Wood Street Clinic Blog

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What to know about cardiorespiratory endurance

Cardiorespiratory endurance is an indication of a person's overall physical health. Cardiorespiratory endurance tests monitor how well the heart, lungs, and muscles perform during moderate to high-intensity exercise.

Increasing cardiorespiratory endurance improves oxygen uptake in the lungs and heart and can help a person sustain physical activity for longer.

Other names for cardiorespiratory endurance include cardiovascular fitness, cardiovascular endurance, and cardiorespiratory fitness.

In this article, we discuss what cardiorespiratory endurance is, how a person can measure it, and why it is important. We also look at how to improve cardiorespiratory endurance, including some examples of exercises.

What is it? Woman jumping rope to improve cardiorespiratory endurance
Jumping rope can improve cardiorespiratory endurance.

Cardiorespiratory endurance measures how well the body performs during long periods of exercise. A person with high cardiorespiratory endurance can sustain high-intensity activities over an extended period without getting tired.

Measuring a person's cardiorespiratory endurance involves examining how well their body takes in and utilizes oxygen.

When a person inhales, their lungs fill up with air and some of the oxygen it contains passes into the bloodstream. This oxygen-rich blood then travels to the heart, which circulates it around the body to the tissues and organs that need it.

The muscles require an adequate supply of oxygen and other nutrients to work properly during high-intensity or extended periods of exercise. If the muscles do not get enough nutrients, waste products begin to accumulate and cause fatigue.

A person's level of cardiorespiratory endurance can directly affect their physical performance.

Thank you for supporting Medical News Today How is it measured? Tests that measure cardiorespiratory endurance include: Metabolic equivalents Metabolic equivalents (METs) refers to the ratio between the energy expended during physical activity and the energy expended while at rest. Finding a person's MET involves measuring how much oxygen their body uses at rest. Maximum oxygen uptake Maximum oxygen uptake (VO2 max) test determines the maximum amount of oxygen the body is capable of using during high-intensity activities, such as sprinting or biking. The VO2 max test typically involves running on a treadmill or pedaling on a stationary bike as fast as possible. During the test, the person wears a chest strap or other body attachment that records their heart rate and a face mask that measures oxygen consumption. Why is it important? Cardiorespiratory endurance indicates a person's level of aerobic health and physical fitness. This information can benefit everyone, not just professional athletes. Having a high cardiorespiratory endurance generally means that a person can perform high-intensity exercise for longer. People trying to lose weight may want to focus on increasing their cardiorespiratory endurance because doing higher-intensity aerobic activities can help a person burn more calories. Scientific research also suggests some other potential health benefits from having an improved cardiorespiratory endurance. For example: A 2017 study suggests that people with higher cardiorespiratory endurance are less likely to develop high blood pressure than those with a lower cardiorespiratory endurance. In a 2015 study, researchers found a positive correlation between cardiorespiratory endurance levels and multitask performance among adults aged between 59 and 80 years. Improving cardiorespiratory endurance may decrease the risk of coronary heart disease and all-cause mortality, according to a 2015 study. How to improve it People can improve their cardiorespiratory endurance through regular exercise. The authors of a 2019 study reported that resistance training, endurance training, and high-intensity interval training led to improvements in cardiorespiratory endurance and muscular strength among adults who were aged 40–65 years old and who were not previously physically active. A 2017 study investigated the effectiveness of a 12-week cross-circuit training program in students who were overweight and had intellectual disabilities. The researchers found participants who followed the training program had an improved exercise endurance, muscle strength, and body mass index. The following exercises can help improve cardiorespiratory endurance, build muscle, and burn calories. People can perform these physical activities at home or add them to their gym routine. Try doing these exercises in sets of 10–15 repetitions, or as many repetitions as possible for 1 minute with a 20-second break in between sets. Jumping jacks: Jumping jacks gif

Start by standing upright with legs together and arms at the sides of the body. Jump up. While in the air, open the legs to spread the feet wide apart and raise the arms overhead. While landing, bring the feet and arms back to the starting position. Burpees: Burpees gif

Begin standing with the feet shoulder-width apart. Bend the knees and place the hands on the floor in front to come down into a squat position. Jump the legs out behind to get into the push-up position, shifting the body's weight onto the hands. Jump the feet back into the squat position. Jump up into the air with arms raised above the head. Land back in the squat position. Mountain climbers (running planks): Mountain climbers (running planks) gif

Start in the plank position, aligning the shoulders over the wrists and keeping the legs straight. Keep the back flat and the head aligned with the spine. Engage the core muscles. Bring the right knee towards the chest. Switch legs by returning the right leg to the starting position and bringing the left knee towards the chest. This completes one repetition. Side-shuffle touches: Start in a standing position with the feet shoulder-width apart and the arms down by the sides. Bend the knees and squat down. Shuffle a shoulder-width to the right and then touch the floor outside the right foot with the fingertips of the right hand. Shuffle a shoulder-width to the left and then touch the floor outside the left foot with the fingertips of the left hand. This is one repetition. Other exercises that can help improve cardiorespiratory fitness include: running power walking swimming dancing jump rope high-intensity sports, such as basketball and soccer Summary Cardiorespiratory endurance is a measure of how well the heart, lungs, and muscles perform during moderate to high-intensity physical activity. Getting regular physical activity, especially aerobic exercise, can improve cardiorespiratory endurance. Aerobic exercises can help promote heart and lung health and improve how well the body circulates and utilizes oxygen.
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What to expect during a physical exam

A physical exam, or a physical, is a routine test wherein a healthcare professional inspects, feels, or listens to different parts a person's body. Other names for a physical include a complete physical exam, a routine physical, and a checkup.

A doctor or nurse may recommend a physical to:

check for possible diseases or medical conditions check for medical issues that may become a problem later on keep track of any changes in a person's physical health determine whether a person needs further tests

In this article, we discuss what to expect during a routine physical exam. We also cover some specific types of physical exam.

What to expect Doctor performs physical examination on patient with stethoscope.
A healthcare professional may listen to the chest during a physical exam.

Healthcare professionals typically carry out a physical exam in their office or in a dedicated room in a medical clinic or hospital.

It is important for the doctor or nurse to make sure that a person feels comfortable during a physical exam. The American Medical Association require clinics to provide a chaperone on request and to allow people to bring a friend or relative into the examination room with them.

Usually, the healthcare professional will also take a medical history before moving onto the physical exam. A medical history is a record of the person's current symptoms as well as any risk factors and previous medical issues that might be relevant.

The doctor or nurse may ask about:

past and current diseases or medical conditions previous operations or medical procedures past immunizations any medicines, vitamins, minerals, and herbal remedies that the person is currently taking current signs and symptoms lifestyle information, such as diet and exercise habits, the use of tobacco and alcohol, and sexual and reproductive history family history of health conditions or diseases

Exactly what the physical examination entails will depend on the reason for the test, but in general it can include:

height and weight measurements nose, mouth, throat, and ear examination with a torch or scope feeling for the pulse in the person's neck, groin, or feet checking the body's reflexes listening to the heart and lungs with a stethoscope measuring blood pressure using a sphygmomanometer feeling the lymph nodes in the neck, underarms, or groin feeling the abdomen to check for abnormalities

For babies and young children, a physical exam may include:

asking questions about their development and growth measuring the circumference of their head checking their fine motor development, such as by asking them to pick up small items or tie their shoelaces checking their gross motor development, which can include asking them to walk, climb stairs, or jump looking in the mouth, eyes, and ears listening to the chest checking the health of the genitals tapping on the knees to check reflexes examining the feet

Sometimes, people undergo physical examinations to check for a particular issue or health condition. In these cases, the healthcare professional may carry out specific tests in addition to or instead of those above. We discuss some of these specific tests below.

Thank you for supporting Medical News Today Skin exam Doctors recommend regular skin exams to look for suspicious growths, moles, or other changes that may be a sign of skin cancer. These exams are particularly important for people with risk factors for skin cancer, such as those with a family history of the condition. A doctor may include a skin exam as part of a routine checkup. The exam will typically involve the doctor checking the person's skin from head to toe. Clinical breast exam A healthcare professional may recommend a clinical breast exam to check for abnormalities in and around the breast area. During this exam, they will use the pads of their fingers to check the entire breast, including the underarm and collarbone area. If they spot a lump, they will note its size, shape, and texture and check whether it moves easily. This is because lumps that are soft, smooth, round, and movable tend to be noncancerous cysts. The doctor will usually then recommend further diagnostic tests. Pap test and pelvic exam A doctor has a discussion with a patient.
A Pap test is one physical exam a female might undergo. During a pelvic exam, a healthcare professional will examine the female reproductive organs to check for any gynecological problems. They may also perform a Pap test to check for signs of cervical cancer. Doctors usually recommend that females have their first pelvic exam when they turn 21 years old or if they experience any of the following symptoms: unexplained pain in the lower stomach or around the vulva vaginal discharge that itches, burns, or smells unpleasant bleeding from the vagina that lasts longer than 10 days missed periods severe menstrual cramps During the appointment, the doctor will usually ask the person about their periods and sexual activity. They will then ask the person to take off their underwear and lie on the table with their feet in stirrups and a sheet covering their stomach and legs. The healthcare professional will visually inspect the area outside of the vagina before moving on to the speculum exam. A speculum is a small plastic or metal instrument. They will insert it into the vagina and then gently open it so that they can see the vaginal canal and cervix. For the Pap test part of the examination, the doctor will use a plastic stick to collect a sample of cells from the inside of the cervix. They will then send this sample to a laboratory for analysis. Learn more about Pap tests here. Digital rectal exam Healthcare professionals commonly use a digital rectum exam to check for signs of prostate cancer in males. They may recommend the exam for people at higher risk of prostate cancer or those who experience any of the following symptoms: bleeding from the rectum a change in bowel habits blood in the semen or urine pain when ejaculating urination difficulties A digital rectal exam only takes a few minutes. It is not usually painful, but it may be uncomfortable. The doctor will ask the person to take off their pants and underwear before giving them a gown or cloth to wrap around themselves. The person will then either stand and bend forward at the waist or lie on their side in the fetal position on an exam table. The healthcare professional will then gently insert a gloved and lubricated finger into the rectum to inspect the prostate for its size and the presence of any bumps, soft or hard spots, and other abnormalities. They will also examine the wall of the lower colon, or rectum. Learn more about these types of test here. Thank you for supporting Medical News Today Summary Physical exams are a routine part of healthcare. Doctors and nurses use them to check on a person's general health, look for potential medical issues, and monitor specific signs. If a doctor suspects an underlying health condition, they will usually recommend further diagnostic testing. They will usually do everything they can to help people feel as comfortable as possible during physical exams. Anyone who has any concerns about undergoing a physical exam should speak to their doctor.
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Hundreds of current medical practices may be ineffective

"Medical reversal" is a term that defines instances in which new and improved clinical trials show that current medical practices are ineffective or misguided. New research reveals that there are currently almost 400 medical reversals.
doctor checking medical record, looking concerned
A new meta-analysis finds that almost 400 medical practices may not be effective.

Medical reversals occur when new clinical research shows that a certain medical practice does not, in fact, work or it does more harm than good.

These new studies are superior to their predecessors because of things like better controls, better study design, or larger sample size.

