Archive for the 'Tips To Protect Your Heart' Category

More Vegetables and Fruits Make More Years of Your Life….

April 3, 2014

True enough, and more studies proving that eating veggies really make a more healthier life.  A recent study offered more information detailing that more fruits and veggies really help deter the onset of diseases especially cancer and heart disease.

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Background Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England.

Methods Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years).

Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion).

Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted.

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The study clearly shows the inverse relationship between the amount of consumed fruits and veggies and risk of death and diseases.  The consumption of seven or more servings of fruits and vegetables was associated with reduced cancer mortality  and  mortality associated with heart disease more than what has been recommended by policy makers of 5 servings daily.

So here’s one food where consumption of more leads to better health.

 

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Skipping Breakfast? Read This!

July 30, 2013

Breakfast is considered the most important meal of the day.  It breaks the fasting period and therefore allows ones metabolism to be back up and running for the day.  Likewise, skipping breakfast has been shown in studies to put a patient at risk for multiple conditions including increasing risk of diabetes since fat breakdown during the period of prolonged fast can cause insulin resistance.  Now comes a new study published in Circulation 2013, showing that skipping breakfast is not healthy and friendly to the heart.

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Abstract

Background—Among adults, skipping meals is associated with excess body weight, hypertension, insulin resistance, and elevated fasting lipid concentrations. However, it remains unknown whether specific eating habits regardless of dietary composition influence coronary heart disease (CHD) risk. The objective of this study was to prospectively examine eating habits and risk of CHD.

Methods and Results—Eating habits, including breakfast eating, were assessed in 1992 in 26 902 American men 45 to 82 years of age from the Health Professionals Follow-up Study who were free of cardiovascular disease and cancer. During 16 years of follow-up, 1527 incident CHD cases were diagnosed. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for CHD, adjusted for demographic, diet, lifestyle, and other CHD risk factors. Men who skipped breakfast had a 27% higher risk of CHD compared with men who did not (relative risk, 1.27; 95% confidence interval, 1.06–1.53). Compared with men who did not eat late at night, those who ate late at night had a 55% higher CHD risk (relative risk, 1.55; 95% confidence interval, 1.05–2.29). These associations were mediated by body mass index, hypertension, hypercholesterolemia, and diabetes mellitus. No association was observed between eating frequency (times per day) and risk of CHD.

Conclusions—Eating breakfast was associated with significantly lower CHD risk in this cohort of male health professionals.

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This study may not be conclusive due to study limitations BUT the results are not surprising to me at all.

Further studies need to be done especially on the relationship of late snacking and death.

A common theme arises however in all these studies that BREAKFAST is important for health and preservation of life.

Statins and Diabetes: What’s New?

August 22, 2012

The fear of developing Diabetes due to the use of cholesterol lowering drug Statins made headlines in the past few years.

We use Statins to lower cholesterol known to cause heart attack and stroke. Studies have shown that statins indeed can lower ones risk to suffer a heart attack or stroke. So when the issue of this drug increasing the blood sugar…which then is the lesser evil?

Or are we treating on one disease and in return give rise to another disease?

The recent analysis of the big statin study called JUPITER  published in Lancet August 11, 2012 raised some very important issues that can clear the controversy:

  1. The risk of developing diabetes mellitus with statin therapy is limited to patients already at a high risk for developing diabetes. These individuals include those with impaired fasting glucose, metabolic syndrome, severe obesity, or increased hemoglobin A1c (HbA1c) levels.
     
  2. In these high-risk patients however, the benefits of statin therapy outweighed the risk of diabetes

This is therefore a very welcome development in this area of Medicine.

Is Frying Foods Bad for the Health?

February 16, 2012

Almost a resounding YES! Until recently the British Medical Journal 2012 published an article that looked at frying and the risk of heart disease. The data will otherwise give us a smile for most who love frying as a way to cook and enjoy food!

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Abstract

Objective To assess the association between consumption of fried foods and risk of coronary heart disease.
Design Prospective cohort study.
Setting Spanish cohort of the European Prospective Investigation into Cancer and Nutrition.
Participants 40,757 adults aged 29-69 and free of coronary heart disease at baseline (1992-6), followed up until 2004.
Main outcome measures Coronary heart disease events and vital status identified by record linkage with hospital discharge registers, population based registers of myocardial infarction, and mortality registers.
Results During a median follow-up of 11 years, 606 coronary heart disease events and 1,135 deaths from all causes occurred. Compared with being in the first (lowest) quarter of fried food consumption, the multivariate hazard ratio of coronary heart disease in the second quarter was 1.15 (95% confidence interval 0.91 to 1.45), in the third quarter was 1.07 (0.83 to 1.38), and in the fourth quarter was 1.08 (0.82 to 1.43; P for trend 0.74). The results did not vary between those who used olive oil for frying and those who used sunflower oil. Likewise, no association was observed between fried food consumption and all cause mortality: multivariate hazard ratio for the highest versus the lowest quarter of fried food consumption was 0.93 (95% confidence interval 0.77 to 1.14; P for trend 0.98).
Conclusion In Spain, a Mediterranean country where olive or sunflower oil is used for frying, the consumption of fried foods was not associated with coronary heart disease or with all cause mortality.

