Heart attack

Heart attack causes and symptoms are different in women

The causes of heart attacks and the warning symptoms that can signal the need for immediate medical attention are different in women than in men, according to a scientific statement issued today by the American Heart Association.

When women don’t recognize this, they may suffer worse outcomes, a fate that is even more likely in black and Hispanic women, according to the AHA.

The organization published its first comprehensive statement on gender differences in heart attack patients in its journal Circulation.

“Women seem to do worse for several reasons,” said Dr. Laxmi Mehta, the lead author of the recommendations and the director of women’s cardiovascular health at Ohio State University in Columbus.

Importantly, people don’t realize that while both sexes may experience chest pain before or during a heart attack, women may be more likely to have unusual symptoms instead, such as shortness of breath, nausea or vomiting, and back or neck pain.

Then, when they do get to a hospital, women may be less likely than men to receive medications that help to prevent clots, decrease the heart’s workload and lower blood pressure or cholesterol.

“There is a lot at stake for women when there is a delay in treatment or lack of adherence to recommended therapies,” Mehta added by email. “Women face higher rates of being readmitted to the hospital, heart failure and death.”

Biology is also part of the problem.

Even though both women and men get heart attacks caused by blockages in the main arteries leading to the heart, the way the clots develop may differ, according to the scientific statement.

Men tend to have a more “classic” type of blockage where plaque ruptures off the artery wall, forms a blood clot and causes a complete halt of blood flow through the artery to the heart, said Dr. Sheila Sahni, chief fellow in cardiovascular disease at the David Geffen School of Medicine at the University of California Los Angeles.

“Women, more often, tend to have a plaque erosion where smaller pieces of plaque break off, become exposed and cause the formation of smaller blood clots which may or may not cause total occlusions all at once, leading to a more subtle presentation,” Sahni, who wasn’t involved in the study, said by email.

In addition, women tend to be about a decade older than men when they suffer heart attacks, potentially making them frailer and more likely to suffer from other health problems such as diabetes that can make their treatment more complicated, Sahni added.

Risk factors also differ by gender, with high blood pressure more strongly associated with heart attacks in women than in men. For young women with diabetes, the risk for heart disease is four to five times higher than it would be for a similar young man.

Race, too, is an issue. Compared to white women, black women have a higher incidence of heart attacks in all age categories and young black women have greater odds of dying before they leave the hospital. Black and Hispanic women are also more likely to have heart-related risk factors such as diabetes, obesity and high blood pressure at the time of their heart attack.

Once a heart attack begins, the best way for women to minimize damage is to get help quickly, said Dr. Leslie Cho, director of the women’s cardiovascular center at the Cleveland Clinic in Ohio.

“Time is muscle,” Cho, who wasn’t involved in the study, said by email. “If women are diagnosed and treated later in the course of the heart attack, they can suffer from irreversible heart damage.”

Source: foxnews

An hour of moderate exercise a day may decrease heart failure risk

Exercising each day can help keep the doctor away.

In a new study reported in the American Heart Association journal Circulation: Heart Failure, researchers say more than an hour of moderate or half an hour of vigorous exercise per day may lower your risk of heart failure by 46 percent.

Exercising each day can help keep the doctor away.

Heart failure is a common, disabling disease that accounts for about 2 percent of total healthcare costs in industrialized countries. Risk of death within five years of diagnosis is 30 percent to 50 percent, researchers said.
Swedish researchers studied 39,805 people 20-90 years old who didn’t have heart failure when the study began in 1997. Researchers assessed their total- and leisure time activity at the beginning of the study and followed them to see how this was related to their subsequent risk of developing heart failure. They found that the more active a person, the lower their risk for heart failure.

They also found:
The group with the highest leisure time activity (more than one hour of moderate or half an hour of vigorous physical activity a day) had a 46 percent lower risk of developing heart failure.

Physical activity was equally beneficial for men and women.
Those who developed heart failure were older, male, had lower levels of education, a higher body mass index and waist-hip ratio, and a history of heart attack, diabetes, high blood pressure and high cholesterol.

“You do not need to run a marathon to gain the benefits of physical activity — even quite low levels of activity can give you positive effects,” said Kasper Andersen, M.D., Ph.D., study co-author and researcher at the Uppsala University in Uppsala, Sweden. “Physical activity lowers many heart disease risk factors, which in turn lowers the risk of developing heart failure as well as other heart diseases.”