Medical reversals often concern medications but they can also affect surgical procedures.

For instance, more than a decade ago, researchers and healthcare professionals realized that stenting procedures did not work for renal artery stenosis and that routine stenting should not be used to treat stable coronary disease.

Now, a new meta-analysis of 3,000 studies identifies almost 400 cases of medical reversals. The review appears in the journal eLife.

Diana Herrera-Perez, a research assistant at the Knight Cancer Institute at Oregon Health & Science University (OHSU), in Portland, is the lead author of the new analysis.

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Analysis finds 396 medical reversals

Referring to well-known endeavors to assess the validity of clinical practices, such as the Cochrane reviews, Herrera-Perez says, "We wanted to build on these and other efforts to provide a larger and more comprehensive list for clinicians and researchers to guide practice as they care for patients more effectively and economically."

To do so, she and colleagues examined over 3,000 randomized controlled trials published in three prestigious medical journals over the last 15 years: The Journal of the American Medical Association (JAMA), The Lancet, and The New England Journal of Medicine (NEJM).

The analysis discovered 396 medical reversals: 154 of them in JAMA, 129 in NEJM, and 113 in The Lancet.

Researchers carried out most of these studies (92%) in high-income countries, while 8% were performed in low- or middle-income countries, including China, India, Malaysia, Ghana, Tanzania, and Ethiopia.

Most of the medical reversals occurred in the fields of cardiovascular disease (20%), public health and preventive medicine (12%), and critical care (11%).

Specifically, the most common interventions involved medications (33%), procedures (20%), vitamins and supplements (13%), devices (9%), and system interventions (8%).

Main takeaways from the results

The study's senior author, Dr. Vinay Prasad, a hematologist-oncologist and associate professor at the OHSU Knight Cancer Institute, comments on the findings.

"There are a number of lessons that we can take away from our set of results, including the importance of conducting [randomized controlled trials] for both novel and established practices," he says.

"Once an ineffective practice is established, it may be difficult to convince practitioners to abandon its use. By aiming to test novel treatments rigorously before they become widespread, we can reduce the number of reversals in practice and prevent unnecessary harm to patients."

Dr. Vinay Prasad

He adds, "We hope our broad results may serve as a starting point for researchers, policymakers, and payers who wish to have a list of practices that likely offer no net benefit to use in future work."

Dr. Prasad cautions that the review has some limitations, such as the small number of journals it includes and the limited expertise of the reviewers.

To overcome such limitations, co-lead study author Alyson Haslam, Ph.D., who is also affiliated with the OHSU Knight Cancer Institute, calls for experts from various fields to critically assess the medical reversals identified in the analysis.

She says, "Taken together, we hope our findings will help push medical professionals to evaluate their own practices critically and demand high-quality research before adopting a new practice in [the] future, especially for those that are more expensive and/or aggressive than the current standard of care."

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What are the perks and problems of being a night owl?

In the collective imagination, night owls are free, creative spirits. Yet studies have shown that people who are more active at night face greater health risks. Do night owls experience more benefits or risks due to their rhythms? This Spotlight feature tackles this and related questions.
three silhouettes in the moonlight
What health risks do night owls face, and why? And should they strive to turn into morning larks?

If, like Bram Stoker's famous character Dracula from the 1897 novel of the same title, you are most active when the moon is up and tend to go into hiding at sunrise, then you might not be a vampire, but you probably qualify as a night person or night owl.

Literature often romanticizes night owls. The fact that they keep unusual hours, and that they are most productive in the evenings or even at night can make them seem mysterious — both appealing and somewhat frightening.

"There is a romance about all who are abroad in the black hours, and with something of a thrill we try to guess their business," wrote Robert Louis Stevenson in Travels with a Donkey in the Cévennes (1879), his account of hiking in the French mountains.

Despite the romantic, mysterious image that books and movies might portray about night owls, many studies warn that people who frequently stay up until the early hours of the morning are placing their health and well-being at risk.

For instance, a 2018 study analyzing the relationship between bedtime habits and health in 433,268 adults found that night owls are more at risk of developing diabetes, and 10% more likely to die prematurely when compared with individuals who identified as morning people.

While few studies have analyzed what percentage of people among the world's populations are night owls, the research that does exist on this topic seems to suggest that a significant number of people do their best work in the evenings.

A study from 2011, which focused on college students in Saudi Arabia, and worked with 540 male and 219 female participants, all aged between 18–32, found that 26.9% of the study participants were "evening types," who performed better later in the day. The study's authors also add that research conducted in Western countries indicates that an even higher number of college students qualify as night owls in Western societies.

Given the high number of people who are naturally inclined to go to bed late and wake up late, it is essential to understand what impact their rhythms may have on their health, and why. In more general terms, research about individual body clocks and sleep-wake patterns can help us build a healthier and happier society.

In this Spotlight feature, we look at what makes a night owl a night owl, what other types there are, and how and why being a night or evening person impacts various aspects of health and well-being.

Circadian rhythms and chronotypes

"The morning was a wretched time of day for him. [...] On no morning of his life had he ever been in good spirits nor done any good before midday, nor ever had a happy idea, nor devised any pleasure for himself or others. By degrees during the afternoon he warmed and became alive, and only towards evening, on his good days, was he productive, active and sometimes, aglow with joy."

person sleeping
'The morning is a wretched time of day...' for night owls.

Thus goes the description, of Harry, a character in Herman Hesse's novel Steppenwolf, which first appeared in English in 1929. It is a good match for the daily patterns of night owls, who tend to be sluggish and unproductive in the mornings and become alert in the evenings.

But who is a night owl? To answer that question, we must first talk about body clocks. All humans — and other animals — have internal regulating mechanisms, or "body clocks," which allow a person to adapt to natural day or night cycles, "telling" them when to eat, rehydrate, have sex, and sleep.

As Dr. Roberto Manfredini — an expert in chronobiology and cardiovascular medicine from the University of Ferrara in Italy — and colleagues explain, "[t]he daily time-keeping system is called 'circadian' from the Latin 'circa diem,' which means 'approximately a day,' deriving from duration of a cycle of earth rotation."

However, not everyone's circadian rhythms coincide. Some people feel the most refreshed early in the morning, but feel like they're falling asleep by 9:00 p.m., and people who are most active in the evenings and have trouble waking up in the morning.

As you've surely guessed by now, these are the so-called morning larks and night owls, respectively or, in more scientific terms, "morning types" and "evening types."

"The degree of morningness or eveningness is one of the most important aspects of individual differences in circadian rhythms, a phenotype known as chronotype," write the authors of a 2017 study featured in the journal Chronobiology International.

To find out whether a person is a morning type or an evening type, researchers typically use a test called the Horne-Ostberg Morningness-Eveningness Questionnaire, which assesses subjective preferences for activities throughout a 24-hour cycle.

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More than 2 chronotypes?

The Morningness-Eveningness Questionnaire does not only distinguish between larks and owls; there is also a third option on this scale, namely the intermediate types, people who do not fully qualify either as morning or evening individuals. The "intermediate types," in fact, might be more widespread than either larks or owls.

person facing wall simulating a clock
There are more than just morning and evening people. A new study has also identified 'afternoon people' and 'nappers.'

"I'm a night owl and a morning bird. Generally, I'm fine both ends. I basically just don't get that much sleep," one person told Medical News Today.

Although most people fall in between the extremes of "morningness" and "eveningness," as a society, we don't have any terms to describe these other chronotypes. Or, more correctly, we didn't have any words until now.

This year, a team of researchers from Belgium and Russia studied intermediate types in more detail, characterized them, and gave them names based on those characteristics.

The new study paper — published online ahead of print in the journal Personality and Individual Differences — identifies two additional chronotypes: "afternoon types" and "nappers."

"[M]orning types," the researchers write in their paper, are the "least sleepy in the morning and most sleepy in the beginning of the night while the opposite trend [is associated with] evening types."

In addition, they explain, "[t]hose who might be named 'afternoon types' [are] least sleepy after the middle of the day and [...] more sleepy not only in the early morning but also at midnight, whereas those who might be named 'napper types' [follow an] op-posite pattern characterized by 'afternoon dip' in combination with lower sleepiness levels both prior and after this dip."

Night owls: An endangered species?

woman reading in bed at night
Night owls are more at risk of diabetes and poor mental health.

But in a context in which the constructs of our global society accommodate morning lark habits — where "the early bird catches the worm" — it is night owls whose health is usually most at risk.

"[The] mismatch between a person's biological time and social time — which most of us have experienced in the form of jet lag — is a common issue for night owls trying to follow a normal working day," notes Elise Facer-Childs, Ph.D.

Formerly affiliated with the University of Birmingham in the United Kingdom, Facer-Childs currently works at Monash University in Melbourne, Australia.

In a study published earlier this year, Facer-Childs and colleagues found that night owls experience something akin to jet lag every day. More precisely, connectivity was lower in certain brain regions of night owls than it was in morning larks.

Essentially, this meant that evening types had shorter attention spans, slower reactions, and less energy than morning people.

An international review published in Advances in Nutrition in 2018 found that adults who fared better in the evenings were more at risk of developing heart disease, as well as type 2 diabetes.

Its authors argue that "this may be potentially due to the poorer eating behavior and diet" in night owls.

Research from 2017 also shows that night owls are more likely to receive a diagnosis of obesity, which is a significant risk factor for conditions such as diabetes and cancer. This study's authors also suggest that "evening types" may have an increased cardiovascular risk.

Finally, some studies suggest that night owls have an increased risk of depression when compared with morning larks.

Should owls turn into larks?

However, most researchers seem to agree that a great deal of these poor outcomes for physical health and mental well-being in the case of night owls may be because they are expected to function and be productive following a morning lark template, which does not suit them.

smart watch
Researchers are still debating whether or not it would be helpful for night owls to adjust their natural rhythms.

"A typical day might last from 9:00 a.m. to 5:00 p.m., but for a night owl, this could result in diminished performance during the morning, lower brain connectivity in regions linked to consciousness, and increased daytime sleepiness," notes Facer-Childs

"If, as a society, we could be more flexible about how we manage time, we could go a long way towards maximizing productivity and minimizing health risks," she adds.

At the same time, though, in a newly published study, Facer-Childs and team suggest that night owls might benefit by switching up their routine a little, by going to bed a couple of hours earlier than usual, and waking up a few hours earlier, too.

"We wanted to see if there were simple things people could do at home to solve this issue," says another one of the recent study's authors, Andrew Bagshaw, Ph.D.

The question of whether night owls should modify their rhythms to try and become "morning people," or whether workplaces should strive to accommodate the different needs of individuals remains highly contentious.

Some people have indeed found that adjusting their routines so that they would become more active in the morning has actually helped them in the long run.

One person told MNT: "I used to be a night owl, and I converted. I used to stay up until 1:00 or 2:00 in the morning and then struggle to get to work on time. Then I decided I wanted to be a writer, so I forced myself to get up early to write before I went to work. Slowly, I converted myself into a morning person."

He also added that now he has become more productive and he does not regret the switch.

