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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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My Vlog: Hypertension Guidelines: Clear as Mud!

My Vlog: Hypertension Guidelines: Clear as Mud! | Heart and Vascular Health | Scoop.it

I've been trying to make sense of guidelines now for a couple of months. We had lipid guidelines that came out in November at the American Heart Association (AHA) meeting, and then in December we had the publication of the new Joint National Committee (JNC 8) guidelines, [1] also called the "2014 hypertension guidelines," and I'm trying to make sense of it.

Seth Bilazarian, MD's insight:

After more than a decade the hypertension (high blood pressure) guidelines were updated.  The delay and changes have been criticized.  Clinicians and patients need regular updates for all risk factor categories: hypertension, cholesterol & lipids and diabetes.  The guideline writers needs some practical guidelines to write better guidelines.  My fast take on the subject at theheart.org on Medscape.com 

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Do Statins cause dementia?

Do Statins cause dementia? | Heart and Vascular Health | Scoop.it

Adults with no history of cognitive dysfunction treated with statins were included from high-quality randomized controlled trials and prospective cohort studies after formal bias assessment. Sixteen studies were included in qualitative & 11 in quantitative synthesis.

Short-term trials did not show a consistent effect of statin therapy on cognitive end points. Long-term cognition studies included 23,443 patients with a mean exposure duration of 3 to 24.9 years. Three studies found no association between statin use and incident dementia, and 5 found a favorable effect. Pooled results revealed a 29% reduction in incident dementia in statin-treated patients.

Conclusion In patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia.
Seth Bilazarian, MD's insight:

Patients are understandably concerned that a medicine might cause problems with their ability to think and function as they age.  For proponents  (like me) of statin type cholesterol lowering medicines the long-term benefit of improved vascular health provided by statins is compelling.  The theoretical benefit on long term brain health from improved vascular health is also interesting but conflicts with some reports taht memory might be effected by statin use.  The authors from Johns Hopkins have provided a useful review of the literature and concluded that statins are neutral to positive for long term brain health and function, and may "support a beneficial role for statins in the prevention of dementia".

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Smoking and Health (1964)

Smoking and Health (1964) | Heart and Vascular Health | Scoop.it

January 11, 2014 marks the 50th anniversary of the first Surgeon General's report on Smoking and Health. The 1964 report was the first comprehensive compilation of research linking cigarette smoking to severe adverse health effects. Victories have occurred since the release of this landmark report, but there are ongoing challenges and gaps in protections and the course that we will chart to ensure that everyone lives and works in a smokefree environment, that no one picks up the smoking habit and subsequent nicotine addiction, and that no one has to needlessly suffer from a smoking- or secondhand smoke-related disease is an ongoing effort.

Seth Bilazarian, MD's insight:

I still see patients in there 70 and 80's who say that the day the Surgeon general's report came out they put down their cigarettes and never smoked again.  Its a testament to the power of information.  It's estimated that 50% of smokers quit on there own.  We live in a new era and information is more disseminated via the web, and often less authoritative than in 1964, but information still has a potent effect on prevention for many.

The patients that did quit smoking in the early 60's would not be alive today had they not responded  to the surgeon general's call.

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What Patients Say Works for Hypertension

What Patients Say Works for Hypertension | Heart and Vascular Health | Scoop.it
CureTogether, a free resource owned by 23andMe, reports out on what patients say works for them in treating hypertension.

Via 27BloodPressure
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Life Expectancy Calculator

Life Expectancy Calculator | Heart and Vascular Health | Scoop.it
Answer this quiz to calculate your life expectancy - see the effects that genetics and lifestyle choices have on your life expectancy.
Seth Bilazarian, MD's insight:

Useful calculator that predicts life expectancy from cardiovascular disease and other risks such as hazardous driving, alcohol and drug use and seat belt use.

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Color-coded labels, healthier food

Color-coded labels, healthier food | Heart and Vascular Health | Scoop.it
Marking such items and displaying them better prompts cafeteria diners to make more wholesome long-term choices

Using color-coded labels to mark healthier foods and then displaying them more prominently appears to have prompted customers to make more healthful long-term dining choices in their large hospital cafeteria, according to a report from Harvard-affiliated Massachusetts General Hospital (MGH).  Previously reported changes have continued up to two years after the labeling intervention was introduced.

“Our current results show that the significant changes in the purchase patterns of both hospital employees and all customers resulting from the labels and the choice architecture program did not fade away as cafeteria patrons became used to them,”

”This is good evidence that these changes in healthy choices persist over time.”

The first phase involved the application of “traffic light” labels — green for the healthiest items, such as fruits, vegetables, and lean sources of protein; yellow for less healthy items; and red for those with little or no nutritional value — to all items in the main hospital cafeteria. Several weeks before the labels were introduced, cafeteria cash registers began to identify and record each purchased item as red, yellow, or green.

