Heart Health Archives - Bill Chesnut MD

PPIs prematurely age cells that line the inside of blood vessels.

“The side effects of long term Omeprazole, Nexium and its related drugs, called PPIs, is alarming. On May 10 a report described PPI drugs being associated with central nervous system dysfunction. Avoid PPI drugs and use Zantac and its class of medications.” Bill Chesnut, MD

(Return to New Health News, https://billchesnutmd.com/new-health-news/)

PPIs prematurely age cells that line the inside of blood vessels, study suggests. AMA Wire __May 11, 2016.

The Houston Chronicle (5/10, Hawryluk) reports that research suggests “proton pump inhibitors prematurely age the cells that line the inside of blood vessels, making them less resistant to blockages that can cause heart attacks and strokes.” The findings were published in Circulation Research.

HealthDay (5/10, Thompson) reports that the findings, from “lab tests,” may “explain why other studies have shown increased risk of heart disease in people who use” PPIs, “said study senior author Dr. John Cooke.”

________________________________________________________________

CIRCULATION RESEARCH_American Heart Association.

Proton Pump Inhibitors Accelerate Endothelial Senescence

Abstract
Rationale: Proton pump inhibitors (PPIs) are popular drugs for gastroesophageal reflux, now available for long-term use without medical supervision. Recent reports suggest that PPI use is associated with cardiovascular, renal and neurological morbidity.

Objective: To study the long-term effect of PPIs on endothelial dysfunction and senescence and investigate the mechanism involved in PPI induced vascular dysfunction.

Methods and Results: Chronic exposure to PPIs impaired endothelial function and accelerated human endothelial senescence by reducing telomere length.

Conclusions: Our data may provide a unifying mechanism for the association of PPI use with increased risk of cardiovascular, renal and neurological morbidity and mortality.

Silent heart attacks make up 45% of all heart attacks.

“The Wake Forest School of Medicine studied > 9,000 people. The paper is Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study. The important finding is not about sex and race differences but that 45% of heart attacks (myocardial infarction) are not clinically documented meaning not causing enough symptoms to cause medical attention. The silent myocardial infarction (SMI) incidence was surprising. The SMI was detected by EKG changes in people who had no symptoms of ever having a heart attack. The study was over eight years. The combined total of heart attacks was 7.4% of the studied group. A heart healthy life style is even more important with this information.” Bill Chesnut, MD
(Return to New Health News, https://billchesnutmd.com/new-health-news/)
Silent heart attacks make up 45% of all heart attacks, study suggests

TIME (5/16, Alter) reports that research suggests “silent heart attacks, which have no symptoms but still involve a loss of blood flow to the heart, make up 45% of all heart attacks and triple the chances of dying from heart disease.” The findings were published in Circulation.

NBC News (5/16, Fox, Powers) reports on its website that investigators “looked at the medical records of 9,500 middle-aged men and women taking part in a heart disease risk study.” The researchers found that “nine years into the study, 317 of the volunteers had ‘silent’ heart attacks and 386 had heart attacks that were noticed right away.”

On its website, CBS News (5/16, Marcus) reports that the researchers also found that “found that silent heart attacks were more common in men – but more likely to cause death in women.”

CNN (5/16, Kounang) reports that the study indicated “having a silent heart attack increased the chances of dying from heart disease threefold and increased chances of dying from any cause by 34%.”

Hormone replacement therapy, HRT, in early menopause may slow progression of cardiovascular disease.

“Hormone Replacement therapy in early menopause is important to decrease the bone loss following menopause. I have posted several articles on this website related to osteoporosis. Post-menopausal women not taking hormone replacement lose 60% of their total bone mass between menopause and 60 years of age.

Now another benefit is reported. The study below shows slowing of atherosclerosis by taking hormone replacement.

It is important to know what replacement is most safe. Also know the safety advantages of vaginal or topical HRT versus oral hormone placement. The metabolism is different when taking a medical orally than transcutaneous. Vaginal HRT with estriol elevates estriol a little and transiently if it elevates blood levels at all.

Testosterone is another hormone loss in menopause. Its involvement in bone loss and atherosclerosis has not been as extensively tested. The research available that I found does not report a significant risk of testosterone replacement to keep the normal pre-menopausal blood level.

This finding is so important in my view that I posted the abstract of the original article just below the announcement in the popular press.

If you know women in the age group to be peri-menopausal please tell them the news.” Bill Chesnut, MD

To go back to New Health News: https://billchesnutmd.com/new-health-news

Starting HRT in early menopause may slow progression of cardiovascular disease, study indicates

The Wall Street Journal (3/30, Beck, Subscription Publication) reports the findings of a 643-patient study published in the New England Journal of Medicine study add to the evidence that beginning hormone replacement therapy (HRT) in early menopause may be protective against cardiovascular disease.

The NPR (3/30, Bichell) “Shots” blog reports that in the study, investigators “directly tested the effect of starting hormone therapy within the first six years after menopause, versus the effect of starting 10 years or more after menopause.” After five years, researchers found that “women who started hormones within six years of menopause had artery walls that thickened a little more slowly than the women on the placebo, whereas the extra estrogen did not seem to slow thickening in the group that started the hormone therapy later.”

ORIGINAL ARTICLE

Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol

Howard N. Hodis, M.D., Wendy J. Mack, Ph.D., Victor W. Henderson, M.D., Donna Shoupe, M.D., Matthew J. Budoff, M.D., Juliana Hwang-Levine, Pharm.D., Yanjie Li, M.D., Mei Feng, M.D., Laurie Dustin, M.S., Naoko Kono, M.P.H., Frank Z. Stanczyk, Ph.D., Robert H. Selzer, M.S., and Stanley P. Azen, Ph.D., for the ELITE Research Group*

N Engl J Med 2016; 374:1221-1231March 31, 2016DOI: 10.1056/NEJMoa1505241

BACKGROUND

Data suggest that estrogen-containing hormone therapy is associated with beneficial effects with regard to cardiovascular disease when the therapy is initiated temporally close to menopause but not when it is initiated later. However, the hypothesis that the cardiovascular effects of postmenopausal hormone therapy vary with the timing of therapy initiation (the hormone-timing hypothesis) has not been tested.

