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Here's Why Eating McDonalds Every Day Is A Bad Idea (Even If You Do Lose Weight)

Here's Why Eating McDonalds Every Day Is A Bad Idea (Even If You Do Lose Weight) | Heart and Vascular Health | Scoop.it

Can you lose weight eating nothing but McDonald's for three months? Yes — as evidenced by the now-famous science teacher who reportedly did just that.

But — while we don't recommend it — you could also lose weight eating nothing but jellybeans. The real story is about portion size and exercise: Cisna went from not exercising or watching his food intake to walking for 45 minutes each day and carefully restricting himself to 2,000 calories and recommended dietary allowances for carbohydrates, cholesterol, etc. (Compare that to Spurlock's 5,000 daily calories and many sodas during Super Size Me.)

Are there nutrients in McDonald's apple slices and side salads? Of course. But navigating a fast food menu so that you get the nutrients you need without completely overloading on calories, sugar, carbohydrates, and saturated fat would be a difficult and perhaps futile endeavor. If your end goal is to improve your health, it would also be ill-advised.

Seth Bilazarian, MD's insight:

Little to add here.  We live in a calorie dense environment.  Avoiding circumstances and places where the calories are dense and nutritional options limited is sensible and wise.  The more people that avoid fast food purveyors the more they will be responsive with better nutritional options. The fast food makers are capitalists.

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Patients Who Achieve 10 Minutes During Treadmill Exercise have excellent prognosis

Patients Who Achieve 10 Minutes During Treadmill Exercise have excellent prognosis | Heart and Vascular Health | Scoop.it
Patients who underwent treadmill exercise echocardiography and exercised for 9 or more minutes using th Bruce protocol (N=7236) were included. Clinical and exercise echocardiographic characteristics and outcomes were evaluated. Exercise echo results were positive for ischemia in 862 patients (12%). Extensive ischemia developed in 265 patients (4%). For patients with normal exercise echo results, all-cause and cardiovascular mortality rates were 0.30% and 0.05% per person-year of follow-up, respectively. For patients who had extensive ischemia, all-cause and cardiovascular mortality rates were 0.84% and 0.25% per person-year of follow-up, respectively. Patients at highest risk were those who had extensive and severe regional wall motion abnormalities at rest (n=58), and their all-cause and cardiovascular mortality rates were 2.65% and 0.76% per person-year of follow-up. Exercise echocardiographic variables did not identify sizable patient subgroups at risk for death and did not provide incremental prognostic information (C statistic was 0.74 compared with 0.73 for the clinical plus exercise electrocardiography model).Conclusion  Patients achieving a workload of 10 or more metabolic equivalents during treadmill exercise testing do not often have extensive ischemic abnormalities on exercise echocardiography. Although exercise echocardiographic results provide some prognostic information, it is not of incremental value for these patients, whose short-term and medium-term prognosis is excellent.
Seth Bilazarian, MD's insight:

The 10 METs described are metabolic equivalents which correlate approximately with the minutes on the standard (Bruce) protocol, i.e. 10 METS is 10 minutes. Patients who can achieve this level of exercise have an "extremely low risk of death from cardiovascular disease" (5 out of 10, 000 had cardiovascular death).

The other finding is that adding imaging with echocardiogram (and implied other imaging like nuclear testing) adds little if patients achieve 10 minutes.
Most patients can achieve this level with training which includes regular walking, and can even be achieved in patients with coronary disease.

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Obesity: consensus statement from National Lipid Association

Obesity:  consensus statement from National Lipid Association | Heart and Vascular Health | Scoop.it

Inter-relationship between adiposopathy, type 2 diabetes mellitus, hypertension, dyslipidemia and atherosclerosis. FFA, free fatty acid; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

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Mortality in Randomized Trials of Antioxidant Supplements

Mortality in Randomized Trials of Antioxidant Supplements | Heart and Vascular Health | Scoop.it

 All randomized trials involving adults published by October 2005 comparing beta carotene, vitamin A, vitamin C (ascorbic acid), vitamin E, and selenium either singly or combined vs placebo or vs no intervention were included. The effect of antioxidant supplements on all-cause mortality was analyzed We included 68 randomized trials with 232 606 participants (385 publications).

Conclusions Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.