Not a black and white issue

Other readers, however, take issue with the idea that night owls should shift their schedules to fit the 9 to 5 regime. "I think where workplaces can offer more flexible hours they should," someone else told us, adding:

"Of course that's not possible in every industry, and there may be key events that most of the workforce need to be working at the same time for, but increasingly it feels like people could work 12 to 8 rather than 9 to 5 and it really wouldn't affect output in any way — bar making them more productive."

"If anything, it's actually economically illiterate not to offer this as you have a whole host of people working way below their maximum potential, which morality aside is simply bad business," the same person asserted.

And night owls do have their advantages, which researchers also acknowledge. One study from 1999 argues that "early to bed, early to rise will likely make you anything but wise," finding that night owls score better on intelligence tests than morning larks.

Furthermore, perhaps unsurprisingly, a more recent study from 2012 found that men who are evening types were able to find more sexual partners, compared with peers who identified as morning people.

But perhaps the solution to the "night owl versus morning lark problem" is not black and white, and a measure of change has to come both from society at large, and from individuals, as they "try on" different daily rhythms and find the ones that bring the best results for health.

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Low fruit and vegetable intake may account for millions of deaths

Findings from a new study suggest that inadequate consumption of fruits and vegetables may be a major factor in heart disease death.
very few vegetables on a plate
Not eating enough fruits or vegetables may have dire consequences for cardiovascular health.

Fruits and vegetables are rich in vitamins, fiber, potassium, magnesium, and antioxidants.

A diet that includes fruits and vegetables can lower blood pressure, reduce the risk of heart disease and cancer, and improve digestive health.

Previous research — part of the Harvard-based Nurses' Health Study and Health Professionals Follow-up Study — confirmed that a diet containing lots of fruits and vegetables can even lower the risk of heart disease and stroke.

After analyzing these results and combining them with findings from other studies, researchers estimated that the risk of heart disease is 20% lower among individuals who eat more than five servings of fruits and vegetables per day, compared with those who eat fewer than three servings per day.

The United States Department of Agriculture recommend that adults eat at least 1.5 to 2 cups per day of fruit and 2–3 cups per day of vegetables. According to another study by the Centers for Disease Control and Prevention (CDC), only around 1 in 10 adults meet these guidelines.

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The global impact of inadequate nutrition

Now, a new study — the results of which the researchers presented at Nutrition 2019, the American Society for Nutrition annual meeting in Baltimore, MD — suggests that a low fruit intake can cause 1 in 7 deaths from heart disease, and that a low vegetable intake can cause 1 in 12 deaths from heart disease.

Analyzing data from 2010, researchers found that low fruit consumption resulted in almost 2 million deaths from cardiovascular disease, while low vegetable intake resulted in 1 million deaths. The global impact was more significant in countries with a low average consumption of fruits and vegetables.

The data suggest that low fruit consumption results in more than 1 million deaths from stroke and more than 500,000 deaths from heart disease worldwide every year, while low vegetable intake results in about 200,000 deaths from stroke and more than 800,000 deaths from heart disease per year.

"Our findings indicate the need for population-based efforts to increase fruit and vegetable consumption throughout the world," says study co-author Victoria Miller, a postdoctoral researcher at the Friedman School of Nutrition Science and Policy at Tufts University in Medford, MA.

Tracking death toll by region, age, and sex

The researchers tracked the death toll by region, age, and sex using diet surveys and food availability data of 113 countries. They combined these with data on causes of death in each country and data on the cardiovascular risk linked to low fruit and vegetable intake.

The findings showed that fruit intake was lower in South Asia, East Asia, and Sub-Saharan Africa, while vegetable consumption was lower in Central Asia and Oceania. Countries in these regions have low average fruit and vegetable intakes and high rates of deaths from heart disease and stroke.

When the researchers analyzed the impact of inadequate fruit and vegetable consumption by age and sex, they found that the biggest impact was among young adults and males. Miller adds that females tend to eat more fruits and vegetables.

"These findings indicate a need to expand the focus to increasing availability and consumption of protective foods like fruits, vegetables, and legumes — a positive message with tremendous potential for improving global health."

Senior study author Dariush Mozaffarian, Friedman School of Nutrition Science and Policy

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Estrogen, vitamin D may protect metabolic health after menopause

Following evidence that estrogen and vitamin D work together to promote bone health, new research from China now suggests that they could also help to stave off metabolic syndrome in postmenopausal women.
vitamin D-rich foods
High levels of vitamin D, in conjunction with estrogen, could help protect the metabolic health of postmenopausal women.

Metabolic syndrome is a cluster of risk factors — such as obesity, high blood pressure, and high blood sugar — that increase the likelihood that a person will develop type 2 diabetes, heart disease, stroke, and other conditions.

The recent study, which features in the journal Menopause, investigated estrogen and vitamin D levels and their link to metabolic syndrome in a group of postmenopausal women in Southern China.

The authors conclude that the findings "suggest a synergistic role" for vitamin D and estrogen deficiency in metabolic syndrome in Chinese postmenopausal women.

Altogether, 616 postmenopausal women took part in the study. Their ages ranged from 49–86 years, and none were taking estrogen or vitamin D supplements at the start of data collection.

The researchers measured the women's blood levels of estradiol — the strongest of the estrogen hormones — and vitamin D, as well as risk factors for metabolic syndrome.

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Study results

The team found a "positive correlation" between vitamin D and estradiol. In other words, women with lower levels of vitamin D tended also to have lower levels of estradiol, and women with higher levels of vitamin D tended also to have higher levels of estradiol.

The researchers also analyzed which metabolic syndrome factors most closely correlated with vitamin D and estradiol. They found that:

Higher levels of vitamin D tended to accompany more favorable measures of blood pressure, blood glucose, and lipids. Lower levels of estradiol tended to accompany less favorable measures of blood pressure, cholesterol, and triglycerides.

In addition, the analysis showed that women with insufficient levels of vitamin D and estradiol were more likely to have metabolic syndrome than women with sufficient levels.

In another analysis, which involved ranking the women according to their vitamin D levels, the researchers found that low estradiol increased the risk of metabolic syndrome in women with insufficient vitamin D.

Assessment of metabolic syndrome

Metabolic syndrome comprises five risk factors: central obesity, high triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, high blood pressure, and elevated blood glucose.

To assess metabolic syndrome status for the recent study, the team used criteria from the International Diabetes Federation (IDF) 2006 definition.

The IDF 2006 definition states that metabolic syndrome consists of central obesity plus any two of the other four factors.

Central obesity means that there is too much fat around the stomach area, which can raise the risk of heart disease to a greater extent than having too much fat in other parts of the body, such as the hips.

For central obesity in Chinese women, the IDF 2006 standard defines this to be a waistline equal to or greater than 80 centimeters (cm) or 31.5 inches (in). For white women in the U.S., this measure would be greater than or equal to 88 cm or 34.6 in.

For the other four risk factors, the IDF 2006 criteria that the researchers used were:

blood triglyceride level of 150 milligrams per deciliter (mg/dl) or higher, or receiving treatment for high triglycerides HDL cholesterol under 50 mg/dl or being in receipt of treatment for high HDL cholesterol blood pressure equal to or greater than 130/85 millimeters of mercury or being in receipt of treatment for high blood pressure fasting blood glucose equal to or greater than 100 mg/dl or being in receipt of treatment for diabetes

HDL cholesterol helps the blood to ferry cholesterol away from the arteries. Too little can increase the risk of heart disease.

Fasting blood glucose of 100 mg/dl can be an early sign of diabetes, which, in turn, can raise the risk of heart disease and other cardiovascular health problems.

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Major public health issue

Metabolic syndrome is a major public health issue. According to a 2015 JAMA study of the United States population, close to 35% of adults and half of those in their 60s and older had metabolic syndrome during 2011–2012.

Dr. JoAnn Pinkerton, executive director of The North American Menopause Society, says that the study shows that low estrogen appears to raise the risk of metabolic syndrome in postmenopausal women with insufficient levels of vitamin D.

She notes that the "Endocrine Society recommends vitamin D levels of 30 [nanograms per milliliter] for postmenopausal women."

"Whether adequate levels of vitamin D improve nonskeletal cardiovascular or cognitive benefits remains the subject of debate, and answers await randomized clinical trial data."

Dr. JoAnn Pinkerton

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Common acne drug could prevent artery hardening

The depositing of calcium, or calcification, helps to harden tissues in the body. Tissue hardening is essential for healthy bone development, but it can cause health problems when it occurs in arteries.
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An antibiotic widely used to treat acne holds the promise of preventing the hardening of arteries, according to a new study.

Stiff, or hard, arteries impede the flow of nourishing blood to tissues and organs. This can raise the risk of cardiovascular conditions, such as high blood pressure, heart attack, stroke. It can also raise the risk of dementia and other age-related diseases.

Now, scientists at the University of Cambridge and King's College London, both in the United Kingdom, have unraveled the chemical changes that cause arteries to harden.

A recent Cell Reports paper gives a full account of the findings.

The study centers around a molecule called PAR, which is short for poly(ADP-ribose). The researchers discovered that PAR could form "dense liquid droplets with calcium ions," which then crystallize when they combine with the elastic tissues in artery walls.

Before the discovery, scientists thought that PAR only had a role in DNA repair. The new findings reveal that it also promotes calcification in arteries.

The researchers also found that the antibiotic minocycline can prevent artery hardening by blocking PAR-triggered calcification.

The treatment, which they tested in cell cultures and rats, does not seem to affect bone.

Minocycline is an existing drug with many uses. Doctors typically prescribe it to treat acne.

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Calcification and artery hardening

"Artery hardening happens to everyone as they age," says Melinda J. Duer, who is a professor in the Department of Chemistry at Cambridge University, "and is accelerated in patients on dialysis, where even children develop calcified arteries."

"But up until now we haven't known what controls this process and therefore how to treat it," she adds.

Duer co-led the study with Catherine M. Shanahan, who is a professor of cell signaling at King's College London. They have been investigating artery calcification for more than 10 years.

The British Heart Foundation (BHF) and Cycle Pharmaceuticals, a company in Cambridge, are funding their research.

In their study paper, the authors explain that calcification that hardens arteries commonly occurs at two sites in the blood vessel. One site is the intima, or the tissue that lines the blood vessel wall. Calcification at this site occurs as part of atherosclerosis.

The other site at which artery hardening occurs is in the media, or the tissue inside the blood vessel wall. Hardening of the media usually happens during aging.

Shanahan explains that for this particular study, they wanted to find out what triggers the calcification, which takes the form of calcium phosphate crystals.

They were particularly interested in finding out why the deposits seem to concentrate "around the collagen and elastin, which makes up much of the artery wall."

In earlier work, the teams had discovered that PAR, which carries out DNA repair inside cells, can also operate outside of cells as a driver of bone tissue production.

That finding led them to wonder whether PAR could also have a role in calcification of other tissues.

Also, when cells undergo oxidative stress and DNA damage, they express two enzymes that produce PAR — PARP1 and PARP2. Scientists have often seen that oxidative stress and DNA damage can accompany calcification in bone and blood vessels.

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Cells export PAR under stress

For the new study, the researchers used "ultrastructural methods" to see what happens at the molecular level when cells get stressed.

They found that as cells perish from oxidative stress, they export PAR. Because PAR has a strong affinity to calcium ions, once it is outside of the cell, it attaches firmly to calcium in preference to other minerals.

