Wood Street Clinic Blog

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Intense light may boost heart health

A novel use of intense light therapy may help decrease the tissue damage experienced during heart attacks, reveals new research in mice.
woman holding her chest
New research introduces a potential novel therapy for heart attacks.

The study, out of the University of Colorado and appearing in the journal Cell Reports, shows that exposing lab mice to intense light for a week improved their outcomes after heart attacks.

The research also suggests that this procedure could benefit humans, and the researchers outline the reason why.

"We already knew that intense light can protect against heart attacks, but now we have found the mechanism behind it," says the study's senior author Dr. Tobias Eckle, professor of anesthesiology at the University of Colorado School of Medicine in Aurora.

Boosting specific gene protects heart

In the study, the researchers discovered that intense light influences the functions of the PER2 gene, which is expressed by a part of the brain that controls circadian rhythms.

By boosting this gene through intense light therapy, the researchers discovered that the mice's heart tissue received extra protection when it experienced issues with oxygen, such as during a heart attack.

Additionally, this intense light also heightened cardiac adenosine, which is a specialized chemical that helps with blood flow regulation. In concert, both benefits helped protect heart health.

Also, when they studied the mice, the researchers found that being able to physically perceive light was vital, as blind mice experienced no benefits from the intense light.

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Humans had similar benefits

The next step was to see if humans could benefit from light therapy. The researchers worked with healthy human volunteers and exposed them to 30 minutes of intense light.

On five consecutive mornings, the researchers exposed the participants to 10,000 lumens of light and drew blood several times.

The researchers found that PER2 levels increased in response to light therapy in the human participants as it did in the mice. They also reported that the human volunteers saw a decreased level of plasma triglycerides and improved metabolism.

Dr. Eckle explained that light plays an essential part in human health, not only in regulating the circadian rhythm but in cardiovascular health as well.

He adds that according to prior studies, more people throughout the U.S. experience heart attacks during the darker months of winter, even in states that traditionally get more sunshine, such as Hawaii and Arizona.

Heart disease and its impact on U.S. adults

Heart disease is widespread throughout the United States. Around 610,000 people die from heart disease every year, which accounts for 1 out of every 4 deaths.

Coronary heart disease is the most common form of heart disease, and around 735,000 people in the U.S. experience a heart attack annually.

While most people know that chest pain is a sign of a heart attack, other less obvious signs include shortness of breath, upper body pain, nausea, cold sweats, lightheadedness, and discomfort in the arms, back, neck, jaw, or upper stomach.

There are many ways that people can reduce their risk of developing heart disease, such as eating better and exercising more. However, it is vital that research to discover new ways to protect the cardiovascular system continues.

This study using intense light highlights how something seemingly unrelated to heart health can have such protective benefits.

This study could have a significant impact on the treatment of heart patients in the future. Eckle says that "if the therapy is given before high risk cardiac and non-cardiac surgery, it could offer protection against injury to the heart muscle which can be fatal."

Eckle believes there are other possibilities, too, adding that "drugs could also be developed that offer similar protections based on these findings."

"However, future studies in humans will be necessary to understand the impact of intense light therapy and its potential for cardio protection."

Dr. Tobias Eckle

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Simple dietary changes may reduce cancer risk, increase lifespan

A new study that involved more than 50,000 participants over a period of 2 decades concludes that eating flavonoid rich foods could stave off disease and extend life.
Woman shopping for vegetables
A study probes the link between polyphenol consumption and mortality.

A considerable amount of research has focused on the role of nutrition in disease risk and mortality.

Despite growing interest, it is a notoriously difficult topic to study for a range of reasons, and drawing reliable conclusions about how food impacts specific health outcomes is challenging.

Although it is obvious that food is vital to our survival, delving deeper into the details of how single compounds impact disease and mortality in humans is difficult.

With that said, researchers have now firmly and scientifically established that eating more fruit and vegetables is associated with reduced cardiovascular and overall mortality risk.

However, exactly how fruits and vegetables protect health is less well known; although a wide array of nutrients are likely involved, many researchers believe that flavonoids play a significant part.

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The flavonoid family

Flavonoids are a class of chemicals called polyphenols. They are present in a range of natural foods, including fruits, vegetables, dark chocolate, red wine, and tea.

These compounds have six subclasses:

flavonols flavan-3-ols flavanones flavones anthocyanins isoflavones

Each of these has the potential to impact the body in different ways and to different degrees.

Recently, a group of scientists from Edith Cowan University in Australia set out to investigate if these compounds actually can extend life and protect health.

The paper, which now appears in the journal Nature Communications, outlines their findings.

The authors write that their primary aim was to "investigate the association of total flavonoid and flavonoid subclass intakes with all cause, [cardiovascular disease]-related, and cancer-related mortality."

The researchers also wanted to see how lifestyle factors such as drinking alcohol and smoking tobacco affected the benefits derived from flavonoids.

Flavonoid research

Earlier studies investigating flavonoids produced interesting results. In short-term studies, they appear to boost certain markers of cardiovascular health. Other papers have described a potential anticancer role for flavonoids.

