Age is the biggest risk for heart disease, but lifestyle and meds have impact

Credit: CC0 Public Domain

Of all the risk factors for heart disease, age is the strongest predictor of potential trouble.
While no one can stop the march of time, making healthy lifestyle choices or adhering to medication regimens for conditions such as high cholesterol, hypertension or diabetes can substantially reduce the risk of heart disease.

19 dec 2018--Understanding which risk factors modifications are actually effective, and by how much, is increasingly important for doctors and patients to understand in light of new blood pressure and cholesterol guidelines that drive medical care.
In a study published online Dec. 7 in the journal Circulation, a research team led by the Duke Clinical Research Institute provided a statistical analysis that answers the question of what works to lower heart disease risk, and by how much.
"Guidelines of who to treat for cardiovascular disease depend on risk, so we need to accurately estimate that risk," said lead author Michael Pencina, Ph.D., vice dean for Data Science and Information Technology at Duke School of Medicine and member of DCRI.
"Although taken individually, each modifiable risk factors contributes only modestly to the heart disease risk model performance," Pencina said. "But our analysis indicates that eliminating or controlling these factors can lead to substantial reductions in serious cardio-vascular events."
Pencina and colleagues analyzed key modifiable heart disease risk factors, including lipids/cholesterol, systolic blood pressure, diabetes and smoking. Each of those factors was assessed for associations with major heart events such as myocardial infarction, angina or cardiac arrhythmia.
Using pooled participant-level data from four National Heart, Lung and Blood Institute studies that included more than 22,000 people aged 45-85, the researchers found that:

• Age, sex, and race account for about 80 percent of the predictive power of cardiovascular risk models, with age being the main predictor.
• Adding either systolic blood pressure, high cholesterol, diabetes, or smoking to a model with other risk factors only minimally increases the ability of the model to determine who will suffer heart disease events.
• Lowering blood pressure to current recommendations (systolic measurement of less than 130) and lowering low-density lipoprotein cholesterol by 30 percent could reduce the 10-year coronary heart disease risk by as much as a third.

Pencina said there are two ways to achieve lower blood pressure and cholesterol: Never acquire the adverse conditions by maintaining a healthy weight and exercising, or manage them with appropriate lifestyle modifications and medications. The better of the two approaches is, not surprisingly, not developing risk factors.
"Our models suggest that when making individual treatment decisions, clinicians and patients should consider not only the 10-year risk of coronary heart disease, but also the expected benefit from the intervention," Pencina said. "We are moving from models that focus either on the causes or the risks, to a model that combines both and focuses on potential risk reduction."

More information: Quantifying Importance of Major Risk Factors for Coronary Heart Disease. Circulation. www.ahajournals.org/doi/10.116 … LATIONAHA.117.031855


Provided by Duke University

AHA names top heart disease and stroke research advances of 2017

New medicines to fight heart disease, updated guidelines for strokes and high blood pressure, and research into genome editing are among the top heart disease and stroke advances in 2017, according to the American Heart Association and American Stroke Association.

08 feb 2018--The AHA, one of the top funders of heart- and stroke-related research worldwide, has been compiling an annual top 10 list of major advances in heart disease and stroke science since 1996. Here, in no particular order, are the organization's picks for leading research accomplishments published in 2017.

Advancing the treatment of strokes

Following publication in 2017 of the DAWN study in The New England Journal of Medicine showing benefits of mechanical clot removal for longer periods after a stroke starts, the AHA/ASA released new guidelines for treating acute ischemic stroke. The guidelines were released at the International Stroke Conference in January 2018 and included additional data from DEFUSE 3, also presented at the meeting.
The new guidelines, published in the journal Stroke, say the clot-removal treatment window may be increased from six hours to up to 24 hours for specific patients who have clots in large vessels in the brain. The guidelines also increase the number of patients who will have access to a clot-dissolving drug proven to lower the chances for disability. The guidelines reiterated the need for fast action when a person shows the symptoms of a stroke, the second-leading cause of death in the world and a leading cause of disability.

Fixing a gene mutation in human embryos

A study in Nature suggests genome editing could be used to correct disease-causing mutations in the heart muscle of human embryos. Researchers focused on the MYBPC3 gene – which provides instructions for making a protein found in heart muscle cells and causes a form of inherited hypertrophic cardiomyopathy – and used new approaches to allow safe and accurate correction of the abnormal gene.
While early, this research furthers the potential for genome editing to correct mutations that pass from parent to child.

A deeper understanding of heart health for those living in food deserts

Health researchers have focused a lot in recent years on so-called food deserts: low-income neighborhoods with low access to healthy food. But a new study found that it's not so much the "desert" itself as it is low income in general that is linked to poor heart health.
The study, in Circulation: Cardiovascular Quality and Outcomes, studied food deserts in metro Atlanta and found people who live there have higher rates of cardiovascular risk factors such as oxidative stress, inflammation and arterial stiffness. However, researchers concluded these associations are mostly due to low income of the area and its residents rather than proximity to a grocery store – a finding which could impact the future use of public health resources in poor neighborhoods.

Cholesterol-lowering drug cuts risk of heart attacks and strokes

A study in The New England Journal of Medicine found that the new injectable cholesterol-lowering drug evolocumab can reduce heart attacks and strokes among high-risk patients. The FOURIER study – paid for by Amgen, which makes and sells the PCSK9 inhibitor evolocumab under the brand name Repatha – showed that the drug cut the risk of having a heart attack, stroke or dying from a cardiovascular cause by 20 percent when added to intensive statin therapy.
The study reported that Repatha lowered "bad" LDL cholesterol by about 60 percent, to a median of 30.

SGLT2 inhibitors may lower rates of death and heart failure for people with diabetes

A large international study in Circulation showed lower rates of death and heart failure for diabetes patients treated with the SGLT2 inhibitors canagliflozin, dapagliflozin or empagliflozin, compared with other glucose-lowering drugs. The CVD-REAL study – paid for by AstraZeneca, which markets dapagliflozin under the brand name Farxiga – looked at more than 300,000 patients with Type 2 diabetes in the U.S., the U.K., Denmark, Norway and Sweden. The results suggest SGLT2 inhibitors may benefit a broad population of patients with Type 2 diabetes.

Improved therapy for treating patients with peripheral artery disease

According to a study in The Lancet, combining low doses of the blood thinner rivaroxaban and aspirin is more effective than aspirin alone in preventing cardiovascular deaths, heart attacks, strokes and major amputations for people with peripheral artery disease, or PAD.
The 33-country COMPASS study looked at 7,470 patients with PAD, a narrowing of the peripheral arteries to the legs, arms, stomach and head. Although major bleeding increased with the combination therapy, fatal or critical organ bleeding did not. Researchers said the new approach is a major advance in treating patients with peripheral artery disease.