METHODS

A total of 643 healthy postmenopausal women were stratified according to time since menopause (<6 years [early postmenopause] or ≥10 years [late postmenopause]) and were randomly assigned to receive either oral 17β-estradiol (1 mg per day, plus progesterone [45 mg] vaginal gel administered sequentially [i.e., once daily for 10 days of each 30-day cycle] for women with a uterus) or placebo (plus sequential placebo vaginal gel for women with a uterus). The primary outcome was the rate of change in carotid-artery intima–media thickness (CIMT), which was measured every 6 months. Secondary outcomes included an assessment of coronary atherosclerosis by cardiac computed tomography (CT), which was performed when participants completed the randomly assigned regimen.

RESULTS

After a median of 5 years, the effect of estradiol, with or without progesterone, on CIMT progression differed between the early and late postmenopause strata (P=0.007 for the interaction). Among women who were less than 6 years past menopause at the time of randomization, the mean CIMT increased by 0.0078 mm per year in the placebo group versus 0.0044 mm per year in the estradiol group (P=0.008). Among women who were 10 or more years past menopause at the time of randomization, the rates of CIMT progression in the placebo and estradiol groups were similar (0.0088 and 0.0100 mm per year, respectively; P=0.29). CT measures of coronary-artery calcium, total stenosis, and plaque did not differ significantly between the placebo group and the estradiol group in either postmenopause stratum.

CONCLUSIONS

Oral estradiol therapy was associated with less progression of subclinical atherosclerosis (measured as CIMT) than was placebo when therapy was initiated within 6 years after menopause but not when it was initiated 10 or more years after menopause. Estradiol had no significant effect on cardiac CT measures of atherosclerosis in either postmenopause stratum. (Funded by the National Institute on Aging, National Institutes of Health; ELITE ClinicalTrials.gov number, NCT00114517.)

People who consume full-fat dairy may weigh less

“This finding supports recent thinking that cultured daily products, cottage cheese, yogurt, etc., are better for health using regular milk, no low or no fat milk. They are a stable in my daily food.” Bill Chesnut, MD.

To go back to New Health News: https://billchesnutmd.com/new-health-news

People who consume full-fat dairy may weigh less, may be less likely to develop diabetes than those who eat low-fat dairy products

The Atlanta Journal-Constitution (4/6, Foreman) reports that “people who consume full-fat dairy weigh less and are less likely to develop diabetes than those who eat low-fat dairy products,” the findings of a 3,333-adult, 15-year study published in the journal Circulation suggest. The study revealed that “people with higher levels of three different byproducts of full-fat dairy had, on average, a 46 percent lower risk of getting diabetes than those with lower levels.”

The CBS News (4/6, Marcus) website points out that another study involving “more than 18,000 middle-age women who were part of the Women’s Health Study – and [of] normal weight, free of cardiovascular disease, cancer, and diabetes at the start of the research – found that those who ate more high-fat dairy had an 8 percent lower chance of going on to become obese over time compared to those who ate less.” No such link was seen “with low-fat dairy product intake,” however.

Study explores impact of vegetable oil on heart health

“This study is full of surprises. There is much to learn by reviewing the data of previous research published to find new interpretations of the same data. The new interpretations may relate to new science since the original recommendations were made.” Bill Chesnut. MD.

To go back to New Health News: https://billchesnutmd.com/new-health-news

Study explores impact of vegetable oil on heart health _ AMA Morning Rounds April 13, 2016.

TIME (4/12, Park) reports that in a study published in the British Medical Journal, investigators who “re-analyzed data from older unpublished studies” found “that it’s possible that too much vegetable oil could actually increase the risk of heart disease – rather than decrease it.” Researchers “delved into the data from the Minnesota Coronary Experiment, conducted from 1968 to 1973.” The investigators “learned that only part of the trial’s results were published, and other data, suggesting the contrary idea that switching animal fats for vegetable fats didn’t protect the heart, was left out.”

On its website, NBC News (4/12, Fernstrom) reports that the researchers “found no association between lower cholesterol levels and longer life, suggesting that reducing the amount of saturated fat in the diet isn’t enough to reduce risk of death from heart disease.”

CBS News (4/12, Marcus) reports on its website that “curiously, participants who experienced a greater reduction in blood cholesterol actually had a higher risk of death.”

Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.

“ This research is a heads-up for hard working people. If you must, want to or just enjoy working more than 45 hours a week, counteract the risk factor by exercise, good consistent diet habits, stress control, good interpersonal relationships, mindfulness, good sleep habits and a regular lifestyle, not having wild variations in your weeks. This risk applies to most physicians in patient care; it is unavoidable. Their skills and knowledge are so needed, they have a strong reason to work excessively.” Bill Chesnut, MD.

Working long hours may be linked to higher risk of heart disease, study suggests

The New York Times (3/10, Bakalar) “Well” blog reports that research suggests “the more hours you work, the greater your risk for heart disease.” Investigators “found that for each additional hour of work per week over ten years, there was a 1 percent increase in the risk for heart disease.” The findings were published in the Journal of Occupational and Environmental Medicine. _________________Ama 3.10.1

Journal of Occupational & Environmental Medicine: ____March 2016 – Volume 58 – Issue 3 – p 221–226

Dose–Response Relation Between Work Hours and Cardiovascular Disease Risk: Findings From the Panel Study of Income Dynamics Conway, Sadie H. PhD; Pompeii, Lisa A. PhD; Roberts, Robert E. PhD; Follis, Jack L. PhD; Gimeno, David PhD

Objectives: The aim of this study was to examine the presence of a dose–response relationship between work hours and incident cardiovascular disease (CVD) in a representative sample of U.S. workers.

Methods: A retrospective cohort study of 1926 individuals from the Panel Study of Income Dynamics (1986 to 2011) employed for at least 10 years. Restricted cubic spline regression was used to estimate the dose–response relationship of work hours with CVD.