Although earlier research has hinted at benefits, there are significant gaps. As the authors of the new study explain:

"Evidence from observational studies is incomplete; studies on cancer mortality are scarce, and additional research is necessary to establish the specific role of flavonoid subclasses and to determine the dose of total and specific flavonoids required to achieve maximum benefit."

To investigate, the scientists took data from the Danish Diet, Cancer, and Health cohort. In total, 56,048 adults took part. During the 23-year followup, 14,083 of the participants died.

After controlling for a range of factors, the authors conclude:

"[W]e provide evidence that an achievable dietary intake of total and individual flavonoid subclasses is associated with a lower risk of all cause, [cardiovascular disease]-related, and cancer-related mortality."

Specifically, they found that those who consumed around 500 milligrams (mg) of flavonoids every day had the lowest risk of cancer- or cardiovascular disease-related deaths. Above the 500 mg threshold, there was no additional benefit.

The scientists also analyzed the impact of each of the six types of flavonoid. They found the same effect across the board.

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500 mg each day

To put the 500 mg threshold into perspective, lead researcher Dr. Nicola Bondonno provides an actionable example:

"It's important to consume a variety of different flavonoid compounds found in different plant based food and drink. This is easily achievable through the diet: one cup of tea, one apple, one orange, 100 grams of blueberries, and 100 grams of broccoli would provide a wide range of flavonoid compounds and over 500 mg of total flavonoids."

The researchers found that the benefits of flavonoids were particularly pronounced in participants who currently smoked and who consumed more than two alcoholic beverages each day. These participants saw the greatest benefits.

However, Dr. Bondonno makes an important point, explaining that "flavonoid consumption does not counteract all of the increased risk of death caused by smoking and high alcohol consumption. By far the best thing to do for your health is to quit smoking and cut down on alcohol."

Exactly how flavonoids might reduce the risk of disease is unclear. However, some scientists believe that their anti-inflammatory qualities might be important.

Alcohol and tobacco both increase levels of inflammation and damage blood vessels. However, as Dr. Bondonno explains, "Flavonoids have been shown to be anti-inflammatory and improve blood vessel function, which may explain why they are associated with a lower risk of death from heart disease and cancer."

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Strengths and limitations

This study has significant strengths — not least the large number of participants and the long follow-up duration. The scientists also captured a wide range of characteristics, lifestyle factors, and other relevant information to help refine their analysis and reduce statistical noise.

However, there are always limitations. For instance, the study was observational, which means that it is not possible to prove conclusively that flavonoids cause the decrease in mortality and disease risk.

For instance, as the authors explain, there is a possibility that flavonoids are "a marker of other unobserved and potentially protective dietary factors."

Importantly, the study only captured dietary information at the start of the study; there is every chance that the participants' diets changed significantly over the following 2 decades.

The authors also note that their sample group was predominantly white, so the relationship between flavonoids and health outcomes may be different in other populations.

In conclusion, this study adds weight to the idea that flavonoids might protect health. However, as ever, scientists will need to carry out more research.

In the meantime, consuming increased quantities of fruits and vegetables will do no harm.

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What to know about forehead veins

Bulging veins can appear anywhere on the body, including the forehead. Veins can expand due to pressure or stress. Skin changes associated with aging may make veins in the forehead appear larger than they are.

Genetic factors or age can influence whether someone gets large veins on their forehead. The skin becomes thinner as the body ages, which can make veins appear more pronounced or larger than they are.

Enlarged veins can appear in the center of the forehead or the sides of the face, near the temples. Bulging forehead veins rarely indicate a medical emergency.

Read on to learn more about bulging forehead veins, including causes and treatments. Possible causes of bulging forehead veins include:

Pressure Inflated Forehead veins
Laughing, sneezing, and screaming may all increase pressure in the head.

An increase in pressure can cause the veins to protrude through the skin. Factors that increase pressure in the neck and head include:

A bulging forehead vein may develop from a tension headache. Tension headaches are the most common type of headache, which occur because of tightness in the muscles of the shoulders, scalp, or jaw.