A new treatment for fighting inflammation and reducing cardiovascular events

Scientists have long believed that reducing inflammation may reduce the risk of heart disease. The CANTOS study published in The New England Journal of Medicine looked at more than 10,000 high-risk patients who previously had heart attacks and found that canakinumab, a monoclonal antibody that targets interleukin-1 beta and blocks inflammation, significantly lowered their rate of having or dying from a heart attack, stroke or other cardiovascular cause. Although the drug did not reduce overall deaths from any cause and was associated with significant side effects, the principle underlying the use of a specific anti-inflammatory antibody is important.

Catheter-based procedure extended for more patients with aortic stenosis

Aortic stenosis – a narrowing of the aortic valve opening – is a common and serious valve disease problem. For patients with severe aortic stenosis at high risk for surgical complications, a procedure called transcatheter aortic-valve replacement, or TAVR, that can be done through a catheter rather than with open-heart surgery, is already an accepted alternative.
The SURTAVI study in The New England Journal of Medicine looked at severe aortic stenosis patients at intermediate risk for complications from surgery and found TAVR to be a viable alternative for them as well.


Provided by American Heart Association

Unsaturated fats, high-quality carbs lower risk of heart disease

Heart diagram. Credit: Wikipedia

While eliminating saturated fats can improve heart health, a new study shows that it makes a difference which foods are used in their place. A study published today in the Journal of the American College of Cardiology shows that replacing saturated fats with unsaturated fats and high-quality carbohydrates has the most impact on reducing the risk of heart disease. When saturated fats were replaced with highly processed foods, there was no benefit.

29 sept 2015--Previous research looked at the association between consumption of saturated fatty acids and the risk of coronary heart disease, but did not specify the replacement for saturated fat - such as unsaturated fats or the type of dietary carbohydrate. This is one of the first studies to distinguish between polyunsaturated fatty acids, monounsaturated fatty acids, and carbohydrates from whole grains or refined starches and added sugars.
"Many physicians could benefit from more in-depth nutritional knowledge to help them counsel their patients on changing their dietary practices in a way that will impact their health. In particular, we found that when study participants consumed less saturated fats, they were replacing them with low-quality carbohydrates such as refined grains that are not beneficial to preventing heart disease," said Frank B. Hu, M.D., Ph.D., study author and professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health.
"Our findings suggest that when patients are making lifestyle changes to their diets, cardiologists should encourage the consumption of unsaturated fats like vegetable oils, nuts, and seeds, as well as healthy carbohydrates such as whole grains," Hu said.
Editor-in-Chief of the Journal of the American College of Cardiology, Valentin Fuster, M.D., Ph.D., FACC, further elaborated on the important role clinicians play in helping patients make healthy lifestyle choices. "All physicians and medical personnel who interact with patients should speak with them about the benefits of consuming unsaturated fats and healthy carbohydrates," Fuster said.
Researchers analyzed data from the Nurses' Health Study, a cohort of 121,701 female nurses enrolled in 1976, and the Health Professionals Follow-up Study, a cohort of 51,529 men enrolled in 1986. For this study, researchers followed 84,628 women and 42,908 men who were free of diabetes, cardiovascular disease and cancer and documented 7,667 incidents of coronary heart disease.
Participants provided information on diet, lifestyle, medical history, and newly diagnosed diseases through questionnaires at baseline and every two to four years for 24 to 30 years. The questionnaire asked how often and in what quantity specific foods had been consumed in the past year and to specify the types of fats or oil used for frying, baking and at the table. The questionnaire was validated against biomarkers of dietary fatty acids.
Researchers noted that participants generally replaced calories from saturated fatty acids with calories from low-quality carbohydrates—such as white bread or potatoes—rather than calories from unsaturated fats found in vegetable oils, nuts and seeds or high-quality carbohydrates like those in whole grains. Replacing 5 percent of energy intake from saturated fats with an equivalent intake from either polyunsaturated fats, monounsaturated fats, or carbohydrates from whole grains was associated with 25 percent, 15 percent, and 9 percent lower risk of coronary heart disease, respectively. However, replacing 5 percent of energy intake from saturated fats with carbohydrates from refined starches or sugars was not associated with either increased or decreased risk of coronary heart disease.
Examples of the kinds of changes that Hu said could result in reduced risk of heart disease:

• Cooking with healthy fats such as canola oil, olive oil or other vegetable oils instead of butter, lard, and hard margarine.
• Exchanging snacks like potato chips and cookies for peanuts, almonds and olives.
• Making sandwiches with a whole wheat bun, avocados and chicken breast instead of large amounts of cheese and processed meats.

Study limitations included the observational nature that did not allow the study to prove causality and self-reported diet questionnaires cannot be completely accurate. However, the authors stated that their results were broadly consistent with those from randomized clinical trials, and the diet questionnaire was validated against fatty acid biomarkers.
In an accompanying editorial, Robert A. Vogel, M.D., Cardiology Section at the Department of Veterans Affairs Medical Center in Denver, said, "Healthfulness clearly lies in the quality or type of both fat and carbohydrate."
The study and editorial are part of a comprehensive Population Health Promotion issue of the Journal of the American College of Cardiology focusing on issues that broadly impact public health and the prevention of cardiovascular disease and related conditions. Population health is a strategic priority of the American College of Cardiology, which recently brought together experts from around the world to address issues such as smoking and nutrition in the context of developing public health strategies for improving population health.

More information: "Saturated fat as compared to unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: A prospective cohort study," Yanping Li, Adela Hruby, Adam M. Bernstein, Sylvia H. Ley, Dong D. Wang, Stephanie E. Chiuve, Laura Sampson, Kathryn M. Rexrode, Eric B. Rimm, Walter C. Willett, Frank B. Hu, Journal of the American College of Cardiology, online September 28, 2015, DOI: 10.1016/j.jacc.2015.07.055

Provided by American College of Cardiology

Osteoporosis linked with heart disease in older people

University of Southampton scientists have discovered a link between coronary heart disease and osteoporosis, suggesting both conditions could have similar causes.

30 jun 2015--In one of the first studies of its kind to use a special scanning technique, researchers found that people with a history of heart disease had substantially lower cortical volumetric bone mineral density in their wrist bone (the distal radius) than those without.

Using a state-of-the-art technique called 'high resolution peripheral quantitative computed tomography', researchers from Southampton's Medical Research Council (MRC) Lifecourse Epidemiology Unit were able to visualise multiple layers of the wrist bone, in much the same way a 3D printer might build up layers of an object. These cross section visuals were used to assess symptoms of osteoporosis - a condition that weakens bones, making them more vulnerable to fractures and breaks.

