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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Deputy Heart Attack - Learn Early Heart Attack Care!

Deputy Heart Attack - Learn Early Heart Attack Care! | Heart and Vascular Health | Scoop.it
Early Heart Attack Care (EHAC) is dedicated to saving lives by detecting the early signs of a heart attack

Take the short quiz to learn the basics of recognizing a heart attack in the early stage in a family, friend or co-worker:  Here's a sample question

 

 What questions should you ask the person experiencing early heart attack symptoms?
A.    Is the discomfort, tightness, pressure, or pain located in the center of the chest? 
B.    Are the symptoms present in the chest, throat, jaw, upper back or inside of the left arm? 
C.    Did these symptoms come on with exertion and do they go away with rest?
D.    All of the above

Seth Bilazarian, MD's insight:

Great educational quiz from @EHAC_Deputy a resource from @SCPCP an organization that certifies hospitals as centers of chest pain excellence.  Part of the problem with care of the heart attack patient is that it cannot start until emergency services are notified.  This big problem results in much of the problem and lasting effects including death and disability.  Early Heart Attack Care (EHAC) can greatly reduce and sometimes eliminate the long term hazard of a heart attack.  

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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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Mental Activity and eXercise (MAX) Trial:  Trial to Enhance Cognitive Function in Older Adults

Mental Activity and eXercise (MAX) Trial:  Trial to Enhance Cognitive Function in Older Adults | Heart and Vascular Health | Scoop.it

The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in relatively small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects.

Participants A total of 126 inactive, community-residing older adults with cognitive complaints.

Interventions All participants engaged in home-based mental activity (1 h/d, 3 d/wk) plus class-based physical activity (1 h/d, 3 d/wk) for 12 weeks and were randomized to either mental activity intervention (MA-I; intensive computer) or mental activity control (MA-C; educational DVDs) plus exercise intervention (EX-I; aerobic) or exercise control (EX-C; stretching and toning); a 2 × 2 factorial design was used so that there were 4 groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1, and MA-C/EX-C.

Results Participants had a mean age of 73.4 years; 62.7% were women, and 34.9% were Hispanic or nonwhite. There were no significant differences between the groups at baseline. Global cognitive scores improved significantly over time (mean, 0.16 SD; P < .001) but did not differ between groups in the comparison between MA-I and MA-C (ignoring exercise, P = .17), the comparison between EX-I and EX-C (ignoring mental activity, P = .74), or across all 4 randomization groups (P = .26).

Conclusions and Relevance In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function.

Seth Bilazarian, MD's insight:

Another feather in the cap of exercise. The benefits on blood pressure, diabetes, cholesterol, muscle and bone strength are well known. In addition, now, this study showed a significant benefit on cognitive (thinking) ability with exercise (moderate intensity, 60 minutes, 3 x / week). There was no added benefit of mental activity such as performing games to enhance the speed and accuracy of visual and auditory processing.
Exercise: low risk, multiple benefits, low cost.

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Blair Kettle's curator insight, November 12, 2013 8:25 PM

"In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function"

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Researchers Compare Exercise, Drugs as Cardiovascular Treatments

Researchers Compare Exercise, Drugs as Cardiovascular Treatments | Heart and Vascular Health | Scoop.it

Structured exercise programs may be as effective, or even more useful, than medication to treat cardiovascular conditions. The authors evaluated and synthesized the results of 305 previous studies to compare the benefits of drug and exercise regimens on disease outcomes.  

After identifying four conditions for which exercise has been studied as a preventive technique—coronary heart disease, stroke, heart failure, and type-2 diabetes—Naci and Ioannidis compared the efficacy of drugs used to treat these conditions to previously-reported effects of exercise.

 They found that structured physical activity was more effective than drug use in the treatment and prevention of strokes, and equally effective in the secondary prevention of coronary heart disease and diabetes.  Diuretic drugs were more successful than exercise, however, in treating heart failure.