Results: A dose–response relationship was observed in which an average workweek of 46 hours or more for at least 10 years was associated with an increased risk of CVD. Compared with working 45 hours per week, working an additional 10 hours per week or more for at least 10 years increased CVD risk by at least 16%.

Conclusion: Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.

Higher percent of body fat may be linked to higher risk of dying early

“This important article studies the body fat percentage and not the BMI index. This is more specific research than articles using the BMI to determine results. Men with highest body fat percent had a 60 percent higher risk of mortality. A warning here for the wise.” Bill Chesnut, MD

To return to New Health News: https://billchesnutmd.com/new-health-news

Higher percent of body fat may be linked to higher risk of dying early, study suggests

The AP (3/7, Neergaard) reports that research published in Annals of Internal Medicine suggests that “a higher percent of body fat, independent of” a “person’s BMI,” may be “linked to reduced survival.”

STAT (3/7, Anyaegbunam) reports that investigators “examined the medical charts and X-rays of people…who had gotten osteoporosis screenings between 1999 and 2013.”

TIME (3/7, Park) reports that when the researchers “looked at how body fat correlated with early death,” they “found that people with the lowest BMI had a 44% to 45% higher risk of dying early – likely because they were malnourished or otherwise ill – than those with more average BMI.” Individuals “with the highest body fat composition, regardless of their BMI, also had the highest risk of dying early – women with more body fat showed a 19% increased risk of early death while men had a 60% higher risk of mortality.”

The Los Angeles Times (3/7, Healy) reports on the study, and also reports on a separate study published in the Annals of Internal Medicine, which “found that in a group of more than 1.5 million Swedish military recruits, men who had poor physical fitness at age 18 were three times more likely to develop Type 2 diabetes in midlife than were those who had been highly fit on the cusp of adulthood.” AMA News.

Return to New Health News, https://billchesnutmd.com/new-health-news

Testing for calcium in the arteries can help predict heart disease

“The Miami Herald article below is from the AMA News 3.6.16, and I include it for it tells the point about cardiac CT well. There are low-grade heart scans that show calcium score and high-grade coronary artery angiogram CT. The message here is the inexpensive calcium score scan may avoid having to take statin drugs. Statins have many side effects, more than listed here. They can cause significant muscle pain and damage. If you are 40-50 and are taking statins, consider getting a calcium heart scan to see if there are any calcium plaques. You may be able to stop taking statin drugs. I had this scan done when it became available and had an average calcium score. When the more sensitive coronary angiogram heart CT became available, I had that because of the calcium score. It showed my coronary arteries were excellent with no stenosis. As my cholesterol is normal, I did not require statin cholesterol-lowering drugs.” Bill Chesnut, MD.

To return to New Health News: https://billchesnutmd.com/new-health-news

Testing for calcium in the arteries can help predict heart disease AMA Morning Rounds 3.6.16.

1. The typical patient to be scanned is in their 40s or 50s whose cholesterol is a tad high and who has family history of heart attacks

2. The scan is not covered by most insurance, and costs $75 to $100
3. It exposes the patient to about the same radiation as a mammogram

Mila Veledar, 61, of Miami learned she had high cholesterol 10 years ago. She started taking statins, which reduced her cholesterol, but raised her liver enzymes. For a few years, she went on and off the medicine.

In 2014, Veledar underwent a coronary calcium scan, also known as a heart scan, which looks for calcium deposits in the arteries and is a predictor of heart disease. Because she had no calcium deposits, her doctor took her off statins.

“My doctor told me my risk of having cardiac problems in the next 10 years was 2 percent. If I take statins, it lowers it to 1.6 percent,” Veledar said.

She stopped taking the statins, which had raised her liver enzymes and brought on headaches and insomnia.

A coronary calcium scan is a CT scan that detects small flecks of calcium in the arteries, said Dr. Gervasio Lamas, chief of the Columbia University Division of Cardiology at Mount Sinai. During the scan, the calcium is quantified and given a score. The lower the score, the better.

“The more calcium you have, the more likely you are to have a heart attack, but it goes beyond being a predictor because it tells you that you have coronary heart disease,” Lamas said. “At some point or another you had a fatty plaque and then your body’s own healing response deposited a little calcium there. The more times your body has had to do that, the more likely you are in the future to have a heart attack.”

“A score of zero means there is no calcium in the coronary arteries, but the scores do increase with age, so there are ‘age-adjusted normals,’” he said. “For an 85-year-old, a calcium score of 40 or 50 may be OK, whereas that score in a 30-year-old would be very concerning.”

The problematic range is anything over 400, with numbers over 1,000 being at extreme risk, Hendel said. “Between 100 and 400 is a gray zone that identifies hardening of the arteries, but it’s a continuum. As the score increases, so does the risk.”

Who should be scanned__The best candidate is someone with moderate risk of heart disease, Lamas said.

“The typical patient that I scan is in their 40s or 50s whose cholesterol is just a little high. They take care of themselves, maybe there was heart attack in a family member years ago,” he said.

A doctor might look at the cholesterol and recommend a statin, Lamas said, but the patient wants another opinion. A scan can give more information to determine if a statin is necessary.

Generally, the criteria for taking statins are high-risk factors such as cholesterol and weight. “Then you are prescribed a lifelong pill to reduce the risk,” said Dr. Khurram Nasir, medical director for the Center for Healthcare Advancement & Outcomes at Baptist Health South Florida. “But emerging evidence is suggesting that people we thought are high risk are actually low risk, and we never had a way of identifying them.”

A study led by Nasir found that about two-thirds of adults 45 and older with no established cardiovascular disease are eligible to take lifelong statins.

“But when we did heart scans, about half of the individuals had no calcium scores, and their 10-year risk was below the level at which you should consider taking a statin,” he said. “The scan is providing patients more information so they can make a better judgment of whether the risk is high enough to take a pill for the next 10 years.”

The heart scan is not a routine test, and there’s a controversy about whether it should become one, Hendel said. “Many physicians think it should. Currently, the American Heart Association and the American College of Cardiology have taken a conservative stand, not recommending it as a routine screening measure,” he said.

