The Los Angeles Times “Booster Shots” blog reports, “They’re called ‘risk factors’ for a reason – people with high blood pressure, diabetes, high cholesterol and/or a smoking habit are much more likely to have heart attacks, strokes and other manifestations of cardiovascular disease, including death,” according to a study published in the New England Journal of Medicine. Continue reading
When it comes to the consumption of alcohol, the message has been decidedly mixed. Some studies show that moderate consumption might offer some health benefits, especially for the heart; other studies show an increased risk for certain cancers, especially breast cancer, with even the consumption of a very small amount of alcohol. What’s a woman to do? Continue reading
The Los Angeles Times “Booster Shots” blog reports, “Fat kids often turn into fat adults with a host of related health problems: diabetes, high blood pressure, clogged arteries.” However, a study published in the New England Journal of Medicine “finds that if those heavy kids lose weight, they may be on a par with people who were never overweight.” Continue reading
In a blog earlier today, “Even low levels of alcohol increase breast cancer risk,” I told you, “Less than a drink a day even a glass of wine with dinner, could change the risk of breast cancer.” So, what am I telling my patients? Continue reading
So, for adding small amounts of salt to your food, should you use salt from the earth or salt of the sea (sea salt)? Recently a reader wrote to ask after seeing TV ads from fast-food restaurants that seem to indicate that french fries seasoned with sea salt are somehow safer and healthier. What’s the truth? Continue reading
CocoaVia and Cirku are new supplements used for high blood pressure and cardiovascular health according to the Natural Medicines Comprehensive Database (NMCD). These products are flavored powders that can be added to a beverage. Each packet contains a cocoa extract providing 350 mg of cocoa flavanols. Those selling the supplements say they may reduce heart disease, but do they? Continue reading
A major study is reporting that people who practiced four low-risk behaviors are 63% less likely to die (during the stydy period) than those who kept none of those practices. The researchers found that ALL four of these low-risk behaviors were individually associated with a reduction in death and that the higher number of behaviors practiced, the lower the risk of death. So, what were they? Continue reading
More research is showing that even small amounts of aerobic exercise help lower coronary heart disease risk. The newest review was published in the journal Circulation, the journal of the American Heart Association, and should encourage even the most sedentary of us to being moving physically. Continue reading
Being satisfied with your life can be good for your heart. That’s the finding of a new study that included almost 8,000 British civil servants, average age 49, who were asked about their satisfaction in seven areas of their lives: romantic relationships, leisure activities, job, family, sex, standard of living and one’s self. Continue reading
In the past I’ve told you that children younger than two years of age should have NO screen time, while children over two should have less than two hours per day. Now we may have to extend this advice to adults. Continue reading
You are likely aware of folks who regularly fast for spiritual reasons. But, did you know that there are significant phyicals benefits to the discipline of regularly fasting? Continue reading
While writing this blog, I was listening to Simon and Garfunkel singing, “Slow down, you move too fast. You need to make the morning last.” At the same time, I found a Bloomberg News report claiming that “working overtime may be a killer, according to research that finds long hours on the job is a heart risk along with smoking, bad cholesterol and high blood pressure.” Continue reading
Last week my blog, Diet soda consumption may be linked to increased heart attacks and strokes, was one of my most read postings in some time. Some commented that perhaps they would switch from diet to regular soda. NOT a good idea at all, and here’s another reason why:
Readers of this blog over the last year, have seen many of my posts on the plethora of studies and recommendations about vitamin D. Now there’s some new data I think you’ll be interested in. Continue reading
I often have patients ask if I think diet sodas are a healthy substitute for regular soft drinks. I tell them, “NO!” The primary reason, that I’ve discussed with you in a past blog, is that diet soda consumption may weaken bones and lead to later osteopenia, osteoporosis, and/or bone fractures.
Now, I have another reason to add: Research presented at the American Stroke Association International Stroke Conference earlier this year suggest that diet soda consumption may be linked to increased heart risks. Continue reading
Spending hours in front of a TV or computer monitor — known as “screen time” — has been linked to signs that the heart needs longer to recover from exercise, an indication of poor heart health. In fact, in recent blogs I’ve told you of other studies showing that “Screen time (TV and computer) may be linked to increased heart risks,” and “Taking small breaks from sitting may help heart and metabolic health.”
Now comes another study, this one published in the journal Heart Asia, which included more than 2,000 people – all in their 30s and from the United States – who didn’t have heart disease. The participants performed eight-minute exercise treadmill tests, which allowed the researchers to determine how long it took for their heart rates to return to normal after brisk activity.
Here are more details in a report from HealthDay News:
The hearts of people who spent more time in front of TV and computer screens tended to take longer to recover, even when researchers took other possible factors into account and tried to reduce their influence on the statistics.
