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Beta Blockers May Not Prevent Heart Attacks and Strokes

http://abcnews.go.com/Health/video/beta-blockers-effective-previously-thought-17378539

By SYDNEY LUPKIN
Oct. 2, 2012

New research suggests that beta-blocker pills don’t prevent heart attacks, strokes or cardiac deaths in patients with heart disease, but doctors are torn over whether there’s enough in the study to make them want to stop prescribing the drugs. Beta blockers have been a standard heart medication for decades.

The study, published in the Journal of American Medical Association, looked at nearly 45,000 patients with prior heart attacks, coronary artery disease or risk factors for coronary artery disease, and found that those on beta blockers didn’t show significantly lower rates of heart attack, stroke or cardiac death than those not on the medication.

“This is a very compelling study that has the potential to shake up the conventional wisdom that exists regarding the role of beta blockers in the management of patients with cardiovascular disease,” said Dr. Randal Thomas, a cardiovascular specialist at the Mayo Clinic. “At a minimum, it will lead to new studies that address this issue once again.”

Beta blockers work by blocking adrenalin receptors in the brain that become activated when the body is stressed. Beta blockers are used to treat heart disease, high blood pressure, anxiety and other conditions.

Some doctors say they are glad beta blockers are being questioned because their use had been “written in stone” for so many years, but others say using a non-randomized data sample is not as reliable as a randomized drug trial.

While the authors attempted to account for differences between the patient groups that might have had an impact on their health, they did not have access to information on why some patients were prescribed these drugs and some were not, said Dr. Richard Besser, the chief heath and medical editor at ABC News.

Dr. Melvin Rubenfire, who directs cardiovascular medicine at the University of Michigan, said he’d been hoping for a study like this, but it won’t change his prescribing habits because he uses beta blockers only in specific cases. Rubenfire also weans patients off the pills 18 months after they have a heart attack if they experience adverse side effects, such as fatigue and erectile dysfunction.

Rubenfire said the existing data wasn’t enough to determine which patients would benefit from beta blockers, and what kinds of beta blockers are better than others. Beta blockers include at least six brand names, including Sectral, Tenormin and Zebeta.

Even study coauthor Christopher Cannon, a professor at Harvard Medical School, said he will continue to prescribe beta blockers to his patients, adding “I would not make too much of this” because the study is only observational.

“All it can do is raise up an idea for us researchers to consider for further study,” he said.

Cannon said this research shows that it’s unclear whether beta blockers add more benefit than the other therapies developed in the decades since beta blockers became a standard of practice for treating patients with heart disease. Since patients are often taking several drugs, it’s hard to pinpoint how much one agent helps compared with another.

Dr. Steven Nissen, who chairs the department of cardiovascular medicine at the Cleveland Clinic Foundation, said the medicine might not be ideal for all of the patients it’s prescribed to, but a new randomized, controlled trial will be necessary to change guidelines for prescribing beta blockers.

“Abandonment of this type of therapy for post-MI [post-heart attack] patients based upon an observational study is not warranted,” he said.

For the time being, the study raises questions, said Dr. Harlan Kumhulz, a professor of medicine, epidemiology and public health at Yale University.

“The question it raises is about how long after having a heart attack should patients remain on beta blockers?” Kumhulz said, noting that beta-blocker patients didn’t have better outcomes than the other patients did after the first year. “The study cannot definitively answer that question — but raises doubts about the need to continue to take them for the rest of a patient’s life.”

Dr. Lauren Hughes of the ABC News Medical Unit contributed to this report.

http://abcnews.go.com/Health/beta-blockers-prevent-heart-attack-stroke-study-jama/story?id=17378403#.UG32y5jA-Sp

How Food Affects High Triglycerides Joy Bauer Food Cures

For those diagnosed with high triglycerides, it’s important to take action to lower your levels and improve your heart health.

High Triglycerides, Food Cures

Triglyceride is just a fancy word for fat — the fat in our bodies is stored in the form of triglycerides. Triglycerides are found in foods and manufactured in our bodies. Normal triglyceride levels are defined as less than 150 mg/dL; 150 to 199 is considered borderline high; 200 to 499 is high; and 500 or higher is officially called very high. To me, anything over 150 is a red flag indicating my client needs to take immediate steps to get the situation under control.