This process produces large calcium droplets that attach to collagen and elastin, the materials in artery walls that give the vessels their elasticity. When the droplets attach to the elastic materials, they solidify into crystals, reducing elasticity and stiffening the arteries.

Duer says that they made this discovery by accident at first and then pursued it. "We never would have predicted that it was caused by PAR," she notes.

Having established the role of PAR in artery calcification, the teams then went in search of a way to stop it. The obvious solution was to look for a PARP inhibitor, which is a molecule that blocks PAR production by blocking one of the enzymes that synthesizes it.

They decided to search for a PARP inhibitor among drugs that had already undergone trials in humans as this would shorten the development time for its use as a treatment to prevent stiff arteries.

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Minocycline stopped artery hardening in rats

With the help of Cycle Pharmaceuticals, the researchers identified and tested six molecules that fit their criteria. One of these, minocycline, proved to be very effective at stopping arteries from becoming stiff in rats with long-term kidney disease.

The team hopes to be conducting human trials of the treatment within the next 2 years.

Prof. Jeremy Pearson, Associate Medical Director at BHF, says that the researchers have revealed the mechanism behind artery calcification and also shown how it differs from bone calcification.

"By doing so, he adds, "they have been able to identify a potential treatment to reduce blood vessel calcification without any adverse effects on bone."

"This type of treatment would benefit many people, and we eagerly await the results of the anticipated clinical trials looking at whether this drug lives up to its early promise."

Prof. Jeremy Pearson

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Heart disease death: 'White coat hypertension' may double risk

New research suggests that untreated 'white coat hypertension' may be a major risk factor for heart disease and heart disease-related death.
doctor taking a patient's blood pressure
Blood pressure may spike when a doctor performs the reading.

White coat hypertension describes a disorder in which a person develops high blood pressure only in the presence of doctors.

Some doctors and researchers believe that white coat hypertension is a sign of underlying anxiety. Others, however, think that it may precede and contribute to the development of actual hypertension.

In the United States, more than 100 million people are living with high blood pressure, or hypertension, which is a contributor to heart attack and stroke.

Experts define high blood pressure as a top reading of at least 130 millimeters of mercury (mm Hg) or a bottom reading of 80 mm Hg or higher.

New research finds that white coat hypertension is in itself a significant risk factor for heart disease and cardiovascular death, just like hypertension.

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Specifically, untreated white coat hypertension may increase the risk of dying from heart disease by more than 100%, according to a new paper that the Annals of Internal Medicine recently published.

Dr. Jordana B. Cohen, who is an assistant professor in the division of Renal-Electrolyte and Hypertension at the University of Pennsylvania School of Medicine in Philadelphia, is the lead author of the research.

"Studies suggest that about one in five adults may have white coat hypertension. Our findings underscore the importance of identifying people with this condition."

Dr. Jordana B. Cohen

Dr. Cohen and colleagues carried out a meta-analysis of 27 observational studies, which included more than 60,000 participants in total. Each of the studies examined the health risks that correlated with white coat hypertension and had a follow-up period of at least 3 years.

Two investigators independently extracted the data from these studies and assessed their quality.

The researchers found that participants who had untreated white coat hypertension were 36% more likely to have heart disease, 33% more likely to die prematurely from any cause, and 109% more likely to die of heart disease.

Treated white coat effect, however, did not correlate with higher cardiovascular risk. Dr. Cohen and colleagues conclude:

"Untreated [white coat hypertension], but not treated [white coat effect], is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office [blood pressure] monitoring is critical in the diagnosis and management of hypertension."

"We believe individuals with isolated in-office hypertension — those who are not taking blood pressure medication — should be closely monitored for transition to sustained hypertension, or elevated blood pressure both at home and the doctor's office," emphasizes Dr. Cohen.

She goes on to add that this "pressing need" for constant monitoring is a "nationwide" concern, as are the lifestyle changes that people should make for better cardiovascular health.

"Simultaneously, we advise individuals with untreated white coat hypertension to engage in lifestyle modifications, including smoking cessation, reduction in their alcohol intake, and making improvements to their diet and exercise regimen."

"We also caution providers not to overtreat individuals with white coat hypertension who are already on blood pressure medication, as this could lead to dangerously low blood pressures outside of the office and unnecessary side effects from medication," concludes Dr. Cohen.

Finally, the authors also point to some limitations of their analysis, noting the insufficient number of studies that evaluated isolated cardiac outcomes. Also, the studies did not contain enough information about the participants' race and ethnicity.

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3 interventions could prevent millions of cardiovascular deaths

Millions of people die prematurely each year due to noncommunicable diseases, some of the most common of which are cardiovascular diseases. New research from Harvard suggests that three tried and tested interventions could prevent many of those deaths if implemented through global policies.
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Three global interventions could prevent millions of deaths over the next couple of decades.

According to the World Health Organization (WHO), 17.9 million deaths worldwide each year are due to cardiovascular disease, accounting for an estimated 31% of yearly global deaths.

The WHO note that heart attacks and strokes account for about 85% of these deaths.

In a new study, researchers from the Harvard T. H. Chan School of Public Health in Boston, MA, have pinpointed three well-known, verified interventions that have the potential to prevent a significant number of such premature deaths at a global level.

More specifically, the Harvard T. H. Chan investigators estimate that the three public health interventions combined could help extend the lives of 94 million people over 25 years, from 2015 through to 2040.

However, the team notes that for this very achievable goal to become a reality, policymakers across the world have to commit to implementing the recommended measures.

"Focusing our resources on the combination of these three interventions can have a huge potential impact on cardiovascular health through 2040," argues the study's lead author Goodarz Danaei, who is an associate professor of global health at Harvard T. H. Chan.

Danaei and colleagues explain their findings in an open-access study paper that appears in the journal Circulation.

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In their analysis, the researchers used data on mean blood pressure levels, as well as sodium (salt), and trans fat consumption in populations from different countries. They accessed this information via population health surveys and country-wide estimates, looking at available data and projections covering a period of 25 years, from 2015 through 2040.

The team found that three "well-known interventions," namely: lowering blood pressure, reducing sodium intake, and eliminating trans fat from one's diet could have an important beneficial effect in terms of preventing millions of premature, cardiovascular event-related deaths worldwide.

The researchers believe that boosting the reach of treatments for high blood pressure to 70% of the world's population could save an estimated 39.4 million people. They also estimate that reducing salt consumption by 30% could prevent an estimated 40 million deaths, as well as decrease blood pressure rates in populations around the world.

This, the researchers explain, is important because high blood pressure is a top risk factor for the development of cardiovascular disease. Finally, they note that cutting the intake of trans fat, which is present in many fast food products and can endanger heart and vascular health, could extend the lives of 14.8 million people, according to the new study.

Danaei and team note that over half of all the premature deaths these interventions would prevent, as well as two-thirds of deaths delayed before the age 70, would most likely be among men. Should there be a global commitment to implementing these interventions, the regions that would see the most benefits would be East Asia, the Pacific, South Asia, and some countries in sub-Saharan Africa.

"Overall, this study indicates that these [three] interventions have enormous potential to save lives. However, scaling up these interventions to global populations is a huge challenge," the researchers write in their study paper.

Countries all over the world would have to dedicate extra resources to providing antihypertensive (blood pressure-lowering) medication, promote education about the risks associated with too much sodium intake, and update and push out new and better health policies.

These goals are entirely achievable, the investigators emphasize. Other programs have already demonstrated this. One such program, tested by Kaiser Permanente in Northern California, was able to increase blood pressure control to 90% among its patients between 2001–2013.

"These are realistic goals that have been shown to be attainable on smaller scales. We need the commitment to scale up the programs to achieve them globally."

Goodarz Danaei

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What causes lower back and hip pain?

When pain in the lower back occurs alongside hip pain, there may be a common cause. Certain health conditions or injuries can affect the nerves in both of these areas.

These pains usually occur as a result of overuse or injury, but they can also be a symptom of an underlying medical condition. People may notice the pain on the left or right side of the body or both.

In this article, we look at possible causes of lower back and hip pain. We also discuss the various treatment options and how to relieve pain.

Causes Woman holding her back due to lower back and hip pain
Possible causes of lower back and hip pain include sprains, strains, and a herniated disk.

It is easy to overwork the lower back and hips because they are responsible for lifting, twisting, and moving the legs and trunk. Pains due to overuse and minor injury are common in these areas of the body.

Although these pains are common, people should not ignore them. Rest and early treatment can significantly improve a person's outlook.

The causes are similar in males and females. The following are some of the most common causes of lower back and hip pain.

