. Even if it did, that would only be part of a complex story. "We can't use a single genetic score to accurately predict obesity," Loos said. "We would end up misinforming a lot of people." The scoring approach, described April 18 in the journal Cell, was developed using data on 2.1 million genetic variants linked to body weight. Khera's team used recently developed computational algorithms to distil that genetic information into the scoring system. Next, they applied it to people involved in four long-running health studies in the United Kingdom and the United States -- three of young and middle-aged adults, and one of children. Overall, the researchers found, the higher a person's genetic scores, the more he or she typically weighed. And the risk of severe obesity was particularly high among people who scored in the top 10%. Among young U.S. adults in that bracket, for instance, almost 16% became severely obese over the next 27 years. That compared with just over 1% of young adults whose genetic risk scores were in the bottom 10%. Khera noted that the effects of a high-risk score started to become apparent as early as age 3. However, many people with even the highest genetic risk scores did not become obese. In a large study of middle-aged U.K. adults, more than half were not obese, though few were normal weight. Loos said the score's predictive value appears to be "not even better than family history." Khera acknowledged some pitfalls of using a score to predict future weight: Some people might become "defeatist" and see no point in exercising and eating healthfully. "We'd want to use this information to improve people's health," Khera said. "So there are many questions we're asking: When would we tell people? How would we tell them? How would we track the effects that information has on their health outcomes?" Loos worried that a genetic risk score would "needlessly scare" some people and could also cause those with a low score to falsely believe they can eat whatever they want and skip exercise. She said the "real value" of studying the genetics of obesity is to better understand the underlying biology. Why are some people susceptible to packing on weight, while others aren't? Khera agreed, and added that it will be important to figure out why people with a very high genetic score manage to avoid excessive weight gain. Khera and colleague Dr. Sekar Kathiresan are listed as co-inventors on a patent application for the genetic risk predictor. More information The U.S. Centres for Disease Control and Prevention has more on the genetics of obesity. https://consumer.healthday.com/ kalip
  4. AHA News: Scared to Exercise After a Heart Attack? It's Probably Scarier If You Don't Exercise is good for you. But for people who have had a heart attack, starting or resuming a workout routine may sound scary, exhausting, complicated -- in short, the last thing they'd want to do. Instead, it probably should be one of the first. "We're trying to make it clear that exercise is as much a part of the standard of care as aspirin or statins or beta blockers," said cardiologist Dr. Benjamin D. Levine, director of the Institute for Exercise and Environmental Medicine and a professor of medicine and cardiology at UT Southwestern Medical Centre in Dallas. That hasn't always been the case, said Kate Traynor, director of the cardiac rehabilitation program at Massachusetts General Hospital's Corrigan Minehan Heart Centre. "When I was a nurse in the 1970s, I can remember they kept people in bed after heart attacks," said Traynor, who is also president of the American Association of Cardiovascular and Pulmonary Rehabilitation. Now, she said, patients are up walking soon after surgery. Research abounds on the benefits. A recent Swedish study found heart attack survivors who identified as "constantly active" had a 71 percent Lower risk of death than the "inactive" participants. A 2017 review of research found heart attack survivors who receive cardiac rehab were 53 percent less likely to die from any cause and 57 percent less likely to die from heart-related causes than survivors who did not get cardiac rehab. "Exercise preserves the strength and flexibility of the heart and enables blood vessels to relax," Levine said. "It helps improve lipids and blood pressure and reduces cardiovascular strain during daily activities." A major key to reaping the benefits of exercise is incorporating it into a lifelong habit. "Sometimes people have an epiphany after a heart attack and that makes it easier for them to come around in their lifestyle," Traynor said. "But many people after a heart attack are just not really ready yet." Maybe they're depressed or afraid to make changes, experts say. "What I think is that people are frightened after a heart attack, and they're not sure what they're capable of doing, whether recreational exercise, occupational exercise, even sexual relations," Levine said. That's where cardiac rehabilitation can help, he said. "Everyone who has a heart attack should go through a period of cardiac rehabilitation. It helps people get past that initial fear and get control of all the risk factors within a multidisciplinary approach after a cardiovascular event." In cardiac rehab, cardiologists, cardiac nurses, physical therapists, exercise specialists, mental health counsellors and nutritionists team up to support each patient. And thus, Traynor said, reduce the risk of another heart attack. Starting small leads to attainable goals, she said. "We help them have successes being on the treadmill or bike and feeling, 'OK, maybe there's more to this.' It becomes more self-fulfilling and keeps them going." Unfortunately, only about a third of heart attack survivors report receiving cardiac rehab, according to the Centres for Disease Control and Prevention. In Dallas, the cardiac rehab clinic at Parkland Health & Hospital System recently added high-intensity interval training (HIIT) -- short bursts of activity with short rest periods -- for heart disease patients who meet certain criteria. With HIIT, 15-minute sessions can be as effective as 60 minutes of a lower-intensity workout, according to some studies. HIIT helped Parkland patient Jesus Rodrigo Sanchez feel better and to believe in himself. The 60-year-old, who has a family history of heart disease, had bypass surgery in December. "It was hard at first," said Sanchez, who bought an elliptical machine to use at home, "but the rehab staff promises they won't give you anything you can't do. didn't believe I could, but now I'm walking 2.8 mph at level 4 incline." For patients whose doctor has not recommended cardiac rehab, Levine suggests they ask for a referral. "Exercise is just really important to aid return to a normal life." https://consumer.healthday.com/ kalip
  5. Is Yoga Heart-Healthy? It's No Stretch to See Benefits, Science Suggests For years, aerobic exercise has been touted for its numerous health benefits, including improved cardiovascular health, better mood, increased energy, and stronger bones and muscles. But there's another form of physical activity that's grabbing headlines -- yoga. Some studies suggest the mind-body practice may be good for heart health, from reducing blood pressure and cholesterol to lowering stress and body mass index. While yoga often is associated with images of limber practitioners, it is more than just stretching and handstands. Originated in India, yoga includes physical poses (asana), breathwork (pranayama) and meditation. There are many yoga styles, including Hatha, Iyengar, restorative and hot yoga, each with a specific emphasis such as alignment or relaxation. Recently, more Americans are stepping onto the mat. According to the Centres for Disease Control and Prevention, 14.3 percent of U.S. adults -- or 35.2 million -- practiced yoga in 2017, up from 9.5 percent in 2012. Many take up the practice as a holistic approach to health and wellness, and for its stress-busting effect. "There's a huge body of literature that says psychosocial stressors such as work and marital stress, as well as anxiety and depression, are associated with increased risk for cardiovascular disease," said Dr. Puja Mehta, an assistant professor of medicine in the division of cardiology at Emory University School of Medicine in Atlanta. "With chronic stress, the sympathetic nervous system is in overdrive," which can lead to inflammation and increased blood pressure. Yoga may help put the brakes on the body's stress response by activating the parasympathetic nervous system, or the "rest and digest" system, through deep breathing and relaxation, Mehta said. Cultivating mindfulness also may encourage participants to engage in other habits that boost cardiovascular health by promoting self-awareness and self-care behaviours. "(This) can have a profound effect on supporting the engagement of healthy behaviours of diet and physical activity," said Dr. Gloria Yeh, associate professor of medicine at Harvard Medical School and director of mind-body research at Beth Israel Deaconess Medical Centre in Boston. Research also shows yoga may lower cardiovascular risk factors. Yeh co-authored a 2014 review of clinical research published in the European Journal of Preventive Cardiology that found yoga had a significant impact on cardiometabolic risk factors compared to doing no exercise at all. For example, yoga decreased total cholesterol by 18.48 mg/dl and triglycerides by 25.89 mg/dl more than the change seen in the control group. Blood pressure improved too. Systolic and diastolic blood pressure decreased 5.21 mmHg and 4.98 mmHg, respectively. The benefits also extend to people with heart disease. Among people with paroxysmal atrial fibrillation, in which symptoms come and go, doing 12 weeks of yoga combined with deep breathing resulted in a lower heart rate, lower blood pressure and higher mental health scores compared to those who didn't do yoga, according to a 2016 study published in the European Journal of Cardiovascular Nursing. Mehta said although these and other scientific studies show promising results, there are some limitations, such as a small number of participants. In addition, because yoga encompasses a variety of elements, there isn't a standard dose of yoga, which makes comparisons across studies difficult, she said. Both Yeh and Mehta said more research is needed, including more randomized clinical trials and a better understanding of the exact mechanism behind yoga's cardiovascular benefits. "We need to better understand for whom yoga may be more beneficial and how," Yeh said. "Because yoga is so heterogeneous with many different styles and emphases, we'd like to be able to match the right exercises with the right people at the right time. We need to understand how best to integrate yoga with other lifestyle measures." And the biggest research question remains, Mehta said: "Are you going to live longer and not have cardiovascular events like heart attack or stroke?" For older adults and people new to yoga, Mehta recommends looking for gentle, restorative or chair-based classes. People with heart disease or high blood pressure may need to modify some poses and avoid postures that place the head below the heart, she said. Experts also suggest pregnant women in particular steer clear of "hot yoga," or yoga classes that take place in a heated room, because of the risk of overheating and dehydration. The bottom line, Yeh said, is that yoga is exercise and "any exercise is better than no exercise, so the activity that someone will do -- and enjoy doing -- will be the one that provides the most benefit." https://consumer.healthday.com/ kalip