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It is always our notion that frying is really bad. Foods that are fried lose water and instead take up fat and increase the caloric density of the food that is fried.  Worst is when the oil is reused as one loses the healthier unsaturated fat and instead increases the amount of the unhealthiest fat which is the trans fat!  What is known is that the risk of obesity and overweight strongly correlated with eating fried foods but this is the only study so far that has evaluated prospectively the relationship between fried foods and cardiovascular disease.

In this study Olive oil or Sunflower oil were used.  Of the total amount of fried food consumed, 24% (34 g/day) was fish, 22% (31 g/day) meat, 21% (30 g/day) potatoes, and 11% (15 g/day) eggs.

In this study population, the detailed analysis of the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition significantly found no association between consumption of fried food and risk of coronary heart disease or all cause mortality.

Some explanations can be made:

1. The oil used in the study was mainly olive and sunflower rather than solid fat.  Olive oils is less prone to oxidation than other edible oils or fat.

2. We are not talking here of fried food in Fast food Burger joints where oils used in deep frying are reused several times and therefore unhealthy!

3. The analysis should not be made to say that fried chips or snacks therefore are safe because the study population here has low consumption of fried snacks that are usually loaded with salt.

This is indeed an exciting development in the field of FRYING!

Just the same..choose foods wisely ….

Choose Healthy!

Regular Exercise Keeps Your Arteries Healthy….

June 19, 2011

Go to fullsize imageIt is known that high sugar and high cholesterol in the blood spell trouble.  Any diabetics almost always has high blood pressure or high cholesterol problem.  Therefore, we aggressively treat their sugars, blood pressure and cholesterol hoping to lower their risk to suffer from a stroke and heart attack.

Most often, doctors tend to forget to remind patients to be more physically active.  Some patients also feel so comfortable that they are already on medications that they dont need to watch out what they eat or do. 

Now comes a new study presented at the Annual Meeting of the American College of Sports Medicine that looked at the value of regular physical activity among patients already on aggressive lowering of sugar and cholesterol and see if regular exercise contributes further to preventing heart disease.

This is so far the first study to document that if one exercise reglarly at least 30 minutes like walking, further reduction in ones risk to heart disease progression can be seen.  When pulse wave activity was measured after 2-5 years, those that exercise less or not at all, had a 14% increase in pulse wave activity suggesting more arterial stiffness.  The study confirms that progression of atherosclerosis or blockage of blood vessels can be sloweddown or halted by adding physical activity to the usual medications we give to lower sugar and cholesterol.

This study further emphasizes to all of us that whatever we do and have in life…

 if we are healthy.. go out and exercise;

if we have heart disease…go out and exercise

if you’re pregnant…go out and exercise….

Exercise will continue to add benefit to whatever medications youre taking for whatever disease you have! PLUS

Exercise difinitely PREVENTS you from falling ill…

Take care of your body…its the only one you have!

Calcium Supplements May Not Be That Safe After All….

April 25, 2011

It has always been my practice to make sure women take their daily calcium supplements to prevent osteoporosis.  It is my contention that by building bone the right way and preventing a fracture is very important health issue.  It is recommended by diffirent medical societies that calcium supplements be given between 1000- 1200 mg per day. 

Now comes a new study showing proofs that calcium supplements may not be that safe after all.  A study published in BMJ in JUly 2010 with a reanalysis done in 2011 showed that calcium supplementation should be reviewed due to inherent harm.

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Abstract

OBJECTIVE:

To investigate whether calcium supplements increase the risk of cardiovascular events.

DESIGN:

Patient level and trial level meta-analyses.

DATA SOURCES:

Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010.

STUDY SELECTION:

Eligible studies were randomised, placebo controlled trials of calcium supplements (>or=500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates.

RESULTS:

15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038).

CONCLUSIONS:

Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.

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The reanalysis of this study done recently and published in the same journal showed that the risk of MI is actualy MODEST at best around 20% for MI and 30% for stroke BUT… considering the huge number of women doctors have been recommending to take calcium supplements… justify a further close look at this practice as this will have enormous impact on health care risk.

For the past year…I have not been recommending calcium supplements to my patients especially my diabetic hypertensive patients.  I make sure that my dietitian supplements their diet with enough calcium sources from food and milk.  If need be, those patients who cant take enough from food are the ones given the supplements but this number is becoming less each day.

If you are taking calcium supplements on your own , my recommendation is to stop.  If you are taking the supplements as part of your osteoporosis program then talk to your doctor first before stopping.

Tylenol and Hypertension: Is There A Link?

April 13, 2011

It has always been my notion that tylenol is the safest of all pain relievers.  Most patinets of mine are advised to take acetaminophen instead of NSAIDS especially if they have arthritis  and have concomitant heart disease or kidney problem.  We all know about the Viox controversy when it was pulled out due to cardiovascular safety.

Now comes a recent report from the Harvard Health Beat regarding a Swiss study that showed taking acetaminophen better known for the brand Tylenol, can actually cause an elevation of Blood pressure.

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The researchers asked 33 men and women with one or more of these problems to take either 1,000 milligrams (mg) of acetaminophen or an identical placebo three times a day for two weeks. Then, after a two-week break, each volunteer took the other treatment. The amount of acetaminophen used in the study is a standard daily dose for pain.

When the participants took acetaminophen, average systolic blood pressure (the top number of a blood pressure reading) increased from 122.4 to 125.3, while the average diastolic pressure (the bottom number) increased from 73.2 to 75.4. Blood pressure stayed steady when participants took the placebo. These increases aren’t large. But they indicate that acetaminophen, like NSAIDs, somehow affects the cardiovascular system.