Seth Bilazarian, MD's insight:

Oxidative stress is implicated in most human diseases so antioxicants mae theoretical sense. . Many primary or secondary prevention trials of antioxidant supplements have been conducted to prevent several diseases.   This trial review found that antioxidant supplements, with the potential exception of selenium, were without significant effects on gastrointestinal cancers and increased all-cause mortality. This review of antioxidant trials not only found that taking them is not beneficial but may be harmful.

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I Had My DNA Picture Taken, With Varying Results

I Had My DNA Picture Taken, With Varying Results | Heart and Vascular Health | Scoop.it

A healthy 28-year-old with concerns about diseases in her family had three different companies check her genetic code. The discrepancies in their results were striking.

23andMe said the most elevated risks — about double the average for women of European ethnicity — were for psoriasis and rheumatoid arthritis, with lifetime odds of getting the diseases at 20.2% & 8.2%. But according to Genetic Testing Laboratories (GTL). The  lowest risks were for — you guessed it — psoriasis (2%) and rheumatoid arthritis (2.6%).

For coronary heart disease, 23andMe and GTL agreed that I had a close-to-average risk, at 26-29%, but Pathway listed odds as “above average.”

In the case of Type 2 diabetes, inconsistencies on a semantic level masked similarities in the numbers. GTL. said risk was “medium” at 10.3%, but 23andMe said risk was “decreased” at 15.7% . In fact, both companies calculated odds to be roughly three-quarters of the average, but they used slightly different averages — and very different words — to interpret the numbers. In isolation, the first would have left me worried; the second, relieved.

Medical ethicists worry about results like these: a lack of industry standards for weighing risk factors and defining terminology.

Scientists have identified about 10 million SNPs within our three billion nucleotides. But an entire genome sequencing — looking at all three billion nucleotides — would cost around $3,000; the tests I took examined fewer than a million SNPs.

“Imagine if you took a book and you only looked at the first letter of every other page,” said Dr. Robert Klitzman, a bioethicist and professor of clinical psychiatry at Columbia. “You’re missing 99.9% of the letters that make the genome. The information is going to be limited.”

Seth Bilazarian, MD's insight:

A life science executive told me recently how elated he was that he and his whole family had taken the"valuable"& progressive approach to have genetic testing.  Had he asked my opinion, I would have shared the experience outlined in this personal account, that my patients have had.
Genetic testing is not ready for prime time and is more likely to be misleading (predicting risk or providing reassurance) and imprecise.
Except for a few diseases like breast cancer genetic testing provides no medical decision making value.  A risk I am concerned about is the lifestyle modifications patient might fail to make because they are falsely reassured about modifiable risks like diabetes and coronary disease  

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Risk‐Treatment Paradox in Transradial Access for Angioplasty (PCI)

Risk‐Treatment Paradox in Transradial Access for Angioplasty (PCI) | Heart and Vascular Health | Scoop.it

Transradial arterial access significantly lowers the risk of access site complications compared to transfemoral arteriotomy. 

 We analyzed 17 509 patients who underwent PCI at 5 institutions. Transradial arterial access was used in 17.8% of patients. In those who underwent transfemoral access, 177 (1.2%) patients had access site complications. Using preprocedural clinical and demographic data, a prediction model for femoral arteriotomy complications was generated. The variables retained in the model:

- elevated age (P<0.001)

- female gender (P<0.001

- elevated troponin (P<0.001)

- decreased renal function or dialysis (P=0.002)

- emergent PCI (P=0.01)

- prior PCI (P=0.005)

- diabetes (P=0.008)

- peripheral artery disease (P=0.003).

Patients with higher predicted risk of complications via transfemoral access were less likely to receive transradial access (P<0.001). Similar results were seen in patients presenting with and without ST‐segment myocardial infarction and when adjusting for individual physician operator.

Conclusions Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access.

Seth Bilazarian, MD's insight:

As the conclusion states: "Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access."

Approaching heart catheterizations & angioplasty procedures from the wrist is slowly increasing in the US.  Cath labs that do not use  the radial approach in all ("Radial-first") rely on the femoral or groin approach.  In these labs, the most challenging patients that would benefit the most are not done from the wrist, because the radial approach is more challenging.  Older patients, smaller patients (women), and in circumstances when time is of the essence (like heart attacks called STEMIs)  don't get done by the radial approach so complications occur.  Unfortunately patients sometimes think they can just request this approach but if the cardiologist and/or cath lab  is not skilled in this technique using the femoral approach is still better.

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Eating healthy is cheaper than you think.