  6. Grief, Divorce Can Really Tax the Heart For some people, the stress of dealing with a particularly rough patch in life or trauma may also strain the heart, a large new study suggests. The research, based on over 1.6 million Swedish adults, found that those diagnosed with a stress-related disorder faced a higher risk of suffering a heart attack or other cardiovascular trouble over the next year. The disorders ranged from adjustment disorder -- which comes in response to difficult times like a divorce, death of a loved one or financial troubles -- to post-traumatic stress disorder. PTSD is diagnosed when a person has lingering and severe stress reactions after a life-threatening event -- such as a serious accident, a natural disaster or an assault. The findings do not prove that those stress disorders actually triggered heart complications, experts said. But there are reasons to believe they contributed, according to Simon Bacon. He is co-director of the Montreal Behavioural Medicine Centre and author of an editorial published with the study. Previous research has found links between mental health conditions (including depression) and poorer cardiovascular health. And, in general, it's thought that there could be direct and indirect reasons, Bacon explained. Stress disorders may have effects on the nervous system that alter blood pressure, heart rate and blood clotting, for example. Plus, Bacon said, people with mental health conditions can have a tough time maintaining a healthy lifestyle, or taking care of any physical health problems they have. "We do know something about the 'how,'" Bacon said. "And I do think this is a real phenomenon." Still, even if stress disorders raise the odds of suffering cardiovascular trouble, the absolute risk to any one person would be small. "I'd be more worried about someone who smoked than about someone with PTSD," Bacon noted. That said, he encouraged people to seek help if they are having trouble dealing with a trauma or difficult life event. Talk therapies, and sometimes medication, can be "very effective," Bacon said. "We don't know if that will prevent cardiovascular disease," he added. "But these are important disorders unto themselves, and you want to address them." The new study findings were based on medical records from nearly 137,000 Swedish adults diagnosed with stress-related mental health conditions -- mainly PTSD, acute stress disorder and adjustment disorder. Acute stress disorder is similar to PTSD, according to the U.S. Department of Veterans Affairs (VA). The difference is in the timing: Acute stress disorder arises in the first month after a trauma; PTSD is diagnosed only after symptoms have lasted for a month. The stress-disorder group was compared with over 171,000 of their siblings, and 1.3 million people from the general population . Overall, the study found, people with stress disorders suffered a "cardiovascular event" at a rate of eight per 1,000 in the first year after the diagnosis. While that's a fairly low figure, it was almost twice that of their siblings, and higher than the population norm. The researchers, who were led by Huan Song, a postdoctoral fellow at the University of Iceland and Karolinska Institute in Stockholm, then took into account for other factors -- such as income, education and any additional mental health diagnoses. Those with stress disorders were still at risk, especially in the first year after their diagnosis. Compared with their siblings, their odds of heart disease or stroke during that year were 64% higher, the findings showed. The greatest difference was seen with heart failure: People with stress disorders had a sevenfold higher risk than their siblings. The report was published online April 10 in the BMJ. It's possible some of those heart failure cases reflect "broken-heart" syndrome, said Dr. Salim Virani, a cardiologist at Baylor College of Medicine and the DeBakey VA Medical Centre, in Houston. That phenomenon happens when severe stress triggers a sudden heart muscle weakness -- causing symptoms like shortness of breath and chest pain. Overall, though, it's difficult to know exactly what's behind the findings, said Virani, who is also with the American College of Cardiology. He noted that the patients were young -- typically in their mid-30s -- when they were diagnosed with a stress disorder. And in young people, Virani said, substance abuse (such as drugs or alcohol) may be behind sudden cardiovascular problems. "This study did not account for substance abuse," he said. "So it's not clear whether that played a role." Virani agreed, though, that stress disorders could have both direct and indirect effects on the heart -- and doctors and patients should be aware of that. More information The American Heart Association has more on mental health and heart health. https://consumer.healthday.com/ kalip
  7. Why should I care about high cholesterol in men? High cholesterol, also called hypercholesterolemia, puts men at greater risk for heart attacks, strokes, and peripheral artery disease. For many men, the risk from high cholesterol starts in their 20s and increases with age. High cholesterol tends to run in families, so obviously genes play a role. But a variety of lifestyle choices -- including diet, activity, and body weight -- also affect cholesterol levels. The only way to know how high your cholesterol levels are is to get a simple blood test. Everyone over 20 should get a cholesterol test at least once every 5 years. If your numbers are high, your doctor may recommend the test more often. What is high cholesterol? Cholesterol is a waxy, fat-like substance made in the liver and other cells. It’s also found in certain foods, such as dairy products, eggs, and meat. Your body needs some cholesterol to produce hormones, vitamin D, and the bile acids that help you digest fat. But the body only needs a limited amount of cholesterol. When there’s too much, health problems, such as heart disease, may develop. There are different kinds of cholesterol, and if there’s too much of certain kinds in your blood, a fatty deposit called plaque can build up on the walls of your arteries. It’s like rust on the inside of a pipe. This plaque build-up can block blood flow to the heart muscle, reducing its oxygen supply. If levels of blood and oxygen to the heart drop far enough, you may start feeling chest pain or find yourself short of breath. A heart attack happens when the plaque completely blocks a blood vessel feeding a section of the heart muscle. If the plaque blocks a blood vessel going to your brain, you can have a stroke. The cholesterol that blocks arteries is called low-density lipoprotein, or LDL. Another kind of cholesterol called high-density lipoprotein or HDL is known as good cholesterol because it helps remove LDL from the blood and eventually from the body. For good health, you ideally want to keep the LDL levels down and the HDL levels up. If this balance isn’t maintained, especially if it’s reversed, you are said to have high cholesterol. What are the risk factors for having high cholesterol? Your risk of having high cholesterol increases if: Your diet is high in saturated fat. These fats, found in meat and full-fat dairy products, raise LDL cholesterol. Dietary cholesterol, found in eggs and organ meats, can also raise blood cholesterol levels, but not as much as saturated fat does. You eat foods containing trans fats. These are artificially made fats found in partially hydrogenated oils. They raise LDL cholesterol and lower HDL cholesterol -- exactly the wrong combination. You eat processed foods or foods high in carbohydrates. These types of foods have also been shown to increase LDL cholesterol. You are overweight or obese. Excess weight increases LDL and lowers HDL. You don’t get much exercise. Studies show that frequent exercisecan boost HDL, the good cholesterol. Lack of exercise can lead to weight gain. How does the doctor know I have high cholesterol? There are two different types of cholesterol tests. The simplest measures total cholesterol levels in the blood. Most doctors, though, use a lipoprotein analysis, which includes: Total cholesterol level LDL cholesterol level HDL cholesterol level Triglycerides (another fat in your blood that raises the risk of heart disease) How can I prevent high cholesterol? To reduce your cholesterol, one of the most important change to make is to cut back on the amount of saturated fat and trans fats in your diet. That means cutting back on meat and poultry -- either by eating smaller portions or eating them less often -- and choosing skim or low-fat dairy products. It also means eating less fried food, processed food, and foods high in sugar. It is also important to increase the amount of soluble fiber you eat. This form of fiber, found in oatmeal, kidney beans, and apples, for example, helps remove LDL from the body. If you are overweight or obese, losing even just a few pounds can help lower your cholesterol levels. There is no magical formula for weight loss, of course, but reducing portion sizes and cutting out things you can easily live without, such as beverages sweetened with sugar, is a good place to start. The average American now gets more than 20% of calories from beverages. Switching to water is painless and can make a big difference in total calories. Regular exercise -- as little as a brisk 30-minute walk most days -- raises HDL and may also slightly lower LDL. Exercise is especially important if you have high triglyceride and LDL levels and more than your share of abdominal fat. What are the treatments for high cholesterol? The first treatment of choice for high cholesterol is adopting a healthier lifestyle. In many people who have cholesterol in the borderline high category, healthier habits can bring the numbers down to normal. If lifestyle changes are not enough, a variety of cholesterol-lowering medications are available. The leading choice -- statin drugs -- are very effective at lowering LDL. Recent studies have confirmed that, by lowering cholesterol levels, these drugs reduce the risk of heart disease. https://www.webmd.com/cholesterol-management kalip
  8. The Link Between Migraines and Cardiovascular Disease Migraines may increase your risk of heart attack, stroke, and more Research has already established that having migraine, especially migraine with aura, increases your risk of ischaemic stroke, the most common type of stroke. Now scientists are finding that if you have migraines, you may also be at an increased risk of developing cardiovascular disease. What the Research Shows Since migraine has been consistently associated with a higher risk of stroke, studies have been looking at how this risk applies to other types of cardiovascular disease as well, such as: Heart attack Haemorrhagic stroke Heart arrhythmias (abnormal heart rate) Transient ischaemic attacks (TIAs, also known as mini-strokes) Angina (chest pain caused by decreased blood flow to your heart) Venous thromboembolism In a 2016 study, 115,541 women were followed for more than 20 years, with 17,531 of the participants reporting a migraine diagnosis. The study found that women with migraines had a 50 percent higher risk of developing cardiovascular disease, particularly heart attack, stroke, or angina. Although the overall risk is still small, it's significant when looking specifically at the population of female migraineurs. A similar 2018 Danish population study compared 51,032 people with migraine to 510,320 in the general population without, none of whom had any previous history of cardiovascular events. The researchers found that migraine is associated with a higher risk of specific manifestations of cardiovascular disease, including both ischaemic and haemorrhagic stroke, heart attack, and venous thromboembolism, in men and women. These associations were even stronger in women than in men, in people who had migraine with aura than those without, and during the first year after being diagnosed with migraine, though they persisted into the long term as well. The researchers also found something that's new to the conversation—an association between migraine and a heart arrhythmia called atrial fibrillation. The association of migraine with an increased long-term risk of cardiovascular disease suggests that migraine could be a significant risk factor for most types of cardiovascular disease, particularly stroke and heart attack. This risk is higher in women, people who have migraine with aura, smokers, and oral contraceptive users. Theories About the Connection Scientists are still scratching their heads about why this link exists, as the connection is likely complex. Here are some of the current theories on the underlying mechanisms migraine and cardiovascular disease may share. Vascular Vulnerability One theory is that the blood vessels of migraineurs may have some sort of vulnerability that influences both the development of migraine and cardiovascular disease. Endothelial dysfunction, a condition in which the deepest layer of your small arteries (the endothelium) stops working properly, is associated with both cardiovascular disease and migraine, so it's possible that it plays a part in vascular vulnerability. Inflammation Inflammation may also play a role in this connection. In fact, in one 2015 study, the combination of a statin and vitamin D (which may have anti-inflammatory effects) were found to prevent migraines—and it's already known that statins benefit your