The technique was used on 350 men and women, aged 70 - 85, who had enrolled on the Hertfordshire Cohort Study. The findings, published today in Osteoporosis International, show that cortical volumetric bone mineral density was lower among participants with coronary heart disease (or ischaemic heart disease) such as angina, heart attack or heart failure. The effect was more prominent in women than in men.

Professor Cyrus Cooper, Director of the MRC Lifecourse Epidemiology Unit and Professor of Rheumatology at the University of Southampton, says: "This is one of the first studies to use this technology to explore bone geometry, density and microstructure in patients with heart disease. The findings highlight the need to evaluate a history of heart disease in the management of osteoporosis in older people and further research is also needed to provide a better understanding of the underlying mechanisms which explain the link between osteoporosis and heart disease."

Dr. Julien Paccou, Clinical Research Fellow at the MRC Lifecourse Epidemiology Unit, University of Southampton, added: "In essence, this work and others show that people with a history of cardiovascular disease tend to have weaker bones. There is a need to better understand this association to improve bone health."

The study Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius was funded by the Medical Research Council.

Provided by University of Southampton

'Perfect storm' of stress, depression may raise risk of death, heart attack for heart patients

The combination of stress and heavy depression can significantly increase heart patient's risk of death or heart attack, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

15 mar 2015--The study examined the effect of high stress levels and high depressive symptoms among nearly 5,000 heart patients. Researchers concluded that risk is amplified when both conditions are present, thus validating the concept of a "psychosocial perfect storm."

"The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use and health risk behaviors," said Carmela Alcántara, Ph.D., lead author of the study and associate research scientist at Columbia University Medical Center for Behavioral Cardiovascular Health in New York.

Study participants included 4,487 coronary heart disease patients, 45 years and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

During in-home examinations and self-administered questionnaires from 2003-07, participants were asked how often during the past week they felt depressed, lonely or sad, or had crying spells. To determine stress levels, participants were asked how often during the past month they felt they were unable to control important things in their lives, felt overwhelmed, felt confidence in their ability to handle personal problems and felt things were going their way.

About 6 percent reported both high stress and high depression.

During an average six-year follow-up, 1,337 deaths or heart attacks occurred. Short-term risk of death or heart attack increased 48 percent for those in the high stress-high depressive symptoms group compared with those in the low stress-low depressive symptoms group.

The elevated risk was most strongly associated with death rather than heart attack; additional result suggest the deaths may have been cardiovascular-related, but more research is needed, researchers said. The risk was significant only during the first two-and-half years from the initial home visit, and wasn't significant for those experiencing either high stress or high depressive symptoms alone, but not both at the same time.

Study findings may challenge traditional research paradigms that only focus on depression and its impact on patients with heart disease, Alcántara said. Behavioral interventions also should be considered to help heart disease patients manage both stress and depression better.

Provided by American Heart Association

Impact of mental stress on heart varies between men, women

This graphic shows the effects of mental stress on psychophysiological domains, myocardial ischemia, and outcomes in men and women. Credit: Zainab Samad et al. Sex Differences in Platelet Reactivity and Cardiovascular and Psychological Response to Mental Stress in Patients With Stable Ischemic Heart Disease: Insights From the REMIT Study. J Am Coll Cardiol. 2014;64(16):1669-1678.

Men and women have different cardiovascular and psychological reactions to mental stress, according to a study of men and women who were already being treated for heart disease. The study, published today in the Journal of the American College of Cardiology, looked at 56 women and 254 men diagnosed with heart disease enrolled in a larger REMIT study of the impact of the medication escitalopram on heart disease induced by mental stress.

After undergoing baseline testing, participants carried out three mentally stressful tasks—a mental arithmetic test, a mirror tracing test, and an anger recall test—followed by a treadmill exercise test. During mental stress tasks and rest periods between tests, researchers conducted echocardiography to study changes in the heart, took blood samples, and measured blood pressure and heart rate.

Researchers from the Duke Heart Center found that while men had more changes in blood pressure and heart rate in response to the mental stress, more women experienced myocardial ischemia, decreased blood flow to the heart. Women also experienced increased platelet aggregation, which is the start of the formation of blood clots, more than men. The women compared with men also expressed a greater increase in negative emotions and a greater decrease in positive emotions during the mental stress tests.

"The relationship between mental stress and cardiovascular disease is well known," said the study lead author Zainab Samad, M.D., M.H.S., assistant professor of medicine at Duke University Medical Center, Durham, North Carolina. "This study revealed that mental stress affects the cardiovascular health of men and women differently. We need to recognize this difference when evaluating and treating patients for cardiovascular disease."

"At this point, further studies are needed to test the association of sex differences in the heart's responses to mental stress and long term outcomes," Samad said. "This study also underscores the inadequacy of available risk prediction tools, which currently fail to measure an entire facet of risk, i.e. the impact of negative physiological responses to psychological stress in both sexes, and especially so among women."

Provided by American College of Cardiology

Coronary calcium predicts heart disease risk in patients with chronic kidney disease 

Calcium buildup in the coronary arteries may be a better indicator of kidney disease patients' risk of heart disease than traditional risk factors used in the general population, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings provide valuable new information that could help safeguard the heart health of patients with kidney disease.

22 aug 2014--Heart disease is the leading cause of death in individuals with chronic kidney disease (CKD). Some studies have found that conventional risk factors for predicting an individual's likelihood of developing heart disease aren't as useful in CKD patients as they are in the general population.

Kunihiro Matsushita, MD, PhD (Johns Hopkins Bloomberg School of Public Health) and his colleagues looked to see if calcium measurements within blood vessel walls might be helpful. Because the kidney helps regulate the body's calcium levels, individuals with chronic kidney disease often have altered calcium metabolism, which may influence the usefulness of calcium in the coronary artery walls as an indicator of heart disease.

The researchers studied 6553 adults aged 45 to 84 years who did not have prior cardiovascular disease and who were participating in the Multi-Ethnic Study of Atherosclerosis. Among the participants, 1284 had CKD.

During a median follow-up of 8.4 years, 650 cardiovascular events (coronary heart disease, stroke, heart failure, and peripheral artery disease) occurred, with 236 of the events occurring in participants with CKD. The investigators found that calcium build-up in the coronary artery walls was more useful for correctly determining CKD patients' risk of cardiovascular disease (particularly coronary heart disease and heart failure) than other measures of atherosclerosis such as thickness of the carotid artery walls and narrowing of the arteries in the legs.

"Our research is important since it assures the usefulness of coronary artery calcium for better cardiovascular disease prediction in persons with CKD, a population at high risk for cardiovascular disease but with potential caveats for the use of traditional risk factors," said Dr. Matsushita.