“[Our study] will trigger debate, which is really important,” said Naci. “In cases where we have evidence of exercise, exercise seems to do really well in comparison to drugs, but there are still a lot of instances where we don’t know how exercise fares against drugs.”

Seth Bilazarian, MD's insight:

Unfortuaneely this eithetr or approach is not best.  For all patients who needs drugs for management of high blood pressure or cholesterol problems or diabetes the question is not drugs or exercsie but should be drugs and exercise.

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Dr. KGM BIYABANI's comment, November 3, 2013 12:00 AM
TREATMENT REGIMENS ARE TO BE INDIVIDUALIZED ACCORDING TO THE PATIENT'S DISEASE AND THE TREATMENT REGIMEN OUTCOMES. ACCORDING TO THE ABOVE STUDY THERE SHOULDN'T BE AN "OR".; TREATMENT REGIMENS MAY INCLUDE MANY PREVENTIVE AS WELL AS CURATIVE THERAPIES, BOTH PHARMACOLOGICAL AND NON-PHARMACOLOGICAL. AT THE END PATIENT/PERSON MATTERS. THERE SHOULD BE "AND" instead of "OR". OF COURSE THERE IS NEVER A MAGIC BULLET IN HEALTHCARE;THAT'S WHY THERE SHOULDN'T BE AN "OR" AS DR. BILAZARIAN HAS SAID. AND I AGREE WITH ROBIN THOMAS ABOUT "THE MAGIC BULLET" PART ONLY.
Dr. KGM BIYABANI's curator insight, November 3, 2013 12:04 AM

TREATMENT REGIMENS ARE TO BE INDIVIDUALIZED ACCORDING TO THE PATIENT'S DISEASE AND THE TREATMENT REGIMEN OUTCOMES. ACCORDING TO THE ABOVE STUDY THERE SHOULDN'T BE AN "OR".; TREATMENT REGIMENS MAY INCLUDE MANY PREVENTIVE AS WELL AS CURATIVE THERAPIES, BOTH PHARMACOLOGICAL AND NON-PHARMACOLOGICAL. AT THE END PATIENT/PERSON MATTERS. THERE SHOULD BE "AND" instead of "OR". OF COURSE THERE IS NEVER A MAGIC BULLET IN HEALTHCARE;THAT'S WHY THERE SHOULDN'T BE AN "OR" AS DR. BILAZARIAN HAS SAID. AND I AGREE WITH ROBIN THOMAS ABOUT "THE MAGIC BULLET" PART ONLY.

Randy Randhawa, DC's curator insight, November 5, 2013 10:45 AM

Daily motivation, "structured exercise programs may be as effective, or even more useful, than medication to treat cardiovascular conditions."

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Trends in Prescribed Drugs Treating Diabetes, Hypertension, and High Cholesterol for Persons under Age 40 in the US

Trends in Prescribed Drugs Treating Diabetes, Hypertension, and High Cholesterol for Persons under Age 40 in the US | Heart and Vascular Health | Scoop.it
From 2000 to 2010, the number of people in the U.S. civilian noninstitutionalized population under age 40 obtaining at least one outpatient prescription anti-diabetic or anti-hypertensive increased.From 2000 to 2010, the total number of outpatient prescriptions for persons under age 40 increased for anti-diabetics, anti-hypertensives, and statins—41%, 49%, & 179%, respectively.Comparing 2000 with 2010, for persons under age 40 in the U.S. civilian noninstitutionalized population inflation adjusted total expenses increased for anti-diabetics (126%) and for statins (97%).From 2000 to 2010, for persons under age 40, the inflation adjusted average cost per drug purchase of a prescription anti-diabetic increased 61% from $77 to $124.From 2000 to 2010, for persons under age 40, the inflation adjusted average cost per drug purchase of a prescription anti-hypertensive and statin decreased.
Seth Bilazarian, MD's insight:

Despite the rise in obesity and incident diabetes and other associated risk factors such as high blood pressure and high cholesterol in children and young adults the treatment rates have increased very little over 10 years. Despite the known long term hazards there is a lack of data on treatment in patients less than 40 years old and therefore real hesitancy to treat by physicians.