Study participants completed questionnaires that included information about lifestyle, physical activity, smoking and alcohol habits, and medication use. Researchers looked at total physical activity, which included job-related activities, and leisure activities. Participants’ self-reported leisure physical activity was divided further into three categories: light, such as casual walking; moderate, such as jogging or swimming; and heavy, such as competitive sports. Diagnoses, hospitalizations and deaths were verified using participants’ medical records.

“The Western world promotes a sedentary lifestyle,” Andersen said. “There are often no healthy alternative forms of transportation; in many buildings it is hard to find the stairs; and at home television and computers encourage sedentary behavior.

“Making it easier and safer to walk, bicycle or take the stairs could make a big difference. Our research suggests that everyone could benefit from getting out there and moving every day.”

Although the relationship between heart failure and exercise has not been broadly studied, the study’s findings reaffirm the importance of continued physical activity for all adults and support the American Heart Association’s recommendations of 150 minutes of moderately intense physical activity every week. For those who need to lower their blood pressure and cholesterol the association recommends 40 minutes 3-4 times per week.

In the United States, heart disease, a major risk factor for heart failure, remains the leading cause of death, claiming 380,000 lives every year. An estimated 5.7 million Americans have congestive heart failure and about half die within five years of their diagnosis.

Source: science daily

Common cholesterol drug linked to death risk

Common cholesterol drug linked to death risk

Niacin, a common cholesterol drug for 50 years, should no longer be prescribed owing to potential increased risk of death, dangerous side effects and no benefit in reducing heart attacks and strokes, researchers said.

“There might be one excess death for every 200 people we put on Niacin. With that kind of signal, this is an unacceptable therapy for the vast majority of patients,” said cardiologist Donald Lloyd-Jones from Northwestern University’s Feinberg School of Medicine.

Niacin should be reserved only for patients at very high risk for a heart attack and stroke who cannot take statins, Lloyd-Jones added.

Lloyd-Jones’s research was based on a large new study that looked at adults, aged 50 to 80, with cardiovascular disease who took niacin (vitamin B3) to see if it reduced heart attack and stroke compared to a placebo over four years.

All patients in the trial were already being treated with a statin medication. Researchers found that Niacin did not reduce heart attacks and stroke rates compared with a placebo.

More concerning, Niacin was associated with an increased trend towards death from all causes as well as significant increases in serious side effects.

These included liver problems, excess infections, excess bleeding, gout and loss of control of blood sugar for diabetics.

“For the reduction of heart disease and stroke risk, statins remain the most important drug-based strategy,” Lloyd-Jones said.

The research appeared in the New England Journal of Medicine.

Source: Times of India

High-fibre diet ‘benefits heart attack patients’

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If you have had a heart attack, eat plenty of fibre because it may improve your long-term chances of recovery, say US researchers.

Heart-attack survivors were more likely to be alive nine years later if they followed a high-fibre diet, a study in the British Medical Journal found. Every 10g-per-day increase in fibre intake was linked with a 15% drop in death risk during the study.

Dietary fibre may improve blood pressure and cholesterol, experts say. On average, most people in the UK get about 14g of fibre a day, against a target of at least 18g. US experts recommend up to 38g a day.

Fruit, such as bananas and apples, root vegetables, such as carrots and potatoes, wholemeal bread, cereals and bran are all good sources of dietary fibre. A jacket potato and baked beans contain about 10g of fibre; two slices of wholemeal bread about 4g.

Breakfast cereals
A low-fibre diet is associated with constipation and gut diseases, such as diverticulitis and bowel cancer, but it may also have implications for heart health, say US researchers.

The Harvard School of Public Health team analysed data from two large US studies involving more than 4,000 men and women who had survived a first heart attack and had provided information about their usual diet via questionnaires.

They were followed for an average of almost nine years after their heart attacks, during which time 682 of the women and 451 of the men died.

Chances of survival appeared to be linked with fibre intake, which was mostly from breakfast cereals. The one in five who ate most fibre had a 25% lower chance of dying from any cause during the nine years after their heart attack compared with the fifth who ate the least.

The high-fibre group was 13% less likely to have a fatal heart attack. The researchers say the findings point to a simple lifestyle step that people could take, alongside their medication, to improve their long-term health prospects.