Thank you for supporting Medical News Today Pregnancy Hormone changes during pregnancy can lead to higher blood volume, which may result in enlarged veins. Progesterone levels increase during pregnancy. Progesterone thickens the uterine lining, preparing the uterus to receive a fertilized egg. Progestin also dilates or expands the blood vessels, which may make them appear larger under the skin. According to the National Institutes of Health (NIH), progesterone levels are ten times higher in females who are pregnant than those who are not. Temporal arteritis Temporal arteritis, or giant cell arteritis, is a type of vasculitis affecting the veins near the temples. Vasculitis refers to inflammation of the blood vessels. Temporal arteritis causes inflammation in the temporal arteries and the surrounding blood vessels. This can lead to bulging veins that extend from the temples to the middle of the forehead. Other symptoms of temporal arteritis include: Sun exposure A Cheerful woman enjoying a sunny day on a balcony
Prolonged sun exposure may cause veins near the skin's surface to dilate. Spending too much time in the sun can damage skin tissue and veins. The heat from the sun causes veins to dilate so that they can regulate the body's internal temperature. However, dilated veins near the surface of the skin have the potential to pop or break, resulting in spider veins. Spider veins refer to small red, blue, or purple lines that appear right below the surface of the skin. These lines indicate broken veins, and they can develop anywhere on the body, including the face. Why might a new vein appear or become visible? A bulging vein might appear suddenly if someone loses a significant amount of weight. People with less body fat may have more prominent veins. Thinning skin due to gaining weight could also explain new bulging veins. Hormonal changes and high blood pressure could also result in the sudden appearance of forehead veins. According to the American Institute of Stress, both physical and mental stress can significantly raise blood pressure. Thank you for supporting Medical News Today Is treatment necessary? In most cases, forehead veins do not require treatment. People who do not like the way their forehead veins look can choose to undergo procedures that reduce their visibility. Treatments for forehead veins include: Electrosurgery: This procedure uses high frequency electrical currents to cut or destroy blood vessels. Sclerotherapy: Doctors use this standard medical procedure to treat varicose and spider veins. It does not require surgery. During sclerotherapy, a doctor will inject a salt solution directly into a vein, causing it to collapse. Endovenous laser surgery: This procedure uses a laser to close or shrink veins. The heat from the laser destroys the tissue lining the walls of blood vessels. The body will naturally absorb the dead tissue. When to see a doctor male patient speaking to doctor
If headaches and dizziness accompany large forehead veins, a person should speak to their doctor. Although large forehead veins do not indicate a medical emergency, people may want to speak with a doctor if they experience: headaches dizziness blurred or double vision pain or tenderness near the temples, mouth, or jaw Even if someone does not experience symptoms, they can still consult a doctor about possible treatment options for large forehead veins. People should carefully consider all the benefits and risks associated with surgical and nonsurgical treatments before making a decision. Thank you for supporting Medical News Today Summary Several factors can contribute to the appearance of bulging forehead veins. These can include natural reasons, such as genetics, aging, and sun exposure. An underlying medical condition that affects the cardiovascular system, such as vasculitis, may also cause large forehead veins. Large forehead veins do not require treatment unless someone does not like the way they look. People can choose from a variety of surgical and nonsurgical procedures to reduce the appearance of forehead veins. People should ask a trained medical professional to review the potential risks and benefits associated with any treatment.
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What to know about brain aneurysms

A brain aneurysm, sometimes called a cerebral aneurysm, is a weak spot in a brain artery. The weak spot creates a balloon that fills with blood.

The walls of the artery are weaker near an aneurysm, which means that the aneurysm can break open, or rupture. A ruptured aneurysm is a life threatening condition that can cause serious brain injuries or stroke. However, not all aneurysms rupture.

People with an aneurysm may need ongoing monitoring to ensure that it is not growing. A doctor may need to remove a larger aneurysm.

In this article, we provide an overview of brain aneurysms, including the types, symptoms, causes, complications, and treatments.

Brain aneurysm statistics A Female doctor analyzing MRI scan of a Brain aneurysm
Around 3–5% of people in the United States experience a brain aneurysm during their lifetime.

According to the National Institute of Neurological Disorders and Stroke, brain aneurysms affect an estimated 3–5% of people in the United States during their lifetime. They are more common in females than in males and tend to affect adults between the ages of 30 and 60 years.

The Brain Aneurysm Foundation state that ruptured brain aneurysms account for just 3–5% of all new stroke cases. If an aneurysm does rupture, it is fatal in about 40% of cases, with 15% of people dying before they reach the hospital.