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Acetaminophen indeed is a safe alternative to the pain killers known as NSAIDs becuase it is safe to the stomach and avoid gastric irritation. 

It is also a better alternative especially to patients taking anticoagulants or drugs to prevent blood clots because it does not interfere with their actions nor further increase bleeding tendencies.

However… people should be extra careful with this new information and therefore should not take acetaminophen lightly.  Meaning, one should also be cautious in taking acetaminophen with a slight onset of headache especially among patients with concomitant cardiovascular disease. 

No matter how safe a drug is perceived to be… along the way comes an alternative that will always be safer… or the other way around.  It is best that we be kept informed because we may be taking drugs that may instead cause harm than good. It is therefore always worth having a periodic visits to your family doctor.

Coffee is GOOD for the HEART

August 27, 2010

Go to fullsize imageAnother good news for us coffee lovers. 

Coffee has been shown to have good effects on the vessels and has been shown to improve the vessels capacity to dilate.  This finding is another plus factor for us drinkers of coffee because it helps reduce the stress of the heart in pushing blood out of the vessels. 

And this plus effect is on top of previous studies showing coffee to be protective against developing diabetes.

The study will be presented during the European Society of Cardiology meeting as an abstract.  The abstract was discussed online in MedPage today.

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One to two cups a day correlated with greater aortic distensibility compared with rarely consuming coffee (P=0.45) in a cohort of men and women 65 and older on the Greek island of Ikaria

Likewise, Chrysohoou and colleagues found that, compared with rarely drinking coffee, moderate consumption of one or two cups a day was associated with:

  • Lower prevalence of diabetes (22% versus 34%, P=0.02)
  • Lower prevalence of high cholesterol (41% versus 55%, P=0.001)
  • Lower body mass index (28 versus 29 kg/m2, P=0.04)
  • Higher creatinine clearance levels (70.2 versus 65 mL/min, P=0.01)
  • Lower prevalence of cardiovascular disease (19% versus 26%, P=0.04)
  • Higher values of aortic distensibility (P<0.05)

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The coffee blend that was used according to the authors were of the traditional Greek blends, which apprently have higher levels of phenol compounds thought to be protective for the heart than coffee typically consumed in the U.S.

This study tells us to drink coffee in moderation and advises us to drink only 1-2 cups per day.

There you go guys…another toast to more days of fun with coffee……

Cut Down on Sweetened Juice To Help Improve BP

June 14, 2010

Go to fullsize imageOne major aspect in controlling ones BP is to lower salt intake. Salt basically increases the reaction of the blood vessels to contrict or “close” – raise your BP then increase the pressure of the heart in pumping blood out of the circulation which in the long term cause heart failure or heart enlargement. As a precaution, we always warn patients from enjoying too much salt.

Now comes an interesting study published in Circulation in June 2010 looking at another aspect of food that we know should be avoided if one has high sugar…but now is known to affect and lower ones BP also.

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BACKGROUND: Increased consumption of sugar-sweetened beverages (SSBs) has been associated with an elevated risk of obesity, metabolic syndrome, and type II diabetes mellitus. However, the effects of SSB consumption on blood pressure (BP) are uncertain. The objective of this study was to determine the relationship between changes in SSB consumption and changes in BP among adults.

METHODS AND RESULTS: This was a prospective analysis of 810 adults who participated in the PREMIER Study (an 18-month behavioral intervention trial). BP and dietary intake (by two 24-hour recalls) were measured at baseline and at 6 and 18 months. Mixed-effects models were applied to estimate the changes in BP in responding to changes in SSB consumption. At baseline, mean SSB intake was 0.9+/-1.0 servings per day (10.5+/-11.9 fl oz/d), and mean systolic BP/diastolic BP was 134.9+/-9.6/84.8+/-4.2 mm Hg. After potential confounders were controlled for, a reduction in SSB of 1 serving per day was associated with a 1.8-mm Hg (95% confidence interval, 1.2 to 2.4) reduction in systolic BP and 1.1-mm Hg (95% confidence interval, 0.7 to 1.4) reduction in diastolic BP over 18 months. After additional adjustment for weight change over the same period, a reduction in SSB intake was still significantly associated with reductions in systolic and diastolic BPs (P<0.05). Reduced intake of sugars was also significantly associated with reduced BP. No association was found for diet beverage consumption or caffeine intake and BP. These findings suggest that sugars may be the nutrients that contribute to the observed association between SSB and BP.

CONCLUSIONS: Reduced consumption of SSB and sugars was significantly associated with reduced BP. Reducing SSB and sugar consumption may be an important dietary strategy to lower BP.

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What does this study tell us:

 That of the >800 adults in the study: that drinking one less sugar-sweetened beverage a day resulted in the lowering of both systolic and diastolic BP by about 1.2 mm Hg and 1.1 mm Hg  over 18 months period of observation.

I am actually not surprised by this relationship.  We all know, anytime a patient has high BP, I always make sure he is not at risk to become diabetic with high cholesterol since the three always come in groups and are always partners in crime. So controlling for one may result in the improvement of the other.  So any dietary intevention that I do for my patients incorporate for the control of the three conditions.

Remember: For every 3-mm-Hg reduction in systolic BP : the risk of dying from stroke is reduced by 8% and the risk of dying for heart disease is redcued by 5%.  So any small amount of decrement is worth it!

There you go guys: another reason to cut down on SUGAR!