More information: The article, entitled "Subclinical Atherosclerosis Measures for Cardiovascular Prediction in CKD," will appear online at jasn.asnjournals.org/ on August 21, 2014.

Provided by American Society of Nephrology

Rheumatoid arthritis and heart disease: Studies shed light on dangerous connection

People with rheumatoid arthritis and other chronic inflammatory conditions are at higher risk of heart disease. Who is in the most danger, why and how best to prevent and detect cardiovascular complications are important questions for physicians and researchers. Mayo Clinic studies presented at the American College of Rheumatology annual meeting shed new light on this connection, in part by revealing factors that seem to put some rheumatoid arthritis patients in greater jeopardy of heart problems: early menopause, more severe rheumatoid arthritis and immunity to a common virus, cytomegalovirus, among others.

28 oct 2013--In one study, Mayo researchers discovered that patients whose rheumatoid arthritis is more severe are likelier to have heart problems. That becomes true soon after rheumatoid arthritis strikes, making early treatment of rheumatoid arthritis important, says co-author Eric Matteson, M.D., chair of rheumatology at Mayo Clinic in Rochester, Minn.

"One thing that we learned in particular in this study is that the high disease burden on the joints in the first year of disease already is a very strong predictor of cardiovascular disease subsequently, and that seems to be mitigated as time goes on if the disease burden can be reduced too," Dr. Matteson says.

In other research, a Mayo team looked at a common virus called cytomegalovirus, a bug many people get and do not even know they have. They found correlations between rheumatoid arthritis patients' immune response to the virus and the development of myocardial disease.

If it turns out that there is this relationship, then it may be that one way to spot patients who are at higher risk for heart disease would be an immune profile or biomarkers related to the cytomegalovirus and its associated immune activation signaling," says Dr. Matteson, a co-author.

Another study found that women with rheumatoid arthritis and early menopause—menopause before age 45—also seem to be at higher risk of heart disease. About two-thirds of patients with rheumatoid arthritis are women, and researchers have long studied possible hormonal influences on development of the disease, Dr. Matteson says.

"This study shows the complex relationship between rheumatoid arthritis, hormones and heart disease," says Dr. Matteson, the senior author. "We also found patients who have had multiple children, especially seven or more, are at higher risk of cardiovascular disease compared with women who have menopause at a normal age or have fewer children."

Provided by Mayo Clinic

Depression can lead to heart disease

Depression may have more far-reaching consequences than previously believed. Recent data suggests that individuals who suffer from a mood disorder could be twice as likely to have a heart attack compared to individuals who are not depressed.

29 nov 2011--This process has been poorly understood — until now. A new study led by Concordia University has found that depressed individuals have a slower recovery time after exercise compared to those who are non-depressed.

These findings suggest that a dysfunctional biological stress system is at play among depressed individuals. Published in the journal Psychophysiology, the research warns of the importance of testing for cardiovascular disease among people suffering from major depression.

"There have been two competing theories as to why depression is linked to cardiovascular disease," says first author Jennifer Gordon, who is a PhD candidate at McGill University. "Depressed people may have poorer health behaviors, which may in turn lead to heart problems. The other possibility is physiological: a problem with the stress system known as the fight or flight response. Our study was the first to examine the role of a dysfunctional fight or flight response in depression in a large population."

Heart rate recovery is a powerful diagnostic tool

A total of 886 participants, who were on average 60 years old, took part in the study conducted by Concordia in association with the Montreal Heart Institute, McGill University, the Hôpital Sacré-Coeur de Montréal, the Université du Québec à Montréal and the University of Calgary.

Approximately 5 per cent of participants were diagnosed with a major depressive disorder. All individuals were asked to undergo a stress test after which their heart rate and blood pressure were recorded. Recovery heart rates and blood pressure levels were compared between depressed and non-depressed individuals.

"We found that it took longer for the heart rate of depressed individuals to return to normal," says senior author, Simon Bacon, a professor in the Concordia University Department of Exercise Science and a researcher at the Montreal Heart Institute. "Heart rate recovery from exercise is one way to measure the fight or flight stress response. The delayed ability to establish a normal heart rate in the depressed individuals indicates a dysfunctional stress response. We believe that this dysfunction, can contribute to their increased risk for heart disease."

"The take-home message of this study is that health care professionals should not only address the mental disorder, but also the potential for heart disease in patients who are suffering from major depression," adds Bacon. "Both of these health issues should be treated to minimize risk of severe consequences."

More information: http://onlinelibra … .01232.x/pdf

Lower socioeconomic status linked with heart disease despite improvements in other risk factor

People with lower socioeconomic status are much more likely to develop heart disease than those who are wealthier or better educated, according to a recent UC Davis study. Published online in BMC Cardiovascular Disorders, the outcomes also show that this risk persists even with long-term progress in addressing traditional risk factors such as smoking, high blood pressure and elevated cholesterol.

29 aug 2011--"Being poor or having less than a high school education can be regarded as an extra risk when assessing a patient's chances of developing cardiovascular disease," said Peter Franks, a UC Davis professor of family and community medicine and lead author of the study. "People with low socioeconomic status need to have their heart-disease indicators managed more aggressively."

Using data from the Atherosclerosis Risk in Communities Study, authors of the current study included information on more than 12,000 people aged 45 to 64 years living in North Carolina, Mississippi, Minnesota and Maryland. Participants reported their education and income levels in 1987, and then over the course of 10 years were periodically evaluated for heart-disease diagnoses and changes in their risk factors, including cholesterol, blood pressure and smoking.

The results indicated that people with lower socioeconomic status had a 50 percent greater risk of developing heart disease than other study participants.

According to Franks, although it is known that people with low socioeconomic status have a greater risk for developing heart disease and other health problems, the reason is often attributed to reduced health-care access or poor adherence to treatments such as smoking cessation or medication. This study showed for the first time that the increased risk endured despite long-term improvements in other risk factors, indicating that access and adherence could not account for the differences.

"Low socioeconomic status is a heart-disease risk factor on its own and needs to be regarded as such by the medical community," Franks said.

According to Franks, previous studies could help explain the link between low socioeconomic status and increased heart-disease risk. Social disadvantages and adversity in childhood may result in lasting adaptations to stress that take a bigger toll on the heart. Cumulative effects of social disadvantage throughout the lifespan could also cause more "wear and tear" on the cardiovascular system.

Franks advocates for including socioeconomic status in the Framingham risk assessment, a tool based on outcomes from the Framingham Heart Study, which is commonly used to determine treatments for heart-disease prevention. He points out that health-care providers in the United Kingdom already consider socioeconomic status in determining care plans.

"Doctors could, for instance, moderately increase the dosage of cholesterol-lowering drugs to reflect the higher risk imposed by socioeconomic status," said Franks, whose research focuses on addressing health-care disparities. "Changes like this would be easy to implement, and the benefits could be significant."