Eating healthy is cheaper than you think. | Heart and Vascular Health | Scoop.it

Harvard School of Public Health (HSPH) crunched the numbers and it’s official: the healthiest diets cost just $1.50 more than unhealthy diets.

 While cost is an issue in when it comes to adding more fresh produce and leaner meats such as fish in your daily diet, few studies have actually evaluated how much more expensive a healthier diet might be. An analysis of 27 studies from 10 higher income countries that compared price points for healthy and less healthy diets. The price differences per serving and per 200 calories for a variety of specific foods, as well as prices per day and per 2,000 calories, which is the average daily recommended caloric intake for U.S. adults.

The results confirm that healthier fare, like fruits, veggies and fish are more expensive than unhealthy foods like processed meals and snacks and refined grains.  However, swapping out some of these less expensive, and less healthy foods, for fresher and more nutritious ones added up to only about $1.50 more per day.

Seth Bilazarian, MD's insight:

The cost, convenience and accessibility of fast food outlets like McDonald's & KFC challenges healthy eating. In my neighborhood, McDonald's offers the family combo (2 Big Macs, 2 McChickens, 4 small fries, 4 small sodas) for $9.99.  KFC has rolled out its $10 Weekend Bucket that offers 10 pieces of chicken for $10.
The value of this research from HSPH is that we can teach that the cost is not an impediment to healthy eating for most Americans.  Fast food accessibility and ease of use is still something that requires education: it's easier to buy a meal at a drive through window than it is to make a salad.
Like most healthy life strategies including exercise and diet - the healthy way is not the easier way.

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Donovan Baldwin's curator insight, December 6, 2013 5:12 PM

Why skimp when it comes to good health. You'll wind up paying more in the long run.

Veronika Bujok's curator insight, December 11, 2013 7:08 AM

people have taste, not have the time and willingness, but cooking is fun and live healthy is an art

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'Thankful forever': Runner revived after suffering heart attack in Thanksgiving race counts his blessings

'Thankful forever': Runner revived after suffering heart attack in Thanksgiving race counts his blessings | Heart and Vascular Health | Scoop.it

On this chilly morning he was among nearly 10,000 pumped-up people running the Feaster Five Road Race in Andover. He ran with his daughter Paige, a student at the University of West Virginia.

“I was really excited,” said the 52-year-old North Andover resident. “It was the third time I had run the Feaster Five. I was with my daughter, who was home from college (University of West Virginia). I just remember being so happy.”

With about 150 yards to go in the 5K race, Dewhirst turned right onto York Street, a pain-in-the-neck hill near the end the course.

“I really wanted to give it my all and finish strong,” said Dewhirst. “I started charging up the hill. I was about three-quarters of the way up when I started feeling light-headed, like I was going to pass out.”

That’s the last thing Dewhirst remembered of his run. He collapsed on the street. He had suffered a heart attack.whirst was revived and whisked him off to Lawrence General Hospital.

Seth Bilazarian, MD's insight:

"“He had no pulse, no heartbeat,” “Our medical team, along with a few runners in the area, responded right away and performed CPR and with an AED and brought Alan back to life. He is lucky he went down in a road race versus in his back yard or walking up his stairs. It’s proof again that running in a road race can actually save your life.”
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Great story by Bill Burt ( @BurtTalksSports ) of Eagle Tribune showing the fantastic life saving results when the chain of survival is in place for rapid CPR (within seconds), rapid defibrilation with an AED (within minutes) then transport to a first rate hospital for heart attack care with angioplasty and stenting (Lawrence General Hospital). Patient returns to a productive life thanks to all the participants which have led to his complete recovery.
Take note of the importance of recognizing early warning signs.  "Dewhirst, ... does recall some issues over the last six months in which he was a little more tired than normal or his heat was “racing” and he needing to stop and breathe." This story turned out great but earlier recognition would have been less dramatic and allot safer.

 

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Moscow Subway Ticket Machine Accepts 30 Squats As Payment

Moscow Subway Ticket Machine Accepts 30 Squats As Payment | Heart and Vascular Health | Scoop.it

To promote exercise and the 2014 Olympics, Olympic Changes installed a very special ticket machine at the Moscow subway station.  Instead of accepting money as payment, the high-tech ticket machine only accepted exercise. Riders could receive a free ticket by standing in front of the machine’s camera, and performing 30 squats or lunges. 