Read more here: http://www.miamiherald.com/living/health-fitness/article62723472.html#storylink=cpy

Return to New Health News, https://billchesnutmd.com/new-health-news

Nut Butter is effective in cutting heart disease risk, reducing belly fat accumulation, and helping to control diabetes.

“The good news of eating nuts is discussed here. I am including this to bring attention to avoiding nut butters that added sugar, palm oil or hydrogenated oils, and skip the reduced fat nut butter. Interesting recipe ideas.” Bill Chesnut. MD.

Get nutty! Protein, fiber, nourishing fats…nut butters have it going on. Cleveland Clinic Wellness newsletter_3.3.16
It’s high time to go nuts…in a good way! There’s a world of nutritious, delicious nut butters out there beyond the children’s classic. No offense, PB&J, but we’re ready to spread our wings and our celery sticks with almond butter, walnut butter, and cashew butter, for starters. “Across the board, tree nuts and nut butters are a superduper source of nutritious fats, fiber, and vitamins and minerals,” says Cleveland Clinic nutritionist Amy Gannon, RD. Cases in point: Walnut butter boasts lots of omega-3 fatty acids, and almond butter is a go-to for vitamin E. These and other little nutritious nuggets can making a big difference for health by (1) cutting heart disease risk, (2) reducing belly fat accumulation, and (3) helping to control diabetes. When shopping, look for products that contain simple ingredients: “just nuts and perhaps salt,” says Gannon. Steer clear of nut butters that contain added sugar, palm oil, or hydrogenated oils, and skip the reduced-fat nut butters, which often replace nutritious fats with sugar and other fillers. If you have a high-power blender or food processor, you can whip up your own nut butter from walnuts, pecans, macadamia nuts, almonds, or hazelnuts — or try a delicious combo. As for how to use nut butter, the sky (er, the tree?) is the limit! Add it to homemade muffins and pancakes, blend it into smoothies, or add a dollop to a baked sweet potato. Try blending some nut butter into Greek yogurt for breakfast or a fruit-and-veggie dipping sauce. Create luxurious sauces, such as a cashew curry or Far-East-inspired almond soy sauce. Because sometimes you feel like a nut…butter!
You may also want to know:

Go nuts! People who eat nuts may live longer

Bariatric Surgery May Reduce Life-Threatening Heart Failure Exacerbation

“Massachusetts General Hospital reports a significant and rapid reduction in the incidence of emergency treatment for heart failure in a good analysis of 1,664 subjects. Morbidly obese people with heart failure should consider weight reduction before their heart failure progresses to the point that surgery cannot be done. The emphasis in bold type is mine.” Bill Chesnut, MD

Bariatric Surgery May Reduce Life-Threatening Heart Failure Exacerbation in Obese Patients

BOSTON — February 25, 2016 — Patients with heart failure who underwent bariatric surgery to treat morbid obesity had a significant reduction in the incidence of heart failure exacerbation, according to a study published in the March issue of the American College of Cardiology.

“We found that bariatric surgery — the most effective way to achieve substantial and sustained weight loss — was associated with a 40% reduction in emergency department visits and hospitalizations for heart failure exacerbation,” said lead author Yuichi Shimada, MD, Massachusetts General Hospital (MGH), Boston, Massachusetts. “These findings are important because, while both obesity and heart failure are major public health problems in the United States, little has been known about whether substantial weight loss would decrease the risk of heart-failure-related adverse events.”

Previous studies have found an increase in heart-failure-related death among obese patients and also have reported that increased body fat can cause unfavorable changes in the shape and performance of the heart. The current study was designed to investigate whether the kind of significant weight loss that usually results from bariatric surgery reduces the risk of heart failure exacerbation.

The MGH team utilized information from large, state-wide databases reflecting emergency department treatment and hospitalizations in California, Florida, and Nebraska to identify patients with heart failure who also underwent bariatric surgery from 2007 through 2009.

These databases use encrypted patient identifiers that allow tracking the experiences of individual patients over time without revealing their identities. The investigators analyzed data covering the 2 years before and after each patient’s surgery. Comparing the pre-surgical and postsurgical periods essentially allowed patients to serve as their own controls, reducing the possibility that confounding factors could affect the study’s results.

Analysis of the results for the entire group of 1,664 patients found a significant and rapid reduction in the incidence of emergency treatment or hospitalization for heart failure exacerbation in the 2 years after surgery.

To address the possibility that some exacerbations might have been missed because participants either moved out of state or died without coming to a hospital, the team focused on a group of 524 patients for whom some sort of emergency room visit or hospitalization was recorded in the databases during the third year after surgery. In that group, exacerbation-related events were somewhat reduced in the first year and were significantly lower in the second. While information on patients’ actual postsurgical weight loss was not available in the analyzed data, the drop in exacerbations paralleled the weight loss reported in previous studies of bariatric surgery results.

“These results imply that clinicians treating patients with both heart failure and morbid obesity should consider surgical weight reduction to help patients control the risk of heart-failure-related events; but it’s also true that some patients have other health problems that make the risks of surgery higher,” said Dr. Shimada. “In those cases, accurate assessment of the risks and benefits of surgery becomes critically important, and this study provides indispensable information for patients and treating physicians. It also will be essential to develop effective nonsurgical options to help such patients achieve substantial and sustained weight loss.”

SOURCE: Massachusetts General Hospital

Be heart smart: Foods rich in omega-3s

“ More goodness- a tasty healthy recipe from the Cleveland Clinic, one of my favorite free newsletters.” Bill Chesnut, MD

Cleveland clinic Wellness Newsletter_February 13, 2016
Be heart smart: Foods rich in omega-3s will keep your ticker ticking!
Want a delicious way to improve your heart health? Increasing your consumption of foods that are rich in omega-3 fatty acids is one of the easiest ways to decrease triglyceride levels and slow the growth of the plaque that can block arteries and increase your risk of heart attack and stroke. The American Heart Association recommends eating two servings of fish — such as salmon, albacore tuna, lake trout, sardines and mackerel — each week. Besides fish, there are plenty of other foods that will keep your heart beating soundly:

Nuts: Walnuts, almonds, cashews, flaxseed and chia seeds are omega-3 powerhouses. Try our Maple-Walnut Baked Apples.
Berries: Just three servings a week of raspberries, strawberries, blackberries and blueberries can reduce the risk of heart attack in women by nearly a third! Try our Berry Smoothie.
Legumes: Black and pinto beans, chickpeas, and lentils help improve blood cholesterol levels. Try our Lentil and Arugula Salad with Crunchy Vegetables.