Sprains and strains Sprains and strains are a common cause of pain around the back and hips. A sprain is a torn or overstretched ligament, while a strain is a torn or overstretched tendon or muscle. People with sprains and strains are likely to experience discomfort that worsens with activity and gets better with rest. Common causes of sprains and strains in this area include: sports injuries a fall or trauma twisting the body in an awkward way lifting something heavy Playing a sport or engaging in other physical activity without warming up properly can contribute to muscle strain. Damage to the ligaments, tendons, or muscles in the hip or lower back can cause: muscle pain muscle weakness tenderness swelling reduced range of motion Treatment People will usually find that their symptoms improve with a few days of rest. Gentle stretching can speed up recovery. Applying a cloth-covered ice pack to the affected area for 10 to 15 minutes at a time can also help. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can reduce the pain and swelling that these muscle injuries cause. If these treatments do not reduce symptoms, the injury may be more serious, for example, a muscle tear. In this case, a person should see their doctor. Thank you for supporting Medical News Today Tight hip flexors The hip flexors are muscles that extend from the hips to the knees. They are responsible for the range of motion in the legs and hips. If these muscles are stiff and tight, often due to remaining in a seated position for too long, a person may experience back and hip pain. Hip flexor strains, which are strains in the hip flexor muscles, can also cause sharp pain in the back and hips. Symptoms of tight hip flexor muscles include: tenderness in the upper leg muscle spasms in the hips or thighs soreness in the hips and thighs Some people may also experience a sense of weakness when trying to kick the leg or lift the knee toward the chest. Read about 10 stretches for tight hips here. Treatment Physical therapy exercises and stretching can help relieve tight hip flexors and reduce discomfort. Examples include pulling the knee toward the chest or lunging one leg forward from a kneeling position to create a stretch in the hips. Avoiding activities that can increase hip flexor tightness, such as sitting too long at a desk or wearing high heels for extended periods, can also help. A herniated disk Woman holding her hip in pain
A herniated disk may cause pain in the lower back, legs, and hips. A herniated disk occurs when one of the cushioning disks between the vertebrae slips out of place. The disk can put pressure on a nearby nerve, which may cause tingling and burning pain in the lower back that extends to the hips and legs. Older adults are prone to herniated disks because of the natural wear and tear of the spine that occurs over time. The disks also become less flexible with age. Common causes of a herniated disk include: improper lifting or twisting while lifting a fall or trauma being overweight repetitive strain on the back driving for long periods smoking Symptoms of a herniated disk include: sciatica, or a sharp, shooting pain from the buttocks down the back of one leg numbness in the leg or foot muscle weakness in the leg or foot In severe cases, people may experience a loss of bowel and bladder function. If this occurs, they should go to the hospital or call 911 right away. Treatment The treatment for a herniated disk involves relieving pain and discomfort while it heals. Bed rest will usually help relieve the pain too. Other treatment options include: physical therapy exercises taking NSAIDs to relieve pain and inflammation epidural steroid injections, which involve injecting corticosteroids into the epidural space containing the inflamed nerves In severe cases, a doctor may recommend surgery to correct a herniated disk. Sacroiliac joint dysfunction The sacroiliac (SI) joints connect the lower portion of the spine to the pelvis. If these joints move too much or too little, people may feel pain in the back and hips. The symptoms of SI joint dysfunction include an aching lower back that makes it difficult for a person to find a comfortable position. The pain will usually worsen with physical activity, such as running or climbing stairs. A herniated disk and arthritis can cause symptoms similar to those of SI joint dysfunction. Treatment Treatment options for SI joint dysfunction include: NSAIDs to relieve pain and inflammation physical therapy exercises to strengthen the core and pelvic muscles stretching and applying ice to the affected areas the injection of a steroid into the SI joint A doctor may suggest that a person has corticosteroid injections to reduce spinal inflammation. In rare instances, they may recommend surgery to fuse the joints. Arthritis Osteoarthritis of the back can result in the breakdown of the protective and cushioning cartilage of the spine. This loss of cushioning can cause the spinal bones to rub together and place greater pressure on the nerves, including the nerves that go to the lower back and hips. Arthritis in the back and hips causes joint stiffness and pain. A person may also experience weakness in the legs and hips, which can interfere with their everyday activities. Treatment Doctors do not have a cure for arthritis, but people can manage their symptoms using medication and lifestyle methods. These include: exercises that strengthen the back and hips muscles to improve flexibility and range of motion trying home remedies for arthritis alternative therapies, such as massage, acupuncture, and nutritional supplementation surgery, if arthritis causes significant spinal canal narrowing NSAIDs Ankylosing spondylitis Ankylosing spondylitis is a form of arthritis that primarily affects the spine, causing chronic inflammation in the spinal joints. Lower back and hip pain are often some of the first symptoms that a person with ankylosing spondylitis experiences. Symptoms include muscle pain and stiffness that is usually worse in the morning. Other symptoms may include: low-grade fever appetite loss malaise, which is a general feeling of discomfort Treatment Doctors do not have a cure for ankylosing spondylitis, but, as with other forms of arthritis, people can manage the condition with a range of medical and at-home treatments. Prescription medications, such as tumor necrosis factor (TNF) blockers and NSAIDs, can help. Certain lifestyle measures, including doing regular physical activity, icing affected areas, and not smoking, can also be beneficial. Paget's disease man with headache or migraine holds head leaning against the vehicle window
Headaches may be a symptom of Paget's disease. Paget's disease of bone is a rare disorder that affects an estimated 1% of people in the United States, according to the American College of Rheumatology. This condition causes a person's bones to remodel abnormally, leading to bone softening, which can affect the pelvis, lower back, hips, and arms. A person with Paget's disease has a higher risk of bone pain and fractures. The symptoms of Paget's disease include: hip pain hearing loss bowed legs, where the knees are wider apart than usual headaches tingling and numbness down the legs Treatment The treatment for Paget's disease involves medications to reduce the likelihood of the bones breaking. Doctors usually prescribe these medicines to treat osteoporosis. In rare cases, a doctor may recommend surgery to repair bones and restore alignment. Thank you for supporting Medical News Today When to see a doctor People should seek emergency attention if they experience any of the following symptoms alongside lower back and hip pain: loss of bowel and bladder function inability to move one or both legs loss of sensation in one or both legs visible deformity in the legs or back, such as the inability to stand up straight If a person experiences less severe symptoms that do not improve with rest and over-the-counter treatments, they should make an appointment with their doctor. A doctor can evaluate their symptoms, make a diagnosis, and recommend the most effective treatments. Summary When a person experiences lower back and hip pain simultaneously, there may be an underlying injury or medical condition causing both of these symptoms. In other cases, the causes may be distinct. Lower back and hip pain can make performing daily activities difficult. If these symptoms do not resolve or suddenly get worse, a person should seek medical attention. Regardless of the cause, early treatment helps improve the outlook of a person with back and hip pain. Without treatment, some causes of the pain can get worse and may ultimately affect a person's mobility and quality of life.
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What is the normal range for troponin levels?

Troponin refers to a group of proteins that help regulate the contractions of the heart and skeletal muscles. High troponin levels can indicate a problem with the heart.

The heart releases troponin into the blood following an injury, such as a heart attack. Very high troponin levels usually mean that a person has recently had a heart attack. The medical term for this attack is myocardial infarction.

In this article, we discuss what troponin is, why doctors test troponin levels, and what the normal range is. We also cover the causes and treatment of high troponin levels and what to expect during the test.

What is troponin? Blood test for troponin levels
A doctor may test troponin levels if a person is experiencing possible symptoms of a heart attack.

Troponin refers to three different proteins. Troponin C binds calcium and transports troponin I so that muscles can contract. Troponin T binds troponin proteins to muscle fibers.

The heart is essentially a muscle, and damage to the heart causes it to release troponin into the bloodstream. Troponin levels in the blood are normally very low, but injuries to the heart can cause the levels to increase significantly.

Troponin tests typically measure levels of troponin I or troponin T in the blood as a way to check for heart damage.

Thank you for supporting Medical News Today Why do doctors test troponin levels? A troponin test can help detect an injury to the heart. A doctor may order the test if a person is experiencing possible symptoms of a heart attack, such as: chest pain shortness of breath a rapid heart rate lightheadedness fatigue A doctor will not use elevated troponin levels alone to diagnose a heart condition. They will also take into account the person's other symptoms and may use other diagnostic tools, such as a physical examination or an electrocardiogram (ECG). Troponin testing, however, allows a doctor to assess the extent of any heart damage, which can guide treatment decisions and help determine if current treatments are effective. What is the normal troponin range? Troponin levels are usually so low that standard blood tests are unable to detect them. Even small increases in troponin can indicate some damage to the heart. Significantly raised levels of troponin, particularly if they rise and fall over a series of hours, are a strong indication of a heart injury. The range for normal troponin levels can vary between laboratories, so it is best to discuss the results with the doctor who ordered the test. Laboratories measure troponin in nanograms per milliliter of blood (ng/ml). The University of Washington's Department of Laboratory Medicine provides the following ranges for troponin I levels: Normal range: below 0.04 ng/ml Probable heart attack: above 0.40 ng/ml Having a result between 0.04 and 0.39 ng/ml often indicates a problem with the heart. However, a very small number of healthy people have higher than average levels of troponin. So, if the result is in this range, a doctor may check for other symptoms and order further tests before making a diagnosis. According to Lab Tests Online, many labs in the United States are now using a high-sensitivity version of the troponin test, which the Food and Drug Administration (FDA) approved in 2017. This newer test can detect elevated troponin levels earlier than previous versions. Doctors usually order a series of troponin tests to monitor how a person's levels are changing over time. Causes of high troponin levels troponin T test
Elevated troponin levels may result from sepsis, kidney failure, heart failure, or a traumatic injury to the heart. Very high levels of troponin typically indicate that a person has had a heart attack, which can occur if the blood supply to some of the heart muscle suddenly becomes blocked. Lower but elevated troponin levels may point to another diagnosis. Some causes of elevated troponin levels can include: sepsis, which is a severe and potentially life-threatening reaction to an infection entering the bloodstream kidney failure or chronic kidney disease heart failure chemotherapy-related damage to the heart pulmonary embolism heart infection myocarditis, which is inflammation of the heart heart damage from using recreational drugs, such as cocaine a traumatic injury to the heart, such as from a sudden, hard blow to the chest Treatment for high troponin levels High troponin levels are a symptom, not a diagnosis, so treatment will focus on finding and addressing the underlying cause. Very high levels of troponin usually indicate that a person has recently had a heart attack. Treatment for a heart attack depends on whether the blockage preventing blood flow to the heart is partial or complete. Some common treatments of a heart attack include: clot-dissolving medications coronary angioplasty, which is a procedure that involves threading a small balloon into the coronary artery to open up the blockage the insertion of a stent — a wire mesh tube — to prop open a blocked blood vessel during an angioplasty bypass surgery, which involves a surgeon creating new pathways for blood to travel to the heart muscle ablation, which is a treatment that destroys certain heart cells using radio waves To prevent the risk of further heart attacks, a doctor will usually recommend lifestyle changes, such as quitting smoking, losing weight, getting more exercise, and eating a more healthful diet. Treatments of other causes of high troponin levels may be different from treatments of a heart attack. Thank you for supporting Medical News Today What happens during the test? A troponin test is a simple blood test, and a healthcare professional will usually take the blood sample from the arm. Blood tests are generally very safe and quick. To take the blood sample, the healthcare professional usually begins by wrapping a band around the person's upper arm. Tightening this band causes the blood vessels to swell, making it easier to draw the blood. The healthcare professional will then insert a needle into a blood vessel and withdraw some blood. The needle may cause a short, sharp sensation, but many people feel little or no pain. It is important for a person to inform the healthcare professional if they feel dizzy or nauseous after giving the sample. Sitting for 5–10 minutes and drinking a glass of water or sugary juice can help relieve dizziness and nausea. A doctor may request additional blood samples over the course of a few hours. Summary Doctors use troponin tests to assess whether there is damage to a person's heart. Very high levels of troponin can indicate a recent heart attack. Doctors usually order troponin testing if they suspect that a person has had a recent heart attack. Higher than normal levels of troponin can also indicate other injuries and conditions that affect the heart. However, doctors do not use elevated troponin levels alone to diagnose a heart condition. They will also take into account the person's other symptoms and may order further tests, such as an ECG. Treatment for high troponin levels depends on the underlying cause. For people having a heart attack, treatment may involve emergency procedures to open the blocked artery.
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Tomato juice: Could 1 cup per day keep heart disease at bay?

Researchers have recently investigated the potential benefits of tomato juice on cardiovascular risk. Although the team reported reductions in blood pressure and cholesterol levels, the results are not entirely convincing.
Bottles of tomato juice
Can tomato juice protect against cardiovascular disease?

Cardiovascular diseases are responsible for the most deaths in the United States.

People can modify certain risk factors, such as smoking, but it is impossible to modify others, such as age.

So, as the population ages, finding ways of reducing cardiovascular risk is of growing importance.

Nutrition is vital for good health, and heart health is no exception. Now, one new study has asked whether regular consumption of unsalted tomato juice might be a cost-effective intervention.

The study authors explain how the tomato "contains a variety of bioactive compounds, such as carotenoid, vitamin A, calcium, and gamma‐aminobutyric acid, which may play a role in maintaining physical and psychological health, including the prevention of [cardiovascular disease]."

Atherosclerosis in brief

The main driver of cardiovascular disease is atherosclerosis, which occurs when plaque builds up within blood vessels. As time goes on, plaque becomes harder, narrowing the arteries.

Atherosclerosis begins when the endothelium, or the inside surface of blood vessels, sustains damage.

This damage can occur for a number of reasons, some of which are high blood pressure, diabetes, and levels of cholesterol in the blood. If a person can control these three factors, they could significantly reduce their risk of atherosclerosis and other cardiovascular conditions.