High triglyceride levels make blood thicker and stickier, which means that it is more likely to form clots. Studies have shown that triglyceride levels are associated with increased risks of cardiovascular disease and stroke — in both men and women — alone or in combination with other risk factors (high triglycerides combined with high LDL cholesterol can be a particularly deadly combination). For example, in one ground–breaking study, high triglycerides alone increased the risk of cardiovascular disease by 14 percent in men, and by 37 percent in women. But when the test subjects also had low HDL cholesterol (that’s the good cholesterol) and other risk factors, high triglycerides increased the risk of disease by 32 percent in men and 76 percent in women.

Fortunately, triglycerides can often be easily controlled with several diet and lifestyle changes — many of the same changes that I outlined in my High Blood Pressure and High Cholesterol sections.

What Factors Can Increase Triglycerides?

As with cholesterol, eating too much of the wrong kinds of fats will raise your blood triglycerides. Therefore, it’s important to restrict the amounts of saturated fats and trans fats you allow into your diet. Triglyceride levels can also shoot up after eating foods that are high in carbohydrates or after drinking alcohol. That’s why triglyceride blood tests require an overnight fast. If you have elevated triglycerides, it’s especially important to avoid sugary and refined carbohydrates, including sugar, honey, and other sweeteners, soda and other sugary drinks, candy, baked goods, and anything made with white (refined or enriched) flour, including white bread, rolls, cereals, buns, pastries, regular pasta, and white rice. You’ll also want to limit dried fruit and fruit juice since they’re dense in simple sugar. All of these low–quality carbs cause a sudden rise in insulin, which may lead to a spike in triglycerides.

Triglycerides can also become elevated as a reaction to having diabetes, hypothyroidism, or kidney disease. As with most other heart–related factors, being overweight and inactive also contribute to abnormal triglycerides. And unfortunately, some people have a genetic predisposition that causes them to manufacture way too much triglycerides on their own, no matter how carefully they eat.

How Can You Lower Your Triglyceride Levels?

If you are diagnosed with high triglycerides, it’s important to take action. There are several things you can do to help lower your triglyceride levels and improve your heart health:

  1. Lose weight if you are overweight. There is a clear correlation between obesity and high triglycerides — the heavier people are, the higher their triglyceride levels are likely to be. The good news is that losing weight can significantly lower triglycerides. In a large study of individuals with type 2 diabetes, those assigned to the “lifestyle intervention group” — which involved counseling, a low–calorie meal plan, and customized exercise program — lost 8.6% of their body weight and lowered their triglyceride levels by more than 16%. If you’re overweight, find a weight loss plan that works for you and commit to shedding the pounds and getting healthier.
  2. Reduce the amount of saturated fat and trans fat in your diet. Start by avoiding or dramatically limiting butter, cream cheese, lard, sour cream, doughnuts, cakes, cookies, candy bars, regular ice cream, fried foods, pizza, cheese sauce, cream–based sauces and salad dressings, high–fat meats (including fatty hamburgers, bologna, pepperoni, sausage, bacon, salami, pastrami, spareribs, and hot dogs), high–fat cuts of beef and pork, and whole-milk dairy products. Other ways to cut back:
    • Choose lean meats only (including skinless chicken and turkey, lean beef, lean pork), fish, and reduced–fat or fat–free dairy products. Experiment with adding whole soy foods to your diet. Although soy itself may not reduce risk of heart disease, it replaces hazardous animal fats with healthier proteins. Choose high–quality soy foods, such as tofu, tempeh, soy milk, and edamame (whole soybeans).
    • Always remove skin from poultry.
    • Prepare foods by baking, roasting, broiling, boiling, poaching, steaming, grilling, or stir–frying in vegetable oil.