Ways To A Healthier Heart

February 3, 2010

See full size imageJust came across this wonderful wonderful article in Harvard HealthBeat News Letter that I want to share.  They are practical steps yet very true to every word.  Worth meditating and taken seriously… and true to its mission…A Healthy Heart!

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10 small steps for better heart health

Change is an important part of living with heart disease or trying to prevent it. A jump in blood pressure or cholesterol earns you a lecture on healthy lifestyle changes. Heart attack and stroke survivors are often told to alter a lifetime of habits.

Some people manage to overhaul their exercise pattern, diet, and unhealthy habits with ease. The rest of us try to make changes, but don’t always succeed. Instead of undertaking a huge makeover, you might be able to improve your heart’s health with a series of small changes. Once you get going, you may find that change isn’t so hard. This approach may take longer, but it could also motivate you to make some big changes.

Here are 10 small steps to get you on the road to better health in 2010.

1. Take a 10-minute walk. If you don’t exercise at all, a brief walk is a great way to start. If you do, it’s a good way to add more exercise to your day.

2. Give yourself a lift. Lifting a hardcover book or a two-pound weight a few times a day can help tone your arm muscles. When that becomes a breeze, move on to heavier items or join a gym.

3. Eat one extra fruit or vegetable a day. Fruits and vegetables are inexpensive, taste good, and are good for everything from your brain to your bowels.

4. Make breakfast count. Start the day with some fruit and a serving of whole grains, like oatmeal, bran flakes, or whole-wheat toast.

5. Stop drinking your calories. Cutting out just one sugar-sweetened soda or calorie-laden latte can easily save you 100 or more calories a day. Over a year, that can translate into a 10-pound weight loss.

6. Have a handful of nuts. Walnuts, almonds, peanuts, and other nuts are good for your heart. Try grabbing some instead of chips or cookies when you need a snack, adding them to salads for a healthful and tasty crunch, or using them in place of meat in pasta and other dishes.

7. Sample the fruits of the sea. Eat fish or other types of seafood instead of red meat once a week. It’s good for the heart, the brain, and the waistline.

8. Breathe deeply. Try breathing slowly and deeply for a few minutes a day. It can help you relax. Slow, deep breathing may also help lower blood pressure.

9. Wash your hands often. Scrubbing up with soap and water often during the day is a great way to protect your heart and health. The flu, pneumonia, and other infections can be very hard on the heart.

10. Count your blessings. Taking a moment each day to acknowledge the blessings in your life is one way to start tapping into other positive emotions. These have been linked with better health, longer life, and greater well-being, just as their opposites — chronic anger, worry, and hostility — contribute to high blood pressure and heart disease.

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As the saying goes…

Dont Worry…Be Healthy and Be Happy!

The Thigh and The Heart…Where’s The Connection?

September 21, 2009

Check your thighs… are they thin or thick?  big or small?

Now get a tape measure and read on…..

An intriguing study published in the British Medical Journal made me think….

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Objective To examine associations between thigh circumference and incident cardiovascular disease and coronary heart disease and total mortality.

Design Prospective observational cohort study with Cox proportional hazards model and restricted cubic splines.

Setting Random subset of adults in Denmark.

Participants 1436 men and 1380 women participating in the Danish MONICA project, examined in 1987-8 for height, weight, and thigh, hip, and waist circumference, and body composition by impedance.

Main outcome measures 10 year incidence of cardiovascular and coronary heart disease and 12.5 years of follow-up for total death.

Results:

  •  A small thigh circumference was associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both men and women.
  •  A threshold effect for thigh circumference was evident, with greatly increased risk of premature death below around 60 cm.
  • Above the threshold there seemed to be no additional benefit of having larger thighs in either sex.
  • These findings were independent of abdominal and general obesity, lifestyle, and cardiovascular risk factors such as blood pressure and lipid concentration.

Conclusions:

  • A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death.
  • The adverse effects of small thighs might be related to too little muscle mass in the region.
  • The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in early identification of individuals at an increased risk of premature morbidity and mortality.

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What is interesting of this study is the finding that the risk to cardiovascular disease was in fact  more highly related to thigh circumference than to waist circumference. 

Now therefore…we have a very simple way of determining based on a method we can easily do anywhere pt measure and assess ones risk! 

The CUT OFF size is 60 cm…that’s the magic number …anything smaller is harmful so the study says….

Will the risk reverse once we increase the circumference of the thighs? Again …the whole picture of a healthy lifestyle still is the best way to combat chronic diseases and heart disease. 

But for now, thinner thighs mean lesser muscle mass which may mean insulin may not work properly and therefore can predispose this individual to diseases like diabetes and high blood pressure.   In this study, the people with a thigh measurement of less than 46.5 centimetres (18 inches)had roughly double the chances of getting heart and circulation problems or dying during the study.  

So what needs to be done? If you have a small thighs you can do something about it!!!!

Exercise!!!

Another reason for us to move and work out!

Sleep Well To Prevent High Blood Pressure!!!

July 4, 2009

A simple measure to reduce BP is to have a good night’s sleep!!!

Here’s a new study that shows us one tip to have a better controlled blood pressure  published in Archives of Internal Medicine:

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BACKGROUND: Epidemiological studies have reported an association between self-reported short sleep duration and high blood pressure (BP). Our objective was to examine both cross-sectional and longitudinal associations between objectively measured sleep and BP.