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Cut Salt, Save 500,000 U.S. Lives Over a Decade, Study Finds

Cut Salt, Save 500,000 U.S. Lives Over a Decade, Study Finds | Heart and Vascular Health | Scoop.it

Reducing salt in Americans' diets would save hundreds of thousands of lives over 10 years, according to a new study.

Excess salt, the primary source of sodium, contributes to high blood pressure and cardiovascular disease, the leading killer in the United States.

Immediately reducing people's salt consumption from current levels to the upper limit of the U.S. government guideline -- 2,300 milligrams a day -- would save 500,000 to 850,000 lives over the next decade, largely by reducing heart attacks and strokes, the study found.

Gradually reducing sodium levels in processed or restaurant foods by 4 percent a year for 10 years would still save 280,000 to 500,000 lives over a decade, the researchers concluded.

The average American consumes about 3,500 mg per day, and men tend to ingest much more than that, according to the study, which was published Feb. 11 in the journalHypertension.

Seth Bilazarian, MD's insight:

Saving 50,000 lives per year is pretty significant since there would also be a reduction in people living with diseases like stroke and heart attack and the associated disabilities.

To put this in perspective in the current debate about guns.

Guns are responsible for roughly 30,000 deaths a year in America; more than half of those deaths are suicides. In 2010, 606 people, 62 of them children younger than 15, died in accidental shootings.

from Atlantic http://goo.gl/itytZ ;

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Diabetes Study Ends Early With a Surprising Result

Diabetes Study Ends Early With a Surprising Result | Heart and Vascular Health | Scoop.it
Diet and weight loss did not prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes.

A large federal study of whether diet and weight loss can prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes has ended two years ahead of schedule because the intensive program did not help.  Many have assumed diet and exercise would help, in part because short-term studies had found that those strategies lowered blood sugar levels, blood pressure and cholesterol levels. Still, medical experts said there were many benefits to diet and exercise even if they did not reduce cardiovascular disease in people with diabetes.

About 25 million Americans have Type 2 diabetes. Many are overweight or obese. On average, the disease increases heart disease risk by 2 to 2 &frac12; times.  Study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.

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Candy at the Cash Register — Obesity & Chronic Disease Risk Factor

Candy at the Cash Register — Obesity & Chronic Disease Risk Factor | Heart and Vascular Health | Scoop.it

A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made. Our reluctance to interfere with or regulate the food environment is a direct consequence of the belief that people's food choices reflect their true desires. However, given the large proportion of people who claim that they want to lose weight and the small proportion who are actually able to do so, we must concede that human behavior doesn't always conform with professed goals. The reality is that food choices are often automatic and made without full conscious awareness. Placement of foods in prominent locations increases the rate at which they're purchased; purchase leads to consumption; and consumption of foods high in sugar, fat, and salt increases the risks of chronic diseases.  Although placement is a factor that is right in front of our noses, we should consider treating it as a hidden risk factor, like carcinogens in water, because placement influences our food choices in a way that is largely automatic and out of our conscious control and that subsequently affects our risk of diet-related chronic diseases.

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BCHS- Alyssa Snyder's curator insight, February 26, 2013 4:04 PM

Many people believe it is their choice conciously of what they will buy and eat that night for their dinner. Sometimes it isnt, it could possibly be a subconcious decision made when we go to a store and look at the candy surrounding a cash register. Due to the placing of the sweet and sugar-rich foods, we are chosing them more than the nutrisous foods past generations would chose. Many things effect our eating ehaviour though, such as commercials, placings of food, whic many people would not think of as a major thing for chosing food, and also what our parents usually buy. We can prevent this by avoiding those aisles that have suh=gary foods or foods that are attractive to us located in them.