Victoria Taylor, of the British Heart Foundation, said: “High-fibre foods are a key part of a healthy balanced diet, and this study suggests they may have a particular benefit for heart-attack survivors.

“We can’t say for sure what caused the fibre benefit seen here, but we do know that, on average, we’re not getting enough fibre in our diets. “Fibre comes from a range of foods, including fruit and veg, beans and lentils, and also from cereal products, which this study found to be particularly beneficial.

“To get more fibre, you can make simple swaps, such as trading white bread for wholegrain versions or opting for higher-fibre breakfast cereals, like porridge or muesli.”

Source: BBC

Too much running could actually kill you sooner

Training to run a marathon has got to be one of the healthiest things you can do, right? Maybe not: A new study found that “moderate” runners lived longer than people who don’t exercise at all — and people who run lots of miles

The study involved 3,800 runners who supplied info on their heart risk factors and their use of NSAIDs like ibuprofen; almost 70% of the group clocked more than 20 miles a week. The findings were presented Sunday, but have yet to be published in a peer-reviewed journal. According to the results, how much should you run? One cardiologist who reviewed the data suggests you no more than 2.5 hours per week, spread out between two or three sessions consisting of slow or moderately-paced running.

It’s not clear why too much running might be bad for longevity, but the study appears to rule out factors like prior cardiac risk (linked to things like high blood pressure, high cholesterol, diabetes, family history, and smoking) or excessive use of NSAIDs (which have been linked to heart problems).

One doctor who’s also a running coach tells NBC San Diego that extreme exercise can actually “cause some scarring of the heart.” And another recent study found that male marathon runners had more plaque in their coronary arteries—which can lead to a heart attack—than non-runners, Pioneer Press reports. Again, it’s not clear why, but one researcher notes, “It is plausible, not proof by any stretch, that metabolic changes when running could be moderately toxic to arteries.”

Source: KSDK

Poor Heart Health Linked to Alzheimer’s Risk

A new study links heart disease with increased odds of developing dementia.

Researchers found that artery stiffness — a condition called atherosclerosis — is associated with the buildup of beta-amyloid plaque in the brain, a hallmark of Alzheimer’s disease.

“This is more than just another example of how heart health relates to brain health. It is a signal that the process of vascular aging may predispose the brain to increased amyloid plaque buildup,” said lead researcher Timothy Hughes, from the department of internal medicine at Wake Forest University in Winston-Salem, N.C.

Plaque builds with age and appears to worsen in those with stiffer arteries, he said. “Finding and preventing the causes of plaque buildup is going to be an essential factor in the prevention of Alzheimer’s disease and extending brain health throughout life,” Hughes added.

Alzheimer’s disease is the most common form of dementia among older adults. The progressive brain disorder seriously affects thinking, memory and the ability to carry out daily activities.

The report, published March 31 in the online edition of JAMA Neurology, looked at brain images and arterial health of patients 83 and older.

Cardiologists and neurologists are starting to warm to the idea that heart health and brain health are not independent, but interrelated, said Dr. Kevin King, an assistant professor in the department of radiology at the University of Texas Southwestern Medical Center at Dallas and author of an accompanying journal editorial.

“I find the new direction to be satisfying in that it is a more holistic approach,” King said. “The invention of these cool new tools to directly image amyloid plaque while people are alive allows us to look at these interactions that have been very difficult to tease apart.”

But still more research is needed, he said, “into how chronic vascular disease impacts the brain and leads to dementia.”

For the study, researchers used PET scans to examine plaque development in the brains of 81 dementia-free elderly adults.

They also measured the stiffness of arteries by assessing the speed that blood moves through them — a process called pulse wave velocity.

Over two years, the percentage of patients with plaque in their brain increased from 48 percent to 75 percent. Moreover, the development of plaque was associated with increased stiffness of arteries, the research team found.

Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City, welcomed the study.

“One of the most important problems in clinical dementia is parsing out what role brain blood vessels play in the clinical status,” Gandy said. “This is a groundbreaking paper that promises to put us on an evidence-based course toward unraveling this mystery.”

“There is increasing evidence that arterial stiffness plays not just an important role in cardiovascular disease but also in cerebrovascular disease, impaired mental function and dementia in older individuals,” he said.