cardiovascular risk by lowering cholesterol. Hormones Because oestrogen is so closely associated with both migraine and cardiovascular disease, it may also explain the connection between the two conditions, as well as why women are at higher risk. Cardiovascular Risk Factors Migraineurs seem to have a higher number of cardiovascular risk factors, which may play a role as well. For instance, in the aforementioned 2016 study, compared to the women without migraines, the migraineurs were more likely to have characteristics that put someone at a higher risk of having a heart attack or stroke, including: High blood pressure (hypertension) High cholesterol levels Current smokers A family history of heart attacks Obesity (body mass index, BMI, of 30 or more) Another study, published in 2018, looked at the association between migraine and hypertension in 29,040 women who didn't have high blood pressure. After an average follow-up time of 12.2 years later, the researchers found that, compared to women who had no history of migraine, those who had any history of migraine had a higher risk of developing hypertension. Specifically, they found that: Women who had migraine with aura had a 9 percent higher risk. Women with migraine without aura had a 21 percent higher risk. Those with any past history of migraine had a 15 percent higher risk. Since we know high blood pressure is a risk factor for cardiovascular disease, this study's findings may be another explanation for the relationship between migraine and cardiovascular disease. Genetics Shared genetic markers that increase the vulnerability for both migraine and cardiovascular disease are another theory behind the connection. The big picture here is that a connection or an association doesn't mean that one causes the other. Instead, there is simply a link and potentially one or more shared mediators. What This Means for You There isn't yet any evidence to confirm whether preventing migraines may lower the risk of developing cardiovascular disease. It's only known that migraines seem to pose additional cardiovascular risk, especially for women. This cardiovascular risk is especially a concern for women as they get older because the risk for cardiovascular disease increases as they approach midlife and menopause. This is a result of the natural aging process and probably the decline in oestrogen that women experience as their ovaries fail and they stop menstruating. If you have migraines, there aren't currently any guidelines suggesting that your doctor should implement heart and stroke preventive measures, such as aspirin therapy, based on the presence of migraines alone. There is also no scientific data supporting the use of a migraine preventive medication in preventing another stroke in a migraineur with a history of stroke. However, if you have migraines, it doesn't hurt to ask your doctor to check for and review with you other cardiovascular risk factors—like a history of smoking, use of oral contraceptives, high blood pressure, high cholesterol, or a family history of heart attacks or strokes— which should be done for everyone anyway. A Word from Verywell Cardiovascular disease is a leading concern, especially for women as they approach midlife, whether or not you have migraines. However, having migraines may pose an additional risk. What is causing the link between migraines and cardiovascular disease needs to be determined by future scientific studies. In the meantime, take steps to be good to your brain, heart, and blood vessels by maintaining a normal weight, quitting smoking, eating a healthy diet, and exercising regularly. https://www.verywellhealth.com kalip
  9. Middle Eastern Red Pepper-Walnut Dip Ingredients 60 grams walnut halves 3 large cloves fresh garlic, cut into large pieces 1/4 cup plus 1 teaspoon olive oil 1 large jarred, roasted red pepper (about 150 grams) ½ cup thinly sliced scallion greens 1 teaspoon ground cumin ½ teaspoon smoked paprika ½ teaspoon crushed red pepper flakes ¼ teaspoon salt 2 tablespoons balsamic vinegar ½ teaspoon sugar ¼ cup finely bread crumbs Preparation Preheat oven to 175°C Place walnuts on a baking sheet. Toast until they darken slightly, about 10 minutes, stirring once or twice. Remove from the heat and set aside. While the nuts are toasting, in a small skillet combine garlic and oil on medium high heat. Cook until the oil bubbles. Reduce heat to maintain a gentle simmer and cook garlic just until it begins to turn yellow, 5 to 7 minutes. Do not brown garlic. Remove from heat and let sit for 5 minutes. Remove garlic pieces with a spoon and discard garlic. About 4 tablespoons of garlic infused oil will remain. In a food processor or blender, combine bell pepper, scallions, cumin, smoked paprika, red pepper flakes, salt, balsamic vinegar, sugar, toasted walnuts, and garlic infused olive oil. Puree 45 to 60 seconds to form a coarse paste, scraping the sides and bottom of the bowl once or twice. Add breadcrumbs and stir in or pulse until the texture is similar to pesto. If mixture is loose or watery, add 1 to 2 tablespoons additional breadcrumbs and pulse. Mixture will thicken upon standing. Serve immediately, or store in the refrigerator, tightly covered, for up to 4 days. Ingredient Variations and Substitutions Instead of using the oven, nuts can be toasted in a heavy skillet over medium heat on the stovetop. Stir nuts 3 to 5 minutes, until they are golden brown. Watch closely, as nuts burn easily.Replace homemade garlic infused oil with ¼ cup commercially prepared garlic oil. Garnish with additional chopped walnuts and olive oil if desired. To make this recipe gluten-free, use gluten-free, bread crumbs. https://www.verywellfit.com/recipes-4157077 kalip
  10. Stair Running Workouts to Build Speed and Power Advanced Training for Speed and Power If you're looking for a high-intensity workout that helps build speed, power, and cardiovascular fitness, stair running is ideal. Running stairs is also a great addition to any agility training program because it builds quickness and foot speed while providing an excellent sprint workout. Benefits of Stair Running Running stairs targets some of the largest muscles in the body, including the glutes, quads, and calves—the same muscles used for lunges and squats. Stair running is a plyometric exercise, meaning the muscles exert maximum force in short intervals of time, causing the muscles to extend and contract in a rapid or "explosive" manner. Running up stairs also forces you to work against gravity, building strength and power." Stairs are much steeper than most hills, so running stairs will make climbing hills easier. Stair running accelerates your heart rate rapidly and makes you breathe faster to take in more oxygen. This, in turn, improves your VO2max—the maximum amount of oxygen you can use during intense exercise. A 2005 NIH study published in the British Journal of Sports Medicine showed that short bouts of stair-climbing five days a week for eight weeks improved VO2max by 17 percent in women. Another study, published in a 2016 issue of BMJ Open Diabetes Research & Care, found that walking up and down stairs for 3 minutes 60 to 180 minutes after a meal lowered blood sugar levels in people with type 2 diabetes. Where to Run Stairs Many athletes run stairs at a stadium, but you can also look for a stairway in a park or other outdoor location or a stairwell in a building. If you don't have easy access to stairs where you live, be on the lookout for a hill with a fairly steep incline. Hill repeats provide a similar workout to stair running and may be slightly easier to get started with. And don't confuse stair running with using a stair climbing or elliptical machine. Running stairs requires more focus, more control, and more muscles to perform well. Plus, you don't have to join a gym or buy a pricey machine yourself. Find a good set of stairs and you're good to go. Getting Started If you haven't done stair workouts before, you should plan to start slowly and gradually build up your time and intensity. Stair running uses muscles you may not have used before, and overdoing your first workout will result in unnecessary muscle soreness. Follow these guidelines as you build up to a regular routine: Make sure you warm up thoroughly prior to your stair running workout. Walking briskly on a flat surface for five to 10 minutes is a good way to get the blood flowing and limber up. Avoid running stairs on your first few workouts. Begin by walking up the stairs, one step at a time. As you build up to a jog, keep your weight centred with your head up and eyes looking forward rather than down at your feet. By week three you can begin running, or perhaps try to take two steps at a time Use the return to the bottom as your rest interval, and then do another set Work up to about 10 sets per workout depending upon the length of your stairs. A 20 to 30-minute workout will give you plenty of intensity Add stair running into your workout routine on your high-intensity training days or as part of an interval training workout. In general, it's best not to do more than two stair workouts a week. What Goes Up Must Come Down Walking down the stairs may seem to be a breeze after running up them, giving you a chance to catch your breath. Going downhill also has surprising benefits on blood sugar, according to research presented at the American Heart Association Scientific Sessions in 2004. However, walking downstairs puts more strain on your knees and ankles than walking up. You hit the ground harder with each step. Often, it's the descent that causes the most post-workout soreness due to the eccentric nature of the muscle contraction on the way down the stairs. So if you are new to stair workouts, take it easy on the way down for the first several workouts. If you have significant knee issues, stair running may not be the right exercise for you. A Word From Verywell While stair running has many benefits, keep in mind that it is a strenuous exercise and may not be suitable for everyone. If you are wondering if it's safe for you, talk to your doctor before beginning a stair running program—and always stop your workout if you notice any aches, pains or other injury warning signs. https://www.verywellfit.com kalip
  11. Can you boost your memory by walking backward? A study shows that moving in reverse may help with short-term memory. Lost your car keys? Instead of retracing your steps, you might want to try walking backward to jog your memory. A study published in the January issue of Cognition found that people who walked backward, imagined they were walking backward, or even watched a video simulating backward motion had better recall of past events than those who walked forward or sat still. Why? That's still something of a mystery, says Dr. Daniel Schacter, the William R. Kenan, Jr., Professor of Psychology in the Department of Psychology at Harvard University. It's possible that people associate going backward with the past and this somehow triggers a memory response. "We know it can't have anything to do with how they've encoded the information," says Dr. Schacter. After all, people weren't walking backward when they stored the memories tested in this study. It may take future studies to shed additional light on the issue. "But I found the results intriguing," says Dr. Schacter. Testing the effects of motion Researchers decided to test the effect of backward movement on memory because numerous past studies have found links between motion and memory. They recruited 114 people to take part in six different memory experiments. In the experiments, they showed participants a video of a staged crime, a word list, or a group of images. They then asked the participants to walk forward, walk backward, sit still, watch a video that simulated forward or backward motion, or imagine walking forward or backward. The participants then answered questions related to the information they saw earlier. In all cases, people who were moving backward, thought about moving backward, or saw a video depicting reverse motion were better able to recall the information they had been shown earlier, compared with those sitting still. In five of the six experiments, memory was better when people moved backward than when they moved forward. On average, the boost in memory lasted for 10 minutes after people stopped moving. In the staged crime experiment, for example, participants watched a video of a woman, sitting in a park, who has her bag stolen. Researchers tested how well people could answer 20 questions about the simulated crime, depending on the direction they moved or if they sat still. They found that people who walked backward were significantly more likely to answer more questions correctly, regardless of how old they were or other factors. The findings suggest that this motion strategy might be a means of helping people better recall past events. Improving memory recall Dr. Schacter says backward motion could one day be added to existing techniques already in use to boost memory. One such method is called a cognitive interview. The interviewing technique helps people to recall details of a recent event, for example, if they witnessed a crime. "What interviewers are trying to do is get as much accurate information as they can without inducing a false memory," says Dr. Schacter. They do this by metaphorically walking the person through the event forward and backward. It's possible that literally walking backward may do something similar in the brain, he says. Using backward motion could potentially augment the cognitive interview or be used as a separate technique, he says. One key question that remains to be answered, however, is whether the technique would promote accurate recall of everyday events, says Dr. Schacter. "It's really too early to say whether there would be practical applications," he says. The study authors said that future research will look to uncover not only why this technique seems to improve memory recall, but also whether motion-based memory aids could help elderly adults or people with dementia. In the meantime, will walking backward help boost your short-term memory? "This study would suggest that there are some circumstances where t his might be the case," says Dr. Schacter. "It may be worth trying." https://www.health.harvard.edu kalip
