Obesity and heart failure

Morbidly obese people are more than two times as likely to have heart failure than those with a healthy body weight, though they are not more likely to have other cardiovascular problems like stroke or heart disease, according to John Hopkins researchers.
The researchers could not explain the link, even after accounting for other risk factors such as high blood pressure and cholesterol and diabetes that are known to be connected to extra weight. It may be the weight puts higher demand on the heart and fat may release toxic molecules.
The study, published online in the Journal of the American Heart Association, suggests that while there are treatments for other heart related maladies, weight loss may be the only sure-fire approach to stave off heart failure. 
“Obesity in our study has emerged as one of the least explained and likely most challenging risk factors for heart failure because there is no magic pill to treat it, no drugs that can easily address the problem like there are for high cholesterol and high blood pressure,” says Dr. Chiadi Ndumele, assistant professor of medicine and member of theCiccarone Center for the Prevention of Heart Disease at Hopkins' School of Medicine. “Even with diet and exercise, people struggle to lose weight and keep it off, and for the morbidly obese, the struggle is often insurmountable.”
About a third of Americans are obese and more than five percent morbidly obese. And almost six million people have heart failure, where an enlarged or weakened heart muscle diminishes the heart’s efficiency, according to the U.S. Centers for Disease Control and Prevention. Those suffering from heart failure often are short of breath and fatigued and have swollen ankles.
In the pool of records reviewed for the study, which was funded by grants from theNational Heart, Lung and Blood Institute, the higher the body mass index, the higher the risk for heart failure.
“Even if my patients have normal blood sugar, cholesterol and blood pressure levels, I believe I still have to worry that they may develop heart failure if they are severely obese,” Ndumele said in a statement. “If our data are confirmed, we need to improve our strategies for heart failure prevention in this population.”

Take care of your body

Take care of your body. It's the only place you have to live. Jim Rohn

People are ending up in hospital because we're living longer

The number of people going to hospital in the UK with heart disease and stroke is rising, new figures have revealed. 
There were 1.69 million hospital visits for cardiovascular disease (CVD) in 2013 to 2014 across the UK, which is up from 1.64 million in 2010 to 2011.
However, deaths from CVD - which includes heart disease, strokes and peripheral artery disease - are decreasing, figures from the British Heart Foundation show.
The charity warned up to seven million people in the UK are currently living with cardiovascular disease - but the death rate has fallen from around 341,000 deaths in 1979 to 155,000 deaths in 2014. 

It said better diagnosis and treatments have helped to dramatically cut the number of deaths from heart disease and stroke while an increasing and ageing population may be prompting the higher numbers of hospital visits.
It is also calling for more research to help prevent, diagnose and treat heart disease as the increasing hospital visits for CVD is placing a massive burden on the healthcare system.

The Oxford University researchers, commissioned by the BHF, looked at a range of materials including trends in hospital admissions, prevalence, and treatment data along with mortality and population data from the UK's national statistics agencies.
They also looked at a range of surveys including Health Surveys of England and Scotland General Lifestyle Survey (GLS) along with data on hospital admissions and diagnosis from National Health Service records.
The researchers suggested potentially higher levels of deprivation might help to explain why Scotland had the highest death rates and prevalence of CVD in the UK

They found that 4.3 per cent of Scotland's population was living with coronary heart disease, compared with 3.9 per cent of those living in both Wales and Northern Ireland, and 3.3 per cent in England.
Coronary heart disease death rates decreased by 72 per cent in England, 70 per cent in Wales, 71 per cent in Scotland and 76 per cent in Northern Ireland between 1979 and 2013.
Researcher Dr Nick Townsend, of the University of Oxford, said: 'Despite large reductions in mortality from CVD, coronary heart disease (CHD), and stroke, these conditions have remained a substantial burden to the UK, with rises in treatment and hospital admissions for all CVD.'

Immediate hospital treatment is the best option for someone who is suffering a heart attack or stroke, according to Professor Peter Weissberg of the BHF.
He called for more research to try and find a way to eradicate atherosclerosis, a potentially serious condition where arteries become clogged with fatty substances.
The study is to be published in the journal Heart. 