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Tomatoes for Stroke Prevention?

Tomatoes for Stroke Prevention? | Heart and Vascular Health | Scoop.it

My comment:  Another data point adding to the recommendation for 5 fruits and vegetables daily.  DON'T take some nutritional supplement - eat your veggies!

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Lycopene, which is found in high concentrations in tomatoes and tomato-based products, may lower stroke risk in men, researchers found. "Foods such as tomatoes, guava, watermelon, and grapefruit are good sources of lycopene,"  "When a tomato is cooked, the heat processing actually increases the levels of cis-lycopene, which is easily absorbed by the body."

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Vitamins Herbal & Natural - A Cardiologists Perspective

Pentucket Medical cardiologists Seth Bilazarian and Sunny Srivastava discuss vitamins and dietary supplements as alternative, complimentary and natural therapies.

Patients often think doctors are "against" the use of vitamin or herbal therapies.  I try to explain on our community program "Matters of the Heart"  the doctors viewpoint on Vitamin supplements - cautions and recommendations.  I speak about Vitamin D deficiency and its treatment.

Because its a VItamin or because it says its natural doesn't mean its good.

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Credibility of YouTube for Health Information on Heart Attack

Credibility of  YouTube for Health Information on Heart Attack | Heart and Vascular Health | Scoop.it

Take Home Message:  Internet search for health information is growing: 71% of adults in US in 2007.  YouTube is used for health info and this study assessed the credibility of the info for heart attacks (MI).  

Most content (98%) was posted in the last 3 years. Videos from professional societies were the least watched but had the most thorough content coverage (symptoms, physiology, prevention & treatment).  The other sources (94% of content) from personal experience, news reports & pharmaceutical industry  had seven times greater number of views. But these were not thorough.  Only 7% urged immediate treatment for a heart attack - the most important of all public messages.  Prevention was mentioned in 17% of videos. Caveat Emptor.  (Caveat Spectator)  With Web 2.0, its better to trust trusted sources.

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Low-Risk Diet & Lifestyle Habits in the Prevention of Myocardial Infarction

Low-Risk Diet & Lifestyle Habits in the Prevention of Myocardial Infarction | Heart and Vascular Health | Scoop.it

Background  Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI).

Methods  The population of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors:

1.  healthy diet (top quintile of Recommended Food Score)

2.  moderate alcohol consumption (10 to 30 g/day)

3.  no smoking

4.  being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week)

5.  no abdominal adiposity (waist circumference < 37 inches).

Results  During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14. This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population.

Conclusions  Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.

Seth Bilazarian, MD's insight:

The greater the combination of heathy behaviors the greater the benefit in risk reduction for heart attack.  Choosing just two (diet and moderate alcohol) reduces the risk of heart attack by 35%.  Subscribing to all 5 has an impressive 80% reduction in heart attack.

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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 12:48 PM

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

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Preventable Deaths from Heart Disease & Stroke infographic

Preventable Deaths from Heart Disease & Stroke infographic | Heart and Vascular Health | Scoop.it

Important progress has been made, but more is needed to continue to save lives, particulalry for people under 65 yeras.  Black men are at the highest risk of dying early fromheart disease and stroke.  Counties in Southern states have the greratest risk overall.

Seth Bilazarian, MD's insight:

Nearly 800,000 Americans die each year from heart disease and stroke.  Most of the major risk factors can be manged or prevented: high blood pressure, high cholesterol, diabetes, smoking, unhealthy diet, physical inactivity and obesity.