Types of aneurysm Doctors classify aneurysms according to the shape of the weak spot in the artery. There are three main types of aneurysm: Saccular aneurysms form a pocket on the outside of an artery. They are the most common type of cerebral aneurysm. Some people refer to them as berry aneurysms due to their appearance. Fusiform aneurysms occur when the blood vessel expands on all sides. This type of aneurysm is more common after an injury to a blood vessel. Mycotic aneurysms are those that form a sac around an artery. They happen when an infection from another area of the body gets into the bloodstream and spreads to the brain. Myocarditis, a type of heart infection, is a common culprit, but mycotic aneurysms are very rare. The size of an aneurysm is a significant predictor of whether or not it will rupture: Small aneurysms are less than 11 millimeters (mm) across — about the size of a large pencil eraser. Large aneurysms are 11–25 mm in diameter — roughly the size of a dime. Giant aneurysms are 25 mm or larger — more than the diameter of a quarter. Some aneurysms grow over time, and a small number grow rapidly. Growth, especially rapid growth, increases the risk that the aneurysm will rupture. Thank you for supporting Medical News Today Symptoms and early warning signs Larger aneurysms are more likely than smaller ones to cause symptoms before they rupture, but most aneurysms do not cause any symptoms during this stage. When people with an unruptured aneurysm do experience symptoms, they may include: pain above or behind the eye that gets worse or does not go away with time numbness weakness paralysis or twitching on one side of the face vision changes, such as blurred or double vision a dilated pupil in only one eye Sometimes an aneurysm leaks before it ruptures. Doctors call this a sentinel rupture or sentinel bleed. Sentinel ruptures sometimes cause sentinel headaches. A sudden, severe headache — especially one that does not fit a person's usual headache pattern or that is worse than any other headache they have ever had — could be a sentinel headache. Other symptoms of a sentinel rupture include: nausea or vomiting vision changes confusion or changes in consciousness a stiff neck light sensitivity fainting or seizures cardiac arrest Anyone who has symptoms of an aneurysm should seek immediate medical care. If a person has previously received a diagnosis of an unruptured aneurysm, it is essential that they make the emergency care team aware of this. Causes and risk factors a father and son hug.
A person may be at risk of a brain aneurysm if they have a family member who has experienced one. Brain aneurysms are more common in females than in males and more likely to affect adults between 30 and 60 years old. In addition, genetic and lifestyle factors that weaken the walls of blood vessels greatly increase the risk of aneurysm. Risk factors for brain aneurysms include: genetic conditions that weaken blood vessels, including polycystic kidney disease, some connective tissue disorders, and arteriovenous malformations (AVM) a close family member, such as a parent, child, or sibling, having an aneurysm uncontrolled high blood pressure drug use disorder, particularly that involving drugs that raise blood pressure, such as amphetamines and cocaine using illicit drugs intravenously smoking a brain tumor head injuries infections in the arteries Diagnosis While brain imaging techniques, such as CT scans and MRI scans, can help doctors diagnose some aneurysms, an angiogram allows them to make a definitive diagnosis. To perform a cerebral angiogram, a doctor will insert a small, thin tube called a catheter into a blood vessel in the groin and direct it into the blood vessels of the brain under X-ray guidance. There, they will inject a dye that makes it easier to see the blood vessels and any unusual structures. An angiogram can help the doctor assess the size and severity of the aneurysm, as well as its type. This information helps them make appropriate treatment recommendations. Treatment Not all brain aneurysms require immediate treatment. If the aneurysm is small, a doctor may recommend monitoring it over time. The best treatment option will depend on the following factors: the person's age any neurological or medical conditions whether the aneurysm has ruptured the risk of the aneurysm rupturing any family history of subarachnoid hemorrhage A person with a family or personal history of aneurysm rupture may need treatment even if the aneurysm is small. A doctor may recommend an endovascular procedure or surgery to treat the aneurysm. Endovascular procedure During an endovascular procedure, a surgeon inserts a catheter through the groin, then navigates to the aneurysm. Next, they pack the aneurysm with metal coils or a stent to redirect the blood flow. Doing this stops blood from flowing into the aneurysm, which prevents rupture. Surgery Surgery for an aneurysm requires an operation on the brain, which will take place under general anesthesia. This procedure usually requires a person to spend several days in the hospital, and it may be necessary to shave the person's head. During the operation, a surgeon clips the aneurysm to prevent blood from flowing into it. Following this treatment, most aneurysms do not reoccur. Risks of treatment Both endovascular treatment and brain surgery come with risks, including: heart or lung damage stroke surgical complications, such as infection death surgery failure that makes further treatment necessary Complications An unruptured aneurysm typically does not cause any complications. However, a ruptured aneurysm can cause serious, lasting health conditions, and it can be fatal. Possible complications of a ruptured brain aneurysm include: hemorrhagic stroke, a type of stroke that occurs as a result of bleeding in the brain rebleeding, which happens when an aneurysm ruptures again changes in the sodium level in the brain, which may cause permanent brain damage vasospasm, a spasm that causes arteries to narrow, limiting blood flow to the brain and potentially causing serious brain damage or a stroke seizures hydrocephalus, which happens when cerebrospinal fluid accumulates in the brain, causing dangerous pressure that may damage this organ Prevention woman running to try and help herself sleep better
A healthful lifestyle may help reduce the risk of a brain aneurysm. Some aneurysms are not preventable. However, a healthful lifestyle can support blood vessel health and reduce the risk of an aneurysm. People can reduce their risk using the following strategies: quitting smoking, if applicable abstaining from using drugs that elevate blood pressure avoiding or limiting medications that increase blood pressure, under the guidance of a doctor adopting a healthful lifestyle that includes a balanced diet and regular exercise talking to a healthcare professional about strategies to control blood pressure seeking advice on further strategies to reduce aneurysm risk if a first degree relative (a parent, child, or sibling) has had an aneurysm People who have unruptured aneurysms should talk to a doctor about how to minimize the risk of rupture. Ongoing monitoring can reduce this risk and guide a doctor's treatment decisions. Thank you for supporting Medical News Today Differences between an aneurysm and stroke An aneurysm is not a stroke, but it can cause one. When an aneurysm bursts, this deprives the brain of blood, potentially leading to a stroke. The symptoms of a ruptured aneurysm and stroke are similar but not identical. While both cause neurological symptoms, such as dizziness or blurred vision, aneurysms also typically cause headaches. Both conditions are serious medical emergencies that demand immediate treatment. Therefore, a person should see a doctor whether they have symptoms of an aneurysm, stroke, or both. Learn more about the differences between aneurysms and stroke here. Outlook Among people who survive an aneurysm rupture, about 25% die from complications within 6 months, and 66% have lasting neurological damage. For this reason, it is important to identify and treat aneurysms as early as possible. Prompt medical care increases a person's chances of survival.
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'Intensive blood pressure management' may preserve brain health

New research compares intensive blood pressure control with standard blood pressure management and finds that the former correlates with a lower chance of developing white matter lesions later in life.
man taking his blood pressure
Managing your blood pressure 'intensively' may prevent brain damage later in life, new research suggests.