The same thing happened in those who didn’t exercise much or at all, according to Dr. Jien-Jiun Chen, of the Cardiovascular Center at National Taiwan University Hospital Yun-Lin branch in Douliou, Taiwan, and colleagues.
Other research has linked more screen time to:
- abnormal blood sugar metabolism and
- metabolic syndrome,
which all are thought to boost the risk of heart disease, the study authors noted in a news release from the journal’s publisher. They added that in comparison to other sedentary behaviors, screen time expends even less energy than reading, writing, or driving.
The bottom line? The more physical activity you get, the better it is for you and your heart.
Two of my recent blogs warned of sitting too long in front of a computer at work:
- Does lunch in front of a computer make us eat more?
- Computer time may be linked to increased heart risks
Now Bloomberg News reports that “taking small breaks from sitting down such as standing for phone calls or walking to see colleagues may trim office workers’ waistlines and help their heart and metabolic health.” Continue reading
An easy-to-remember formula for good health (0, 5, 10, 30, 150) is proposed in a wonderful editorial in American Family Physician titled “Preventive Health: Time for Change.” The author suggests this formula to physicians to “help patients achieve healthy lifestyle goals”:
- 0 = no cigarettes or tobacco products
- 5 = five servings of fruits and vegetables per day
- 10 = ten minutes of silence, relaxation, prayer, or meditation per day
- 30 = keep your BMI (body mass index) below 30
- 150 = number of minutes of exercise per week (e.g., brisk walking or equivalent)
The editorial is penned y Colin Kopes-Kerr, MD, from the Santa Rosa Family Medicine Residency in Santa Rosa, California:
It is time to make a decision. Which will be our health promotion strategy—primary prevention or secondary prevention?
Traditionally, the only one available to us was secondary prevention. Medicine consisted of a one-on-one physician-patient relationship, and taking care of patients meant minimizing the impact of any diseases the patient had. We did not have the time or tools to do anything else. More recently, we have been able to reduce a patient’s mortality by 20 to 30 percent by treating heart disease with a statin or beta blocker. These two medications have had the most dramatic effects in secondary prevention.
But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.
There are 10 major studies on the effects of primary prevention.(1–15) These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality.
Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.
Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week.(16) For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet.(11) A standard of five servings of fruits and vegetables is much easier to remember and adhere to.
There is strong support for at least one weight-related variable in a healthy lifestyle. This may include body weight, body mass index (BMI), waist circumference, or waist:hip ratio. The INTERHEART study showed waist:hip ratio to be the most predictive of cardiovascular disease.(6) However, unlike BMI calculation, measurement of weight:hip ratio has not yet become standard in U.S. practices. I use BMI as the metric, and a value less than 30 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2.
The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction.(7) The INTERHEART study offers useful suggestions for measuring stress—perception of severe stress at home or at work, financial stress, or major life events.(7)
The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval.(17) To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day.(17) This is enough time to produce a change in biorhythms and is achievable for most patients.
Information alone does not lead to behavior change, however. Motivational interviewing or brief negotiation is a new framework that can close the gap between knowledge of available lifestyle interventions and changing behaviors. The framework has already been proven markedly effective for tobacco, drug, and alcohol addiction.(18) Few physicians have received the training necessary to implement motivational interviewing or brief negotiation. Resources for learning about these skills include the Kaiser Permanente Medical Group Web site and the book Motivational Interviewing in Health Care: Helping Patients Change Behavior.(18)
In terms of health, we can have it all. We have the requisite tools to convert knowledge into healthy behaviors. This newfound power to reduce diabetes, heart disease, stroke, cancer, and all-cause mortality with primary prevention strategies should impel us to change how we counsel patients. Research is needed to explore why some physicians are not making this change.
Address correspondence to Colin Kopes-Kerr, MD, at firstname.lastname@example.org. Reprints are not available from the author.
Author disclosure: Nothing to disclose.
- Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16–22. View here
- Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–797. View here
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401–411. View here
- Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. View here
- Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292(12):1433–1439. View here
- Yusuf S, Hawken S, Ounpuu S, et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952. View here
- Rosengren A, Hawken S, Ounpuu S, et al.; INTERHEART Investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–962. View here
- Chiuve SE, McCullough ML, Sacks FM, et al. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 2006;114(2):160–167. View here
- Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118(9):947–954. View here
- Kurth T, Moore SC, Gaziano JM, et al. Healthy lifestyle and the risk of stroke in women. Arch Intern Med. 2006;166(13):1403–1409. View here
- King DE, Mainous AG III, Geesey ME. Turning back the clock: adopting a healthy lifestyle in middle age. Am J Med. 2007;120(7):598–603. View here
- Khaw KT, Wareham N, Bingham S, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study [published correction appears in PLoS Med. 2008;5(3):e70]. PLoS Med. 2008;5(1):e12. View here
- Ford ES, Bergmann MM, Kröger J, et al. Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and nutrition–Potsdam study. Arch Intern Med. 2009;169(15):1355–1362. View here
- Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Arch Intern Med. 2009;169(22):2096–2101. View here
- Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302(4):394–400. View here
- U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. View here.