Seth Bilazarian, MD's insight:

Here's a Russian idea that would have huge implications for bending the cost curve for health care in America

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Ekaterina's curator insight, December 1, 2013 8:48 PM

What a great idea! Perhaps other countries should join in!

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CORAL and ERASE Trials of Peripheral Intervention for PAD - unpacked with Mark Creager

CORAL and ERASE Trials of Peripheral Intervention for PAD - unpacked with Mark Creager | Heart and Vascular Health | Scoop.it
Is renal stenting dead post-CORAL? Should we intervene more in PAD after ERASE? Drs. Bilazarian and Creager discuss these peripheral trials from AHA 2013.
Seth Bilazarian, MD's insight:

Great opportunity to understand the practice implications of two trials presented at AHA 2013.  CORAL of renal artery stenting and ERASE of supervised exercise therapy in lower extremity PAD patients.

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Are We in a Medical Education Bubble Market? Ratio of Debt to Income is soaring

Are We in a Medical Education Bubble Market?  Ratio of Debt to Income is soaring | Heart and Vascular Health | Scoop.it

The problem is this: if we aim to reduce the costs of health care, we need to reduce the costs of medical education. We don't have to believe that the high cost of medical education is what causes increases in health care costs in order to develop this sense of urgency. We just have to recognize that the high costs of medical education are sustainable only if we keep paying doctors a lot of money, and there are strong signs that we can't or won't. Only about 20% of health care costs are attributable to physician payments, and many of the current efforts to reduce costs are aimed elsewhere, such as hospital payments, and have only indirect effects on physicians' earnings. But physicians' and dentists' earnings have been sluggish since the early 2000s.

Although it seems unlikely that we're in a bubble market for medical education, we may already be in one for veterinary medicine. That bubble will burst when potential students recognize that the costs of training aren't matched by later returns. Then the optometry bubble may burst, followed by the pharmacy and dentistry bubbles. At the extreme, we will march down the debt-to-income-ratio ladder, through psychiatrists to cardiologists to orthopedists . . . until no one is left but the MBAs.

Seth Bilazarian, MD's insight:

I highly recommend this perspective piece at NEJM.  The current approach of lowering physician payment as a strategy for medical cost reduction is flawed on several levels Chiefly because it only accounts for 20% of costs.   The comparison of US Physician incomes with non-US docs, that is commonly made, is also flawed because of the differences in medical education cost burdens US physicians carry into practice.  The "best and brightest" are already voting with their feet.  The final line I hope is not prescient - ". . until no one is left but the MBAs.".

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Electronic cigarettes for smoking cessation: Only work 7.3% at 6 months

Electronic cigarettes for smoking cessation: Only work 7.3% at 6 months | Heart and Vascular Health | Scoop.it

Electronic cigarettes (e-cigarettes) can deliver nicotine and mitigate tobacco withdrawal and are used by many smokers to assist quit attempts. We investigated whether e-cigarettes are more effective than nicotine patches at helping smokers to quit.657 people were randomised (289 to nicotine e-cigarettes, 295 to patches, and 73 to placebo e-cigarettes) and were included in the intention-to-treat analysis. At 6 months, verified abstinence was 7·3% (21 of 289) with nicotine e-cigarettes, 5·8% (17 of 295) with patches, and 4·1% (three of 73) with placebo e-cigarettes (risk difference for nicotine e-cigarette vs patches 1·51 [95% CI −2·49 to 5·51]; for nicotine e-cigarettes vs placebo e-cigarettes 3·16 [95% CI −2·29 to 8·61]). Achievement of abstinence was substantially lower than we anticipated.. We identified no significant differences in adverse events, with 137 events in the nicotine e-cigarettes group, 119 events in the patches group, and 36 events in the placebo e-cigarettes group. We noted no evidence of an association between adverse events and study product.E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events. Uncertainty exists about the place of e-cigarettes in tobacco control, and more research is urgently needed to clearly establish their overall benefits and harms at both individual and population levels.