Gastric Bypass Surgery in Patients Aged Older Than 35 Associated With Improved Survival

“Great news here that gastric bypass surgery helps in adults aged 35 and older. This post from the AMA News joins similar results in orthopedic research including the benefits of gastric bypass surgery before knee replacement arthroplasty. I added the emphasis in the last paragraph highlighting the good news.” Bill Chesnut, MD

Gastric Bypass Surgery in Patients Aged Older Than 35 Associated With Improved Survival February 10, 2016

Lance E. Davidson, Ph.D., of Brigham Young University, Provo, Utah, and colleagues examined whether gastric bypass surgery is equally effective in reducing mortality in groups undergoing surgery at different ages. The study was published online by JAMA Surgery.

Bariatric surgery is effective in reducing all-cause and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known. For this study, all-cause and cause-specific mortality rates were estimated from a cohort within 4 categories defined by age at surgery; younger than 35 years, 35 through 44 years, 45 through 54 years, and 55 through 74 years. A cohort of 7,925 patients undergoing gastric bypass surgery and 7,925 group-matched, severely obese individuals who did not undergo surgery were identified through driver license records.

The authors found that gastric bypass surgery was associated with improved long-term survival for all patients undergoing surgery at ages older than 35 years. The lack of mortality benefit for those younger than 35 years was primarily derived from a significantly higher number of externally caused deaths, particularly among women. “Importantly, this study implies that gastric bypass surgery is protective against mortality even for patients who undergo surgery at an older age. Gastric bypass surgery also reduces the age-related increase in mortality risk compared with severely obese individuals who do not undergo surgery.”

To read the full article and a related commentary by Malcolm K. Robinson, M.D., of Harvard Medical School and Brigham and Women’s Hospital, Boston, please visit the For The Media website.

SOURCE: JAMA Surgery

The recipe for preventing diabetes and heart disease? More Waldorf salad, please.

The recipe for preventing diabetes and heart disease? More Waldorf salad, please.

Walnuts are a wonder food, loaded with protein, fiber and nourishing fats. They’re a great source of alpha-linolenic acid, which is integral to bone health and heart health. These flavorful nuts also appear to be a delicious way to reduce the risk of diabetes, according to a new study. Two ounces of walnuts (about 14 pieces) a day for six months was shown to improve blood vessel function and reduce “bad” (LDL) cholesterol. Walnuts may also reduce the risk of certain kinds of cancer, notably prostate.

To get more walnuts into your diet, try swapping granola for a handful of crushed walnuts to top your morning yogurt, or add them to a homemade smoothie. At lunch or dinner, sprinkle walnut pieces on salads, or better yet, try our Spinach Salad with Oranges and Walnuts. For a savory side dish, combine green beans and spinach with walnut pesto.

Cleveland Clinic Wellness newsletter.

FDA approves MRI-safe defibrillators

FDA approves MRI-safe defibrillators

The Minneapolis Star Tribune (2/8, Carlson) reports that the Food and Drug Administration has approved Medtronic’s Amplia MRI Quad CRT-D SureScan and Compia MRI Quad CRT-D SureScan devices. The devices are “resynchronization defibrillators that are safe to use with magnetic resonance imaging” because they use “MRI-safe lead wires.”

Why you should use self-measured blood pressure monitoring.

“This newsletter for physicians patient instructions is good advice. The graph of the blood pressure readings is very helpful to any provider.” Bill Chesnut, MD.

Why you should use self-measured blood pressure monitoring

AMA wire2/8/2016, 3:37 PM

In the last decade, the number of hypertension-related deaths in the United States increased by 66 percent according to the Centers for Disease Control and Prevention (CDC). Self-measured blood pressure monitoring (SMBP) is a great way to engage patients in managing their hypertension. With American Heart Month underway, we’re sharing three key advantages to using SMBP in your practice.

Sometimes called home blood pressure monitoring, SMBP is any self-measured blood pressure that occurs outside the clinical setting. Research has shown that SMBP not only improves blood pressure control, but also increases patient engagement in making healthy lifestyle changes and improving medication adherence.

Here are three clinical benefits of using SMBP in your practice:

SMBP is a better predictor of health. Randomized controlled trials have shown that blood pressure measurements conducted at home predict cardiovascular morbidity and mortality better than blood pressure measurements taken at the doctor’s office.
You will obtain more blood pressure readings over a longer period of time.Having blood pressure readings that are more representative of a patient’s true blood pressure are crucial to accurately diagnosing and assessing blood pressure control options for patients with hypertension.
SMBP also helps guide your decision making when trying to diagnose a patient with high blood pressure. Using blood pressures measured outside of the office is now recommended by the U.S. Preventive Services Task Force to confirm the diagnosis of hypertension when office blood pressures are high.
SMBP helps patients take control of their own health. Patients often adhere to treatment more often when they feel like they are a part of the process of improving their health.
Read how one patientpartnered with his physician to improve his health using self-measured blood pressure.

Other ways to improve blood pressure monitoring

Make sure your health care team is getting the most accurate readings and taking the most effective action to help your patients with hypertension get their blood pressure under control. The AMA’s Improving Health Outcomes initiative offers several resources for your team and your patients.

The “M.A.P.” (Measure accurately, Act rapidly, Partner with patients) collection of tools includes:

Common errors in blood pressure measurement
Posters that shows the proper positioning for the patient and the cuff
Additional resources about self-measured blood pressure

Replacing saturated fats with unsaturated fats may help reduce risk of CV disease

“This report is computer analysis of self-reporting eating habits of 128,000 participants. Beware of that type of research. The authors make a good point, shown in other studies, that carbohydrates are bad. The switch from fat to carbohydrates in food is one of the leading causes of obesity in our culture.” Bill Chesnut, MD

Replacing saturated fats with unsaturated fats may help reduce risk of CV disease

TIME (9/29, Park) reports that research “published in the Journal of the American College of Cardiology finds that too much saturated fat is indeed harmful to the heart,” but “if you cut out calories from saturated fat, the kinds of calories you replace them with can be just as” harmful.