More research of the relationship between high blood pressure, high cholesterol, vascular disease, arterial stiffness and the development of dementia is needed, Fonarow said.

King noted that injury to the blood vessels in the brain may dramatically alter the onset and progression of Alzheimer’s disease.

“The implication of this study is that we may be able to prevent or at least delay Alzheimer’s disease by proper control of cardiac risk factors,” King added.
Reducing heart risks means eating a healthy diet, exercising, maintaining normal weight, minimizing stress and not smoking. These behaviors can help keep blood pressure and cholesterol at safe levels, experts say.

But much still needs to be learned about the association between heart health and brain health, King said. “A lot remains unknown about what changes in arteries may be leading to chronic brain disease. We just don’t know enough about blood flow to the brain.”

Source: webmd

Indian-American scientist finds why cholesterol worsens in winter

Cholesterol levels usually go up in colder months – a trend that may be driven by behavioural changes that occur with the changing seasons, new research by an Indian-American researcher shows.

While previous studies have shown that heart attacks and heart-related deaths increase during the winter, researchers at Johns Hopkins’ Ciccarone Center for the Prevention of Heart Disease were interested in finding out whether cholesterol parameters might follow a similar pattern.

They studied a massive data representing 2.8 million adults – the largest study so far to look at seasonal lipid trends in adults.

“We found that people tend to have worse cholesterol numbers on average during the colder months than in the warmer months – not by a very large amount, but the variation is significant,” said Parag Joshi, a cardiology fellow at Johns Hopkins Hospital.

“The data instead validates a clear seasonal pattern and underscores the need to pay attention to behaviours that are critical to minimising cardiovascular risk,” Joshi said.

“In the summer, we tend to get outside, we are more active and have healthier behaviours overall,” Joshi added.

“In the colder months, we tend to crawl into our caves, eat fat-laden comfort foods and get less exercise, so what we see is that LDL and non-HDL bad cholesterol markers are slightly worse,” he added.

So you have a lipid signature of higher risk but it is driven by behaviours that occur with the changing seasons.

Researchers speculate the shorter days of winter – and limited time spent outside – also mean less sun exposure and, subsequently, lower concentrations of vitamin D, which has also been associated with the ratio of bad to good cholesterol.

More research is needed to further tease out what might be behind these seasonal variations, Joshi told the gathering at the American College of Cardiology’s 63rd Annual Scientific Session recently.

Source: samachar

Study to Test If Chocolate Pills Can Prevent Heart Attacks

For those who believe in the power of chocolate comes the start of a new study. Researchers will look into whether certain ingredients in dark chocolate can help prevent heart attacks and strokes.

But before you start digging into your stash of chocolate, know that researchers won’t be handing out thousands of candy bars to participants.

The study, which will include 18,000 men and women, will focus on bio-active nutrients found in the cocoa bean, without all the extra ingredients such as sugar, found in chocolate candies.

Testers will be given dark chocolate pills that contain 750 milligrams of cocoa flavanols, naturally occurring plant-based nutrients found in chocolate. And unfortunately for them, the pills won’t actually taste like candy.

According to Dr. JoAnn Manson, one of the study’s lead researchers, in previous studies, cocoa flavanols have been shown to reduce blood pressure and improve cholesterol levels.

Participants at the Brigham and Women’s Hospital in Boston and the Fred Hutchinson Cancer Research in Seattle will be given two capsules a day of the cocoa flavanols or dummy pills for four years.

The study is sponsored by Mars Inc., the company behind M&M’s and Milkyway bars and the National Heart, Lung and Blood Institute. Mars Inc. has been researching cocoa flavanols for the past 20 years and already sells CocoaVia cocoa extract capsules containing 250 mg of flavanols.

The company claims that to get the same amount of CocoaVia flavanols, you’d have to eat one and a half bars of dark chocolate containing 300 calories, 22 grams of fat and 24 grams of sugar.

Source: Los Angeles times

Sodium intake double in Bangladesh

As many as 12 million people suffer from high blood pressure in Bangladesh which is the main cause of heart attacks, brain strokes and kidney diseases, says a study

Excessive intake of sodium is resulting in serious health problems like high blood pressure, as people have been found to be taking more than double the required amount of sodium through salt.