    • Most stick margarines contain trans fats, and trans fats are also found in some packaged baked goods, potato chips, snack foods, fried foods, and fast food that use or create hydrogenated oils. (All food labels must now list the amount of trans fats, right after the amount of saturated fats — good news for consumers. As a result, many food companies have now reformulated their products to be trans fat free…many, but not all! So it’s still just as important to read labels and make sure the packaged foods you buy don’t contain trans fats.) If you use margarine, purchase soft-tub margarine spreads that contain 0 grams trans fats and don’t list any partially hydrogenated oils in the ingredients list. By substituting olive oil or vegetable oil for trans fats in just 2 percent of your daily calories, you can reduce your risk of heart disease by 53 percent. There is no safe amount of trans fats, so try to keep them as far from your plate as possible.
  3. Avoid foods that are concentrated in sugar (even dried fruit and fruit juice). Sugary foods can elevate triglyceride levels in the blood, so keep them to a bare minimum.
  4. Swap out refined carbohydrates for whole grains. Refined carbohydrates — like white rice, regular pasta, and anything made with white or “enriched” flour (including white bread, rolls, cereals, buns, and crackers) — raise blood sugar and insulin levels more than fiber-rich whole grains. Higher insulin levels, in turn, can lead to a higher rise in triglycerides after a meal. So, make the switch to whole wheat bread, whole grain pasta, brown or wild rice, and whole grain versions of cereals, crackers, and other bread products. However, it’s important to know that individuals with high triglycerides should moderate even their intake of high–quality starches (since all starches raise blood sugar) — I recommend 1 to 2 servings per meal.
  5. Cut way back on alcohol. If you have high triglycerides, alcohol should be considered a rare treat — if you indulge at all, since even small amounts of alcohol can dramatically increase triglyceride levels.
  6. Incorporate omega-3 fats. Heart–healthy fish oils are especially rich in omega–3 fatty acids. In multiple studies over the past two decades, people who ate diets high in omega–3s had 30 to 40 percent reductions in heart disease. Although we don’t yet know why fish oil works so well, there are several possibilities. Omega–3s seem to reduce inflammation, reduce high blood pressure, decrease triglycerides, raise HDL cholesterol, and make blood thinner and less sticky so it is less likely to clot. It’s as close to a food prescription for heart health as it gets. If you have high triglycerides, I recommend eating at least three servings of one of the omega–3–rich fish every week (fatty fish is the most concentrated food form of omega three fats). If you cannot manage to eat that much fish, speak with your physician about taking fish oil capsules, which offer similar benefits.The best foods for omega–3 fatty acids include wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, and Pacific oysters. Non-fish sources of omega–3 fats include omega–3–fortified eggs, ground flaxseed, chia seeds, walnuts, butternuts (white walnuts), seaweed, walnut oil, canola oil, and soybeans.
  7. Quit smoking. Smoking causes inflammation, not just in your lungs, but throughout your body. Inflammation can contribute to atherosclerosis, blood clots, and risk of heart attack. Smoking makes all heart health indicators worse. If you have high cholesterol, high triglycerides, or high blood pressure, smoking magnifies the danger.
  8. Become more physically active. Even moderate exercise can help improve cholesterol, triglycerides, and blood pressure. Aerobic exercise seems to be able to stop the sharp rise of triglycerides after eating, perhaps because of a decrease in the amount of triglyceride released by the liver, or because active muscle clears triglycerides out of the blood stream more quickly than inactive muscle. If you haven’t exercised regularly (or at all) for years, I recommend starting slowly, by walking at an easy pace for 15 minutes a day. Then, as you feel more comfortable, increase the amount. Your ultimate goal should be at least 30 minutes of moderate physical activity, at least five days a week.