Life expectancy

Life expectancy would grow by leaps and bounds if green vegetables smelled as good as bacon.  Doug Larson

Gallstones and heart disease risk

People who’ve suffered gallstones may have a slightly increased risk of developing heart disease down the road, a large new study suggests.
In a group of more than one-quarter million U.S. adults, researchers found those with a history of gallstones were 17 percent more likely to develop heart disease over the next few decades. 
Gallstones and heart disease share some of the same risk factors -- such as obesity, type 2 diabetes and unhealthy cholesterol levels. But those risk factors couldn’t completely explain away the finding, the researchers said.
To cardiologist Dr. Richard Stein, the study makes a “pretty convincing” case that gallstones, themselves, are a risk factor for heart disease.
Stein, who wasn’t involved in the research, is director of the urban community cardiology program at New York University School of Medicine.
He said that people with a history of gallstones may want to pay extra attention to their cardiovascular health.
“Eat a heart-healthy diet, exercise, keep your blood pressure down. It would be prudent to get your other heart disease risk factors under control,” said Stein, who is also a spokesperson for the American Heart Association.
Gallstones are hard particles that develop in the gallbladder -- a small organ that stores the bile fluids that help the body digest fat and fat-soluble vitamins.
Gallstones form when there are imbalances in the substances that make up bile: Excess cholesterol is the usual suspect, according to the U.S. National Institute ofDiabetes and Digestive and Kidney Diseases (NIDDK).
For many people, gallstones cause no symptoms, NIDDK says. But if they block a bile duct, they can cause abdominal pain -- often after a heavy meal. Most often, treatment involves surgically removing the gallbladder.
Some studies have suggested that people with a history of gallstones face a higher risk of heart disease. But these studies have had limitations, according to Dr. Lu Qi, the senior researcher on the new study. Qi is also a professor at Tulane University in New Orleans.
So Qi’s team combed through data from three large, long-running studies of U.S. health professionals.
In all, the studies followed more than 269,000 men and women for up to 30 years. Just over 6 percent of women and 3 percent of men said they’d ever been diagnosed with gallstones.
Among women, Qi’s team found, those with a history of gallstones were up to 33 percent more likely to eventually develop heart disease. For men, gallstones were linked to an 11 percent increased risk.
The researchers then pooled those results with findings from four previous studies that included nearly 900,000 people. All together, they found that adults with a history of gallstones were 23 percent more likely to develop heart disease​.
Although the study couldn’t prove a cause-and-effect relationship between gallstones and heart disease, Qi suggested that changes in the gut’s “microbiome”​ may play a role.
That refers to the trillions of bacteria and other microbes that normally dwell in the digestive​ system. Gallstones, Qi explained, can disrupt the balance of microbes in the gut, and recent studies have linked such disturbances to the risk of heart disease.
But, he stressed, that’s just a theoretical explanation for now.
Stein speculated on another possibility: Some cases of gallstone disease might spur low levels of inflammation in the body that feed the development of heart disease.
“We’ve known for years that chronic, low-grade inflammation is associated with heart disease,” Stein said.
Whatever the reasons for the link, Qi said it highlights a connection between the gastrointestinal and cardiovascular systems.
“To help protect your heart health, you may also need to protect your gastrointestinal system,” he said.
There are certain risk factors for gallstones that you cannot change, according to NIDDK. People with a family history of them are at increased risk, for instance. Gallstones are also more common in women than men.
But some other factors -- such as obesity, and diets high in fat and processed carbohydrates -- can be changed, the institute suggests.
The study was published online Aug. 18 in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

cholesterol smarts

Saturated fat is a bigger culprit than cholesterol in your diet. Meats, whole-fat dairy products, and other foods from animals can be loaded with it. It's also in some vegetable oils such as palm and coconut oil. But foods with cholesterol can also raise your cholesterol. So most people should cut cholesterol -- in foods such as organ meats, egg yolks, and whole milk -- to less than 300 mg a day.

Cheese has a lot of saturated fat. Just three slices of cheddar cheese, for example, has about 18 grams. That's more saturated fat than you should probably have in one day! In fact, cheese is the biggest source of saturated fat in the typical American diet. Choose low-fat or non-fat cheeses, or consider skipping cheese.