  12. Even one drink a day increases stroke risk, study finds Even light-to-moderate drinking increases blood pressure and the chances of having a stroke, according to a large genetic study in The Lancet, countering previous claims that one or two drinks a day could be protective. The UK and Chinese researchers followed 500,000 Chinese people for 10 years. They say the findings are relevant to all populations and the best evidence yet on the direct effects of alcohol. Experts said people should limit their alcohol consumption. It is already known that heavy drinking is harmful to health and increases stroke risk - but some studies have suggested drinking small amounts can be good for the health, while others indicate there is no safe level of alcohol consumption. What did the research find? The researchers, from the University of Oxford, Peking University and the Chinese Academy of Medical Sciences, found that: one to two drinks a day increased stroke risk by 10-15% four drinks a day increased the risk of having a stroke by 35% For the purposes of their study, one drink was defined as either: a small glass of wine a bottle of beer a single measure of spirits About 16 in 100 men and 20 in 100 women will have a stroke in their lifetime in the UK. So, if a group of 100 non-drinkers started drinking a glass or two every day, there would be an extra two strokes - a small increase. According to Prof David Spiegelhalter, from the University of Cambridge, that's an increase in total stroke risk of 38% for every half a bottle of wine drunk per day. He said: "It is very roughly the opposite effect of taking a statin", which are drugs prescribed by doctors to help lower cholesterol levels in the blood and prevent heart attacks and strokes. The study also found no evidence of light or moderate drinking having a protective effect, in other words, reducing the risk of stroke. When it came to the effect of alcohol on heart attack risk, the researchers said the effects were not clear cut and more data needed to be collected over the next few years. "Claims that wine and beer have magical protective effects is not borne out," said study author Prof Richard Peto, from the University of Oxford. Why China? East Asian countries are useful places to study the effects of alcohol. Many people with Chinese ancestry have a combination of genes that puts them off drinking alcohol. It causes an unpleasant reaction and makes them feel unwell. As a result, there is a wide variation of alcohol intake in China - one in three men doesn't drink and very few women do. But by comparing the health outcomes of drinkers and non-drinkers according to their genetic profile, scientists say they have been able to assess - with much more certainty than before - the direct effects of alcohol on stroke risk, distinct from any other factors. Western populations don't possess these genes, so it would be impossible to carry out a similar study here. Most studies are observational, which makes it's difficult to judge which factor is causing what effect. Dr Iona Millwood, study author and senior epidemiologist at the University of Oxford, said: "Our genetic analyses have helped us understand the cause and effect relationships." So what does this mean for me? The researchers say their key message is that there is now clear evidence of no protective effect of moderate drinking on stroke. That means drinking even small amounts of alcohol each day can increase the chances of having a stroke. This is reflected in the current UK guidance - which advises a limit of 14 units of alcohol a week, with several alcohol-free days to keep health risks low. What do other experts say? Dr Stephen Burgess, from the University of Cambridge, said there were some limitations to the study - that it only looked at a Chinese population and focused mainly on the drinking of spirits and beer, not wine. But he said the research reflected the culmination of many years of research into the impact of alcohol consumption. "It strongly suggests that there is no cardiovascular benefit of light drinking and that risk of stroke increases even with moderate light alcohol consumption," he said. "Risk of stroke increases proportionally with the amount of alcohol consumed, so if people do choose to drink, then they should limit their alcohol consumption." Prof Kevin McConway, emeritus professor of applied statistics at the Open University, said the study didn't answer every question. "It has certainly advanced what we know about the role of alcohol in some diseases but it can't be the last word," he said. "The new study doesn't tie down exactly how alcohol works to increase stroke risk but doesn't appear to increase heart attack risk." Prof David Spiegelhalter, Winton professor for the public understanding of risk, at the University of Cambridge, said the study was making him waver. "I have always been reasonably convinced that moderate alcohol consumption was protective for cardiovascular disease, but now I am having my doubts," he said. https://www.bbc.com/news/health kalip
  13. Five-minute 'needle' nose job? A speedy 'non-surgical' nose job that takes just minutes may be possible using tiny needles and an electric current, US researchers believe. Bendy cartilage structures - like ears and the tip of the nose - can be remodelled with electromechanical reshaping (EMR), they claim. It would be done under local anaesthetic, saving patients cuts, stitches and scars, a science conference in Florida heard. No human tests have been done yet. The researchers have tried EMR on animals. It was able to change a rabbit's ears from upright to bent. How does it work? Cartilage is rubbery to the touch, but is made up of tiny strands of a protein, called collagen, linked together by other small proteins. It is flexible, yet holds its shape. EMR involves passing an electric current through the tissue (via small needles) to make the cartilage pliable for reshaping. One of the researchers, Dr Michael Hill, said: "Once the tissue is floppy you can mould it to whatever shape you want." The researchers believe that once the tissue has been reshaped and allowed to 'set' or harden for a few minutes (with the current off), the change should be permanent. Dr Hill and his colleague Prof Brian Wong, from the University of California, told the American Chemical Society meeting that EMR could be useful f or treating other conditions, such as tight tendons and vision problems caused by the shape of the front of the eye (the cornea). Long way off Prof Iain Whitaker is a plastic surgeon at Swansea University Medical School and a member of the British Association of Plastic Reconstructive and Aesthetic Surgeons. He said although the work was interesting, it was much too soon to tell whether it might be something that could be offered to patients. "It's always good to look for new ways to reduce the invasiveness of surgery but it could be tricky to move this work into human trials," he said. "You'd need ethical and regulatory approval, and to know that it was safe. "If it works like the researchers hope, then I can see how it might be useful for reshaping something like prominent ears. "Noses might be a bit more limited because about a third of the nose is bone. You might be able to reshape the nasal tip perhaps." A concern is whether manipulating the cartilage might damage it. "It's not exactly clear yet how this procedure works. We don't know if the integrity will hold up and there could be a risk of adverse results," he said. Dr Hill said the procedure involves temporarily changing the acidity or pH of tissues and that it would be important to make sure this did not cause any damaging side effects before doing human trials or offering it to patients. More tests are needed. What can go wrong with a 'regular' nose job? Rhinoplasty, or nose reshaping, is an operation, done under general anaesthetic (meaning the patient is asleep), to change the shape or size of the nose. If you are getting it done for cosmetic reasons, it is unlikely that the NHS will provide it and you will have to pay (upwards of around £4,500). The surgeon may remove or rearrange the cartilage and bone in the nose and make cuts to the covering skin (open rhinoplasty) or inside the nostrils (closed rhinoplasty). Nose reshaping surgery can occasionally result in: permanent breathing difficulty damage to the cartilage wall between your nostrils an altered sense of smell heavy nosebleeds Any type of operation also carries a small risk of: excessive bleeding developing a blood clot in a vein infection an allergic reaction to the anaesthetic Source: NHS Choices https://www.bbc.com/news/health kalip
  14. Natural Approach to Angina Treatment Often a symptom of coronary heart disease or another heart condition, angina occurs when the heart muscle doesn't get enough blood. Although angina is typically marked by discomfort in the chest, pain can also affect the shoulders, arms, neck, jaw, or back. Symptoms Angina often feels like indigestion (especially in the case of stable angina) and may include the following symptoms: pain or discomfort in the chest (typically with a sensation of squeezing or pressure), possibly accompanied by pain the arms, neck, jaw, shoulder, or back nausea fatigue shortness of breath anxiety sweating dizziness Treatment Since an increase in severity of angina symptoms can indicate worsening heart health or the threat of a heart attack, it's important to closely monitor your condition and notify your doctor of any changes. You should also seek immediate medical attention if your chest pain lasts longer than a few minutes and doesn't subside after you take angina medication. Treatments for angina include the use of medication (such as nitrates, beta-blockers, and ACE inhibitors) and medical procedures (such as angioplasty and coronary artery bypass grafting). Doctors also recommend making lifestyle changes (such as following a heart-healthy diet and a safe exercise program) to help control angina. Alternative Therapies Given the serious nature of angina, it's crucial to work with a physician in managing the condition. Traditional medical treatments based on an individual's unique needs and conditions have been shown to reduce mortality when applied appropriately. There are some alternative therapies that may supplement your prescribed treatment, but keep in mind that so far, scientific support for these therapies is lacking. Talk to your doctor about using these options to help keep angina symptoms in check: 1) Hawthorn Often used by herbalists for high blood pressure, the herb hawthorn has been found in preliminary studies to aid cardiac function in people with heart disease. 2) L-Carnitine Derived from the amino acid lysine, L-carnitine occurs naturally in the body and is also sold as a dietary supplement. According to alternative medicine practitioners, L-carnitine may help to decrease the swelling that causes arteries to narrow. L-carnitine was found to improve exercise tolerance in people with stable angina in a 2000 study. 3) Yoga In a 1999 study of 93 people with angina or risk factors of coronary artery disease, researchers found that a 14-week yoga program helped improve heart health. Other relaxation techniques (such as meditation and tai chi) may help manage angina by lowering your stress levels. Causes For most people, the reduced blood flow associated with angina results from atherosclerosis (the build-up of fatty deposits in your arteries). Build up that is sufficient to cause angina, is a potentially life-threatening condition that requires medical attention. There are three different types of angina: Stable angina (which tends to flare up during periods of physical exertion or stress) Unstable angina (which doesn't follow a pattern and may signal an impending heart attack) Variant angina (which typically occurs during periods of rest) Stable angina is the most common form of the condition. Each type of angina requires a different type of medical treatment. A Word From Verywell If you're considering the use of any form of alternative medicine, talk with your primary care provider first. Self-treating a condition and avoiding or delaying standard care may have serious consequences. https://www.verywellhealth.com kalip