Numerous large, cohort studies have linked midlife hypertension to mild cognitive impairment and dementia later on.

Some of these studies found a higher risk of lesions in the brain's white matter in older age among people with high blood pressure in their 50s.

The white matter of the brain consists of bundles of axons, which are the thin elongations of neurons. White matter is "white" due to myelin — the protective substance that covers the axons. Unlike gray matter, white matter continues to evolve in our adulthood and midlife.

Previous studies have tied abnormalities in the brain's myelin, such as the thinning of this layer, with a range of neurological conditions, including Alzheimer's and other dementias.

White matter lesions, which appear on an MRI scanner, reflect such myelin disruptions. White matter lesions can also indicate high water content, higher glial cell sensitivity to injury, porous brain blood vessels, or ministrokes.

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New research explores the connection between midlife hypertension and white matter lesions, which may lead to cognitive impairment later in life.

Specifically, a team of researchers asked themselves if intensive blood pressure treatment correlates with a limited "progression of small vessel ischemic disease, as reflected by cerebral white matter lesion volume."

Dr. Nick Bryan, Ph.D., from the Department of Diagnostic Medicine at the University of Texas at Austin, is the corresponding author of the new paper.

Dr. Bryan and team examined the brain scans of 449 participants and found that intensive control of blood pressure in their 50s did, indeed, corresponded with a lower likelihood of white matter lesions later on.

The findings of the research now appear in JAMA.

The researchers examined the brain scans of the participants who had enrolled in the National Institutes of Health's (NIH) Systolic Blood Pressure Intervention Trial (SPRINT).

As part of SPRINT, the participants — who were 50 years old on average at baseline and at high cardiovascular risk — undertook brain scans at the beginning of the study and 4 years later.

During this time, the participants received either standard treatment, which reduced systolic blood pressure to less than 140 millimeters of mercury (mm Hg) or intensive treatment to lower systolic blood pressure below 120 mm Hg.

Over the 4 years, the total volume of white matter lesions rose by 0.92 cm3, on average, in the intensive treatment group. By contrast, white matter lesion volume rose by 1.45 cm3, on average, among the participants who received standard treatment.

"Intensive treatment significantly reduced white matter lesion accumulation in people who had a higher chance of experiencing this kind of damage because they had high blood pressure," reports study co-author Dr. Clinton B. Wright, the director of the Division of Clinical Research at NIH's National Institute of Neurological Disorders and Stroke (NINDS).

Another co-author of the study, Lenore J. Launer, Ph.D., who is a senior investigator at NIH's National Institute on Aging (NIA) Laboratory of Epidemiology and Population Sciences, also comments on the findings.

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She says: "SPRINT MIND has produced promising initial results in the battle against the nation's growing problem with aging brain disorders. Both the brain scans and cognitive tests reinforce the potential benefits that intensive blood pressure management may have on the brain."

"We hope that these findings will become the foundation for future studies on how to protect the brain throughout a person's life," adds Launer.

The findings strengthen the results of a previous study that found intensive blood pressure control reduces mild cognitive impairment occurrence.

"These findings on white matter lesions — primarily in the aggressive control of blood pressure — are encouraging as we continue to advance the science of understanding and addressing the complexities of brain diseases, such as Alzheimer's and related dementias," adds Dr. Richard J. Hodes, the director of the NIA.

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Study finds 'disturbingly' high levels of 'ugly cholesterol'

New research shows that levels of remnant particle cholesterol, also known as "ugly cholesterol," in the blood are much higher than experts previously thought.
close up of doctor's hands and blood test
New research points to high levels of remnant cholesterol in the blood.

This research explored the link between remnant cholesterol and cardiovascular disease and came to an alarming conclusion.

Researchers from the University of Copenhagen and Copenhagen University Hospital in Denmark led the study.

Their findings now appear in the journal Atherosclerosis.

Hopes are high that this finding could have a positive impact on both the prevention and treatment of cardiovascular disease in the future.

The team used data from the Copenhagen General Population Study, which included cholesterol specific test results from around 9,000 people.

Using an advanced measuring method called metabolomics, researchers were able to identify the amounts of good, bad, and "ugly" cholesterol within each sample.

They found that equal parts of all of these types of cholesterol make up total cholesterol, which means that the impact of having higher levels of ugly cholesterol is much greater than scientists previously thought.

"Our results show that the amount of remnant cholesterol in the blood of adult Danes is just as high as the amount of the bad LDL [low density lipoprotein] cholesterol," says chief physician Prof. Børge Nordestgaard, from the University of Copenhagen and Copenhagen University Hospital.