The current study analyzed purchase patterns for the 24 months following the program’s implementation and found that the changes present at the end of the first year were virtually unchanged at the end of the second. Overall, purchases of “green” items had increased 12% , compared with the pre-intervention period, and “red” item purchases dropped 20%. Purchases of “red” beverages — primarily sugar-sweetened beverages — dropped 39%, while “green” beverage purchases increased 10%. The changes remained similar for all types of employees, and overall cafeteria sales during the two-year period were stable.

Seth Bilazarian, MD's insight:

Like many nutrition issues helping end users get educated is of paramount importance.  People can't make wise choices if they don't know what the best nutritional options are, but this study took it a step further by adding the information at the point of selection and purchase.  It worked well, but as a user of the cafeteria it's still a challenge to avoid the Papa Gino's pizza station after a long day. 

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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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Adverse Cardiovascular Events After Ingestion of Energy Drinks

Adverse Cardiovascular Events After Ingestion of Energy Drinks | Heart and Vascular Health | Scoop.it

Energy drink (ED) consumption has been linked to several adverse event reports, but there is limited data on related cardiovascular (CV) complications.. We searched case reports in peer-reviewed journals from 1980, to 2013, in which an acute CV event was associated temporally with ED consumption.

We identified 14 eligible articles involving 15 cases (5 atrial arrhythmias, 5 ventricular arrhythmias, 1 QT prolongation, 4 ST-segment elevations). Two additional cases of cardiac arrest from our institution are included. Of these 17 cases of ED-related acute CV events (13 male cases; 15 cases aged <30 years, age range 13 to 58 years), only 1 had minor previous cardiac disease. Cardiac investigations did not reveal any predisposing cardiac abnormality in the majority of cases. Of the 11 cases related to a serious event (i.e., cardiac arrest, ventricular arrhythmia, or ST-segment elevations), 5 reported acute heavy ED consumption, 4 reported co-ingestions with alcohol or other drugs, and 2 were found to have a channelopathy. Potential mechanisms of ED-related cardiac events are reviewed. In conclusion, several adverse CV events after consuming ED have been reported in the literature. Although causality cannot be inferred from our series, physicians should routinely inquire about ED consumption in relevant cases, and vulnerable consumers such as youth should be advised that caution is warranted with heavy consumption and/or with concomitant alcohol or drug ingestion.

Seth Bilazarian, MD's insight:

The ingredients in energy drinks present theoretical risk for arrhythmia's.  The risk, however is not born out by this report based on the few cases (17 cases) presented in the literature.  This may be related to poor reporting by clinicians, of events which have a possible or probable linkage to energy drink use, 

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askdrmaxwell's curator insight, January 27, 1:50 PM

Energy drinks are not good for your health. They contain excessive amounts of caffeine and potentially-harmful additives and preservatives. 

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Study finds Americans are beginning to consume fewer calories and eat at home more often.

Study finds Americans are beginning to consume fewer calories and eat at home more often. | Heart and Vascular Health | Scoop.it

Americans are beginning to consume fewer calories and eat at home more often, according to a government study that suggests the nation's diet is taking a slightly healthier turn.

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JAMA => The War Against Tobacco: 50 Years and Counting

JAMA => The War Against Tobacco: 50 Years and Counting | Heart and Vascular Health | Scoop.it

JAMA theme issue on tobacco control.  Epidemiology, original reserach and the status of e-cigarettes and strategies for quitting cigarettes is reviewed.  It's been 50 years since the Surgeon General's report. 

Seth Bilazarian, MD's insight:

The cover collage is great.  How far we've come, but not all the way there.  The advertisement of a physician recommending smoking at the top left with highlights of the Surgeon general's report and other news highlights over the last 50 years.

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Adherence Toolkit | National Lipid Association Online

Adherence Toolkit | National Lipid Association Online | Heart and Vascular Health | Scoop.it

The consequence of not recognizing and addressing these barriers is too great to ignore. The breakdown of medication adherence begins in the prescriber’s office and the likelihood of adherence diminishes as the patient proceeds to the pharmacy to fill the prescription and once the patient takes the medication home.

Reference: Adapted from Oyekan E. The B-SMART Medication Adherence Checklist. A Tool to make it easier for Physicians and Providers to do the right thing when addressing America’s other drug problem – Medication Non Adherence. Website: Department of Managed Health Care.  http://dmhc.ca.gov/library/reports/news/rci/oyekan.pdf

 

Seth Bilazarian, MD's insight:

A helpful monograph from National Lipid Association on the problem of medication and lifestyle adherence by patients.

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Frequently Asked Questions About "Better" Fats from AHA

Frequently Asked Questions About "Better" Fats from AHA | Heart and Vascular Health | Scoop.it
What are the "better" fats and which foods contain them?

The unsaturated fats (monounsaturated and polyunsaturated) are also found in many foods.  Vegetable oils, nuts, and seafood are recommended sources of these fats.

Seth Bilazarian, MD's insight:

Great resource on FAQs about, un-, mono-, poyun- and saturated fat Dscussion about omega -3 and 6 fatty acids and fish oil is very clear and understandable..  The words "eat fish" appear often. 

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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