METHODS: This study is ancillary to the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. Blood pressure was measured in 2000 and 2001 and in 2005 and 2006. Sleep was measured twice using wrist actigraphy for 3 consecutive days between 2003 and 2005. Sleep duration and sleep maintenance (a component of sleep quality) were calculated. Analyses included 578 African Americans and whites aged 33 to 45 years at baseline. Outcome measures were systolic BP (SBP) and diastolic BP (DBP) levels, 5-year change in BP, and incident hypertension.

RESULTS: After we excluded the patients who were taking antihypertensive medications and adjusted for age, race, and sex,

  • shorter sleep duration and lower sleep maintenance predicted significantly higher SBP and DBP levels cross-sectionally as well as more adverse changes in SBP and DBP levels over 5 years (all P < .05).
  • Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio, 1.37; 95% confidence interval, 1.05-1.78).
  •  Adjustment for 16 additional covariates, including snoring and daytime sleepiness, slightly attenuated the associations between sleep and BP.

 CONCLUSION: Reduced sleep duration and consolidation predicted higher BP levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP.
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There you go guys… nake sure you sleep better..and rest well. 

Dont let worries or pressure bother you too much. 

Associate the bed with a good night’s sleep…  not only will you feel refreshed the next day BUT healthier too!

For a Healthier Heart… Sleep Well!!!

How To Lower Cholesterol Levels Naturally

June 3, 2009

Here’s one interesting article from the Harvard Health Publications HealthBeat on ways we can do to lower cholesterol naturally without meds:

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15 tips for lowering your cholesterol naturally

Many factors contribute to the development of heart disease or stroke. Genes and gender play a role, but for most of us, what we eat is an important factor as well. The good news is that a few small changes to your diet can help lower your cholesterol, which in turn will lower your risk for heart disease and stroke. Here are 15 heart-healthy eating tips to help you in the fight against high cholesterol.

1. Eat meat sparingly. Relegate meat to a minor part of your diet instead of making it the centerpiece of most meals. Trim off fat and skin from meats and poultry. Avoid fatty cuts of beef, pork, and lamb; instead choose lean meats, or substitute fish or skinless white-meat poultry. When dining out, choose a smaller portion of meat, or meatless pasta or fish dishes.

2. Opt for low-fat dairy products. Avoid dairy foods that contain whole milk or cream; instead, use low-fat or nonfat versions.

3. Watch the snacks. Choose low-fat snacks (homemade popcorn, carrots, dried fruits, or fresh fruits) instead of high-fat ones (potato chips and candy bars). Avoid store-bought bakery products unless they are explicitly low in saturated fats and free of trans fats.

4. Cut down on saturated fat in cooking. Use liquid cooking oils rather than butter or margarine. Use nonstick pans. Instead of frying your food, bake, broil, roast, steam, or stew. Discard drippings, and baste with wine or broth.

5. Avoid palm and coconut oils. Most vegetable oils are unsaturated, but these two contain mostly saturated fat. Choose canola, sunflower, safflower, corn, soybean, olive, and peanut oils.

6. Reduce dietary cholesterol. Strive to eat less than 200 mg of dietary cholesterol a day. Limit eggs to no more than four egg yolks per week; two egg whites can replace a whole egg in most recipes. Limit lean meat, fish, and poultry to no more than 6 ounces per day (a 3-ounce portion is about the size of a deck of playing cards). Stay away from cholesterol-rich organ meats, such as liver, brains, and kidneys.

7.  Increase complex carbohydrates and fiber. Emphasize foods with complex carbohydrates—such as fruits and vegetables, whole-grain products, and legumes (dried beans and peas)—that are low in calories and high in fiber. Eat more water-soluble fiber, such as that found in oat bran and fruits. This type of fiber can significantly lower your blood cholesterol level when eaten in conjunction with a low-fat diet.

8. Eat fruits and vegetables. To protect your heart, eat plenty of fruits and vegetables.

9. Go for nuts. Nuts are associated with a lower risk of heart disease. They’re a healthful and filling source of protein, but go easy on them; they have lots of calories, so too much could cause weight gain.

10. Add fish to your diet. Countries with high fish consumption have a lower risk of death from all causes as well as from cardiovascular disease. Like nuts, oily fish contain the essential fatty acids known as omega-3s and omega-6s. Since our bodies can’t make these, we have to eat foods that contain them to gain their benefits, which include improved cholesterol levels.

11. Reduce salt intake. High blood pressure is a major risk factor for cardiovascular disease. Diets high in salt increase risk of hypertension.

12. Avoid trans fats. According to the Institute of Medicine’s Food and Nutrition Board, there are no redeeming qualities to trans fats, and no safe levels. They raise LDL cholesterol and lower HDL cholesterol. The National Cholesterol Education Program urges people to eat as little as possible. Avoid or eat only very small quantities of foods that list hydrogenated oil or partially hydrogenated oil among their first ingredients. These products contain a lot of trans fat.

13. Drink alcohol only in moderation. Regular, moderate drinking can reduce the risk of cardiovascular disease, but heavy drinking negates the benefits. Moreover, the advantages aren’t strong enough to recommend alcohol for anyone who doesn’t already drink. For those who do, the Dietary Guidelines for Americans recommend no more than one drink a day for women, and one or two drinks a day for men.