As many as 12 million people suffer from high blood pressure in Bangladesh which is the main cause of heart attacks, brain strokes and kidney diseases, according to a survey conducted by National Heart Foundation Hospital and Research Institute (NHFHRI).

According to the World Health Organisation (WHO), an adult man or woman should take only five grams of salt every day. The NHFHRI survey, however, found that in urban areas, people take 10.3 grams of salt a day, with males taking 11 grams and females 9.3 grams.

Findings of the survey was disclosed at a seminar organised by the NHFHRI at the institute’s auditorium in the capital yesterday. The seminar was titled “World salt awareness week-2014” while Dr Sohel Reza Chowdhury, Professor of the Department of Epidemiology and Research at NHFHRI, presented the keynote paper.

The keynote paper said heart attacks and strokes are the leading causes of death globally. Each year, 1.73 crore people die of these diseases while more than 80% of the deaths occur in lower and middle income countries.

In Bangladesh, the prevalence of non-communicable disease (NCD) is on the rise while heart attacks and strokes are the most common among the NCDs.

Health minister Mohammad Nasim spoke as the chief guest at the seminar. He said in order to ensure proper investigation into the incidents of deaths due to negligence of doctors, the government was planning to introduce new rules for Bangladesh Medical and Dental Council (BMDC).

“BMDC will be given the power to cancel the registration of a doctor if the allegation of negligence against him is proved. The health ministry will sit with renowned and senior health professionals to discuss the issue,” he said.

The minister urged the authorities of big hospitals to provide the poor patients with special facilities.

Source: dhaka Tribune

Women Face Delays in Heart Attack Care: Study

Among young and middle-aged adults, men tend to receive faster hospital care than women for heart attacks and chest pains, a new study finds.

Anxiety appeared to be a key factor — women who appeared anxious upon admittance to the hospital tended to have delays in crucial care, the study authors found.

“Patients with anxiety who present to the emergency department with noncardiac chest pain tend to be women, and the prevalence of [heart attack or chest pains] is lower among young women than among young men,” the Canadian researchers said. “These findings suggest that [emergency-room staff] might initially dismiss a cardiac event among young women with anxiety.”

One heart expert wasn’t surprised by the findings.

“It has been shown in multiple trials that there are gender differences in the treatment of heart disease between men and women entering a hospital,” said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City.

“In younger adults, ages 18 to 55, this reality has also shown to be true,” she said. “When women enter a hospital, it is critical that this bias is eradicated.”

In the study, researchers looked at more than 1,100 adults aged 55 or younger treated for heart attack or chest pains — also called angina — at 24 hospitals in Canada, one in the United States and one in Switzerland. The median ages of the patients were 50 for women and 49 for men.

After arriving at the hospital, men underwent electrocardiograms (ECGs) within 15 minutes and clot-dissolving therapy within 21 minutes, compared with 28 minutes and 36 minutes, respectively, for women, the researchers said in the March 17 issue of the Canadian Medical Association Journal.

“Anxiety was associated with failure to meet the 10-minute benchmark for ECG in women but not in men,” said the researchers, led by Dr. Louise Pilote, a professor of medicine at McGill University in Montreal.

Digging deeper, the researchers found that patients with multiple heart attack risk factors and those with heart attack symptoms that were considered outside the norm also faced delays in care.

Steinbaum pointed out the incongruity of some of these findings.

“When analyzed, the women patients were sicker and were more likely to have diabetes, high blood pressure and a family history of heart disease,” she said. “With these multiple risk factors for heart disease, the likelihood of symptoms being heart-related are higher — yet they were not as expeditiously treated for a heart attack.”

“This delay in treatment is critical, especially in the setting of a heart attack, as death rates in patients who have multiple health problems is higher,” Steinbaum said.

Another heart specialist agreed.

“Since women often present with nontypical symptoms when having a heart attack, it is very important that physicians look at younger women, too, to make sure the symptoms they are having do not represent a developing heart attack,” said Dr. Lawrence Phillips, an assistant professor in the department of medicine at NYU Langone Medical Center in New York City.

“One of the most important take-home points from this study is the need to have an electrocardiogram early,” Phillips said. “An ECG is able to, in many cases, diagnose a heart attack as it occurs. By improving the rapidity of this test, we can start needed therapy earlier and, in doing so, save lives.”

Source: web md