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Fish oil (ω-3 Fatty Acid Supplements) for Secondary Prevention of Cardiovascular Disease: From “No Proof of Effectiveness” to “Proof of No Effectiveness”

Fish oil (ω-3 Fatty Acid Supplements) for Secondary Prevention of Cardiovascular Disease: From “No Proof of Effectiveness” to “Proof of No Effectiveness” | Heart and Vascular Health | Scoop.it

The Figure shows the results of our analysis. The analysis of the 14 randomized placebo-controlled studies indicated futility, ie, proof of no effectiveness; interestingly enough, the final part of the curve was far beyond the boundary of futility. Our secondary analysis, which was based on 16 studies, gave essentially the same result (data not shown).

The results of our analysis can be seen as the proof of no effectiveness of ω-3 fatty acid supplements for secondary prevention of cardiovascular disease. Our evaluation is also a good example of the role that TSA can play to integrate the results of traditional meta-analyses.

Seth Bilazarian, MD's insight:

Enough said.  If something is useless (as fish oil clearly is) it should not be used.  There are costs and potential unknown interactions with useful medications.  In addition the purity, potency and authenticity of these supplements is not regulated adding hazard for users.

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Heart Health in Future Foretold in Teens

Heart Health in Future Foretold in Teens | Heart and Vascular Health | Scoop.it
Many U.S. adolescents are already on their way to increased cardiovascular risk in adulthood, researchers found.

Roughly half of about 5,000 study participants ages 12 to 19 (54.7% of males and 50.5% of females) met "ideal" standards for fewer than five of the seven variables developed by the American Heart Association to define cardiovascular health, according to Christina Shay, PhD, of the University of Oklahoma Health Sciences Center in Oklahoma City, and colleagues.

And 0% met all seven variables including not smoking and having low total cholesterol, the researchers reported online in Circulation: Journal of the American Heart Association.

Seth Bilazarian, MD's insight:

Will this be the first generation that has worse health than the prior generation?  It is amazing that 0% of the surveyed teens met all the ideal seven variables:

Cardiovascular health among adolescents is defined using the ideal state of seven variables:

Smoking status (never smoked)Body mass index (BMI below the 85th percentile)Dietary intake (consumption of healthy levels of at least four of the following: vegetables, fish, whole grains, sodium, and added sugar in sugar-sweetened beverages)Physical activity (at least 60 minutes of moderate to vigorous activity a day)Blood pressure (below the 90th percentile)Blood glucose (less than 100 mg/dLTotal cholesterol (less than 170 mg/dL)

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Cardiovascular Health among Adult Americans - state by state - Only 3.3% ideal

Cardiovascular Health among Adult Americans - state by state - Only 3.3% ideal | Heart and Vascular Health | Scoop.it
Seth Bilazarian, MD's insight:

AHA recently proposed a new metric of cardiovascular health comprised of 7 health behaviors and factors. State-level assessments have not been reported. Using 2009 Behavioral Risk Factor Surveillance System (BRFSS) data from all 50 states and District of Columbia. As data are self-reported, the AHA definition of cardiovascular health was modified using self-reported:

1. hypertension

2. high cholesterol

3. diabetes

4. current smoking status

5. weight classification

6. physical activity

7. dietary behavior

Ideal cardiovascular health was defined as meeting current guidelines or standards from each behavior or factor. The percentage of population in each state with ideal cardiovascular health and the adjusted prevalence ratio of ideal cardiovascular health in each state were estimated (adjusted for age, sex, race/ethnicity and levels of education).

In 2009, 3.3% reported as ideal cardiovascular health (n = 356,441). Large disparities of ideal cardiovascular health existed by age, sex, race/ethnicity and level of education - the elderly, males, non-Hispanic blacks and those with lower levels of education were less likely to have ideal cardiovascular health. The percentage of population with ideal cardiovascular health varied by state, ranging from 1.2% to 6.9%. In conclusion, the prevalence of ideal cardiovascular health is very low in the US adult population and varies substantially by state.

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5 Foods That Fight Heart Disease

5 Foods That Fight Heart Disease | Heart and Vascular Health | Scoop.it

While losing excess weight, reducing saturated fat in the diet, and partaking in daily physical activity are all key to lowering your risk of heart disease, adding heart-healthy foods to your diet can also help.