  15. Restenosis After Angioplasty and Stenting Restenosis refers to a gradual re-narrowing of a coronary artery after a blockage has been treated with angioplasty and stenting. If restenosis occurs, it usually happens within 3 - 12 months of the procedure. Because restenosis causes the artery to become narrow again, symptoms of angina commonly return. Restenosis was recognised as a problem in the very earliest days of angioplasty, occurring in as many as 40 - 50% of people who were treated with angioplasty alone. In fact, the reason stents were developed in the first place was to reduce the incidence of restenosis. To a large degree, stents have been successful in doing so. Even with the first generation of bare metal stents (BMS), the incidence of restenosis was substantially reduced (to roughly 20 - 30% in 12 months). Subsequently, drug-eluting stents (DES) were developed to attempt to reduce restenosis even further. In DES, the stents are coated with drugs that inhibit the tissue growth that leads to restenosis. The first generation of DES reduced the incidence of restenosis to about 15% at five years. Newer DES have reduced the rate of restenosis even further, to about 5 - 7% at five years. What Causes Restenosis? Angioplasty (and stent placement, since it is always accompanied by angioplasty) is a form of tissue trauma. During angioplasty, a catheter carrying a deflated balloon is passed across an atherosclerotic plaque in a coronary artery, and then the balloon is inflated. The inflation of the balloon compresses the plaque, thus widening the opening of the artery. A stent — a system of tiny struts — is then expanded at the site of the angioplasty, to keep the expanded artery from collapsing back down. Compression (or “smashing,” if you prefer) of the plaque is not a gentle process, and virtually always creates trauma to the blood vessel wall. Restenosis occurs as a result of tissue growth at the site of treatment. It can almost be thought of as a result of a “healing” process following the localised trauma of angioplasty. The endothelial cells that normally line the coronary artery proliferate at the site of the trauma. If this proliferation of endothelial cells becomes excessive, the cells can obstruct the blood vessel at the site of the stent. Restenosis can also occur as a result of recurrent atherosclerosis — the process that caused the coronary artery blockage in the first place. Restenosis caused by atherosclerosis tends to appear a relatively long time after the procedure — a year or more. The more typical restenosis, which is usually seen within 6 months and almost always within 12 months following the procedure, is usually caused by endothelial tissue growth. Restenosis vs. Thrombosis Restenosis is not the same as the more dreaded stent thrombosis, the sudden occlusion of a stent from the formation of a blood clot. Stent thrombosis is usually a catastrophe, since it often produces sudden and complete blockage of the coronary artery. The risk of thrombosis is highest the first few weeks or months after stent placement, but is greatly reduced with the use of platelet-inhibiting drugs. There is also a small but real risk of late stent thrombosis, thrombosis occurring a year or more after the stent was placed, and in recent years it has become apparent that antiplatelet drugs should be continued for at least one year and likely even longer. The best way to prevent late stent thrombosis, however, remains controversial. How Is Restenosis Treated? While the use of DES has greatly reduced the incidence of stent restenosis, it has not eliminated the problem. If restenosis occurs and is producing symptoms of angina, treatment usually involves a repeat procedure, typically, insertion of a second stent in the same location. Medical (non-invasive) therapy for angina is also an alternative. Coronary artery bypass surgery is another option for people with stent restenosis, especially if the restenosis recurs after a second stent. Summary Restenosis was originally the major limitation in using angioplasty and stents for coronary artery disease. As stent technology has improved, restenosis has now been greatly limited as a problem. However, the use of modern stents has introduced another management problem to the care of coronary artery disease, stent thrombosis. The best way to reduce the risk of this new problem is still being worked out. https://www.verywellhealth.com/heart-disease-4014709 kalip
  16. The Importance of Hibernating Myocardium The important concept of “hibernating myocardium” (myocardium means heart muscle) still seems to be a foreign idea to some doctors, but cardiologists are well aware of it. In some people with coronary artery disease (CAD), portions of heart muscle that appear to be severely damaged and non-functional are actually still viable and can be “revived” if the blood supply is restored. It has been estimated that between 20 to 50% of people with heart failure caused by CAD have a substantial amount of hibernating myocardium, and therefore, have the potential of realising meaningful improvement if blood flow can be restored to their cardiac muscle. The “Old” Way of Thinking About Heart Muscle Viability Traditional medical thought did not leave room for such a thing as hibernating myocardium. The heart muscle functions normally as long as there is sufficient blood flow. If the blood flow becomes insufficient to meet the needs of the heart muscle (for instance, when a person with CAD begins exercising), the muscle becomes transiently ischaemic (starved for oxygen), and angina may occur. Ischaemic heart muscle does not function normally. In fact, performing an echocardiogram during exercise is one way to diagnose ischaemia, since the echo test can visualise segments of heart muscle that fail to contract normally when they are deprived of sufficient oxygen. The way doctors traditionally thought about CAD, either the ischaemia would soon go away (because, for instance, the person with CAD would stop exercising when angina appeared), or the ischaemia would persist until a heart attack (myocardial infarction or death of heart muscle) occurred. So classically, the myocardium supplied by a diseased coronary artery could exist in one of three states: normal, ischaemic, or dead. But it turns out that heart muscle might also persist in a fourth state, a state referred to as hibernation. What Is Hibernating Myocardium? Hibernating myocardium is just what it sounds like. Like a bear hibernating through the winter, despite all appearances hibernating heart muscle is not dead, but rather has just assumed a “dormant” state. It no longer functions normally — it does not contract with each heartbeat, and is not contributing to the work of the heart. But neither is it dead. It is merely in a state of self-protective inactivity. It has shut down every one of its functions that is not immediately critical to its staying alive. Heart muscle may enter a state of hibernation when the CAD is severe enough to produce ischaemia that is chronic and relatively constant, rather than the more typical ischaemia that comes and goes relatively infrequently (which is the case in most people with angina). So, essentially, the heart muscle is never really getting enough blood flow to function normally, but it is — just barely — getting enough blood flow to stay alive. Why It's Important Hibernating heart muscle is an important concept because the muscle is still potentially viable, and the hibernation can be reversed. If the hibernating muscle’s blood supply can be restored — through bypass surgery or stenting — there’s a reasonably good chance the hibernating myocardium can “wake up,” and begin once again contributing to cardiac work. In a person with heart failure, this increased cardiac work capacity might make all the difference. There are special tests that cardiologists can do to help differentiate hibernating myocardium from heart muscle that is non-viable (that is, dead), including MRI studies, and special echocardiographic testing. Bottom Line Since this kind of testing is non-invasive and essentially risk-free, pursuing the possibility of hibernating myocardium is often entirely reasonable. If this assessment reveals a substantial amount of hibernating myocardium, then “waking up” that portion of heart muscle could potentially improve heart failure significantly and surgery should be strongly considered. https://www.verywellhealth.com/heart-disease-4014709 kalip
  17. Bad Info May Be Scaring Patients Away from Heart-Healthy Statins More than a quarter of people who could benefit from taking statins don't, and a new survey suggests that while not enough doctors are prescribing the cholesterol-lowering drugs, fears about side effects also play a part. "There is so much misinformation about statins in the media that it's clearly permeated and now is affecting people's ability to take these medications and improve their cardiovascular health," said lead author Dr. Corey Bradley. She's a researcher at the Duke Clinical Research Institute in Durham, N.C. The new survey focused on almost 5,700 older adults who'd been recommended for statin therapy, based on data kept in a national registry that tracks cholesterol management and heart disease treatment. Popular prescribed statins include atorvastatin (Lipitor), rosuvastatin (Crestor), pravastatin (Pravachol) and simvastatin (Zocor). More than 26 percent of the patients, 1,511, were not taking statins even though they'd benefit from them, the survey revealed. About 31 percent of those not taking statins said they'd tried the drugs but stopped, and another 10 percent said they turned down the medication outright when a doctor recommended it, researchers found. Side effects were the most common reason given by these folks, and they were less likely to believe statins are safe than people who used the medication. However, there's also strong evidence that doctors aren't doing everything they can to prescribe these medications for those who need them. Fifty-nine percent of adults not taking statins said they weren't because a doctor had never offered them a prescription. It's possible that some of these people were offered statins and forgot, but that in itself is damning, Bradley said. "If a patient didn't remember the conversation, it likely wasn't an effective one," she said. "We need to improve the way we frame these conversations and continue to have them." The findings were published March 27 in the Journal of the American Heart Association. Bad or misleading information circulating about statins is overwhelming doctors' efforts to get patients to take the cholesterol-fighting medications, said Dr. Nieca Goldberg, who wasn't involved with the study. She's a cardiologist and medical director of the NYU Langone Joan H. Tisch Centre for Women's Health in New York City. Estimates are that about 1 in every 10 patients have a side effect from statins, Goldberg said. Muscle aches are the most commonly reported side effect. Despite this, clinical trials have shown that the difference in muscle ache symptoms between