On its website, NBC News (9/29) reports that investigators “used two big, ongoing studies of nearly 85,000 nurses and 43,000 doctors who fill out detailed questionnaires about what they eat every four years.”

The Boston Globe (9/29, Boodman) carries a “Stat” article that reports, “Swapping saturated fats for refined carbohydrates like white rice had no effect on heart disease, while replacing them with unsaturated fats — abundant in nuts, seeds, vegetable oils, and fish — lowered the risk of cardiovascular disease by 15 to 25 percent.” Meanwhile, “replacing saturated fats with whole grains led to a smaller but still significant reduction in the risk of clogged arteries and heart attack.”

AMA News, October, 2015.

Who should use statins?

“Statins are even more important than previously thought. More people qualify for them. They have side effects, including muscle cramps. Know the side effects you might have while you take these marvelous health aides.” Bill Chesnut, MD

USPSTF releases draft recommendation on who should use statins

The AP (12/22, Neergaard) reports that the US Preventive Services Task Force (USPSTF) has issued a draft recommendation on “who qualifies for cholesterol-lowering stains.” In the new “draft guidelines” released Dec. 21 for public comment, the USPSTF “says the…medications will be of most benefit to some people ages 40 to 75 whose risk of cardiovascular disease over the next decade is at least 10 percent.” According to the AP, the task force recommendations “are similar to…2013 guidelines from the American Heart Association and American College of Cardiology.”

TIME (12/22, Park) reports that physicians can assess patients’ “10-year risk by plugging certain information into a web-based calculator formulated by the” AHA and ACC. Two years ago, “the two groups debuted” a “revised algorithm, along with their recommendation that people with a 7.5% or greater risk of heart events in the next 10 years consider taking a statin to reduce that risk.” The USPSTF, however, “concluded that people with a 10% or greater risk of heart problems in the next 10 years, based on the 2013 AHA-ACC calculator, and who have diabetes, high cholesterol, high blood pressure or who smoke, can lower their risk of having a heart attack or stroke by a ‘moderate amount’ by taking a statin.”

HealthDay (12/22, Thompson) reports that the “panel added that people with a 10-year risk of heart attack and stroke between 7.5 percent and 10 percent might also benefit from statins, and should discuss the matter with their” physician.

Warning symptoms may be common prior to sudden cardiac arrest

“This is important information for all of us. Being human, having all this information and staying alive is complicated.” Bill Chesnut, MD

Warning symptoms may be common prior to sudden cardiac arrest

The AP (12/22, Neergaard) reports that research published in Annals of Internal Medicine “suggests a lot of people may ignore potentially life-saving warning signs hours, days, even a few weeks before they collapse” due to cardiac arrest.

On its website, CBS News (12/22, Marcus) reports that the study of 839 patients found that approximately “half of patients who have a sudden cardiac arrest first experience symptoms like intermittent chest pain and pressure, shortness of breath, palpitations, or ongoing flu-like symptoms such as nausea and abdominal and back pain.” However, “80 percent of them ignore their pre-arrest symptoms.”

HIV preexposure prophylaxis not widely used

On the front of its Personal Journal section, the Wall Street Journal (12/22, D1, Reddy, Subscription Publication) reports that although the CDC estimates that 1.2 million Americans could benefit from using Truvada (emtricitabine and tenofovir disoproxil fumarate) to prevent the spread of HIV, fewer than 22,000 people are estimated to take the drug. The CDC estimates that one-third of primary care physicians have not heard of Truvada.

AMA News December, 2015

Nearly 80 percent of heart attacks in the United States go undiagnosed

“Nearly 80% of first heart attacks are missed. This is good research using MRI imaging in one radiology center and studying 1,840 participants. The so-called “silent myocardial infarctions” are a standard part of medical knowledge but this is the first research of such high quality confirming the truth.” Bill Chesnut, MD

MRI Study at the National Institutes of Health. http://www.statnews.com/2015/11/08/silent-heart-attacks/

Nearly 80 percent of heart attacks in the United States go undiagnosed, according to the first nationwide study of its kind.

These “silent” heart attacks, often mistaken for indigestion or muscle pain, might be too small to draw attention, but they are much more common than cardiologists had previously thought, the study, released Sunday, found. And since they put people at greater risk of additional heart attacks later on — possibly big ones — experts say patients who feel any chest pain should seek medical care, even if their symptoms only seem like heartburn.

Heart attacks happen when arteries get blocked by plaques of cholesterol, making it impossible for oxygen-filled blood to nourish the heart. Without air, a part of the heart muscle dies, and scar tissue forms.

Even the smallest heart attack leaves behind a scar, which is more fibrous than living muscle and won’t contract along with the rest of the organ. That makes the heart’s job harder and increases the risk of heart failure.

In the past, researchers have looked for signs of silent heart attacks using a test known as an electrocardiogram, which detects the electrical current that keeps the heart pumping. When scar tissue forms after a heart attack, the electrical signal changes, and doctors can see that abnormality on the ECG. But sometimes, with smaller scars, this test just isn’t precise enough to pick up on the difference.

Now, by turning to a newer scanning technology called magnetic resonance imaging, or MRI, researchers have shown just how much they had been undercounting silent heart attacks.

“It’s almost like having looked at a petri dish first with a magnifying glass, and then having the availability of a microscope. All of a sudden you can see things that you couldn’t see before,” said Dr. Richard Chazal, a cardiologist at the Lee Memorial Health System in Fort Myers, Fla., and president-elect of the American College of Cardiology, who was not involved in the study.

Even the smallest heart attack leaves behind a scar.