The authors of the recent study published a similar study in 2015. In their previous work, they concluded that drinking unsalted tomato juice over 8 weeks reduced the levels of triglycerides in the blood of middle-aged women. Triglycerides are a type of fat; high levels of these fats contribute to atherosclerosis.

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Another look at tomato juice

Their previous results prompted the scientists to widen their net and assess whether tomato juice might also benefit other cardiovascular risk factors, such as high blood pressure and lipid and glucose metabolism, over a longer period.

This time, they also wanted to measure the benefits of tomato juice in people of different ages and sexes. The scientists published their findings in the journal Food Science & Nutrition.

According to its authors, "the current study is the first to investigate the effects of tomato or tomato product intake on cardiovascular disease risk markers over the course of a year and over a wide age range."

At this point, it is important to note that the authors received a research grant from the Kikkoman Corporation to conduct both this study and the previous one.

The Kikkoman Corporation manufacture a range of soy sauces but also hold the exclusive marketing rights to the Del Monte brand in Asia, where the company "manufactures and markets tomato-based goods."

1 cup each day

In total, the scientists recruited 184 men and 297 women as participants. For 1 year, all participants had access to as much unsalted tomato juice as they wanted; the average was around 215 milliliters per day per person, which is slightly less than 1 cup.

At the beginning and end of the study, the scientists measured a range of factors, including blood pressure, levels of triglycerides and cholesterol in the blood, and fasting plasma glucose.

They analyzed data from the 94 participants who had hypertension or prehypertension (elevated blood pressure not high enough for the person to receive a diagnosis of hypertension).

Their blood pressure was significantly lower after 1 year of consuming tomato juice. Average systolic blood pressure dropped from 141.2 to 137.0 millimeters of mercury (mm Hg). Also, average diastolic blood pressure dropped from 83.3 to 80.9 mm Hg.

According to the American Heart Association's (AHA) guidelines, this change in blood pressure would move the average participant from hypertension stage 2 down to hypertension stage 1.

These effects were similar for both men and women and people of all ages.

No change for glucose or triglycerides

The researchers also assessed glucose metabolism in 62 participants with untreated impaired glucose tolerance; however, there were no significant improvements for these people.

In a subgroup of 127 participants with abnormal lipid levels in their blood, there were no changes to triglycerides or high-density lipoprotein (HDL), or "good," cholesterol.

However, they did see a significant drop in the level of low-density lipoprotein (LDL), or "bad," cholesterol. LDL is a risk factor for atherosclerosis.

Importantly, using a questionnaire, the researchers ensured that the participants' lifestyles had not changed significantly over the year, which might account for these beneficial changes.

Sizable limitations

The study has a number of significant limitations; aside from the source of its funding, the study only recruited a relatively small number of participants. In the blood pressure analysis group specifically, there were only 94 individuals.

It is also worth noting that the participants were all residents of Kuriyama, Japan. Therefore, it is possible that the results might not apply to other populations or ethnicities.

Also, the researchers did not have access to the participants' other dietary habits; in some cases, it might be possible that when a participant introduced a glass of tomato juice, it replaced a less healthful snack.

Therefore, it could be the removal of the snack that generated the health benefits, rather than the juice itself.

Also, when the scientists checked for lifestyle changes between the beginning and end of the study, only around half of the participants had completed the questionnaire. It is quite possible that during those 12 months, some people made significant changes to their levels of exercise or food intake.

That being said, these are not the first studies to examine whether tomato products could reduce cardiovascular risk. For instance, as one meta-analysis of 21 studies concluded:

"The available evidence on the effects of tomato products [on cardiovascular] risk factors supports the view that increasing the intake of these has positive effects on blood lipids, blood pressure, and endothelial function."

The cardiovascular benefits of tomato juice are gathering evidence. However, the new study is not powerful enough to prompt a change in drinking habits; we may need to wait a little longer before we can draw reliable conclusions.

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Cardiovascular disease: 7 simple steps that lower future risk

Maintaining good cardiovascular health — as the American Heart Association define it — over an extended period helps lower the risk of cardiovascular disease in the future.
woman's hands forming a heart symbol against pink background
New research gives important clues on how to protect heart health.

This is the main takeaway of a study which now appears in the journal JAMA Network Open.

Using the best evidence available, the American Heart Association (AHA) developed the so-called Life's Simple 7 — a collection of factors that can help predict and protect a person's heart health.

"Life's Simple 7" consists of four "modifiable behaviors" — that is, things you can do to lower your chances of developing heart diseases. These are: quitting smoking, maintaining a healthy weight, eating healthfully, and being physically active.

The AHA also includes three measures: blood pressure, cholesterol, and blood sugar. Keeping these in check, suggest the AHA, and following the four behaviors above reduces the risk of dying from stroke or cardiovascular disease (CVD).

The AHA suggest assessing each metric and behavior and grading them as "poor," "intermediate," and "ideal." So, the AHA would deem a behavior such as smoking regularly as "poor," having smoked in the past year as "intermediate," and quitting smoking or not smoking at all as "ideal."

"Only about 2% of people in the United States and other countries meet all the ideal requirements for these seven factors," explains Dr. Xiang Gao, who is an associate professor of nutritional sciences and director of the Nutritional Epidemiology Lab at Pennsylvania State University.

Dr. Gao is the last and corresponding author of the new study, which aimed to see if sticking to these seven steps over time will lower a person's future risk of CVD.

The fact that so few people meet AHA's criteria, Dr. Gao continues, "raises the question of whether improving these metrics is related to lower future risk of CVD. It should, but no one had the data to support this idea."

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To find out, Dr. Gao and team examined data from 74,701 Chinese adults who took part in the Kailuan Study. The study participants answered questionnaires about their overall health and took part in various clinical tests three times between 2006 and 2010.

The researchers gathered this information and analyzed how it related to the incidence of CVD in the following years.

In 2006–2010, the researchers identified five heart health patterns that the study participants followed. "[A]bout 19% of participants were able to maintain a better cardiovascular health score over the 4 years," reports Dr. Gao.

"We found that those people had a 79% lower chance of developing heart disease in the future than people who maintained a low cardiovascular health score."

The researchers say that they obtained the same results when they looked at stroke and heart attack risk.

"We also examined whether improving cardiovascular health score over time affected future risk of CVD," Dr. Gao continues.

"We found that improvement of overall cardiovascular health over time related to lower future CVD in this population, even for those with poor cardiovascular health status at the beginning of the study."

Dr. Xiang Gao

Finally, the researchers also ran several tests repeatedly, each time removing one of the seven health factors. They did so to see if one health factor was more important than the others, but found no significant difference in risk prediction when they removed a single measure.

"This suggests that overall cardiovascular health is still the most important thing and that one factor isn't more important than the others," Dr. Gao says. "It also helps confirm that these seven metrics are valid and a very useful tool for developing a strategy for cardiovascular disease prevention."

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Common heartburn drug linked with fatal conditions

New research suggests that drugs commonly used for heartburn, acid reflux, and ulcers may raise the risk of numerous fatal conditions, including heart disease and stomach cancer.
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A new study warns about the dangers of a class of drugs called proton pump inhibitors.

Physicians often prescribe proton pump inhibitors (PPIs) to treat gastrointestinal conditions that involve an excess of acid production.

Nexium, Aciphex, Zegerid, Dexilant, Prevacid, Prilosec, and Protonix are only some of the brand names that PPIs have taken over the years.

More than 15 million people in the United States take prescription PPIs, according to the most recent statistics available, and even more may be taking over-the-counter PPIs.

A new study, appearing in the journal The BMJ, suggests that these drugs may increase the risk of death from various chronic health conditions.

Dr. Ziyad Al-Aly, an assistant professor of medicine at the Washington University School of Medicine in St. Louis, MO, is the senior investigator of the study.

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For the new study, Dr. Al-Aly and colleagues examined data from the medical records of the U.S. Department of Veterans Affairs.

The researchers looked at data available from mid-2002 to mid-2004, a period during which 157,625 people in the cohort received PPI prescriptions from their physicians and 56,842 people received H2 blockers, another kind of acid suppressant.

The scientists clinically followed the participants — who were predominantly male, Caucasian, and 65 years old or older — for up to a decade.

They used the data to build a statistical model of a clinical trial, which would see the participants randomly assigned to take either PPI or H2 blockers.

This allowed them to estimate that during the follow-up period, there would be 45.2 excess deaths per every 1,000 individuals taking PPIs.

Honing in on the causes of death, the findings revealed associations with cardiovascular disease, stomach cancer, and chronic kidney disease.

The model estimates the death rates for cardiovascular disease to be 88.7 per 1,000 people in the PPI group and 73.3 per 1,000 people in the H2 blocker group.

This scientists saw 4.3 deaths in every 1,000 people from stomach cancer in the PPI group, with 4.6 deaths from the disease in the H2 blocker group in their model. The rates for chronic kidney disease deaths were 8.6 per 1,000 people in the PPI group and 4.4 in the H2 blocker group.

Also, the risk of death increased with the duration of the treatment, even when the study participants had taken low doses of the drug.

Finally, the research revealed that over half of those taking PPIs had no medical need for them. "Most alarming to me is that serious harm may be experienced by people who are on PPIs but may not need them," comments Dr. Al-Aly. "Overuse is not devoid of harm."

"PPIs sold over the counter should have a clearer warning about [the] potential for significant health risks, as well as a clearer warning about the need to limit the length of use, generally not to exceed 14 days," continues the lead researcher. "People who feel the need to take over-the-counter PPIs longer than this need to see their doctors."

"Taking PPIs over many months or years is not safe, and now we have a clearer picture of the health conditions associated with long-term PPI use," adds Dr. Al-Aly.

"Our study suggests the need to avoid PPIs when not medically necessary. For those who have a medical need, PPI use should be limited to the lowest effective dose and shortest duration possible."

Dr. Ziyad Al-Aly

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Is coffee bad for the heart or not?

Studies on coffee consumption variously claim that coffee harms the arteries, that it protects the heart, or that it has no effect on cardiovascular health. New research on thousands of participants weighs in again on the link between this favorite beverage and heart health.
coffee cup in a heart made from coffee beans
New findings suggest that even heavy coffee drinkers may have nothing to worry about when it comes to cardiovascular health.

Does coffee harm, protect, or have no effect on heart health and the vascular system?

For years, scientists have been trying to answer these questions, since coffee is such a favorite beverage around the world.

While some studies warn that drinking coffee can increase a person's risk of cardiovascular events, others suggest that it can help maintain heart health and blood vessel function.

Some research has suggested that regularly drinking a lot of coffee contributes to aortic stiffness — this is when the aorta, which is the largest blood vessel in the human body, becomes less and less flexible. Aortic stiffness can contribute to the risk of cardiovascular disease.

At the same time, other evidence has indicated that drinking more than three cups of coffee a day can protect against atherosclerosis, a condition in which plaque builds up inside the arteries, preventing blood from flowing normally.

Now, a new study conducted by researchers from the Queen Mary University of London in the United Kingdom has found that even people who drink a significant amount of coffee each day do not experience arterial stiffness, meaning that coffee does not increase their risk of cardiovascular problems in this way.