Here are 5 foods that are deliciously good for your heart: Beans, Oats, Nuts, Fish, Whole Grains.

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Are You Likely to Respond to Exercise?

Are You Likely to Respond to Exercise? | Heart and Vascular Health | Scoop.it
Research has confirmed that people's physiological responses to exercise vary wildly. Now a new genetic test promises to tell you whether you are likely to benefit aerobically from exercise.
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Fish Oil Pills Do Not Prevent Cardiovascular Events

Fish Oil Pills Do Not Prevent Cardiovascular Events | Heart and Vascular Health | Scoop.it

My Comment:  We could save allot of health care resources (and have less burping)  if we stopped using fish oil and stopped doing fish oil research.  Enough is enough!  Eat fish, dont take fish oil pills.

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Pooled from 20 randomized trials evaluating the effects of consuming omega-3s on adults which included 68,680 participants, results revealed no decrease in risk of all-cause mortality, cardiac death, sudden death, myocardial infarction (MI), or stroke when supplementation was employed.

The findings "do not justify the use of omega-3 as a structured intervention in everyday clinical practice or guidelines supporting dietary omega-3 polyunsaturated fatty acid administration," researchers concluded.

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Fish oil for Cardiovascular Outcomes in Diabetics

Fish oil for Cardiovascular Outcomes in Diabetics | Heart and Vascular Health | Scoop.it

Take Home Message:  In an era of evidence based medicine the Fish Oil strategy continues to disappoint for cardiovascular disease prevention. The main beneficiary of these repeated trials are the researchers.  Fish oil can be omitted, especially by patients who take many other medicines to help reduce the pill  burden.  Eat fish instead.

 

Daily supplementation with 1 g of n–3 fatty acids in daibetics did not reduce the rate of cardiovascular events over 6 years in patients at high risk for cardiovascular events.

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Association of Aspirin With Major Bleeding

Association of Aspirin  With Major Bleeding | Heart and Vascular Health | Scoop.it

KEY TAKE AWAY: This trial looked at PRIMARY prevention.  The use of a drug to prevent a first event such as heart attack.  This study has no bearing on SECONDARY prevention.  Drug use to prevent a second event (after a heart attack).  The net benefit of aspirin for secondary prevention would substantially exceed the bleeding risk. =>  DON'T STOP if you are in this group.

There is a debate about aspirin in primary prevention.  Is the bleeding too high compared with reduced heart attack benefit?  Because risk factors for bleeding overlap with cardiovascular risk  factors, "guidelines advocating the routine use of aspirin for primary prevention for individuals above moderate risk of coronary heart disease should be carefully considered as this approach may not be advisable for all patients."

In this study18.5% of patients were younger than 50 - a low risk group.  The annual aspirin bleeding rate is about 0.6%.

I will continue to recommend aspirin for high risk men with multiple coronary risk factors including diabetes after age 50, who do not have a history of GI bleeding, consistent with guidelines from AHA and ADA.

 

The editorial by Jolanta M. Siller-Matula, MD, PhD accompanying the paper does a great job reviewing these issues.

http://goo.gl/82iPr ;

 

From the JAMA article:

The benefit of aspirin for primary prevention of cardiovascular events is relatively small for individuals with and without diabetes. This benefit could easily be offset by the risk of hemorrhage.

In 186,425 individuals treated with low-dose aspirin and matched controls without aspirin.  During 5.7 years follow-up, the bleeding rate was 5.58 for aspirin users and 3.60 (per 1000 person-years) for those without aspirin.  Aspirin was associated with a greater risk of major bleeding.  In a population-based cohort, aspirin use was significantly associated with an increased risk of major gastrointestinal or cerebral bleeding episodes. Patients with diabetes had a high rate of bleeding that was not independently associated with aspirin use.

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