More information: The study "Do Changes in Traditional Coronary Heart Disease Risk Factors Over Time Explain the Association between Socio-Economic Status and Coronary Heart Disease?" is available online at http://www.biomedc … 1-2261/11/28

Provided by University of California - Davis

Satisfaction with the components of everyday life appears protective against heart disease

While depression and anxiety have long been recognised as risk factors for heart disease, there is less certainty over the beneficial effects of a 'positive' psychological state, Now, following a study of almost 8000 British civil servants, researchers say that a satisfying life is indeed good for the heart.

11 july 2011--The results of the study are published online today by the European Heart Journal.

The civil servants - who were all members of the Whitehall II study cohort in the UK with an average age of 49 years - were questioned about seven specific areas of their everyday lives: love relationships, leisure activities, standard of living, job, family, sex, and one's self. They were asked to rate their satisfaction in each domain on a scale of 1 ('very dissatisfied') to 7 ('very satisfied'). Ratings for each domain were also combined to provide an average satisfaction score for their overall lives.

The participants' health records were then examined for coronary related deaths, non-fatal heart attack, and clinically verified angina over a follow-up period of around six years.

Results of the investigation showed that higher levels of average life satisfaction were associated with a reduced (and statistically significant) risk of total coronary heart disease of 13% (HR 0.87; 95% CI: 0.78 – 0.98), after controlling for demographic and other health characteristics. An approximate 13% reduced risk of heart disease was also associated with satisfaction in four of the specific life domains - job, family, sex, and self (but not with love relationships, leisure activities, or standard of living). The reduced risk of total coronary heart disease was found in both men and women.

There was a 'dose response' in these associations such that those reporting the greatest average life satisfaction appeared to enjoy the greatest risk reduction in total coronary disease. However, when examining the association between average life satisfaction and fatal or non-fatal heart attack separately from angina, reduced risk was only evident with angina, which appeared to be driving the association between life satisfaction and total coronary heart disease. Such findings may be accounted for by the relatively young age of the study participants or by the possibility that life satisfaction may relate to a general risk of atherosclerosis but not to factors predisposing individuals to heart attack. Nevertheless, the authors propose that understanding the psychological profile of patients with angina may add predictive value to an assessment of their subsequent heart disease risk.

'Taken together,' say the investigators, 'this research indicates that being satisfied with specific life domains - in particular, one's job, family, sex life, and self - is a positive health asset associated with a reduction in incident coronary heart disease independently of traditional risk factors.'

Commenting on the results, investigator Dr Julia Boehm from the Department of Society, Human Development, and Health, at the Harvard School of Public Health, Boston, USA, said: 'Although conventional risk factors such as health behaviors, blood pressure, lipids and body mass index did not explain the relationship between life satisfaction and total coronary heart disease, other behavioural or biological mechanisms that promote resilience cannot be ruled out. Moreover, these findings suggest that interventions to bolster positive psychological states - not just alleviate negative psychological states - may be relevant among high-risk individuals.'

Provided by European Society of Cardiology

Study reinforces link between obesity, high-fat meals and heart disease

The effect of a high-fat meal on blood vessel walls can vary among individuals depending on factors such as their waist size and triglyceride levels, suggests new research at UC Davis.

21 feb 2011--The new research reinforces the link between belly fat, inflammation and thickening of the arterial linings that can lead to heart disease and strokes.

Triglycerides are types of fat molecules, commonly associated with "bad cholesterol," known to increase risk of inflammation of the endothelium, the layer of cells that lines arteries.

"The new study shows that eating a common fast food meal can affect inflammatory responses in the blood vessels," said Anthony Passerini, assistant professor of biomedical engineering at UC Davis, who led the project.

"Our techniques allowed us to measure the inflammatory potential of an individual's lipids outside of the body and to correlate that with easily measured characteristics that could be used to help better understand a person's risk for vascular disease," Passerini said.

Passerini collaborated with Scott Simon, professor of biomedical engineering at UC Davis, to develop cell culture models to mimic the properties of blood vessels. They wanted to learn how triglyceride levels can cause endothelial inflammation, and find a way to assess an individual's inflammatory potential.

They recruited 61 volunteers with high and normal fasting triglyceride levels and a range of waist sizes, then measured levels of triglyceride particles in their blood after they ate a typical fast food breakfast from a major fast food franchise: two breakfast sandwiches, hash browns and orange juice.

Passerini's team found that after eating the high-fat meal, the size of a type of a particle called triglyceride-rich lipoprotein (TGRL) varied directly with the individual's waist size and preexisting blood triglyceride level. These particles can bind to the endothelium, triggering inflammation and an immune response that brings white blood cells to repair the damage. Over time, this leads to atherosclerosis.

The researchers tested whether TGRL particles from the volunteers' blood could cause cultured endothelial cells in the laboratory to express markers for inflammation.

There was a mixed response: individuals with both a waist size over 32 inches (not terribly large by most standards) and high triglyceride levels had large lipoprotein particles that bound easily to the endothelial cells and caused inflammation in response to an immune chemical "trigger."

The TGRLs only caused inflammation when exposed to this immune molecule, which suggests that people with existing low-grade inflammation may be more susceptible to endothelial dysfunction related to triglyceride "spikes" that occur after eating high-fat meals, Passerini said.

In people who are predisposed, repeated episodes of inflammation could lead to atherosclerosis. Passerini's lab is continuing to investigate how abdominal obesity, high triglyceride levels and inflammation can lead to atherosclerosis.

More information: The findings are published online in the journal American Journal of Physiology - Heart and Circulatory Physiology.

Provided by University of California - Davis

Cost to treat heart disease in United States will triple by 2030

The cost to treat heart disease in the United States will triple by 2030, according to a policy statement published in Circulation: Journal of the American Heart Association.

27 jan 2011--"Despite the successes in reducing and treating heart disease over the last half century, even if we just maintain our current rates, we will have an enormous financial burden on top of the disease itself," said Paul Heidenreich, M.D., chair of the American Heart Association expert panel issuing the statement.

The panel estimated future medical costs based on the current rates of disease and used Census data to adjust for anticipated population shifts in age and race. The rigorous methods they devised didn't double count costs for patients with multiple heart conditions.

"These estimates don't assume that we will continue to make new discoveries to reduce heart disease," Heidenreich said. "If our ability to prevent and treat heart disease stays where we are right now, costs will triple in 20 years just through demographic changes in the population."

The panel said effective prevention strategies are needed to limit the growing burden of cardiovascular disease — the leading cause of death in the United States that accounts for 17 percent of overall national health expenditures.