Seth Bilazarian, MD's insight:

The lack of success using e-cigarettes to quit smoking is consistent with the experience of my patients.  The 7.3% rate is low and not different from nicotine patches. For my patients, I fear that the well intentioned switch to e-cigarettes, with plans to quit, results in permanent e-cigarette use.  We just don't have any safety data about the use of these devices that are not regulated for quality or purity by FDA and largely made outside the US.  This study was small and there was a trend toward more adverse events with e-cigs.  The best I can tell my patients is that short term use as a strategy to quit smoking is probably safe. My blog on the topic:  http://www.medscape.com/viewarticle/801964?t=1

 

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My Life Check - Life's Simple 7™

My Life Check - Life's Simple 7™ | Heart and Vascular Health | Scoop.it

Learn about the state of your heart and what you can do to live better. Take the My Life Check Assessment. I recommend reviewing the American Heart Association’s Life’s Simple 7 to learn about your cardiovascular health in a patient-friendly format. You can go through the Life’s Simple 7 assessments and bring those numbers, as well as your questions, to your doctor.

Just recently a patient with a family history of heart disease asked, “Am I doing everything I can to avoid developing coronary heart disease as I get older?” We looked at the computer in my office together for an introduction to Life’s Simple 7.

I also explained how to sign up on the AHA’s Heart360 website, where you can enter and track personal cardiovascular health information (such as blood pressure, weight, glucose and cholesterol measurements, and medications). It was easy. And within less than 15 minutes we were linked up on Heart360, which patients and doctors can use to communicate online — quickly and securely — about a patient’s health."

Seth Bilazarian, MD's insight:

The AHA's Simple 7 is a great place for people to start to begin to know aboiut strategies that can reduce lifetime risk of heart attack and stroke.

The SEVEN are listed but the website does a great job explaining each in detail:

1.  Get Active 

2. Control Cholesterol

3. Eat Better

4. Manage Blood Pressure

5.  Lose Weight

6. Reduce Blood Sugar

7.  Stop Smoking

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Steve Kingsley's curator insight, November 17, 2013 2:13 PM

Simple to prescribe... hard to follow for most.

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How Regular Exercise Helps You Balance Work and Family

How Regular Exercise Helps You Balance Work and Family | Heart and Vascular Health | Scoop.it
A reduction in stress is tantamount to an expansion of time.

... the neat trick of successfully integrating work and life mainly through a skillful alignment of priorities

But something else about them, it turns out, has probably helped: their adherence to regular exercise. New research by my colleagues and I (forthcoming in Human Resource Management) demonstrates a clear relationship between physical activity that is planned, structured, repetitive, and purposive – to use Caspersen and colleagues’ seminal definition of exercise – and one’s ability to manage the intersection between work and home.

My colleagues and I surveyed a population of working adults to gather input regarding both their exercise habits and their experience of resolving work and home demands. Briefly, those respondents who reported regular exercise were less likely to experience conflict between their work and home roles.

That’s a somewhat counterintuitive finding. An exercise regimen is, after all, yet another draw onscarce time – and often deleted from professionals’ lives for exactly that reason. How could adding it to an already busy schedule help resolve work/home tradeoffs?

Seth Bilazarian, MD's insight:

The short and long term benefits of physical and mental health provided by regular exercise are well documented, but now ALSO more successful integration of work and family.  Compelling evidence becomes more compelling.

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Right heart catheterization using antecubital venous access: Feasibility, safety and adoption rate

Right heart catheterization using antecubital venous access: Feasibility, safety and adoption rate | Heart and Vascular Health | Scoop.it
RHC via PVA (i.e., internal jugular, femoral or subclavian) is generally a low risk procedure; however, complications may occur and are usually access site related. RHC via an antecubital approach has regained attention given the increase in transradial left heart catheterizations.Results : Two hundred seventy-two RHC procedures were included (106 AVA, 166 PVA). The adoption rate of AVA for RHC increased rapidly since its introduction in our laboratory in 2010 (100% PVA in 2008 and 2009, 85% AVA in 2012). All procedures were successful; however, 6% of procedures required additional, alternate access to the original site. Initial success rates were similar in the two groups (91 vs. 96% for AVA and PVA respectively, P = 0.12). Fluoroscopy time was shorter in the group of patients who underwent the procedure via AVA. The complication rate was 0% in the AVA group compared with 3% in the PVA group (P = 0.16).Conclusion: RHC via the AVA is a feasible and safe alternative to PVA. Our experience and rapid adoption support the use AVA as the access site of choice for RHC in uncomplicated patients.
Seth Bilazarian, MD's insight:

As more procedures are done in the catheterization laboratory from the wrist or radial artery there is an increasing interest in doing other procedures from the upper extremity. Coronary procedures are done from an artery and are called "left heart" procedures. Catheterization of the right heart is done from veins and this paper reviewed the brisk and rapid adoption of the arm vein for this procedure at one center, The arm approach avoids the older groin approach allowing more rapid ambulation and upright positioning of the patient after the procedure.