Before about age 50, men tend to have higher total cholesterol than women. But women's "bad" cholesterol tends to rise with menopause when the female hormone estrogen declines. After about age 50, women usually have higher cholesterol than men of the same age.

There are no specific symptoms of high cholesterol. To know if your cholesterol is too high, you have to have a blood test.

Although cholesterol levels generally rise with age, you don't have to be older to have high cholesterol. Even children can be at risk, especially if they have a family history of high cholesterol and heart disease. Everyone should start getting cholesterol tests at age 20, or earlier, according to the American Heart Association.

Cholesterol is waxy, fat-like material that your body needs to make hormones, vitamin D, and acids for digesting food. But your body makes all the cholesterol your body needs. You don't need to add to it in your diet.

HDL (high-density lipoprotein) cholesterol is actually the "good" cholesterol. An HDL level of 60 mg/dL (milligrams of cholesterol per deciliter of blood) or above helps lower the chance that you'll get heart disease.

Too much LDL (low-density lipoprotein) cholesterol raises your risk of heart disease. An LDL level of130 mg/dL or above is considered high. Excess LDL will contribute to the formation of thick, hard buildups, known as "plaque," on the walls of your arteries. Your arteries become narrower and harder, so less oxygen-rich blood can flow through. This is known as atherosclerosis, a leading cause of heart attacks and strokes.

Soluble fibers can lower blood cholesterol levels. Oatmeal is a good source of soluble fiber. So are beans and many fruits and vegetables. In studies, LDL cholesterol dropped 3%-5% in people who added five to 10 grams of soluble fiber a day to their diet. A bowl of oatmeal and a banana have about 2 grams of soluble fiber.

Eggs do have a lot of cholesterol. In fact, two scrambled eggs have more cholesterol than the total amount you should have in a day. But you should think about more than just the cholesterol grams in any food you're eating. For example, chocolate pie is loaded with calories and saturated fat, which can also increase cholesterol, so you wouldn't want to have a lot of it. Eggs may have cholesterol, but they're also a great source of protein and lots of other nutrients. The cholesterol is all in the yolk, so egg whites or yolk-free egg substitutes are a good alternative. If you're worried about your cholesterol levels, check with your doctor.

You need some fat in your diet. Fats supply energy and essential fatty acids, and they help absorb nutrients from the foods you eat. The trick is to eat the best kind of fats. When you can, replace animal fats with plant fats (like nuts, seeds, olive or canola oils), which can actually help lower cholesterol. Eat as little trans fats as possible, and cut saturated fat to less than 10% of your calories.

Exercise or other regular physical activity can help lower your "bad" LDL cholesterol and raise your "good" HDL cholesterol. Adults should get at least 30 minutes of moderate-intensity exercise on most days of the week. But any regular physical activity lowers your risk of high cholesterol and heart disease.

Shoot for a total cholesterol level of less than 200 mg/dl. A level of 200 to 239 mg/dL is considered "borderline high" and 240 mg/dL or more is high.
For LDL (bad cholesterol), anything under 100 mg/dL is best. Levels of HDL (good cholesterol) that are lower than 40 mg/dL raise men's chances of getting heart disease. HDL levels less than 50 mg/dL raise the chance of heart disease in women.

Statins are the best-known type of cholesterol-lowering medication. They can drop LDL cholesterol by 20% to 55%. Statins help the liver produce less cholesterol and boost its ability to remove LDL cholesterol already in the blood. They also help raise "good" HDL cholesterol.

Most people don't need drugs to lower their cholesterol. Diet, exercising, and losing weight can help do it. The TLC (Therapeutic Lifestyle Changes) program can guide you on the changes you should make, depending on your risk for heart disease. The main goals are to eat less saturated and trans fat and cholesterol, and get more physically active. If those things alone don't lower your levels, your doctor might suggest eating more soluble fiber, like beans and oatmeal, and adding plant stanols or sterols. The best sources for stanols and sterols are fortified foods, including margarine and orange juice. If you can't do that, you'll probably need to take medicine.