"We have previously shown that remnant cholesterol is at least as critical as LDL cholesterol in relation to an increased risk of myocardial infarction and stroke, and [this] is therefore a disturbing development."

Prof. Børge Nordestgaard

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Measuring cholesterol and what it means

When someone gets their cholesterol checked, it is not a single blood test result. Instead, the test results include different levels of different types of cholesterol: high density lipoprotein (HDL) (or good cholesterol), LDL (or bad cholesterol), triglycerides, and total cholesterol.

Generally, for better health outcomes, people should strive for higher levels of HDL and lower levels of LDL and triglycerides. Breaking it down in this way provides more information than a simple total cholesterol test.

The method the scientists used in this study (metabolomics) offers even more vital information.

Prior studies on this topic have shed some light on remnant cholesterol; researchers have found that being overweight or having obesity was the main cause of high levels of both remnant cholesterol and triglycerides in adults.

Prof. Nordestgaard notes that with the new knowledge the team gleaned from this study, the prevention of cardiovascular disease should not only focus on LDL cholesterol, as that is not the only type that can lead to health issues.

"So far, both cardiologists and [physicians] have focused mostly on reducing LDL cholesterol, but in the future, the focus will also be on reducing triglycerides and remnant cholesterol," he says.

High cholesterol treatment

If someone discovers that their cholesterol levels are not optimal, there are a few options available for treatment.

Focusing on heart healthy foods — which includes eating more fruits and vegetables, whole grains, nuts, poultry, and fish — is a good way to help improve these levels. It is also important to reduce the consumption of foods high in saturated fat and sugar.

Also, people should try to avoid being sedentary, as physical activity can help improve cholesterol levels. Furthermore, cigarette smoking increases the risk of coronary heart disease in people with high cholesterol.

Making lifestyle changes — such as improving the diet, getting more exercise, and quitting smoking — can help improve cholesterol levels. However, if those methods do not work, doctors can also prescribe medication.

Losing weight may be the best thing someone can do to lower their "ugly" cholesterol and triglyceride levels.

"Our findings point to the fact that prevention of myocardial infarction and stroke should not just focus on reducing the bad LDL cholesterol, but also on reducing remnant cholesterol and triglycerides."

Prof. Børge Nordestgaard

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Plant based diet may reduce cardiovascular death risk by 32%

New research adds to the mounting body of evidence that eating more plant based foods and fewer animal ones may contribute to a healthy heart and cardiovascular system.
person chopping vegetables
Eating more vegetables and less meat contributes to a healthy heart, new research suggests.

Not only is eating fewer animal products good for the planet, but it is also good for your health, as more and more studies suggest.

Particularly, a growing body of evidence is showing that a plant based diet could benefit cardiovascular health.

By way of example, one such recent study found that eating more plant based foods slashes the risk of heart failure by 40%, while another one found that a vegetarian diet cuts the risk of heart disease death by the same percentage.

Now, a new study appearing in the Journal of the American Heart Association strengthens these findings, as researchers find that eating more vegetables, legumes, nuts, and whole grains and fewer animal products correlate with a much lower risk of dying of a heart attack or other serious cardiovascular event.

Casey M. Rebholz, Ph.D., who is an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, is the lead author of the new study.

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Studying dietary intake and heart health

Rebholz and colleagues examined data from 12,168 middle aged people who had enrolled in the Atherosclerosis Risk in Communities (ARIC) study. The ARIC project clinically followed the participants between 1987 and 2016.

The researchers in the latest study categorized the participants' diet using four diet indexes: "In the overall plant based diet index and provegetarian diet index," they explain, "higher intakes of all or selected plant foods received higher scores."

"[I]n the healthy plant based diet index, higher intakes of only the healthy plant foods received higher scores," while "in the less healthy plant based diet index, higher intakes of only the less healthy plant foods received higher scores."

The researchers applied three Cox proportional hazards models to calculate hazard ratios and assess "the association between plant based diet scores and incident cardiovascular disease, cardiovascular disease mortality, and all cause mortality."

25% lower risk of death from any cause

The findings reveal that the participants who had the highest intake of plant based foods and scored the highest on the indexes were 16% less likely to have a cardiovascular condition — such as a heart attack, stroke, or heart failure — when the researchers compared them with adults who consumed the smallest amount of plant based foods.

High plant based food consumers were also 25% less likely to die from any cause and had a 32% lower risk of dying from a cardiovascular condition.

"While you don't have to give up foods derived from animals completely, our study does suggest that eating a larger proportion of plant based foods and a smaller proportion of animal based foods may help reduce your risk of having a heart attack, stroke or other type of cardiovascular disease," says the lead researcher.

"There might be some variability in terms of individual foods, but to reduce cardiovascular disease risk, people should eat more vegetables, nuts, whole grains, fruits, legumes, and fewer animal based foods."

Casey M. Rebholz

Dr. Mariell Jessup, the chief science and medical officer of the American Heart Association (AHA), who was not involved in the study, also comments on the results.