people on statins and those taking placebos is less than 1 percent, and about 0.1 percent for people who stopped taking statins due to muscle pain, according to a December review published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology. "When patients get a new medicine, they discuss it with their friends or they look it up online, and they get so much information," Goldberg said. "Some of patients who really are concerned about taking the medicine are really only focused on the side effects. They go online and get the side effects of the medicine, and that data is not put into perspective for them by anyone." Patients were more likely to report never being offered a statin if they were female (22 percent higher odds), black (48 percent higher), or uninsured (38 percent higher). Those seen by a cardiologist were more likely to be offered a statin than those in primary care. Bradley and Goldberg said doctors need to come up with better ways to talk with patients about statins and the drugs' perceived side effects, especially if the person has stopped taking them. Despite their concerns, about 60 percent of the patients who stopped taking a statin would consider retrying it, the survey showed. "We have a tendency to view that if a patient stops a medication they were previously on, then that's a closed door," Bradley said. "This study suggests we should re-engage with the patient and discuss their concerns." Goldberg said she encourages her patients to forward their questions and concerns through a secure internet portal, "so there's a continuing dialogue. "We don't start the day wanting to prescribe medicine to everyone, but we do want to lower a person's risk, and sometimes lowering risk for heart disease involves not only diet and exercise, but needing a medication," Goldberg said. More information The Mayo Clinic has more about statin side effects. https://consumer.healthday.com kalip
  18. Can exercise reverse the ageing process? While many in their 80s and 90s may be starting to take it easy, 85-year-old track star Irene Obera is at the other end of the spectrum. Setting multiple world athletics records in her age category, she is one of a growing band of "master athletes" who represent the extreme end of what is physically possible later in life. Another is John Starbrook, who at 87 became the oldest runner to complete the 2018 London Marathon. Studies suggest regular exercise is more effective than any drug yet invented to prevent conditions facing older people, such as muscle loss. To reap the full benefits, this pattern of behaviour should be laid down in a person's teens and early 20s. What can we learn from elderly athletes? Studying master athletes - sportspeople aged 35 and over - gives us an idea of what is physically possible as we age. Analysing the world record performance times of each age group unsurprisingly reveals that physical ability does ultimately diminish, the older you get - but doesn't fall off rapidly until after the age of 70. It is reasonable to assume these top athletes have a healthy lifestyle in general; as well as exercising, they follow a balanced diet and don't smoke or drink heavily. So their results can help us determine how much of this decline is due to the ageing process itself. Can exercise reverse the ageing process? The greater health of older exercisers compared to their sedentary counterparts can lead people to believe physical activity can reverse or slow down the ageing process. But the reality is that these active older people are exactly as they should be. In our distant past we were hunter-gatherers, and our bodies are designed to be physically active. So, if an active 80-year-old has a similar physiology to an inactive 50-year-old, it is the younger person who appears older than they should be, not the other way around. We often confuse the effects of inactivity with the ageing process itself, and believe certain diseases are purely the result of getting older. Actually, our modern sedentary lifestyles have simply speeded up our underlying age-related decline. This contributes to the onset of diseases such as type 2 diabetes, cardiovascular disease and cancer. Many of us are simply not active enough. In England fewer than half of 16-24 year olds meet the recommendation for aerobic and muscle strengthening exercises; for 65-74 year-olds, it falls to fewer than one in 10. Quality of life Not only does exercise help prevent the onset of many diseases, it can also help to cure or alleviate others, improving our quality of life. Recent studies of recreational cyclists aged 55-79 suggest they have the capacity to do everyday tasks very easily and efficiently because nearly all parts of their body are in remarkably good condition. The cyclists also scored highly on tests measuring mental agility, mental health and quality of life. he younger you start exercising the better. Analysis of American adults aged 50-71 found those who had exercised between two and eight hours a week from their teens through to their 60s, had a 29-36% lower chance of dying from any cause over the 20-year study period. The study suggests active young people should keep their activity levels up, but also that those aged 40 and above may be able to become more physically active and reap similar benefits. Master athletes Martina Navratilova became the oldest main draw Wimbledon tennis champion at the age of 46 Striker Kazuyoshi Miura, 52, of Yokohama FC is the world's oldest professional footballer. Otto Thaning became the oldest person to swim the English channel at 73, while 71-year-old Linda Ashmore was the oldest woman to do the same thing. Robert Marchand cycled 14 miles in an hour in 2017 at the age of 105, setting a new record Modern problems In today's world we have largely been able to get away with problems related to our inactivity, by leaning on the crutch of modern medicine for support. But while our average life expectancy has increased quite rapidly, our "healthspan" - the period of life we can enjoy free from disease - has not. Many benefiting from projected life expectancy increases by 2035 will spend their extra years with four diseases or more, according to a study in England. While pharmaceuticals are improving all the time, exercise can do things that medicine cannot. For example, there is currently no drug available that can protect against loss of muscle mass and strength, the biggest factor in our loss of physical function. Ageing population Being more active is not only better for an individual, it is also vital for the functioning of our wider society as it ages. In 2018, almost one in five Britons were over 65, while one in 40 were over 85. The number of people aged 65 and over is projected to rise by more than 40% in the next 16 years. The average 85-year-old costs the NHS more than five times as much as a 30-year-old, analysis suggests. https://www.bbc.com/news/health kalip
  19. Are Eggs the Cholesterol Enemy Again? Eggs, a staple of the American diet, have been cast once again as a villain. It’s not specifically the eggs, but the cholesterol in eggs that seems to be the problem, according to a new study. Wait, what? Yes, it’s true. Even the researchers who worked on the study aren’t happy about it. “It’s sad news to everyone,” says study author Norrina Allen, PhD, a cardiovascular epidemiologist at the Northwestern University School of Medicine in Chicago. You might be forgiven for thinking of eggs as beyond reproach. In 2015, the experts who compile the U.S. Dietary Guidelines largely gave cholesterol a pass, saying there wasn’t enough evidence to support telling Americans to stick to a certain daily limit. WW (formerly Weight Watchers) doesn't require members to track or measure how many eggs they eat, counting them as a free food on its diet plan. As Americans have embraced low-carb diets, many have turned to eggs as a reliable protein source. According to industry data, the average American will eat more eggs in 2019 than any time for the past 20 years. But a new study of studies is once again advising caution with cholesterol, and specifically eggs, which are a rich source of the waxy fat. The average egg contains 200 milligrams -- more cholesterol than is in most fast-food double cheeseburgers. Of course, cheeseburgers have many other dietary problems, including saturated fat and sodium. Earlier versions of the dietary guidelines have advised Americans to keep their cholesterol under 300 milligrams daily. Cardiologists say they realized that people are confused. “The problem is that everybody is fixated on protein, and unfortunately Americans get a lot of saturated fat and cholesterol from animal sources of protein,” says Leslie Cho, MD, director of the women’s cardiovascular centre at the Cleveland Clinic in Ohio. “Here’s what we want to tell our patients: We’re sorry it’s so confusing. One day you have this news. Another day you have that news. It’s horrible, and I totally sympathize,” says Cho. “The totality of evidence is pretty clear, ” she says. “Eat mostly vegetables and try to limit the amount of saturated fat and dietary cholesterol,” including eggs and other products with animal fat, says Cho, who was not involved in the study. She said the new study did a good job of summing up the evidence. The research is a new analysis of six previous studies that included nearly 30,000 Americans. Those studies all took written snapshots of participants’ diets and then followed them forward in time. In some cases, people in the studies were followed for between 10 and 30 years. They found that eating just half an egg a day was linked to a 6%-8% increased risk of having a heart attack, stroke, or early death over the course of the study, compared to someone who didn’t eat eggs. What’s more, the more eggs a person ate, the more those risks increased. People in the study who averaged an egg every day saw their risk of a heart-related event such as a heart attack or stroke increase by 12% compared to someone who didn’t eat eggs. Those who averaged two eggs every day had a 24% increased risk of heart-related events. Researchers saw similarly increased risks for people who ate processed and unprocessed red meat. Bottom Line on Eggs Still Unclear Those numbers sound big, but they are what’s known in science as relative risks. The researchers also looked at absolute risks -- the risk increase to a person over a given period of time. Absolute risks are what matter most when considering how a behaviour or choice might influence your health. Over the course of these studies, eating just half an egg a day, or about three eggs a week, increased a person's risk of a heart attack, stroke or some other heart-related event by a small amount -- about 1%. It boosted a person’s risk of an early death by about 2%. Those associations held even when researchers looked at the overall quality of a person’s diet. Those who included eggs as part of a healthy diet didn’t have lower risks compared to those who ate eggs alongside less nutritious foods. Marion Nestle, PhD, is a professor of nutrition, food studies, and public health at New York University. She points out that those associations are “modest.” “Is it clinically meaningful? Hard to know,” says Nestle, who was not involved in the study. Nestle also points out that many of the studies considered for the 2015 dietary guidelines that exonerated dietary cholesterol as a risk for heart disease were funded by the egg industry. Mickey Rubin, executive director of the American Egg Board’s Egg Nutrition Centre, questioned the new study’s findings. While the findings are “interesting and point to the need for further research, Rubin said in a statement that the study is “inconsistent with multiple recent studies showing no association between eggs and heart disease risk.” This new study, he noted, had nearly 30,000 participants. A previous meta-analysis of multiple studies had more than 350,000 participants and found no correlation between egg consumption and cardiovascular risk. The new analysis is observational, which means that it can’t prove cause and effect. There could be other reasons people who ate more eggs had greater numbers of heart problems besides the eggs. But the study was also carefully done. When researchers adjusted their results to account for the effects of cholesterol by itself, the association with heart disease and death went away, giving them confidence that it was the cholesterol, as opposed to something else in eggs, that was the link. It follows a 2018 study that looked at the totality of evidence collected from 28 studies that had people eat eggs as an experiment and then looked at changes to their blood lipids. Overall, the study found eating eggs boosted total cholesterol by about 5 points compared to people who were on diets that didn’t include eggs. Most of that increase came from an increase in LDL, or “bad” cholesterol. Even though today’s news may be jarring, nutritionists say you don’t have to give up on eggs completely if they’re a regular part of your diet. “While scientists are sorting all of this out, an egg now and then does not seem unreasonable,” Nestle says. “As with everything else in nutrition, variety, unprocessed and moderation are strategies that work pretty well.” The study authors agree. “In this case, what we’re really talking about is just the cholesterol component of eggs, so the egg yolks,” Allen says. “But there are other parts of the eggs. There are amino acids and there’s choline, and those might have a benefit. So we’re not suggesting eliminating eggs from your diet. But we do recommend that people do consider them in moderation,” she says. One healthier substitution might be replacing whole eggs with egg whites, she says. Clarification: After the story ran, WW (formerly Weight Watchers) contacted us to clarify that it does not encourage members to eat any food with abandon” as our story originally stated. Instead, they say, zero-point foods are foods that don’t have to be tracked or measured on their diet plan. https://www.webmd.com/cholesterol-management kalip