- Dialogue Partner. View here
- Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press; 2008. View here
Krill oil is now being promoted as a better alternative to fish oil supplements. Krill are tiny shrimp-like crustaceans.
Promoters say that krill oil provides similar cardiac benefits as fish oil, but with fewer capsules and no fishy taste.
However, krill oil supplements contain less of the omega-3s EPA and DHA than fish oil supplements. Nevertheless, manufacturers claim krill oil is better absorbed because the omega-3s are in a phospholipid form.
According to the experts at the Natural Medicines Comprehensive Database, “Preliminary evidence shows that a specific krill oil product (Neptune Krill Oil NKO, Neptune Technologies & Bioresources, Inc) can lower cholesterol and triglycerides.”
“But,” they add, “overall there’s much better evidence that fish oil can lower triglycerides and cardiovascular risk.”
Furthermore, krill oil usually costs more than fish oil.
So, the NMCD recommends to prescribers, “For now, advise patients to stick with fish oil. Recommend taking it with food or trying an enteric-coated product if fishy taste is a problem. Suggest krill oil only for healthy people who want to add these omega-3s to their diet but can’t tolerate fish oil.”
An Italian study finds that a hostile personality type is linked to a thickening of neck artery wall — which may be associated with an increased risk of heart attack, heart disease, and stroke. Here are the details from a report in HealthDay News:
Hostile people, especially those who are manipulative and aggressive, may be paying a price in terms of heart health, a new study finds.
These types of people showed a thickening in the walls of their neck arteries tied to a 40 percent higher risk of having the artery narrow. And that could boost their risk for cardiovascular disease, heart attack and stroke, the researchers concluded.
“The public is often worried about stress, but sometime it’s how our personalities interact with stress that can have an effect on health,” noted Dr. Ralph Sacco, president of the American Heart Association and chairman of neurology at the University of Miami Miller School of Medicine. He was not involved in the study.
“Knowledge is the first step to making behavior change,” he added. “If there are things that we know, in terms of stress and antagonism, it may help change people’s behavior if they know it’s related to vascular risk.”
The report appears in the journal Hypertension.
For the study, a research team led by Angelina Sutin, a postdoctoral fellow at the U.S. National Institute on Aging, collected data on more than 5,600 people in four villages in Sardinia, Italy.
The researchers found that those who had high scores for antagonistic traits had more thickening of the neck (carotid) arteries, compared with more agreeable people.
Thickness of carotid artery walls is a risk factor for heart attack and stroke, the researchers note.
After three years, people who scored higher on antagonism or low on agreeableness, particularly those who were manipulative and quick to anger, continued to have thickening of their artery walls. These traits were also predictive of greater of arterial thickening, Sutin’s group found.
People who scored in the lowest 10 percent of agreeableness and had the highest levels of antagonism had about a 40 percent heightened risk for thickened arterial walls, they add.
In a journal news release, Sutin said that “people who tend to be competitive and more willing to fight for their own self-interest have thicker arterial walls, which is a risk factor for cardiovascular disease,” Sutin said in a statement.
“Agreeable people tend to be trusting, straightforward and show concern for others, while people who score high on antagonism tend to be distrustful, skeptical and at the extreme cynical, manipulative, self-centered, arrogant and quick to express anger,” she added.
In general, men had more thickening of the artery walls than women. But among women who were antagonistic, the risk quickly caught up with that of men. “Whereas women with agreeable traits had much thinner arterial walls than men with agreeable traits, antagonism had a much stronger association with arterial thickness in women,” Sutin said.
Usually, thickening of the artery walls is a sign of age; however, young people with antagonistic traits already had thickening of the artery wall, she added.
This finding remained consistent even after lifestyle factors such as smoking were taken into account, the researchers noted.
The findings — consistent with research in more urban regions — may apply to others in the world, whether they live in smaller towns or cosmopolitan areas, Sutin said. “This may not be unique to Italians.”
Commenting on the study, Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine said that “the active, toxic, ingredient in the infamous ‘Type A’ personality profile is hostility.”
Angry people do tend to be less healthy, he said. “The burgeoning field of psycho-immunology reveals the multiple and powerful pathways by which our emotional state influences hormones and neurotransmitter levels, in turn influencing the functioning of our immune and nervous systems – and perhaps everything else,” Katz said.
The independent effect of chronic anger appeared to be as strong as that of other key risk factors, such as high blood pressure, although this was a study of association, not cause and effect, Katz noted.
“We have ample reason to conclude that chronic anger is bad for us,” he said. “Now the challenge: in a world of many irritations and stressors, how do we [make] chronic anger and hostility go away? That many benefits would ensue if we met this challenge — for both [people’s] carotid arteries and society — seems abundantly clear.”