A team led by Dr. David Bluemke, director of radiology and imaging sciences at the National Institutes of Health Clinical Center in Bethesda, Md., studied older Americans, aged 45 through 84, from six US communities. Over the course of 10 years, the researchers examined any participant who complained of heart problems with clinical tests and ECGs. Then, in the 10th year, they administered cardiac MRIs to everyone to look for undetected attacks.

Of the 1,840 participants, 146 had experienced heart attacks — but most of these had been missed by doctors and patients alike. MRIs were needed to spot nearly 4 out of 5 of the heart attacks.

Compare these findings with data from 2002, and the difference is striking. When researchers were looking for silent heart attacks using ECGs, their findings showed that only 20 percent of heart attacks had gone undiagnosed.

The reason MRI is so much more sensitive is that it picks up changes in the architecture of the heart’s tissues. Before you go into an MRI machine, you are injected with a metallic liquid. That liquid pools differently in scarred heart tissue than it does in healthy heart tissue, which often makes the scar appear as a bright patch to the physician.

But don’t expect to get routine MRIs the way you might with colonoscopies or mammograms. “MRIs are costly, so we don’t anticipate screening people who are asymptomatic,” said Bluemke. “But we do know that it’s increasingly useful when there are unanswered questions about the dysfunction of the heart.”

Bluemke and his colleagues published their findings in the Journal of the American Medical Association.

Eric Boodman can be reached at [email protected]
Follow Eric on Twitter @ericboodman

High blood pressure should be confirmed outside of physician’s office

“High blood pressure is important! Check your blood pressure! Elsewhere on this site, I posted a short video of how to correctly check your blood pressure. If you are being treated for hypertension, record your blood pressure readings at home on a graph and give this to your prescribing provider. The US Preventive Services Task Force says “ambulatory blood pressure monitoring is the first choice.” I will look for more information about recording ambulatory BP.” Bill Chesnut, MD

High blood pressure should be confirmed outside of physician’s office, USPSTF says

NBC News (10/13, Fox, Edwards) reports that while “blood pressure checks definitely save lives and are worth doing, experts said” yesterday, “patients need to get their blood pressure screened outside the doctor’s office, too.” The reason is that “some people’s blood pressure spikes when they see a” physician, “while other people may have dangerous surges when they wake up in the morning, or through the day, the US Preventive Services Task Force [USPSTF] says in new recommendations,” which are published in the Annals of Internal Medicine.

HealthDay (10/13, Reinberg) reports that “ambulatory blood pressure monitoring is the first choice for confirming a diagnosis of high blood pressure…said” the USPSTF. However, “when not available, home monitors are an acceptable alternative.”

Heart disease undertreated, underdiagnosed in women

“This is an important subject. Please help spread the word.” Bill Chesnut, MD

AMA NEWSLETTER 1.26.16

Group says heart disease undertreated, underdiagnosed in women!

NBC Nightly News (1/25, story 8, 2:00, Holt) reported that an American Heart Association report “says heart disease remains undertreated and underdiagnosed in women.”

The Washington Post (1/25, Dennis) reports in “To Your Health” that “because the causes and symptoms of heart attacks can be strikingly different between the sexes, women are more vulnerable to slower diagnosis and inadequate treatment, according to” the “scientific statement published” in Circulation.

TIME (1/25, Sifferlin) reports that “women are also underrepresented in clinical trials for heart disease, the authors note.” Only about one-fifth of participants enrolled are women, “and even when women are included in trials, researchers often do not parse out the gender-specific data that could deepen scientists’ understanding of how the disease affects women.”

The CBS News (1/25, Marcus) website reports that the statement “also says black and Hispanic women are even more at risk for heart attacks and have poorer outcomes when they do have one.”

The Health Benefits of Dark Chocolate

“This information is from the AMA Wire newsletter in the last few months. Originally published by the AMA in 2009, it is still current and most interesting. I want you to have this longer version of the recent post.” Bill Chesnut, MD

The Health Benefits of Dark Chocolate

By Kate Hanley
Published 10/20/2009

Imagine that you are sitting down to eat an antioxidant-rich food that has been proven to provide significant benefit to your heart health. What do you see on your plate — fresh green salad sprinkled with beautiful vegetables? Brown rice sautéed with chicken and broccoli? Now imagine that the food is also so delicious that it seems more like a decadent treat than a health promoter. What could this magic food possibly be? Chocolate. Dark chocolate, to be precise.

What Makes Dark Chocolate So Good for You
The primary health-promoting benefit of dark chocolate comes from its high levels of flavonoids — potent antioxidants also found (albeit in lower amounts) in tea, red wine, and apples. Antioxidants are important because they protect cells and tissues from damage by free radicals, which are unstable molecules that can alter and weaken cells. Consider them as an insurance policy against the wear and tear that comes from stress, poor diet, and the inevitable process of aging.

Dark chocolate also contains significant amounts of two important minerals: A 1.5 ounce serving of dark chocolate provides 15 percent of the recommended daily allowance (RDA) of magnesium (important for energy production, strong bones, relaxed muscles, and effective nerve transmission), and 34 percent of the RDA of copper (which helps the body create the chemical messengers known as neurotransmitters and is associated with a lowered risk of developing cardiovascular disease).

As if that’s not enough, this near-magic treat promotes cardiovascular health in the following ways:

Improves blood flow and protects arteries.A 2007 Swiss study of heart transplant patients found that the diameter of their coronary arteries was significantly increased after eating a single dose of dark chocolate. Which means that dark chocolate has a healthy effect on these important arteries that supply life-sustaining oxygen to the heart. A 2007 study by Chinese researchers found that participants who ate approximately 1.5 ounces of dark chocolate daily for two weeks significantly improved coronary blood flow. “Blood flow is vital to heart health because the blood carries oxygen, and oxygen is fuel for cells,” explains Tom Morledge, MD, of the Center for Integrative Medicine at the Cleveland Clinic. Consider that the heart pumps 24 hours a day, 365 days a year, and it’s easy to see why an optimum source of energy is important to its function. On the other hand, eating a fast food hamburger with all the trimmings can cause the arteries in our bodies to have impaired function within an hour.
• Prevents blockage of the arteries. LDL, or “lousy,” cholesterol becomes harmful if it is damaged by free radicals, which changes the structure of the LDL, causing it to become oxidized LDL cholesterol. Oxidized LDL cholesterol is then taken up by inflammatory cells that are in the lining of the arteries. The more accumulation, the more likely it is to form blockages that can impede blood flow or clots that can rapidly form, which trigger a heart attack. “Many studies suggest that the flavonoids in dark chocolate decrease the free radical damage of LDL cholesterol,” Dr. Morledge says. In addition, the flavonoids have a similar effect to aspirin. “Flavonoids are a natural blood thinner and affect platelets which can cause clots that lead to heart attacks.” We don’t know yet whether dark chocolate can actually prevent a heart attack, but some recent studies suggest that this might be the case.
• Raises levels of good cholesterol. HDL, or “healthy,” cholesterol works to moderate overall levels of cholesterol, and even small increases in HDL can lead to significant reduction in risk of developing heart disease. “For every 1 milligram improvement in HDL cholesterol, you get a 2 percent reduction in the risk of a heart attack,” Dr. Morledge says. Although studies present conflicting evidence about the full impact dark chocolate on HDL levels, several studies have linked dark chocolate consumption with higher HDL.

An Added Bonus
Although chocolate devotees won’t be at all surprised to hear it, research has also shown that dark chocolate can enhance mood and promote cognitive function: A 2004 study from British researchers found that participants who ate dark chocolate performed significantly better on visual tests that required quick reaction times and reported a noticeable uptick in their mood and energy levels.

Dark Chocolate Versus Milk Chocolate
Hate to break it to milk chocolate fans, but all this great news about the health benefits of chocolate does not apply to milk chocolate. There are two primary reasons: First, the benefits of chocolate come from the cocoa bean itself, and dark chocolate typically contains two to three times as much cocoa content than milk chocolate. Second, while both dark and milk chocolate contain high levels of saturated fat, the saturated fat in dark chocolate is primarily stearic acid, which comes from cocoa butter and has been found to have a neutral impact on cholesterol in humans. While milk chocolate also gets some of its fat from heart-healthy cocoa butter, it also gets some from milk, which contains saturated fat that is linked with higher cholesterol levels.

Milk chocolate also contains more sugar than dark chocolate, which may explain why a 2008 study conducted at the University of Copenhagen found that dark chocolate provides long-lasting feelings of fullness and reduces cravings for unhealthy foods, while milk chocolate caused people to consume more calories later and crave sweets, salty, and fatty foods. When you consume large amounts of sugar, it causes blood sugar levels to spike and then drop — the plunge then cues the body to seek more blood sugar, which translates into unhealthy cravings. Fatty foods and carbohydrate rich foods also stimulate that reward system of the brain and result in cravings which can result in overeating.
The Pretend Chocolate
And then there’s white chocolate, which is not really chocolate at all. White chocolate is a confection based on sugar and fat (either cocoa butter or vegetable oils) without the cocoa solids. And without the cocoa solids, you’re missing the key ingredient. Therefore, it shouldn’t come as a surprise that a recent study showed zero health benefits from eating white chocolate.

How Much Is Healthful?
The first step to making sure that your dark chocolate consumption is indeed good for you is to consume an appropriate serving size. “Dark chocolate still has calories, after all,” Dr. Morledge says, “so you don’t want to eat so much of it that you gain excess weight, which is a risk factor for developing heart disease.” Most of the studies that have measured the health benefits of dark chocolate have used serving sizes of approximately 1.5 to 3 ounces — look at the nutritional information on the back of the bar before you start eating to decide how much you’ll consume. “We don’t know how much or often you should eat it, whether it’s once a week, once a day, or somewhere in between,” Dr. Morledge says. “I tell people to keep the saying ‘Everything in moderation’ in mind when they’re deciding how much to eat and when.”

Perhaps the best way to add dark chocolate to your diet is as a replacement for other sweets you may be consuming — you’ll likely be eating fewer calories, consuming substantially fewer grams of sugar and sodium, and getting a lot more fiber if you opt for more traditional desserts. Not convinced? Compare the numbers on dark chocolate, carrot cake, a chocolate chip cookie from Starbucks, and a 1.5 ounce of Hershey’s milk chocolate for yourself:

	Serving Size	Calories	Sugar	Sodium	Fiber
Dark Chocolate	1.5 ounces	220	12 grams	5 mgs	5 grams
Milk Chocolate	1.5 ounces	210	24 grams	35 mg	1 gram
Carrot Cake	1/6 cake	300	27 grams	320 mg	2 grams
Chocolate Chip Cookie	1 cookie	350	34 grams	300 mg	3 grams

When you are shopping for a dark chocolate bar, let the cocoa content be your guide — it is typically listed prominently on the label, and you want a bar with at least 70 percent cocoa beans. The higher the percentage, the more antioxidant content. If you really want to prioritize the antioxidant content, consider buying cocoa powder — it has the highest concentrations of flavonoids of any dark chocolate product.

Gastric balloon swallowed like a tablet may help patients lose excess weight

“Anything that helps our epidemic of obesity is welcome news. There are so many hidden medical consequences of obesity. I hope someday we will have an affordable effective help for obese children, the critical time of opportunity. “Bill Chesnut, MD

Gastric balloon swallowed like a tablet may help patients lose excess weight

The Los Angeles Times (11/6, Healy) reports in “Science Now” that the Elipse device, an encapsulated “gastric balloon that’s swallowed like a [tablet] and then sits in the stomach filled with fluid, helped patients lose more than a third of their excess weight over a four-month period,” according to the results of a study presented at Obesity Week. The study of “34 overweight and obese subjects who got the balloon lost an average of 22 pounds after four months – roughly 37% of their excess weight,” the study found. The device has yet to be approved by the FDA, however.

HealthDay (11/6, Mozes) points out that the Elipse device “is intended for patients with a BMI as low as 27,” whereas “invasive approaches are typically reserved for severely obese patients – those with a body-mass index (BMI) of 35 and up.” The device is not permanent. After a period of “about four months, the balloon automatically deflates, at which point its thin shell is naturally excreted.”

AMA newsletter_10.06.15