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Obesity: consensus statement from National Lipid Association

Obesity: consensus statement from National Lipid Association | Heart and Vascular Health | Scoop.it

Adiposopathy: simplified relationship between pathogenic adipose tissue and cardiovascular disease. Adiposopathy is promoted by unhealthy nutrition and a sedentary lifestyle in genetically and environmentally predisposed individuals. With impaired adipogenesis of peripheral, subcutaneous adipose tissue during positive caloric balance, existing fat cells may hypertrophy, circulating free fatty acids may increase, and lipids may be deposited in nonadipose tissue organs (eg, liver, muscle, possibly pancreas) resulting in lipotoxicity. Adiposopathic endocrine and immune responses may be directly pathogenic to the cardiovascular system or otherwise interact with other body systems. If not mitigated by these other body organs, adiposopathy may indirectly cause or promote major atherosclerotic risk factors 

Seth Bilazarian, MD's insight:

A complex relationship made simple by realizing that the top is all that you need to know about preventing the hazards of obesity related medical illness.

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Relation Between Optimism and Lipids in Midlife

Relation Between Optimism and Lipids in Midlife | Heart and Vascular Health | Scoop.it

The hypothesis that optimism is associated with a healthier lipid profile was tested. The participants were 990 mostly white men and women from the Midlife in the United States study, who were, on average, 55 years old.  Models examined the cross-sectional association between optimism and lipid levels, accounting for education and health status (e.g., chronic medical conditions).

After adjustment the results suggested that greater optimism was associated with greater HDL cholesterol and lower triglycerides. Optimism was not associated with low-density lipoprotein or total cholesterol. The findings were robust to a variety of modeling strategies including the effect of cholesterol treatment. The results also indicated that diet and body mass index might link optimism with lipids.

This is the first study to suggest that optimism is associated with a healthy lipid profile; moreover, these associations can be explained, in part, by the presence of healthier behaviors and a lower body mass index.

Seth Bilazarian, MD's insight:

The associations were small but clinically significant. The optimism effect is similar in size to the effect of physical activity.  From the paper, "optimism might serve as a precursor to healthy behavior by motivating " behavior for favorable expectations of the future.

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FIrst Day of ACA: Realizing the Promise of the Affordable Care Act—1/1/2014

FIrst Day of ACA: Realizing the Promise of the Affordable Care Act—1/1/2014 | Heart and Vascular Health | Scoop.it

First, this is the first day of fundamental reform of the business and regulation of health insurance in all 50 states: 

Banning the practice of "medical underwriting" by which insurance companies rate enrollees based on their health status and medical history, Banning pre-existing condition exclusions from US health insurance everywhere, Establishing "guaranteed issue" as the new operating paradigm for individual health insurance, Completely eliminating lifetime limits on all health insurance, and Establishing "minimum essential benefits" that must be included in nearly all licensed health insurance policies everywhere.

Second, Medicaid coverage begins for close to five million uninsured low-income Americans in participating states, with many more millions to follow. This will happen more slowly than the Affordable Care Act's designers expected because of the Supreme Court ruling that made the Medicaid expansions optional for states. But come they will.

Third, private health insurance coverage starts for about one million Americans purchasing coverage through the federal/state health insurance marketplaces with many more to follow.

Fourth, the principle of personal responsibility -- aka the "individual mandate" -- to obtain health insurance coverage takes effect, with the Supreme Court's stamp of approval.

From Boston.com by same author

Seth Bilazarian, MD's insight:

The ACA has many laudable aspects, especially its potential to increase the coverage of the uninsured with improved access to care.  The rollout however has been anxiety provoking because of implementation SANFUs and this violates a chief tenet of insurance.  Having insurance is supposed to reduce anxiety and uncertainty and this program has increased uncertainty fro all participants: hosptials, doctors and patients..