14. Read labels carefully. Avoid prepared foods that list any of the following among the first few ingredients: meat fat, coconut or palm oil, cream, butter, egg or yolk solids, whole milk solids, lard, cocoa butter, chocolate or imitation chocolate, or hydrogenated or partially hydrogenated fat or oil. Watch out for fast foods and other unlabeled products; when you don’t know what you’re getting, eat sparingly.

15. Change strategies. If three months of healthy eating doesn’t bring your total and LDL cholesterol levels into the desired range, consult your physician and a dietitian. If the numbers still don’t budge after six months, it may be time to consider medication.

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Simple measures we can at home to avoid getting th compications associated with a high cholestrol level in the blood.  High cholesterol levels have been shown to increase ones risk to suffer from stroke and heart attack. 

The good news is , we now have ways to control and lower the cholestrol levels by taking care of what we eat and through medications.

Be Health Smart and Check the Labels!

Meat Is Not NEAT!

April 7, 2009

Go to fullsize imageIt is easier to convince a child to eat meat than to eat veggies.  This scenario is given.  We are exposed to too many ads on meat whether chicken meat or beef meat on TV and newspapers.  It is therefore a challenge to parents to introduce other varieties of food that we deem healthier to the next generation.  It may take us some time to be successful but a little step can indeed go a long way overtime!

Now comes another study to support the concept that meat is really not neat!  Published in the latest edition of  Archives of Internal Medicine:

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Background  High intakes of red or processed meat may increase the risk of mortality. Our objective was to determine the relations of red, white, and processed meat intakes to risk for total and cause-specific mortality.

Methods  The study population included the National Institutes of Health–AARP (formerly known as the American Association of Retired Persons) Diet and Health Study cohort of half a million people aged 50 to 71 years at baseline. Main outcome measures included total mortality and deaths due to cancer, cardiovascular disease, injuries and sudden deaths, and all other causes.

Results  There were 47 976 male deaths and 23 276 female deaths during 10 years of follow-up.

  • Men and women in the highest vs lowest quintile of red (HR, 1.31 [95% CI, 1.27-1.35], and HR, 1.36 [95% CI, 1.30-1.43], respectively) and processed meat (HR, 1.16 [95% CI, 1.12-1.20], and HR, 1.25 [95% CI, 1.20-1.31], respectively) intakes had elevated risks for overall mortality.
  • Regarding cause-specific mortality, men and women had elevated risks for cancer mortality for red (HR, 1.22 [95% CI, 1.16-1.29], and HR, 1.20 [95% CI, 1.12-1.30], respectively) and processed meat (HR, 1.12 [95% CI, 1.06-1.19], and HR, 1.11 [95% CI 1.04-1.19], respectively) intakes.
  • Furthermore, cardiovascular disease risk was elevated for men and women in the highest quintile of red (HR, 1.27 [95% CI, 1.20-1.35], and HR, 1.50 [95% CI, 1.37-1.65], respectively) and processed meat (HR, 1.09 [95% CI, 1.03-1.15], and HR, 1.38 [95% CI, 1.26-1.51], respectively) intakes.
  • When comparing the highest with the lowest quintile of white meat intake, there was an inverse association for total mortality and cancer mortality, as well as all other deaths for both men and women.

Conclusion  Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality.

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This study further confirms the relationship between red meat and cancer, heart and overall risk of death.  Likewise, the study also showed that fish or intake of white meat was associated with a reduction in the risk of death.

Translating the data to common language…it means…

Over 10 years, those that eat meat equivalent to a quarter-pound hamburger can increase ones risk to die from cancer by 22 percent and the risk to die from heart disease by 27 percent. 

Bottom Line is:

Cut The Red Meat… Enjoy Fish in time for the Lenten Season….

High Blood Sugar Predicts Death in Heart Attack Patients

February 26, 2009

Just a note for all of the readers with family members who are diabetics.  This is just to make you aware that control of sugar is of paramount importance even at the time of hospitalization especially due to heart attack.

This new study published in Archives of Internal Medicine, Feb 2009 shows that the relationship between fasting blood sugar on admission and its ability to predict outcome of death within 6 months of the acute attack.

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Background  Elevated blood glucose level at admission is associated with worse outcome after a myocardial infarction. The impact of elevated glucose level, particularly fasting glucose, is less certain in non–ST-segment elevation acute coronary syndromes. We studied the relationship between elevated fasting blood glucose levels and outcome across the spectrum of ST-segment elevation and non–ST-segment elevation acute coronary syndromes in a large multicenter population broadly representative of clinical practice.

Methods  Fasting glucose levels were available for 13 526 patients in the Global Registry of Acute Coronary Events. A multivariate logistic regression analysis was used for assessing the association between admission or fasting glucose level and in-hospital or 6-month outcome, adjusted for the variables from the registry risk scores.

Results 

  • Higher fasting glucose levels were associated with a graded increase in the risk of in-hospital death (odds ratios [95% confidence intervals] vs <100 mg/dL: 1.51 [1.12-2.04] for 100-125 mg/dL, 2.20 [1.64-2.60] for 126-199 mg/dL, 5.11 [3.52-7.43] for 200-299 mg/dL, and 8.00 [4.76-13.5] for 300 mg/dL).
  • When taken as a continuous variable, higher fasting glucose level was related to a higher probability of in-hospital death, without detectable threshold and irrespective of whether patients had a history of diabetes mellitus.
  • Higher fasting glucose levels were found to be associated with a higher risk of postdischarge death up to 6 months.
  • The risk of postdischarge death at 6 months was significantly higher with fasting glucose levels between 126 and 199 mg/dL (1.71 [1.25-2.34]) and 300 mg/dL or greater (2.93 [1.33-6.43]), but not within the 200- to 299-mg/dL range (1.08 [0.60-1.95]).