She says, "The [AHA] recommend[s] eating a mostly plant based diet, provided the foods you choose are rich in nutrition and low in added sugars, sodium (salt), cholesterol and artery clogging saturated and trans fats."

"For example, French fries or cauliflower pizza with cheese are plant based but are low in nutritional value and are loaded with sodium (salt). Unprocessed foods, like fresh fruit, vegetables, and grains, are good choices," Dr. Jessup explains.

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Study strengths and limitations

The study's lead researcher also points out that this is one of the first studies to examine this association in the general population. By contrast, most previous research has found cardiovascular benefits for plant based diets in smaller populations, such as vegetarians.

Also, the "findings are pretty consistent with previous findings about other dietary patterns, including the Dietary Approaches to Stop Hypertension, or DASH diet, which emphasize the same food items," Rebholz adds.

However, the study has some limitations, such as the self-reported nature of the dietary intake.

Also, the ARIC study measured the dietary intake of plant based and animal based foods decades ago, say the scientists, so the measurements may not reflect the modern food industry.

Finally, the study cannot prove causation.

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Fat burning heart rate: Everything you need to know

The fat burning heart rate is supposed to be the rate at which a person's heart should beat per minute to achieve maximum fat burning results.

Fitness professionals and people looking to get in shape often talk about the fat burning heart rate. For people looking to lose weight, hitting a fat burning heart rate could sound like an excellent idea.

While there may be evidence to suggest that this method primarily burns fat, there are more factors that a person should consider when working out.

Keep reading for more information on a fat burning heart rate and whether it is effective for weight loss.

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What is the fat burning heart rate? a man measures his heart rate to see how much fat he is burning
A person's heart rate starts to increase when they exercise. A person's heart rate is often a good indicator of the intensity of the exercise or activity that they are doing. When sitting or lying down, a person's heart rate is usually 60–100 beats per minute. This rate is a person's resting heart rate. When a person exercises, their heart rate starts to increase. A person's maximum heart rate is the highest heart rate a person can safely achieve, often during high intensity exercises. Most people working at this intensity will have shorter workouts because it is hard to maintain. The fat burning heart rate supposedly falls between these two extremes. When a person is hitting their fat burning heart rate, their body is burning more stored fat than sugar and other carbohydrates. As a result, people often focus on reaching the fat burning zone when they exercise to burn the maximum amount of fat. Chart and how to calculate There is an equation for figuring out a person's maximum heart rate and fat burning heart rate. The fat burning heart rate is based on the maximum heart rate. It is important to note that these equations are not suitable for determining safe heart rates for children. To calculate the maximum heart rate, a person should subtract their current age from 220. For example, a 40-year-old's maximum heart rate would be 180 beats per minute. To calculate the fat burning heart rate zone, a person should determine the upper and lower limits. The upper limit is 70% of the maximum heart rate. The lower limit is about 50% of the maximum heart rate. Using the same example, a 40-year-old's fat burning heart rate is between 90 (50% of 180) and 126 (70% of 180) beats per minute. People interested in increasing their endurance and cardiovascular strength often train at higher levels. Sometimes called the cardio zone, people training for performance increases often train at 70–85% of their maximum heart rate. The following chart shows the breakdown of heart rates based on a person's age. an infographic for fat burning heart rate
Thank you for supporting Medical News Today Is it effective? The fat burning heart rate zone has some merit, but it is limited, and some people may rely on it too much. The idea of the fat burning heart rate zone is based on how the body burns fuel when exercising. In general, the higher the heart rate, the more fat the body burns compared with other calorie sources, such as carbohydrates. This has led many to believe that hitting and staying in the fat burning heart rate zone is the best way to burn fat and lose weight. However, the reality is more complex. According to an older study from 2009, the optimal heart rate for burning fat is actually between 60.2% and 80%. The authors also found that these heart rate "zones" had considerable overlap, and that people could get similar results from any heart rate, as long as they were exercising. The American Council on Exercise (ACE) caution against relying too heavily on the fat burning heart rate. The ACE point out that calculating maximum heart rate based on 220 is not very accurate, since many more factors than age alone determine a person's fitness level. Thank you for supporting Medical News Today They suggest that a person should work with a fitness trainer to help determine their exercise capabilities. The ACE also have their own heart rate chart that shows heart rate zones based on age and the fitness level of the person. Like the authors of the 2009 study, the ACE also point out that a person will burn fat regardless of whether they are in the fat burning or cardio zone during exercise. It likely makes little difference which "zone" a person is in when it comes to burning fat and losing weight. Still, for some, keeping an eye on their heart rate during exercise can help them maintain their intensity or pick up their pace if the activity is not challenging enough. A person should always speak to a doctor before starting a new exercise program. A doctor or other healthcare provider can recommend healthy heart rate levels and other tips for people who are looking to lose weight. Summary A person's fat burning heart rate falls within a range of values based on their age. However, people will burn calories and fat regardless of their heart rate when exercising. A person who is interested in burning fat should discuss their goals with a doctor, who can recommend exercises and safe heart rates based on their needs and fitness levels.
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Periumbilical pain: What to know

Periumbilical pain is a painful sensation around the belly button. It is a common complaint, and because many conditions can cause it, it may be challenging for doctors to diagnose.