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Association of Nut Consumption with Total and Cause-Specific Mortality

Association of Nut Consumption with Total and Cause-Specific Mortality | Heart and Vascular Health | Scoop.it

Nuts are nutrient-dense foods that are rich in unsaturated fatty acids, fiber, vitamins, minerals, & many other bioactive substances, such as phenolic antioxidants and phytosterols. Observational studies & clinical trials have suggested that nut consumption has beneficial effects on coronary heart disease and its intermediate biomarkers (e.g., blood cholesterol). FDA concluded in 2003 that for most nuts, consumption of 43 g (1.5 oz) per day, as part of a low-fat diet, “may reduce the risk of heart disease.” More recently, a randomized primary-prevention trial involving persons at high cardiovascular risk showed a significant reduction in major cardiovascular events among participants assigned to a Mediterranean diet — one component of which was supplementation with walnuts, hazelnuts, or almonds — as compared with a control diet.

Seth Bilazarian, MD's insight:

This short multimedia film is an excellent review for the public to understand a large epidemiologic study of over 100,000 men and women.  Diets were assessed and the impact of eating peanuts and tree nuts is explained and how to interpret and not OVER interpret this data is well explained.

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Donovan Baldwin's curator insight, December 14, 2013 4:53 PM

I love pecans and have found a place in DFW that usually has the best I ever found.

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Heart Healthy Holiday Party Survival Guide

Heart Healthy Holiday Party Survival Guide | Heart and Vascular Health | Scoop.it

Attending a holiday party doesn’t mean your heart healthy decisions should take a back seat. In fact, this is where they matter most. Holiday parties are prime for tasty, caloric snacks and sugary cocktails, which can be detrimental to heart health, and waistline. But it doesn’t have to be. Keep these five tips in mind the next time you’re invited to a soiree.

1. Put it on a plate 

2. Find a mix

3. Share

4. Stay hydrated

5. Pace yourself

 

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Facts About AFib & The Risk Of Stroke

Facts About AFib & The Risk Of Stroke | Heart and Vascular Health | Scoop.it

Atrial fibrillation (AFib), a type of irregular heartbeat, not caused by a heart valve problem affects approximately 5.8 million people in the U.S. – including me. AFib not caused by a heart valve problem puts people at a 5 times greater risk for stroke. It's why I'm challenging you now to learn the fibs and the facts about AFib-related stroke risk, and share them with everyone you care about.

Seth Bilazarian, MD's insight:

Good basic quiz providing info about  atrial fibrillation.  Fibs or Facts is an educational campaign from Bristol-Myers Squibb and Pfizer to help people learn the fibs and facts about AFib not caused by a heart valve problem and its associated increased risk of stroke.

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Donovan Baldwin's curator insight, December 4, 2013 6:19 AM

Having had my own AFib event, I found this interesting and informative.

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The next frontier in heart care: Research aims to personalize treatment with genetics

The next frontier in heart care: Research aims to personalize treatment with genetics | Heart and Vascular Health | Scoop.it

Cardiologists have struggled in recent years to score major advances against heart disease and stroke. Although death rates have been dropping steadily since the 1960s, progress combating the twin diseases has plateaued by other measures.

Genetics has had a profound impact on cancer treatment in recent years. Now, heart-disease specialists hope genetics will reveal fresh insight into the interaction between a person's biology, living habits and medications that can better predict who is at risk of a heart attack or stroke.

Heart disease is linked to about 800,000 deaths a year in the U.S. In 2010, some 200,000 of those deaths could have been avoided, including more than 112,300 deaths among people younger than 65. Now, widespread prevalence of obesity and diabetes threatens to undermine such gains. And a large gap remains between how white patients and minorities—especially African-Americans—benefit from effective strategies.

Seth Bilazarian, MD's insight:

There's great hope that personalized genetic testing can help with both risk assessment and helping to streamline treatment decisions for patients.  Being able to tell a patient that based on your genetic profile you have a 60% chance of response to treatment A and a 30% chance of response to treatment B would be a fantastic advance in treatment efficiency and cost. Unfortunately, the closest thing we currently have , to this in current application is genetic testing for the drug Plavix (clopidogrel) and the adoption has been fraught with difficulty.  Clinicians and patients wait with eager anticipation of this research.

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Steve Kingsley's curator insight, November 30, 2013 6:02 PM

About 800,000 deaths a year in the U.S. due to heart disease... while better treatments are always welcome, the best -- an least costly -- treatment is prevention = healthy lifestyle!