Conclusions  Short-term and 6-month mortality was increased significantly with higher fasting glucose levels in patients across the spectrum of acute coronary syndromes, thus extending this relation to patients with non–ST-segment elevation myocardial infarction. The relation between fasting glucose level and risk of adverse short-term outcomes is graded across different glucose levels with no detectable threshold for diabetic or nondiabetic patients.

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Better still…. across the spectrum of diabetes management that good control should always be practiced.  

No ifs or buts…its the RULE!

Reduction in short term complications, the sense of well being…plus reduction of long term complications like stroke and heart attack…are more than enough for any diabetic in the family to make sure that good control should always be practiced.  

Ths study tells us that up to the time of the acute event, high sugar continues to present itself as a menace.  And that high sugar should not be relegated as a mere stress effect but for me should be aggressively treateed as metabolic effects can have lasting impact on ones health and are irreversible!

Be aggressive as high sugar may not manifest any symptoms until its late!

How To Check Your Blood Pressure At Home….

October 1, 2008

High blood pressure is now a common ailment that we hear among our friends.  The way we live our lives, the genes and our lifestyle contribute sugnoificantly to increasing this risk.  Almost always, doctors require patienhts to monitor their blood pressure at home however, majority do it wrongly or make use of wrong machines to record their BP.

The Harvard News Letter has come up with some tips that I want to share with you:

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Your blood pressure changes from hour to hour, sometimes even minute to minute. Standing up, watching an exciting sports event, eating a meal, even the time of day influence your blood pressure. It jumps around so much that you are more likely to get a “normal” reading if you check it at home rather than in the doctor’s office.

When it comes to measuring blood pressure, technique matters. Doing it wrong can give you a reading that’s too high or too low. (To see a brief video on using a home blood pressure monitor, visit health.harvard.edu/128.)
There are two things to do before you start. First, check your machine against the one in your doctor’s office. Second, make sure you have the right size cuff — the inflatable part should encircle at least 80% of your upper arm.

When you first start to check your blood pressure at home, measure it early in the morning, before you have taken your blood pressure pills, and again in the evening, every day for a week. After that, follow the plan your doctor recommends, or check it one or two days a month. Each time you take a reading:

  • Avoid caffeinated or alcoholic beverages, and don’t smoke, during the 30 minutes before the test.
  • Sit quietly for five minutes with your back supported and feet on the floor.
  • When making the measurement, support your arm so your elbow is at the level of your heart.
  • Push your sleeves out of the way and wrap the cuff over bare skin. Measure your blood pressure according to the machine’s instructions. Leave the deflated cuff in place, wait a minute, then take a second reading. If the readings are close, average them. If not, repeat again and average the three readings.
  • Don’t panic if a reading is high. Relax for a few minutes and try again.
  • Keep a record of your blood pressure readings and the time of day they are made.

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Simple tips that can go a long way in ensuring good control of BP.  Remember, the doctor can only help in advising what type of drug is best for you.  Then the remaining half of the job is done by you… making sure you eat the right food, the right amount of salt and getting the right amount of “stress”.

By making it a habit to check your blood pressure may not help “cure the disease” as 99% of hypertension has no identifiable cause,  BUT it will help ensure a smooth control of BP during the day to day activity that you do.  As a result, you can be assure that the simple measures that you do are being done to help prevent complications including heart attack and stroke.

Keep Your BP in Control!

Sleep and High Blood Pressure… Check Your Kids!

August 27, 2008

Go to fullsize imageI just came across a new study that showed poor sleep is affecting a lot of our teens these days.  Its either they have problems falling asleep or problems waking up early or just plain LACK of Sleep for whatever reason.  This study involved around 200 adolescents between ages 13-16 was recently published in the Journal Circulation August issue and is really an eye opener for parents with kids… by making sure that their kids follow a sleep habit that is healthy.

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Odds of prehypertension associated with sleep disturbances

Sleep problem Unadjusted OR (95% CI) p Adjusted OR p
Low sleep efficiency (<85%) 4.52 (2.11-9.70) 0.0001 3.50 0.0028
Short sleep (<6 h) 2.79 (1.07-7.34) 0.0366 2.54 0.0679

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The kids with sleep inefficiency meaning they have trouble falling asleep or wake early and those with poor sleep (6.5 hours or less) had systolic blood-pressure levels that were higher than their peers on average 4 mm Hg.  This problem of hypertension may result in long lasting complications and development of end organ damage involving the heart, kidneys and eyes among our kids at an early age.  Fortunately this is one risk of hypertension that is MODIFIABLE.

What then can be modified to afford better sleep habit among our teens? 

I have three Simple recommendations:

  • Limit Home Internet Use.  Only for school work and no to games during school days!  Overexcitement results in being hyperactive due to adrenaline rush and this limits sleep quality.
  • A Good Study Habit to avoid cramming.  This should have been trained as early as preschool!
  • Limit soda or other drinks rich in caffeine especially during dinner time

A Better Adjusted Kid Is A Healthy Kid!

An Aspirin A Day Can Keep BP At Bay…

June 24, 2008

Aspirin has been touted a miracle drug because of its health benefits in protecting high risk patients like our diabetics from heart attack and stroke. The combination of illnesses including diabetes , hypertension and cholesterol increases a patients risk for stroke and heart attack.