Learn more about Food Cures for high triglycerides.

http://www.joybauer.com/high-triglycerides/about-high-triglycerides.aspx

Top 10 Myths About Cardiovascular Disease American Heart Association

Top 10 Myths About Cardiovascular Disease

How much do you really know about your heart’s health? It’s easy to be fooled by misconceptions. After all, heart disease only happens to your elderly neighbor or to your fried food-loving uncle, right? Or do you know the real truth – that heart disease can affect people of any age, even those who eat right?

Relying on false assumptions can be dangerous to your heart. Cardiovascular disease kills more Americans each year than any other disease. But you can boost your heart smarts by separating fact from fiction. Let’s set the record straight on some common myths.

  1. “I’m too young to worry about heart disease.” How you live now affects your risk for cardiovascular diseases later in life. As early as childhood and adolescence, plaque can start accumulating in the arteries and later lead to clogged arteries. One in three Americans has cardiovascular disease, but not all of them are senior citizens. Even young and middle-aged people can develop heart problems – especially now that obesity, type 2 diabetes and other risk factors are becoming more common at a younger age.
  2. “I’d know if I had high blood pressure because there would be warning signs.” High blood pressure is called the “silent killer” because you don’t usually know you have it. You may never experience symptoms, so don’t wait for your body to alert you that there’s a problem. The  way to know if you have high blood pressure is to check your numbers with a simple blood pressure test. Early treatment of high blood pressure is critical because, if left untreated, it can cause heart attack, stroke, kidney damage and other serious health problems. Learn how high blood pressure is diagnosed.
  3.  “I’ll know when I’m having a heart attack because I’ll have chest pain.” Not necessarily. Although it’s common to have chest pain or discomfort, a heart attack may cause subtle symptoms. These include shortness of breath, nausea, feeling lightheaded, and pain or discomfort in one or both arms, the jaw, neck or back. Even if you’re not sure it’s a heart attack, call 9-1-1 immediately. Learn you risk of heart attacktoday!
  4. “Diabetes won’t threaten my heart as long as I take my medication.” Treating diabetes can help reduce your risk for or delay the development of cardiovascular diseases. But even when blood sugar levels are under control, you’re still at increased risk for heart disease and stroke. That’s because the risk factors that contribute to diabetes onset also make you more likely to develop cardiovascular disease. Theseoverlapping risk factors include high blood pressure, overweight and obesity, physical inactivity and smoking.
  5. “Heart disease runs in my family, so there’s nothing I can do to prevent it.” Although people with a family history of heart disease are at higher risk, you can take steps to dramatically reduce your risk. Create anaction plan to keep your heart healthy by tackling these to-dos: get active; control cholesterol; eat better; manage blood pressure; maintain a healthy weight; control blood sugar; and stop smoking.
  6. “I don’t need to have my cholesterol checked until I’m middle-aged.” The American Heart Association recommends you start getting your cholesterol checked at age 20. It’s a good idea to start having a cholesterol test even earlier if your family has a history of heart disease. Children in these families can have high cholesterol levels, putting them at increased risk for developing heart disease as adults. You can help yourself and your family by eating a healthy diet and exercising regularly.
  7. “Heart failure means the heart stops beating.” The heart suddenly stops beating during cardiac arrest, not heart failure. With heart failure, the heart keeps working, but it doesn’t pump blood as well as it should. It can cause shortness of breath, swelling in the feet and ankles or persistent coughing and wheezing. During cardiac arrest, a person loses consciousness and stops normal breathing.
  8. “This pain in my legs must be a sign of aging. I’m sure it has nothing to do with my heart.” Leg pain felt in the muscles could be a sign of a condition called peripheral artery disease. PAD results from blocked arteries in the legs caused by plaque buildup. The risk for heart attack or stroke increases five-fold for people with PAD.
  9. “My heart is beating really fast. I must be having a heart attack.” Some variation in your heart rate is normal. Your heart rate speeds up during exercise or when you get excited, and slows down when you’re sleeping. Most of the time, a change in your heartbeat is nothing to worry about. But sometimes, it can be a sign of arrhythmia, an abnormal or irregular heartbeat. Most arrhythmias are harmless, but some can last long enough to impact how well the heart works and require treatment.
  10. “I should avoid exercise after having a heart attack.” No! As soon as possible, get moving with a plan approved for you! Research shows that heart attack survivors who are regularly physically active and make other heart-healthy changes live longer than those who don’t. People with chronic conditions typically find that moderate-intensity activity is safe and beneficial. The American Heart Association recommends at least two and a half hours of moderate intensity physical activity each week. Find the help you need by joining a cardiac rehabilitation program, or consult your healthcare provider for advice on developing a physical activity plan tailored to your needs.

Learn more:

http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Top-10-Myths-about-Cardiovascular-Disease_UCM_430164_Article.jsp

Growing number of children diagnosed with high blood pressure CBS News

“We’ve all seen it. We’ve seen it associated with the marked increase in obesity, but not to these numbers,” said Dr. Rick Kaskel, pediatric kidney specialist at Montefiore Hospital in New York. “And, I think the hospitalization rate is what is astounding here.”

http://www.cbsnews.com/8301-18563_162-57455592/growing-number-of-children-diagnosed-with-high-blood-pressure/

A Dire Sign of the Obesity Epidemic: Teen Diabetes Soaring, Study Finds

“It’s one thing for an overweight or obese 55-year-old gaining an extra few pounds a year to develop diabetes at age 65 and then have a heart attack. It’s a very different thing if the clock starts ticking at age 10,” Ludwig says. “Children have so many more years to suffer from the consequences from these serious medical problems related to obesity.

Type 2 diabetes, the most common form of the disease, is a condition that until recently doctors almost never saw in kids. But that was before the childhood obesity epidemic.

“We’re looking at the prospect of heart attack, stroke and kidney failure becoming common complications of young adulthood,” Ludwig says.

The new study also found disturbingly high levels of other problems that increase the risk for heart attacks and strokes in kids, including high blood pressure and high cholesterol.

Researchers are especially concerning about the high rate of diabetes among teenage girls.

“These are teen girls — adolescent girls — who are going to become mothers in the next five to 10 years. And if their weight is not healthy, we’re going to have another generation of these children with metabolic problems that lead to diabetes and prediabetes,” says Melinda S. Sothern of Louisiana State University.

http://www.npr.org/blogs/health/2012/05/21/153030283/a-dire-sign-of-the-obesity-epidemic-teen-diabetes-soaring-study-finds

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