"Unhealthy behaviors and unhealthy environments have contributed to a tidal wave of risk factors among many Americans," said Nancy Brown, American Heart Association CEO. "Early intervention and evidence-based public policies are absolute musts to significantly reduce alarming rates of obesity, hypertension, tobacco use and cholesterol levels."

Currently, 1 in 3 Americans (36.9 percent) have some form of heart disease, including high blood pressure, coronary heart disease, heart failure, stroke and other conditions. By 2030, approximately 116 million people in the United States (40.5 percent) will have some form of cardiovascular disease, the panel said. The largest increases are anticipated in stroke (up 24.9 percent) and heart failure (up 25 percent).

Between 2010-30, the cost of medical care for heart disease (in 2008 dollar values) will rise from $273 billion to $818 billion, the authors predicted. "We were all surprised at the remarkable increase in costs that are expected in the next two decades," Heidenreich said. "We need to continue to invest resources in the prevention of disease, the treatment of risk factors and early treatment of existing disease to reduce that burden."

Provided by American Heart Association

Diet, Cognitive Ability May Play Role in Heart Disease

24 nov 2009-- Seniors who eat plenty of fruits and vegetables and who have good cognitive function are much less likely to die from heart disease than those who have poorer cognitive function and eat fewer fruits and vegetables, a new study has found.

Cognitive function refers to the ability to think, remember, plan and organize information.

Researchers at the Drexel University School of Public Health in Philadelphia analyzed diet and cognitive data on 4,879 people (3,101 women and 1,778 men), age 70 and older, who took part in the U.S. Longitudinal Study of Aging. The participants were followed for an average of seven years.

The analysis revealed that:

• Those who ate three or more servings of vegetables daily had a 30 percent lower risk for dying from heart disease and a 15 percent lower risk for dying from any cause during the follow-up period than those who ate fewer than three servings of vegetables a day.
• There was a significant association between higher consumption of fruits and vegetables and decreased prevalence of cognitive impairment.
• People who scored high on cognitive functions tests were less likely to die from heart disease or any other cause during the follow-up than were those with low scores.

The study was to be presented Wednesday at the American Heart Association's annual meeting in Orlando, Fla.

More information

The U.S. National Heart, Lung, and Blood Institute explains how to prevent and control heart disease risk factors.

Don't blame fast food: Mummies had heart disease

ORLANDO, Fla., 19 nov 2009 – You can't blame this one on McDonald's: Researchers have found signs of heart disease in 3,500-year-old mummies.

"We think of it as being caused by modern risk factors," such as fast food, smoking and a lack of exercise, but the findings show that these aren't the only reasons arteries clog, said Dr. Randall Thompson, a cardiologist at the Mid America Heart Institute in Kansas City.

He and several other researchers used CT scans, a type of X-ray, on 22 mummies kept in the Egyptian National Museum of Antiquities in Cairo. The subjects were from 1981 B.C. to 334 A.D. Half were thought to be over 45 when they died, and average lifespan was under 50 back then.

Sixteen mummies had heart and blood vessel tissue to analyze. Definite or probable hardening of the arteries was seen in nine.

"We were struck by the similar appearance of vascular calcification in the mummies and our present-day patients," said another researcher, Dr. Michael Miyamoto of the University of California at San Diego. "Perhaps the development of atherosclerosis is a part of being human."

One mummy had evidence of a possible heart attack but scientists don't know if it was fatal. Nor can they tell how much these people weighed — mummification dehydrates the body.

Of those whose identities could be determined, all were of high social status, and many served in the court of the Pharaoh or as priests or priestesses.

"Rich people ate meat, and they did salt meat, so maybe they had hypertension (high blood pressure), but that's speculation," Thompson said.

With modern diets, "we all sort of live in the Pharaoh's court," said another of the researchers, Dr. Samuel Wann of the Wisconsin Heart Hospital in Milwaukee.

The oldest mummy with heart disease signs was Lady Rai, a nursemaid to Queen Ahmose Nefertari who died around 1530 B.C. — 200 years before King Tutankhamun.

German imaging company Siemens AG, the National Bank of Egypt and the Mid-America Heart Institute paid for the work. Results are in this week's Journal of the American Medical Association and were reported Tuesday at an American Heart Association conference.

Less than 1 in 5 heart problems are diagnosed before symptoms appear

Clinicians are missing golden opportunities to identify heart disease before patients start displaying symptoms, according to a study of 13,877 people published in the May issue of UK-based IJCP, the International Journal of Clinical Practice.

12 may 2009--Researchers from Oregon, Maryland and Delaware, USA, found that just over 11% of the respondents had been diagnosed with heart disease. However, only 19% of those individuals - who had been involved in the ongoing study for two years - said that their heart disease was picked up during routine screening.

More than half of the diabetic patients with heart disease who took part in the study (54%) reported that their heart disease was diagnosed when they became symptomatic and a further 22% said it was picked up while they were being treated for other health issues.

The figures were lower for individuals without diabetes. Just under half (48%) were diagnosed with heart disease when they became symptomatic and 15% were picked up during treatment for other conditions.

"Our study showed that not enough patients with heart disease are being picked up during routine screening or treatment for conditions like diabetes, which are commonly associated with heart problems" says lead author Dr Sandra J Lewis from the Northwest Cardiovascular Institute in Portland, Oregon. "The majority of those who took part in the study were not diagnosed until they started displaying symptoms."

Coronary heart disease (CHD) is the leading cause of death in the United States, accounting for more than 450,000 deaths a year. Approximately 15.8 million Americans who are 20 or older suffer from the disease.

"Many individuals do not show symptoms and go undiagnosed until the disease is in an advanced state, often when they have actually had a heart attack" explains Dr Lewis.

"That is why it is so important to diagnose CHD before patients experience their first crisis, by looking at major risk factors such as smoking, having high blood cholesterol, having high blood pressure, being overweight, being physically inactive or just getting older.

"Guidelines recommend that all adults over the age of 20 should receive risk factor screening from their family doctor every two to five years. There are more specific guidelines for patients with type 2 diabetes as their risk of a heart attack is twice as high as the general population."

The analysis from the SHIELD study (Study to Help Improve Early evaluation and management of risk factor Leading to Diabetes) was performed to see if ongoing recommendations for improved screening in the USA were resulting in more patients being diagnosed with heart disease before they became symptomatic.

It forms part of the larger SHIELD survey of 211,097 US households who responded to a national questionnaire.

More than 18,400 people who had participated in the baseline and first follow-up SHIELD surveys - and had diabetes or one of the five cardiometabolic risk factors - were sent questionnaires and 13,877 (75%) responded. Of these, 1,573 (11% of the total) had been diagnosed with heart disease.

Just under two-thirds had heart disease on its own (62%). They were predominantly male (59%) and white (91%) with an average age of 67. The remaining 38% had heart disease and type 2 diabetes. They were slightly more likely to be women (50.7%), 88% were white and their average age was 69.