In the recent American Society of Hypertension Annual Convention, a particular study was presented regarding the effect of aspirin on hypertension. The study is discussed in detail at the Diabetes in Control website...

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The subjects were randomized into three groups: lifestyle modification only, lifestyle modification plus aspirin 100 mg every morning, or lifestyle modification and aspirin 100 mg taken at bedtime. They underwent continuous blood pressure monitoring for 48 hours at baseline and after 3 months of intervention.

Ambulatory blood pressure was unchanged in the nonpharmacologic group and in the morning aspirin group, but the nighttime aspirin administration resulted in a mean decrease of 5.4 mm Hg in systolic blood pressure and 3.4 mm Hg in diastolic blood pressure compared to baseline values, without any change in heart rate or physical activity. Reductions in blood pressure were similar for both day and night.

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This study will somehow affect the way we give aspirin. In clinical practice, it really doesnt matter when aspirin is taken as long as patients are taking it eveyday. But with this recent outcome…might as well give them at night until this study will be proven otherwise….

And as always…we continue to emphasize a low salt diet and more physical activity on top of medications to help curb the rising prevalence of complications arising from hypertension.

Another Wonderful News on Aspirin and Health!

Soy Protein and The Heart….

May 26, 2008

Go to fullsize imageThere are many conflicting data on soy protein and the heart especially the claim that they lower cholesterol.  In fact in 1999 based on studies during that time, the US FDA allowed a health claim on food labels stating that a daily diet containing 25 grams of soy protein, also low in saturated fat and cholesterol, may reduce the risk of heart disease. 

However, the American Heart association in January of 2006 made a review of available data and made a conclusion that soy protein in itself did not significantly lower the bad cholestrol nor did it have any significant effect in increasing the good cholesterol.

But as an endocrinologist looking for alternative source of meat protein, the use of soy protein in place of meat which has high staurated fat will continue to play a major role in our attempt to reduce the risk of our patients from cardiovascular disease.

Recently a new article on the benefit of soy protein came out in Annals of Internal Medicine.  This study is so relevant to my practice especially among diabetic patients with kidney disease.  These are the patients we try to avoid taking meat protein because of the possibility of causing kidney function deterioration.  The study did not only show a good effect in sugar control but also markers of inflammation suggesting a potential effect in reducing cardiovascular disease plus improving markers of kidney function.

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Soy protein consumption significantly affected cardiovascular risks such as fasting plasma glucose , total cholesterol , LDL cholesterol, and serum triglyceride concentrations.

Serum CRP levels were significantly decreased by soy protein intake compared with those in the control group .

Significant improvements were also seen in proteinuria  and urinary creatinine ( both measures od kidney function) by consumption of soy protein.

CONCLUSIONS—Longitudinal soy protein consumption significantly affected cardiovascular risk factors and kidney-related biomarkers among type 2 diabetic patients with nephropathy.

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Here is a list of the common sources of soy protein that we can enjoy includes: Tofu, soymilk, soyflour. Tempeh and Miso.  The soymilk and textured soy protein can be used as subsitute for meat or cows milk while the soyflour can be used in baking needs.

I believe in the benefits of soy protein.  I hope for more studies to come that will provide us with more data on its beneifts and potential to reduce disease risk especially the Heart!

Soy Protein: A Better Partner for the Heart!

Having High Sugar and High Blood Pressure Can be Deadly…

May 23, 2008

Go to fullsize imageAlmost always a patient that suffers from diabetes is obese, have high triglycerides and low HDL and develops high blood pressure and high cholesterol… the combination of which is called the Metabolic syndrome.  If any of these conditions are not addressed then ones risk to suffer from chronic complication like heart disease is increased.  Whether the sum of the components or the combination of two parts or only one component is present makes a patient more at risk to die is not well documented.

The new study published in Annals of Internal Medicine May 2008 now shows that having two parts increases the risk to die more than having the combination for the components of the syndrome itself….

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  1. After multivariable adjustment, compared with persons without MetS, those with MetS had a 22% higher mortality .
  2. Higher risk with MetS was confined to persons having elevated fasting glucose level  or treated diabetes mellitus or hypertension as one of the criteria;
  3. Persons having MetS without High Fasting Glucose or MetS without hypertension did not have higher risk.
  4. Evaluating MetS criteria individually, we found that only hypertension and EFG predicted higher mortality;
  5. Persons having both hypertension and Elevated Fasting Glucose had 82% higher mortality .
  6. Substantially higher proportions of deaths were attributable to EFG and hypertension (population attributable risk fraction [PAR%], 22.2%) than to MetS (PAR%, 6.3%).

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There you go my friends…just having diabetes or hypertension makes one at higher risk to die from heart disease.  More so if high blood sugar is joined by high blood pressure then the risk to die is 82%!!!!

The above study therefore tells us that making a diagnosis of metabolic syndrome does not entail more risk to die than having just diabetes of hypertension alone.  Such that… it’s utility as a diagnosis and as a risk factor for cardiovascular mortality is put in question. 

So friends…please dont take these two conditions lightly!!! As an endocrinologist, I take these conditions seriously and that all patients with Diabetes are screened for blood pressure and cholesterol abnormalities and vice versa! 

To summarize the study:

Having High Sugar especially if with High Blood Pressure Can Be DEADLY!