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The Autopsy of Chicken Nuggets Reads “Chicken Little”

The Autopsy of Chicken Nuggets Reads “Chicken Little” | Heart and Vascular Health | Scoop.it
To determine the contents of chicken nuggets from 2 national food chains.  Chicken nuggets have become a major component of the American diet. We sought to determine the current composition of this highly processed food. Randomly selected nuggets from 2 different national fast food chains were fixed in formalin, sectioned and stained for microscopic analysis. Striated muscle (chicken meat) was not the predominate component in either nugget. Fat was present in equal or greater quantities along with epithelium, bone, nerve, and connective tissue. Chicken nuggets are mostly fat, and their name is a misnomer.
Seth Bilazarian, MD's insight:

The poor nutritional qualities of processed foods like chicken nuggets include high salt/sodium levels and high levels of fat (saturated and trans-fat) and low levels of protein.  The results of the post-mortem exam described in this pathologic study (including microscopic evaluation (histology))  move the discussion from poor nutritional aspects of these "foods" to frank repulsion at the findings of "generous quantities of fat and other tissue, including connective tissue and bone spuicules".  Everything but the meat!

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Eat a Healthy Diet and Drink Wisely to Postpone Dying If You Survived a Myocardial Infarction

Eat a Healthy Diet and Drink Wisely to Postpone Dying If You Survived a Myocardial Infarction | Heart and Vascular Health | Scoop.it

The Mediterranean diet as the most likely dietary model to provide protection against CHD.  Increasing adherence to the Mediterranean diet has been consistently beneficial for prevention of major chronic diseases, including fatal and nonfatal CHD, as well as all-cause mortality.

 In 4098 participants in the Nurses’ Health Study who survived an initial MI.  average dietary quality improved only marginally post-MI among the highly educated health professionals

Nevertheless, for participants who increased the diet/nutrition score, there was a 29% reduction in all-cause mortality and a 40% reduction in cardiovascular mortality. The AHEI2010 diet score used includes 11 components: vegetables, fruits, nuts and legumes, red meat and processed meats, sugar-sweetened beverages, alcohol, polyunsaturated fat, trans fat, omega-3 fat, whole grains, and sodium intake.

Many of the recommendations regarding these foods and nutrients are similar to the traditional Mediterranean diet: high consumption of whole grains, fruits, and vegetables; substantial intake of protein from plant sources (nuts and legumes); moderate intake of polyunsaturated fat; fish as a source of omega-3 fatty acids; and alcohol; and a low consumption of trans fat, meat and meat products, and sugar-sweetened beverages.

Seth Bilazarian, MD's insight:

From the Editorial: Patients who survive an MI are likely to receive up-to-date medical care, including cardiac rehabilitation, antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors, and β-blockers. These interventions reduce the chances of a second MI, but a sizable residual risk  persists. The message from this study is that MI survivors should eat a healthy diet and drink wisely to further reduce the risk of subsequent cardiovascular death or simply postpone dying.

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Harvard study provides best evidence yet that nuts may reduce risk of death

Harvard study provides best evidence yet that nuts may reduce risk of death | Heart and Vascular Health | Scoop.it

New research provides strongest evidence to date that eating nuts can reduce a person’s risk of dying from cancer, heart disease, and a number of other causes.  The study, published Wednesday in the prestigious New England Journal of Medicine, involved more than 118,000 healthy volunteers and found that those who regularly consumed a one-ounce daily serving of walnuts, almonds, cashews, or other tree nuts had a 20% lower risk of dying from any cause during the three-decade long study compared to those who did not eat nuts. Nut eaters were 25 percent less likely to die from heart disease, 10 percent less likely to die from cancer, and 20 percent less likely to die from diabetes as well as lung diseases. The study found that nut eaters enjoyed longer lifespans even if they did not exercise, avoided fruits and vegetables, and were overweight. A decade ago, the Food and Drug Administration determined that there was enough evidence to announce to Americans that eating 1&frac12; ounces of nuts each day “may reduce the risk of heart disease.”

Seth Bilazarian, MD's insight:

When thinking about adding nuts to your diet its hard not to think about the adage that, "you are what you eat".  But eating nuts is definitely not only not "nuts" but quite nutritionally sensible.  Tree nuts are nutritious foods filled with folate, potassium, fiber, good monounsaturated fats, and antioxidants.  In addition, snacking on nuts makes it less likely non-healthy snacks of processed foods and foods containing trans-fats are in the diet.  Peanuts are not nuts.

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Veronika Bujok's curator insight, December 5, 2013 9:48 AM

Daily handful of nuts for health. Nuts, these are the best natural oils for the body.