  20. Docs Back Off Aspirin to Prevent 1st Heart Attack -- Millions of aging Americans worried about heart attacks and strokes have for years popped a low-dose aspirin each day, thinking the blood thinner might lower their risk. But new guidelines issued Sunday by two cardiology groups say that, for most adults, the practice may no longer be warranted. The new heart health guidelines were issued jointly by the American College of Cardiology (ACC) and the American Heart Association (AHA). The two groups agree that for older adults at low risk -- no history of heart attack, stroke or cardiac surgeries -- the risk of bleeding that comes with daily low-dose aspirin is now thought to outweigh any heart benefit. "Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease," Dr. Roger Blumenthal, co-chair of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, said in a statement. "It's much more important to optimise lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin," said Blumenthal. He's a professor of cardiology at Johns Hopkins Medicine in Baltimore. The bottom line, according to Blumenthal: "Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding." Why the change? The AHA and ACC say that the most up-to-date research shows that even at a low dose (typically 81 milligrams), the odds for dangerous bleeding that comes with daily aspirin use now outweighs any benefit. Dr. Kevin Campbell is a cardiologist working in North Carolina. Speaking with CNN, he said that advances in cardiovascular care may have also rendered daily aspirin an obsolete treatment for the average person. "For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol," explained Campbell, who wasn't involved in drawing up the new guidelines. "This makes the biggest difference," he said, "probably negating any previously perceived aspirin benefit in primary prevention." The AHA and ACC stressed that daily aspirin does have an important role to play for people at high risk -- those with a prior history of heart attack, stroke or cardiac procedures such as stenting or open heart surgery. In those cases, daily use of the blood-thinning pill "can be lifesaving," the groups said. People who find they have trouble lowering their high cholesterol or controlling their blood sugar might also be considered for daily low-dose aspirin, as long as their risk for bleeding doesn't outweigh any potential benefit, the guidelines say. But for people at low to average risk of heart disease, a healthy lifestyle is by far the best path to living a long, healthy life. "The most important way to prevent cardiovascular disease, whether it's a build-up of plaque in the arteries, heart attack, stroke, heart failure or issues with how the heart contracts and pumps blood to the rest of the body, is by adopting heart healthy habits and to do so over one's lifetime," Blumenthal said. That includes staying away from smoking, second-hand smoke and vaping, the two heart groups said. It also means sticking to heart-healthy diets that focus on fruits, vegetables, nuts, whole grains and fish. Intake of salt, saturated fats, fried foods, processed meats and sugary beverages should all be kept to a minimum. Exercise is also of great benefit to the heart: At least 150 minutes per week of moderate-intensity exercise (brisk walking, swimming, dancing or biking, for example) is recommended. According to the new guidelines, all of the steps listed above can help you stick to another recommended goal: maintaining a healthy weight. And what about cholesterol? Healthy living helps keep arteries clear, the AHA and ACC said, but if more help is needed, statins might have to be taken. "Statins should be commonly recommended with lifestyle changes to prevent cardiovascular disease among people with elevated low-density lipoprotein [LDL] cholesterol levels at or above 190 mg/dl," the two groups explained in the statement. Statins may also be indicated for people with "type 2 diabetes and anyone who is deemed to have a high likelihood of having a stroke or heart attack upon reviewing their medical history and risk factors," the AHA and ACC said. The new guidelines were presented on Sunday at the ACC's annual meeting in New Orleans https://consumer.healthday.com/ kalip
  21. New neurons for life? Old people can still make fresh brain cells, study finds One of the thorniest debates in neuroscience is whether people can make new neurons after their brains stop developing in adolescence— process known as neurogenesis. Now, a new study finds that even people long past middle age can make fresh brain cells, and that past studies that failed to spot these newcomers may have used flawed methods. The work “provides clear, definitive evidence that neurogenesis persists throughout life,” says Paul Frankland, a neuroscientist at the Hospital for Sick Children in Toronto, Canada. “For me, this puts the issue to bed.” Researchers have long hoped that neurogenesis could help treat brain disorders like depression and Alzheimer’s disease. But last year, a study in Nature reported that the process peters out by adolescence, contradicting previous work that had found new-born neurons in older people using a variety of methods. The finding was deflating for neuroscientists like Frankland, who studies adult neurogenesis in the rodent hippocampus, a brain region involved in learning and memory. It “raised questions about the relevance of our work,” he says. But there may have been problems with some of this earlier research. Last year’s Nature study, for example, looked for new neurons in 59 samples of human brain tissue, some of which came from brain banks where samples are often immersed in the fixative paraformaldehyde for months or even years. Over time, paraformaldehyde forms bonds between the components that make up neurons, turning the cells into a gel, says neuroscientist María Llorens-Martín of the Severo Ochoa Molecular Biology Centre in Madrid. This makes it difficult for fluorescent antibodies to bind to the doublecortin (DCX) protein, which many scientists consider the “gold standard” marker of immature neurons, she says. The number of cells that test positive for DCX in brain tissue declines sharply after just 48 hours in a paraformaldehyde bath, Llorens-Martín and her colleagues report today in Nature Medicine. After 6 months, detecting new neurons “is almost impossible,” she says. When the researchers used a shorter fixation time—24 hours—to preserve donated brain tissue from 13 deceased adults, ranging in age from 43 to 87, they found tens of thousands of DCX-positive cells in the dentate gyrus, a curled sliver of tissue within the hippocampus that encodes memories of events. Under a microscope, the neurons had hallmarks of youth, Llorens-Martín says: smooth and plump, with simple, undeveloped branches. In the sample from the youngest donor, who died at 43, the team found roughly 42,000 immature neurons per square millimetre of brain tissue. From the youngest to oldest donors, the number of apparent new neurons decreased by 30%—a trend that fits with previous studies in humans showing that adult neurogenesis declines with age. The team also showed that people with Alzheimer’s disease had 30% fewer immature neurons than healthy donors of the same age, and the more advanced the dementia, the fewer such cells. Some scientists remain sceptical, including the authors of last year’s Nature paper. “While this study contains valuable data, we did not find the evidence for ongoing production of new neurons in the adult human hippocampus convincing,” says Shawn Sorrells, a neuroscientist at the University of Pittsburgh in Pennsylvania who co-authored the 2018 paper. One critique hinges on the DCX stain, which Sorrells says isn’t an adequate measure of young neurons because the DCX protein is also expressed in mature cells. That suggests the “new” neurons the team found were actually present since childhood, he says. The new study also found no evidence of pools of stem cells that could supply fresh neurons, he notes. What’s more, Sorrells says two of the brain samples he and his colleagues looked at were only fixed for 5 hours, yet they still couldn’t find evidence of young neurons in the hippocampus. Llorens-Martín says her team used multiple other proteins associated with neuronal development to confirm that the DCX-positive cells were actually young, and were “very strict,” in their criteria for identifying young neurons. Heather Cameron, a neuroscientist at the National Institute of Mental Health in Bethesda, Maryland, remains persuaded by the new work. Based on the “beauty of the data” in the new study, “I think we can all move forward pretty confidently in the knowledge that what we see in animals will be applicable in humans, she says. “Will this settle the debate? I’m not sure. Should it? Yes.” https://www.sciencemag.org/ kalip
  22. Triple Tomato Pasta with Spinach and White Beans Tomatoes get their red colour from lycopene, an antioxidant that may help to prevent cancer and cardiovascular disease. Cooking tomatoes actually helps to increase lycopene content, therefore potentially boosting its disease-fighting power. In addition to lycopene, this recipe also provides great nutritional benefits from the cannellini beans. These beans are full of fibre, at 6 grams per half cup serving. They are also one of the highest potassium beans out there, a micronutrient and electrolyte that can help lower blood pressure. Ingredients 230 grams whole wheat penne pasta 1 can low sodium cannellini beans 1 tablespoon olive oil 1 package baby spinach 2 cups cherry tomatoes, diced 1 cup sun-dried tomatoes in oil ¼ cup sliced/slivered almonds 1 tablespoon tomato paste 1 teaspoon balsamic vinegar 2 cloves garlic (or 1 teaspoon minced) 2 teaspoons dried basil 1/2 teaspoon salt 1/4 teaspoon black pepper ¼ teaspoon crushed red pepper Preparation 1. Cook pasta according to package directions. 2. Combine pesto ingredients (slivered almonds through crushed red pepper) in a food processor and blend until mostly smooth; some small chunks are okay. You may need to add water to thin, but do not add more than a few tablespoons since the sauce is meant to be thick. 3. Drain and rinse cannellini beans. 4. Add olive oil to a pan and heat to medium high. Add baby spinach and cook until wilted. Remove from heat. 5. Combine the pasta, beans, spinach, and tomatoes into one large pot. Add the pesto and mix well. 6 Divide into 4 bowls and serve. https://www.verywellfit.com kalip
  23. Ricky I have only now noticed your post (apologies ) My thoughts and best wishes are with you and your family. kalip