The average time since diagnosis was 11.7 years in CHD patients without diabetes and 10.7 years in individuals with diabetes and CHD. Almost a third of the non diabetes group (31%) and 36% of the diabetes group had been diagnosed since 2001 when a number of consensus statements and guidelines on screening and prevention were published.

"Despite increased knowledge and awareness of the risk factors for CHD, many individuals are not diagnosed with heart disease until they are symptomatic" concludes co-author Dr Kathleen Fox from Strategic Healthcare Solutions in Monkton, Maryland.

"The fact that only a small percentage of the SHIELD respondents were diagnosed through screening indicates that there is a missed opportunity to diagnose heart disease during earlier, less severe stages of the disease.

"As blood pressure and weight are evaluated when most patients visit their family doctor, medical providers already have information about two key modifiable risk factors.

"Our study demonstrates the need for improved targeted education aimed at both patients and doctors to reduce heart disease before symptoms occur."

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The paper can be viewed free at: www.ijcp.org

Less severe first heart attacks linked to heart disease death reductions

American Heart Association journal report

20 jan 2009--The severity of first heart attacks has dropped significantly in the United States — propelling a decline in coronary heart disease deaths, researchers reported in Circulation: Journal of the American Heart Association.

"This landmark study suggests that better prevention and better management in the hospital have contributed to the reduction in deaths," said Merle Myerson, M.D., Ed.D., lead author of the study, cardiologist and director of the Cardiovascular Disease Prevention Program at St. Luke's-Roosevelt Hospital of Columbia University in New York City.

"Better control of risk factors for heart disease, such as blood pressure and cholesterol as well as improvements in hospital management may lessen the severity if somebody has a heart attack," Myerson said. "We also considered whether people had less severity because they got to the hospital sooner, but that was not the case."

The study extends previous findings from the Atherosclerosis Risk in Communities (ARIC), an ongoing epidemiologic study that includes data from four areas — Forsythe County, N.C., including Winston-Salem; Washington County, Md., including Hagerstown; and the suburbs of Minneapolis, Minn. and Jackson, Miss. Both whites and African-Americans were included in the study.

In a previous analysis of ARIC data gathered from 1987 to 1994, researchers found a decrease in many, but not all indicators of severity. Myerson and colleagues included an extra eight years of data, covering 10,285 patients, ages 35 to 74, who were discharged from the hospital diagnosed with a definite or probable first-time heart attack from Jan. 1, 1987 through Dec. 31, 2002. The new findings show a more consistent picture with a clear decline in severity of heart attacks.

Researchers assessed severity based on patients' electrocardiogram (ECG) findings, the levels of enzymes in the blood associated with heart muscle damage and hemodynamic abnormalities related to blood flow and blood pressure.

Adjusted for age, sex and race, the new findings included:

• A significant drop occurred in the proportion of patients who had major ECG abnormalities, including an average 1.9 percent per year decline in initial ST-segment elevation, a 3.9 percent decline per year for a new (subsequent) Q-wave, and 4.5 percent per year decline for any major Q-wave.
• The average percentage of patients with abnormal biomarkers dropped 0.7 percent, a modest but statistically significant decline.
• Hemodynamic factors (forces involved in blood circulation) showed mixed results. For example, the percentage of patients with cardiogenic shock dropped 5.7 percent per year. But the proportion with systolic blood pressure of 100 mm Hg or less was unchanged, and the percentage with an abnormal pulse rate — less that 60 or more than 100 beats per minute — increased moderately.
• The results for men, women and African Americans paralleled the study's overall results.
• There was some evidence of possible race-related differences between whites and African Americans in new Q-waves and the percent of decline in confirmed heart attacks, which dropped more in whites.
• The percentage of patients who arrived at the hospital in less than two hours after symptom onset remained at approximately 33 percent; there was no significant change over the study time period.
• These new findings demonstrate that there has been a decrease in heart attack severity and an increased survival among first-time heart attack sufferers; both of which can help to explain the decline in deaths from coronary heart disease.

"The reduction in severity of first-time heart attacks, along with other factors, has impacted on the declining number of deaths from coronary heart disease" Myerson said. "This tells us that better primary prevention as well as better care for those with acute heart attacks is working. Attributing the reduction in severity to specific causes will be an important next step so effective strategies can be reinforced and public health policies can be better directed."

Co-authors are: Sean Coady, M.A.; Herman Taylor, M.D.; Wayne D. Rosamond, Ph.D.; and David C. Goff Jr., M.D. Individual author disclosures are available on the manuscript.

The National Heart, Lung, and Blood Institute funded the ARIC study.

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Statements and conclusions of study authors that are published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability.

The heart disease mutation carried by 60 million

The worst luck in the world? Muscle protein gene mutation in one in 100

19 jan 2009--Heart disease is the number one killer in the world and India carries more than its share of this burden. Moreover, the problem is set to rise: it is predicted that by 2010 India's population will suffer approximately 60% of the world's heart disease. Today, an international team of 25 scientists from four countries provides a clue to why this is so: 1% of the world's population carries a mutation almost guaranteed to lead to heart problems and most of these come from the Indian subcontinent, where the mutation reaches a frequency of 4%.

Heart disease has many causes, some carried in our genes and others linked to our lifestyle, but all seemingly complex, hard to pin down and incompletely understood. So the new study published in Nature Genetics is striking for the size and simplicity of the effect it reports.

The mutation, a deletion of 25 letters of genetic code from the heart protein gene MYBPC3, is virtually restricted to people from the Indian subcontinent. But there, Caste and Tribe, Hindu, Muslim, Sikh, Christian and others are all united by this affliction.

The mutation was discovered five years ago in two Indian families with cardiomyopathy, but its significance only became apparent after almost 1500 people from many parts of India, some with heart disease and some without, were studied.

Scientists express this genetic risk as an odds ratio, where 1.2 would be a small effect and 2.0 a large one. For the MYBPC3 mutation, the odds ratio is almost off-scale, a staggering 7.0. Carriers usually show few symptoms until middle age, but after that age most are symptomatic and suffer from a range of effects, at worst sudden cardiac death.

"The mutation leads to the formation of an abnormal protein," explained the study leader, Kumarasamy Thangaraj from the Centre for Cellular and Molecular Biology, Hyderabad, India. "Young people can degrade the abnormal protein and remain healthy, but as they get older it builds up and eventually results in the symptoms we see."

The combination of such a large risk with such a high frequency is, fortunately, unique. "How can such a harmful mutation be so common?" asks Chris Tyler-Smith from The Wellcome Trust Sanger Institute, Hinxton, UK. "We might expect such a deleterious change to have 'died out'.