Lead author Prof. Steffen Petersen and colleagues presented the study's findings yesterday at the annual British Cardiovascular Society (BCS) Conference in Manchester, U.K.

The British Heart Foundation, a registered charity based in the U.K. that supports research about heart and circulatory conditions, funded the study.

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Same results across all groups

In the new study, the research team analyzed the data of 8,412 participants recruited via the U.K. Biobank Imaging Study. At the BCS Conference, the team explained that the participants agreed to undergo cardiovascular magnetic resonance imaging and other specialist assessments to allow the investigators to determine the state of their cardiovascular function.

The participants also self-reported how much coffee they typically drank on a day-to-day basis. Following these reports, the investigators then categorized the participants into three groups, according to their coffee consumption habits:

people who drank one or fewer cups of coffee a day those who drank between one and three cups of coffee per day those who drank more than three cups of coffee per day

In their final analysis, Prof. Petersen and team excluded individuals who drank more than 25 cups of coffee per day, as well as those who had cardiovascular disease at baseline.

When comparing measurements of arterial stiffness between the three groups, the researchers found no differences between moderate and heavy coffee drinkers (those who drank between one and three or more than three cups of coffee per day, respectively) and those who had one cup off coffee or less per day.

These results, the investigators say, suggest that even drinking significant amounts of coffee is unlikely to have an ill effect on arterial health, so it may not negatively influence heart health and vascular function.

"Despite the huge popularity of coffee worldwide, different reports could put people off from enjoying it. Whilst we can't prove a causal link in this study, our research indicates coffee isn't as bad for the arteries as previous studies would suggest," explains study coauthor Kenneth Fung.

These findings remained in place after the investigators adjusted for possible factors contributing to arterial stiffness, including age, biological sex, ethnicity, smoking status, alcohol consumption, height, weight, eating habits, hypertension (high blood pressure), high cholesterol, and diabetes.

What should and what shouldn't we believe?

The researchers also noted that moderate and heavy coffee drinkers were more likely to be male, habitual smokers, and frequent drinkers of alcohol.

"Although our study included individuals who drink up to 25 cups a day, the average intake amongst the highest coffee consumption group was five cups a day. We would like to study these people more closely in our future work so that we can help to advise safe limits," Fung also specifies.

Prof. Metin Avkiran, who is Associate Medical Director at the British Heart Foundation, and who was not involved in the current research, explains that such studies about the relationship between coffee consumption habits and heart health can help individuals make better-informed decisions.

"Understanding the impact that coffee has on our heart and circulatory system is something that researchers and the media have had brewing for some time. There are several conflicting studies saying different things about coffee, and it can be difficult to filter what we should believe and what we shouldn't."

Prof. Metin Avkiran

"This research will hopefully put some of the media reports in perspective, as it rules out one of the potential detrimental effects of coffee on our arteries," Prof. Avkiran says.

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Type 2 diabetes: High-intensity exercise may restore heart function

Type 2 diabetes can sometimes result in a loss of heart function. However, the results of a new study suggest this function may be recovered through high-intensity exercise.
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High-intensity exercise can protect the hearts of those living with type 2 diabetes, new research suggests.

Around 90–95% of the 30 million people in the United States who have diabetes have type 2 diabetes. In type 2 diabetes, the body's cells become resistant to the effects of insulin, the hormone that helps to convert blood sugar into energy.

With insulin unable to activate this energy conversion within cells, a rise in the body's blood sugar level occurs and creates the conditions for prediabetes and type 2 diabetes.

Elevated blood sugar levels can be very harmful, potentially causing vision loss and creating serious health problems within various organs, including the heart and kidneys.

Researchers behind the new study are from the University of Otago in Dunedin, New Zealand, and they have published their work in the American College of Sports Medicine's journal, Medicine & Science in Sports & Exercise.

They say that exercise is probably the best way to prevent heart disease among people with type 2 diabetes. They acknowledge, however, that one issue may be that many people with the condition have impaired heart function and so might be unable to train hard enough to receive the benefits of this exercise.

The Otago team put this to the test in their study, which focused on the benefits of high-intensity interval training (HIIT). HIIT involves short bursts of intense sprinting or stair climbing with alternate periods of moderate intensity exercise, such as jogging or fast walking.

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HIIT for 3 months improves heart function

In the study, over the course of 3 months, 11 middle-aged adults with type 2 diabetes engaged in 25-minute exercise sessions that included 10 minutes of very high-intensity activity.

The team took measures of heart function from the participants at the start of the study and the end of the 3-month training period. They then compared these measures to a control group of five participants who did not undertake the training.

The study found that the participants who undertook HIIT demonstrated improved heart function after 3 months and that this result was without any changes to their medication or diet.

More importantly, the study demonstrated that the high-intensity program was a safe and viable exercise regimen for middle-aged adults with type 2 diabetes, with an impressive 80% adherence rate over the course of the study.

Scientists will need to reproduce the results in larger studies to be sure of the benefits of HIIT among people with type 2 diabetes.

Lead author Genevieve Wilson, who did the study as part of her Ph.D., says the team's findings demonstrate that high-intensity exercise may provide "an inexpensive, practical way to reverse, or reduce the loss in heart function caused by type 2 diabetes."

Wilson adds that this is important as the leading cause of death in type 2 diabetes patients is heart disease.

Dunedin School of Medicine senior research fellow Dr. Chris Baldi supervised Wilson's work with coadviser, cardiologist and Associate Professor in the Department of Medicine, Gerry Wilkins.

Together, the researchers note that the study shows the HIIT program for middle-aged adults with type 2 diabetes was safe, and the participants were able to stick to it for the majority of the time.

"There are two important clinical implications of this work," Dr. Baldi maintains. "The first, that adults with type 2 diabetes will adhere to high-intensity interval training and are capable of comparable increases in aerobic capacity and left ventricular exercise response as those reported in non-diabetic adults."

"Secondly, high-intensity exercise is capable of reversing some of the changes in heart function that seem to precede diabetic heart disease," he continues.

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Reducing the risk of heart complications

For those with type 2 diabetes, the National Institute of Diabetes and Digestive and Kidney Diseases recommend some useful steps to lower the risk of developing heart disease.

These are the Manage your diabetes ABCs:

A is for the A1C test, which shows the average blood glucose level over the previous 3 months. For most people, the ideal A1C is below 7%, but a healthcare team can help set the right goal. B is for blood pressure. High blood pressure can cause a heart attack. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. C is for cholesterol. Too much "bad" cholesterol (LDL cholesterol) in the body can clog up blood vessels, increasing the risk of a heart attack or stroke. Statins can help reduce this cholesterol. S is for stop smoking. Diabetes and smoking both narrow blood vessels, forcing the heart to work harder. Quitting smoking lowers the risk of heart attack and other illnesses.
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Menopause and heart health: Why timing hormone therapy is key

Researchers already know that menopause affects the heart, but a new study suggests that changes start to take place in the years leading up to this phase. The study findings could change how doctors administer hormone replacement therapy.
close up of woman's hands and doctor, talking
New research suggests that changes in heart health may occur sooner than scientists previously believed.

The older a person gets, the more likely they are to develop heart disease. However, the risk of the condition — which is the biggest killer of women in the United States — increases even more during menopause.

Experts believe that this is due to a drop in the levels of estrogen, as this hormone helps the arteries function properly.

Hormone replacement therapy (HRT) is one way to treat the symptoms that this decline causes, but the fears surrounding this treatment have not subsided since decades-old research suggested a link to heart issues and cancer.

The American Heart Association (AHA), for example, caution against using the therapy to reduce the risk of coronary heart disease.

A 2017 JAMA study found that women who took HRT tablets were no more likely to die of cardiovascular disease, cancer, or another cause within 18 years than women who did not take them. Despite this, people are still reluctant to try the treatment.

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Mimicking the perimenopausal period

New findings suggest that HRT may be effective in protecting the heart, but not when people take it after the menopause, as is currently the norm.

The new study, which appears in Acta Physiologica, focused on what happens to the heart during the years leading up to menopause. This period is called perimenopause.

Previously, researchers only studied menopausal or postmenopausal hearts because scientists were unable to replicate the perimenopausal stage in mice.

That changed when a team from the University of Guelph in Ontario, Canada found a way to achieve this.

"We could induce instant menopause in lab mice by removing their ovaries, but that doesn't recapture the gradual change of menopause," says senior author Prof. Glen Pyle. "We now have a lab animal model in which we can make a mouse's ovaries fail slowly over time to mimic the gradual transition to menopause seen in women."

Testing 'the timing hypothesis'

As a result, a group of mice entered menopause slowly over 4 months. Their hearts appeared to look normal and function in the same way, but "markers of stress" appeared.

"So, it's like a house that looks fine, but there's a leak in the foundation. The changes are hidden, but they are there," notes Prof. Pyle.

The team administered drugs mimicking estrogen to the mice during perimenopause.

Prof. Pyle states, "We wanted to test the timing hypothesis: the idea that there's a window of opportunity for taking estrogen so that we could see if we could identify that window and determine how menopause impacted the response to estrogens."

When they examined how the mice's hearts responded to the estrogen, the researchers noted small but significant variations that indicated molecular changes in this vital organ.

According to Prof. Pyle, this showed that the heart had "fundamentally changed [...] during the perimenopausal period."

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When to try HRT

"That tells us that we can't simply place estrogens into a heart years after menopause," Prof. Pyle adds.

"It also tells us that timing is important and that we likely need to move the window for offering estrogen therapy back up, offering it much earlier and not waiting for after menopause."

Prof. Glen Pyle

Most importantly, the study authors want people to consider HRT as a protective treatment once again, instead of fearing it.

As the senior researcher concludes, "We've gone back to the drawing board with this study, back to the lab to get these answers on how menopause changes the heart."

"That's a fundamental question we needed answered. And now we know there are small but significant changes," continues the researcher.

"We want to continue this research to fine-tune estrogen replacement therapy to find out how it can be used beneficially because there's so much evidence that it does work."

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New study links air pollution with atherosclerosis

New research suggests that chronic exposure to ambient ozone may raise the risk of atherosclerosis and harm arterial health.
smog in a city
New findings indicate that smog, which largely consists of ambient ozone, may lead to atherosclerosis, a cardiovascular condition.

Atherosclerosis is the result of fatty deposits — such as cholesterol, fat, or cellular waste — accumulating inside a person's arteries.

Over time, the buildup of plaque inside the blood vessels' walls thickens the arteries, which restricts the blood, nutrients, and oxygen that would normally reach the rest of the body.

Atherosclerosis can lead to more dangerous cardiovascular events, such as coronary heart disease or peripheral artery disease, as well as a heart attack or stroke.

While researchers do not yet know what triggers atherosclerosis, factors such as high blood pressure, high cholesterol, and cigarette smoking are believed to cause much of the damage.

New research points the finger at another possible culprit: air pollution. Meng Wang, Ph.D., an assistant professor of epidemiology and environmental health at the University at Buffalo School of Public Health and Health Professions in New York, is the lead author of the study.

Wang and the team published their findings in the journal Environmental Health Perspectives.

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Wang and colleagues clinically followed 6,619 adults, who were 45–84 years old and who did not have cardiovascular disease or any other conditions at the start of the study.