  24. The New Way of Thinking About Coronary Artery Disease Be wary of cardiologists thinking in the "traditional way" The way we think about Coronary Artery Disease (CAD) and its treatment is in the midst of a major shift, and today, some cardiologists have completely moved to the "new way" of thinking, while others are still stuck in the "traditional way." The differences between these two schools of thought largely explain much of the debate currently taking place among cardiovascular specialists about who to test for CAD, how to test based on symptoms, who needs to be treated for CAD, and how to treat them. Unfortunately, doctors still mired in the traditional way of thinking are missing the boat -- and as a result, are subjecting many of their patients to both undertreatment and vertreatment. The Traditional Way of Thinking About CAD Traditionally, CAD means there are one or more blockages in the coronary arteries. These blockages can restrict blood flow, which can produce angina (chest discomfort), and, if severe, the blockages can suddenly become complete, causing the heart muscle supplied by that artery to die, which is called a "myocardial infarction" or heart attack. Since the chief problem is the blockage, the chief treatment is to relieve the blockage, which can be done with bypass surgery or stenting. The traditional view of CAD, then, focuses on blockages, which means that precise anatomic location and degree of blockages is critical in assessing CAD. Diagnostic tests that do not provide this information and treatments that do not relieve the blockages are not fully adequate. Cardiologists who think traditionally tend to insist on cardiac catheterisations as the only adequate diagnostic test and stenting as the only adequate therapy, though they will reluctantly allow that sometimes the cardiac surgeon needs to get involved for particularly extensive or difficult blockages. The New Way of Thinking About CAD We now know that CAD is about far more than just blockages. CAD is a chronic, progressive disease that tends to be far more widespread within the coronary arteries than is implied by the presence or absence of actual blockages. Plaques are often present in arteries that appear "normal" on cardiac catheterisation. In fact, some patients, especially women, can have widespread CAD that produces a generalised narrowing of the coronary arteries without any actual blockages. Furthermore, heart attacks are produced when a plaque ruptures and causes a clot to form hat suddenly blocks the artery -- and often this occurs at plaques that are not causing blockages prior to their rupture and would have been called "insignificant" on cardiac catheterisation. The key to CAD is not whether specific blockages are present, but whether coronary artery plaques (which often do not cause significant blockages) are present. What This Means for You While actual blockages can and do cause angina and heart attacks and while treating specific blockages is often important, therapy aimed at treating blockages is often neither necessary nor sufficient to adequately treat CAD. Evidence is building that with intensive medical therapy -- largely based on statins but also including aggressive risk-factor modification -- CAD can be halted or even reversed, and plaques can be "stabilised" to reduce the odds that they will rupture. In these individuals, exercise, smoking cessation, weight loss, blood pressure control and (most experts believe) cholesterol control are especially important. The key, then, is to decide whether an individual is likely to have active CAD, that is, whether plaques are likely to be present, and then direct therapy accordingly. To a large extent, deciding whether plaques are likely to be present can be accomplished noninvasively. Begin with a simple assessment of risk to decide whether your risk is low, intermediate or high. ( Here's how to assess your risk simply and easily.) People in the low-risk categories probably need no further intervention. People in the high-risk categories should be treated aggressively (with statins and risk-factor modification), as they are very likely to have plaques. People in the intermediate risk category should consider non-invasive testing with EBT scanning (calcium scans): if calcium deposits are present on the coronary arteries, then they have plaques and should be treated aggressively. When to Look for Blockages Blockages in the coronary arteries are still important. Most experts think that people in the high-risk category should have a stress thallium test. If this test is suggestive of a major blockage, cardiac catheterisation should be considered. A stress test or cardiac catheterisation should also be strongly considered in anybody (whatever their apparent level of risk) who has symptoms of angina. Relieving blockages by surgery or stenting can be extremely effective in treating angina and, in some circumstances, can improve survival. Summary Our thinking about CAD has changed significantly over the past decade or so. It is not simply a disease of blockages that ought to be treated with stents. Treatment aimed at halting or reversing chronic CAD and at stabilising plaques to reduce the odds that they will rupture, is very important, whether "significant" blockages are present or not. https://www.verywellhealth.com kalip
  25. What Is a SPECT Scan? What to expect when undergoing this test A single-photon emission computerised tomography (SPECT) scan produces three-dimensional images, which allows your physician to see what’s going on inside your body’s organs from different angles. SPECT scans fall under the category of nuclear medicine according to the National Institute of Biomedical Imaging and Bioengineering, and the technology involves the use of radioactive materials and a specially-designed gamma camera to create the images. Nuclear medicine involves using radioactive tracers, which are carrier molecules that are bonded with radioactive atoms to evaluate, diagnose, and treat a range of illnesses in the body. Different tracers perform different functions, and the physician will choose the tracer that’s appropriate for you depending on your symptoms or disease that’s being be evaluated. What makes SPECT scans unique to other methods of imaging is that the scan can show how well certain organs of the body are functioning. For example, SPECT scans provide information about how well your heart is pumping, if your heart is getting enough blood, or if the blood flow is precluded by a disease process like coronary artery disease (CAD). Another example of when the SPECT scan may be beneficial is when evaluating the brain. The images made by the SPECT scan can help pinpoint the location of seizures in people with epilepsy and assess areas to see if blood flow to the brain is sufficient. SPECT scans provide a non-invasive way to evaluate the health of certain parts of the body, most commonly the heart, brain, and bones. Purpose of Test SPECT scans can cost-effectively be used in a variety of ways, making them readily available at most hospitals, clinics, and imaging centres. Some of the reasons your doctor may choose to order this test include: Cardiac Conditions Radioactive tracers during the SPECT scan can capture how well your heart is working, and, ultimately, disease processes that may be going on in the heart such as: Narrowing of the arteries Clogged arteries Scar tissue due to heart attacks How well your heart is pumping blood If surgical procedures, like bypass surgeries or other surgeries, were successful Brain and Neurological Conditions SPECT scans can be used to gather information about changes that occur in brain function due to disease processes, including: Traumatic brain injuries (TBIs) Alzheimer’s disease Epilepsy Seizures Strokes Blood flow to the brain Bone disorders SPECT scans can be useful in bone disorders because areas of concern will often light up. The conditions that can be explored using this technology include: Less visible bone fractures such as stress fractures Bone cancer or cancer that has metastasised to areas of bone Bone infections Risk and Contraindications Most people tolerate SPECT scans well, but there may be some instances where the test would be ill-advised. Your doctor may opt not to perform this test for the following reasons: You’re pregnant or nursing. The tests use a low-dose of radiation, which is contraindicated for pregnant women. If you’re nursing, you may be required to wait a certain amount of time before nursing to allow your body time to excrete the radioactive tracer. Though unusual, it’s possible to have an allergic reaction to the tracer. Your team of healthcare professionals is equipped to handle this situation should it arise. Since the SPECT scan does use a low-dose of radiation, talk with your doctor if you have any concerns about your risk of exposure. However, no long-term health risks have been associated with using this method of imaging. Before the Test The things you may need to do to prepare for the scan can differ depending on the reason you have the scan. Your healthcare team should give you specific guidelines for your test. In general, you’ll find the following recommendations helpful: Timing Ask your medical team about the amount of time you should set aside for the scan. Some scans take about 30 minutes. Others may require more or less time depending on the reason for the SPECT scan. Location Testing may be done in a hospital, clinic, or imaging centre. Typically, the scan will be done by a medical team that specialises in nuclear medicine. What to Wear You can wear what you want for the procedure, but you’ll likely be asked to change into a gown before the scan. You may find that casual, loose-fitted clothing is a comfortable choice for the test. Additionally, leave metal items, like watches, jewellery, and earrings, at home. Food and Drink Your healthcare team will let you know if the scan requires you to avoid certain foods or drinks. For example, if you have a SPECT scan for cardiac reasons, you may need to avoid caffeine for several hours before the test. What to Bring Bring your insurance card, a form of identification, and any paperwork you’ve been asked to fill out before the scan. Other Considerations Make sure your doctor has a current list of all the medications, including over-the-counter products and supplements, that you’re taking. Your doctor may want you to stop taking certain ones before the procedure. Also, let your doctor know if you’re pregnant or nursing. ​ During the Test The test consists of two parts: injecting the radioactive tracer and the SPECT scan itself. The Radioactive Tracer An intravenous (IV) line will be inserted into your arm. The radioactive tracer will then be injected via the IV. You may feel a cold sensation as the tracer flows into your body. Once the tracer has been injected, your technician or doctor will instruct you on how long you need to wait before beginning the scan so that the tracer can be fully absorbed into your body. The wait could be as short as 20 minutes. But in some cases, it could take your body hours or days for the absorption to finish. Your medical team will provide you with information on this process. The SPECT Scan During the scan, you’ll be asked to lie on a table. The gamma camera will rotate around your body, creating three-dimensional images of your internal organs and tissues. The scan doesn’t cause pain, so if you experience pain or discomfort, be sure to let your doctor or technician know so that they can assist you with getting more comfortable. After the Test Once the scan is completed, you can usually resume your daily activities right away. Staying hydrated will help your body flush out the remaining portion of the radioactive tracer over the next couple of days. Special instructions may be given to you if you’re nursing, as you may be required to hold off nursing for a period of time while the tracer exits your system. Interpreting Results A radiologist or nuclear medicine physician will evaluate the results of your SPECT scan and report the findings to your physician, so your scan results aren’t likely to be ready immediately. Your SPECT scan images will show bright or dark areas, either in colour in grayscale, where the radioactive tracer has been absorbed by your organs and tissues. Your doctor or a member of their staff will contact you to talk about the results and whether additional testing is needed. One thing to keep in mind is that you can request copies of your SPECT scan images and the report for your records, or if you’d like to get a second opinion. A Word From Verywell Going through the testing process can be a bit nerve-wracking. To help you feel more at ease, make sure your physician takes the time to address your fears or concerns. This will go a long way towards helping you feel more comfortable. https://www.verywellhealth.com/heart-disease-4014709 kalip
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