"We think that the mutation arose around 30,000 years ago in India, and has been able to spread because its effects usually develop only after people have had their children. A case of chance genetic drift: simply terribly bad luck for the carriers."

"The bad news is that many of these mutation carriers have no warning that they are in danger," said Perundurai S. Dhandapany from Madurai Kamaraj University, Madurai, India, "but the good news is that we now know the impact of this mutation."

The lifetime risk of developing heart failure is roughly one in five for a person aged 40 years. Now that this mutation has been identified, there is a new glimmer of hope for some of them. The mutation's effects vary a lot from person to person. Carriers could be identified at a young age by genetic screening and adopt a healthier lifestyle.

"This is a genetic finding of great importance," said Sir Mark Walport, Director of the Wellcome Trust. "Heart disease is one of the world's leading killers, but now that researchers have identified this common mutation, carried by one in 25 people of Indian origin, we have hope of reducing the burden that the disease causes. This research should lead to better screening to identify those at risk and may ultimately allow the development of new treatments."

And perhaps eventually new drugs could be developed to enhance the degradation of the abnormal protein and postpone the onset of symptoms. There is a market of 60 million people waiting.

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Notes to Editors

Publication Details
Dhandapany PS et al. (2008) A common Cardiac Myosin Binding Protein C variant associated with cardiomyopathies in South Asia. Nature Genetics
Published online before print as doi: 10.1038/ng.309

A Mysterious Link Between Sleeplessness and Heart Disease

By RONI CARYN RABIN
25 dec 2008--People who don’t get much sleep are more likely than those who do to develop calcium deposits in their coronary arteries, possibly raising their risk for heart disease, a new study has found.

The 495 participants in the study filled out sleep questionnaires and kept a log of their hours in bed. At night they also wore motion-sensing devices around their wrists that estimate the number of hours of actual sleep. At the beginning, none of the participants, who were ages 35 to 47, had evidence of coronary artery calcification.

Five years later, 27 percent of those who were sleeping less than five hours a night on average had developed coronary artery calcification for the first time, while only 6 percent of those who were sleeping seven hours or more had developed it. Among those who were sleeping between five and seven hours a night, 11 percent had developed coronary artery calcification, the study found.

After accounting for various other causes, the researchers concluded that one hour more of sleep per night was associated with a 33 percent decrease in the odds of calcification, comparable to the heart benefit gained by lowering one’s systolic blood pressure by 17 millimeters of mercury.

The study was published on Tuesday in the Journal of the American Medical Association. The data were drawn from the ongoing Coronary Artery Risk Development In Young Adults study.

Senior author Diane S. Lauderdale cautioned that the new report does not prove a cause-and-effect relationship between a lack of sleep and heart disease.

“It’s important to say that this is the first report and this does not yet prove the association is causal,” said Dr. Lauderdale, an associate professor of health studies at the University of Chicago Medical Center. “Until we know what the mechanism is -- that it’s really a direct or a causal relationship -- there is no point in making recommendations based on this.”

Although a number of studies have suggested that people who sleep less are at greater risk of heart disease and death, this is the first investigation to measure how much its subjects actually are sleeping, said Dr. Sanjay Patel, assistant professor of medicine at Case Western Reserve University and expert in sleep medicine. Patients’ own self-assessments can be very inaccurate, he added.

What isn’t clear is whether reduced sleep triggers physiological changes that increase heart disease risk, or whether a third, unrelated factor causes both changes, he said.

“It’s possible, for example, that people who are under more stress may be both sleeping less and at higher risk of heart disease,” Dr. Patel said.

If so, he added, “If we got those people to sleep more but they still were under a lot of stress, it wouldn’t change their risk of heart disease.”

Higher education levels are also associated with both a lower risk of heart disease and a tendency to get more sleep, said Dr. Lauderdale.

But it is also possible that lack of sleep leads to certain changes, like increasing blood levels of the stress hormone cortisol, which can raise the risk of coronary artery disease over time, Dr. Lauderdale said.

Another possible mechanism could be through the effect that sleep has on average blood pressure levels over a 24-hour period. Blood pressure usually dips when people are asleep, which could provide health benefits for those who get more sleep, Dr. Lauderdale suggested.

Even a Little Overweight, Inactivity Hurts the Heart

By Ed Edelson
24 dec 2008-- Even a few extra pounds and just a little inactivity increased the risk of heart failure in a major study of American doctors.

"What this study shows is that even overweight men who are not obese have an increase in heart failure risk," said Dr. Satish Kenchaiah, lead author of a report on the finding in the Dec. 23 issue of Circulation.

As for exercise, "even a little amount of physical activity appears to decrease the risk of heart failure," said Kenchaiah, who did the research as a epidemiologist at Brigham and Women's Hospital in Boston and is now at the U.S. National Heart, Lung, and Blood Institute.

The study has followed more than 21,000 doctors for two decades, measuring among other factors the influence of overweight and physical activity on development of heart failure, the progressive loss of ability to pump blood, which is often a prelude to major coronary events.

Outright obesity, defined as a body-mass index of 30 or over, has long been known as a risk factor for heart failure. The new report concentrated on men who were borderline overweight, with a body-mass index of 25 to 29.9.

About 5 percent of the doctors were obese, and 40 percent were overweight, when the study began. Adjusting for other risk factors such as high blood pressure and high cholesterol, the study found a 49 percent increased incidence of heart failure in overweight men compared to those with a body-mass index of 25 or less. Incidence of heart failure was 180 percent for the obese men compared to the leaner ones.

It was the same story for physical activity. "Men who engaged in physical activity anywhere from one to three times a month had an 18 percent reduction in heart failure risk," Kenchaiah said. "For those who were active five to seven times a week, the reduction was 36 percent. The more you exercise, the more reduction you achieve."

The association of even minimal physical activity with reduced risk could be explained as an indicator of good habits in general, he said. "It is possible that they have a healthier lifestyle in general," Kenchaiah said.

The study found that doctors who rarely or never exercised were older, smoked cigarettes more often, and were more likely to have high blood pressure or diabetes.

"This new report reinforces what we've said in the past," said Dr. Gerald Fletcher, a preventive cardiologist at the Mayo Clinic in Jacksonville, Fla. "Not being obese but being overweight is definitely a risk factor for heart failure."

While Fletcher said he would have liked a more definitive indicator of physical activity -- the report described it as simply breaking a sweat -- he said the study showed again that "vigorous exercise makes the difference. The more you do, the better it is for you."

Two-thirds of Americans have excess body weight, and only about 30 percent exercise regularly, Kenchaiah said. About 660,000 new cases of heart failure are diagnosed each year in the United States, he said, and 80 percent of the men and 75 percent of the women aged 65 and older who are diagnosed with heart failure die within eight years.