They followed the participants for a mean period of 6.5 years, as part of the Multi-Ethnic Study of Atherosclerosis in which the participants had enrolled. They came from six cities across the United States: Winston-Salem, NC; New York City, NY; Baltimore, MD; St. Paul, MN; Chicago, IL; and Los Angeles, CA.

"We used statistical models to capture whether there are significant associations between ozone exposure and [atherosclerosis]," explains Wang.

"[The model] suggests that there is an association between long-term exposure to ozone and progression of atherosclerosis," he goes on to report.

Specifically, the study found an association between chronic ozone exposure and an "increased rate of carotid wall thickness progression and risk of new plaque formation." These results suggested arterial injury in the carotid arteries — the two large vessels that supply blood to the head and neck.

"This may indicate that the association between long-term exposure to ozone and cardiovascular mortality that has been observed in some studies is due to arterial injury and acceleration of atherosclerosis," comments Wang.

However, the researchers admit that they're in the dark regarding what may cause this link. "We can show that there is an association between ozone exposure and this outcome, but the biological mechanism for this association is not well understood," Wang notes.

To the authors' knowledge, this is the first epidemiological study to examine the link between ozone exposure and "subclinical vascular disease" — that is, injuries that damage the artery walls before a heart attack or a stroke occurs.

According to the American Lung Association, ground-level ozone also damages lung tissue when we breathe it in. Frequently referred to as smog, ozone is a gas molecule that harms lung tissue by chemically reacting to it.

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Can blueberries protect heart health?

According to a new study, consuming 1 cup of blueberries each day might improve the metabolic markers associated with cardiovascular risk.
Hands holding blueberries
Blueberries are tasty, but are they good for our hearts?

Blueberries are delicious and nutritious; if they could also lower the risk of heart disease, that would be a bonus.

For that reason, the United States Highbush Blueberry Council helped fund a study to investigate blueberries' potential benefit to heart health.

Researchers from the University of East Anglia in the United Kingdom teamed up with scientists from Harvard University in Cambridge, MA.

In particular, they wanted to understand whether regularly consuming blueberries could alter the metabolic profile of people with metabolic syndrome.

Metabolic syndrome describes a cluster of conditions that include high blood pressure, excess body fat around the waist, high blood sugar levels, and abnormal cholesterol and triglyceride levels. Together, these factors increase the risk of cardiovascular disease and type 2 diabetes.

Currently, metabolic syndrome affects more than one-third of adults in the U.S., with some experts referring to it as a global epidemic.

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Blueberries and anthocyanins

"Previous studies have indicated that people who regularly eat blueberries have a reduced risk of developing conditions including type 2 diabetes and cardiovascular disease," says lead researcher Prof. Aedin Cassidy.

"This," she says, "may be because blueberries are high in naturally occurring compounds called anthocyanins."

Anthocyanins are water soluble pigments that can appear red, black, blue, or purple. These flavonoids are present in the tissues — including the stems, leaves, flowers, roots, and fruits — of many higher plants.

Previous studies have revealed a relationship between increased anthocyanin consumption and reduced mortality risk; others have linked these chemicals to a reduced risk of cardiovascular disease.

However, to date, much of the research has taken place over a relatively short period; in fact, some studies looked at the consumption of just a single portion of blueberries.

There have also been no randomized controlled trials investigating blueberries' potential to protect against disease in a population with a higher risk of developing type 2 diabetes and cardiovascular disease.

Prof. Cassidy says, "We wanted to find out whether eating blueberries could help people who have already been identified as being at risk of developing these sort of conditions."

Testing blueberry powder

To investigate, the team recruited 115 participants, ages 50–75, all of whom were either overweight or obese and had metabolic syndrome. The study ran for 6 months, making it the longest of its kind.

Importantly, the scientists used "dietarily achievable levels" of blueberries rather than expecting the participants to consume an unsustainable and unrealistic amount of blueberries each day.

They split the participants into three groups:

One group consumed 1 cup (150 grams) of freeze-dried powdered blueberries per day. Another group consumed half a cup (75 grams) of freeze-dried powdered blueberries per day. The final group acted as a control group; they received a powder that looked similar to blueberry powder but which primarily contained dextrose, maltodextrin, and fructose.

At the start and end of the trial, the researchers assessed biomarkers for insulin resistance, lipid status, and vascular function. They recently published their findings in the American Journal of Clinical Nutrition.

"We found that eating 1 cup of blueberries per day resulted in sustained improvements in vascular function and arterial stiffness — making enough of a difference to reduce the risk of cardiovascular disease by between 12 and 15%."

Co-lead study author Dr. Peter Curtis

Interestingly, the scientists only saw the benefits in the group consuming 1 cup of blueberries per day — not in those consuming half a cup.

Dr. Curtis believes that this is because "higher daily intakes may be needed for heart health benefits in obese, at-risk populations, compared with the general population."

It is also worth noting that the blueberry intervention did not alter the other parameters the scientists measured. The authors write:

"No favorable effects of the intervention were shown for the primary endpoint [insulin sensitivity] or indices of glucose control. [...] The intervention had no effect on [blood pressure] or other biomarkers of vascular function."

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Explaining the benefits of blueberries

The scientists believe that the cardiovascular benefits they saw are primarily due to the presence of anthocyanins in blueberries.

In the lower intestine, the body metabolizes anthocyanins to produce a range of chemicals; some of these chemicals provide sustenance to the resident gut bacteria and are "likely play a key beneficial metabolic role," say the study authors.

They offer some examples. For instance, some researchers have shown that syringic acid, which is a chemical that the metabolism of anthocyanin produces, benefits vascular endothelial cells in the laboratory.

Similarly, scientists have found that vanillic acid, another breakdown product, reduces hypertension in rats.

Dr. Curtis concludes, "The simple and attainable message is to consume 1 cup of blueberries daily to improve cardiovascular health."

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At this point, it is worth mentioning that other foods contain anthocyanin, including blackcurrants, black and red raspberries, blackberries, red cabbage, plums, red radish, black carrot, and purple potato.

Although this project was the first long-term, placebo-controlled study to look at blueberries and cardiovascular and metabolic health, it is important to remember that only 115 participants completed this trial.

By the end, only 37 participants remained in the group consuming 1 cup of blueberries per day.

Blueberries are likely to be a healthful addition to any diet, as are most other fruits and vegetables. However, scientists will need to carry out larger studies to confirm the clinical benefits of blueberries.

Because the U.S. Highbush Blueberry Council are dedicated to "driving consumer demand," more research is likely to follow.

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Clinical trial shows why energy drinks are bad for the heart

Energy drinks are popular, especially among teenagers and young adults. But a clinical trial reports that energy drinks caused disturbances to the volunteers' heart rhythms and blood pressure.
Student with energy drink
How do energy drinks affect the heart?

Energy drinks are the second most popular dietary supplement of choice for teenagers and young adults in the United States, according to the National Center for Complementary and Integrative Health (NCCIH).

Packed with caffeine and other ingredients, such as guarana, taurine, ginseng, and B vitamins, these drinks promise to boost concentration, improve physical performance, and reduce fatigue.

A recent article in the American Journal of Preventive Medicine puts the rise in popularity of energy drinks into numbers.

The percentage of 12–19-year-olds consuming energy drinks in the U.S. has risen from 0.2% in 2003 to 1.4% in 2016. The highest increase was among young adults, aged 20–39, from 0.5% to 5.5% in this time period, while the figure rose from 0% to 1.2% in adults aged 40–59, according to the study's authors.

Yet mounting evidence portrays energy drinks in a different light. "Consuming energy drinks raises important safety concerns," according to the NCCIH, with twice as many emergency department visits related to energy drinks recorded in 2011 than in 2007.

In the largest randomized, controlled clinical trial on the subject to date, researchers from the University of the Pacific in Stockton, CA, along with collaborators from other institutions, identify how energy drink consumption affects the heart.

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Hearth rhythm altered

For the study, published in the Journal of the American Heart Association, lead study author Sachin A. Shah, a professor of pharmacy practice at the University of the Pacific, enrolled 34 adults aged 18 to 40.

After an overnight fast, the volunteers consumed two 16-ounce bottles of either one of two energy drinks or a placebo, which contained carbonated water, lime juice, and cherry flavoring. The study was double-blinded, meaning that neither the participants nor the researchers knew who drank which product.

The researchers then measured the volunteers' heart rhythms with standard electrocardiogram and blood pressure readings every 30 minutes for a total of 4 hours.

Here they found a significant change in the time that the chambers of the heart needed to contract and relax. This measure is called the QT interval. The length of the QT interval is linked to a person's heart rate, so scientists often use a corrected version, called QTc, that takes heart rate into account.

A QTc interval of 450 milliseconds (ms) in men and 460 ms in women is considered the maximum for a healthy heart rhythm.

When this number rises — a phenomenon termed QT interval propagation — a person's risk of experiencing life-threatening arrhythmia, or disturbance of the heart's normal beat, and sudden cardiac death increases.

While consumption of the placebo drink caused a maximum change in QTc interval of an average of 11.9 ms, the two energy drinks resulted in average maximum changes of 17.9 ms and 19.6 ms.

Importantly, the researchers saw significant changes in the QTc interval length up to 4 hours after the volunteers had consumed the energy drinks.

In the paper, the authors comment that "According to the [Food and Drug Administration (FDA)], QTc prolongation is a well-established risk factor for arrhythmias, with a prolongation over 10 ms prompting further investigation."

"Energy drinks are readily accessible and commonly consumed by a large number of teens and young adults, including college students," comments study co-author Kate O'Dell, a professor of pharmacy at the University of the Pacific, on the findings. "Understanding how these drinks affect the heart is extremely important."

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Urgent 'need to investigate' ingredients

In addition to the effect on the QT interval, the researchers found an average maximum change of 3.5 millimeters of mercury (mmHg) in diastolic blood pressure and 4.6 to 6.1 mmHg in systolic blood pressure when the study participants had consumed the energy drinks.

In the study, the authors explain that the caffeine in the energy drinks may have contributed to the change in blood pressure, but only to some extent. Other ingredients, particularly taurine, could also play a role.

"We found an association between consuming energy drinks and changes in QT intervals and blood pressure that cannot be attributed to caffeine. We urgently need to investigate the particular ingredient or combination of ingredients in different types of energy drinks that might explain the findings seen in our clinical trial."

Prof. Sachin A. Shah

The authors point to the study's limitations. They asked the participants to drink a total of 32 ounces of energy drink or placebo, which limits how well the results translate to how people consume these products in their normal daily life.

The researchers also studied the volunteer's heart rhythm and blood pressure for only 4 hours, which does not provide insights into the long-term effects or chronic exposure to energy drinks, and they only enrolled healthy volunteers in the study.

Finally, people frequently consume energy drinks in combination with alcohol, which the team did not study in this clinical trial.

It is also important to mention that none of the participants experienced QTc intervals over 500 ms. In the paper, the authors explain that "Clinically, a QT/QTc interval over 500 ms or a change over 30 ms warrants careful monitoring."

Nevertheless, Prof. Shah urges caution: "The public should be aware of the impact of energy drinks on their body, especially if they have other underlying health conditions. Healthcare professionals should advise certain patient populations — for example, people with underlying congenital or acquired long QT syndrome or high blood pressure — to limit or monitor their consumption."

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