In this article, we explore the causes and treatment of periumbilical pain. Also, we will review when a person should seek emergency medical attention.

What is periumbilical pain? Periumbilical pain
An umbilical hernia, acute appendicitis, or a small bowel obstruction can all cause periumbilical pain.

Periumbilical pain occurs in the area surrounding and including the belly button.

When diagnosing abdominal pain, doctors must know where the pain is located.

For example, when a person has appendicitis, the pain often starts around the periumbilical region and then moves to the right lower side of the abdomen. Sometimes, people with appendicitis may report pain in the right side and not in the periumbilical region.

Doctors may need to carry out further examinations to accurately diagnose periumbilical pain.

Thank you for supporting Medical News Today Causes The causes of periumbilical pain can range from mild discomforts to surgical emergencies. People with this type of pain may have difficulty telling their doctor exactly where they feel it. However, depending on the area of the abdomen, pain can be associated with many different conditions. For example, pain in the upper right area of the abdomen could suggest a liver condition, while pain in the upper left area could signal a heart attack or pancreatitis. Some of the causes of periumbilical pain listed below may present in different ways. For example, some people with gastritis, esophagitis, or peptic ulcers may also feel pain in the upper middle area of the abdomen, or the epigastric region. Umbilical hernia If a person has an umbilical hernia, they may notice a bulge in their belly button area, as well as pain. An umbilical hernia occurs when an organ or a part of an organ pushes through the abdominal wall. Infants and young children are more likely to experience an umbilical hernia. In adults, umbilical hernias are more common in women or people with increased abdominal pressure relating to pregnancy or obesity. Acute appendicitis People with appendicitis need a rapid and accurate diagnosis, followed by surgery to remove the appendix. Appendectomy is the most common abdominal surgery among children. People with acute appendicitis may experience periumbilical pain that migrates to the right side. They may also experience a loss of appetite, fever, and tenderness on the right side. Mesenteric artery ischemia Doctors define mesenteric artery ischemia as a lack of blood flow to the small intestine. People can have acute or chronic mesenteric ischemia. In acute mesenteric ischemia, people may have a sudden onset of periumbilical pain, nausea, and vomiting. Abdominal aortic dissection People with an aortic dissection must seek immediate medical attention. An abdominal aortic dissection is when a tear forms in the aorta, which is the major artery supplying blood to the body. Doctors estimate that 3 out of every 1,000 people who present to the emergency department for back, chest, or abdominal pain have an abdominal aortic dissection. The surgeon must treat the abdominal aortic dissection immediately, as mortality can reach up to 50% in the first 48 hours. Small bowel obstruction patient having a ct scan
A doctor may suggest a CT scan to help diagnose a small bowel obstruction. People with a small bowel obstruction have a blockage in their intestine. Several factors can cause these blockages, including: scar tissue in the abdomen hernias cancer inflammatory bowel disease stool impaction foreign bodies Another cause of small bowel obstruction is volvulus, a problem that occurs when a loop in the intestine twists and blocks the bowel. People with small bowel obstruction may experience: periumbilical pain abdominal distension, or a bloated-looking belly nausea vomiting mild-to-severe constipation in some cases, loose stools and gas Children can also experience small bowel obstructions. Some doctors can diagnose a small bowel obstruction by conducting a physical exam. The use of CT, ultrasound, and X-ray imaging has improved the accuracy of small bowel disease diagnosis. Most people with small bowel disease will require surgery to unblock the intestine. Doctors can treat some obstructions using a nonsurgical technique called nasogastric decompression. Gastritis, esophagitis, or peptic ulcer disease People with gastritis, esophagitis, or peptic ulcer disease may report periumbilical pain. Other people with these conditions may experience the pain in the upper central area of the abdomen. Gastritis can be acute or chronic. Some people may not report any symptoms, or they may have very mild symptoms. Other people may experience abdominal pain, vomiting, and nausea. Esophagitis is an inflammation of the esophagus, which is the pipe that connects the mouth to the stomach. The most common symptoms that people with esophagitis report are chest pain, painful swallowing, and difficulty swallowing. People with esophagitis may feel pain in the upper central region of the abdomen or the periumbilical region. People with peptic ulcer disease have ulcers in the stomach and the upper part of the small intestine, or the duodenum. Symptoms of peptic ulcer disease vary depending on a person's age and the location of the ulcers. People with peptic ulcer disease may report epigastric or periumbilical pain, bloating, nausea, and vomiting, among other symptoms. Periumbilical pain in children Appendicitis is the most common reason for emergency abdominal surgery among children. Children with appendicitis need immediate medical attention and a quick diagnosis. Children may complain of abdominal pain in the periumbilical, central, or epigastric regions. The pain will eventually move to the right lower side of the abdomen. It can be difficult to diagnose appendicitis in children because typical symptoms are the exception and not the rule in this age group. Children may report vague, nonspecific symptoms such as stomach pain, or they may develop a fever or vomit. Doctors may need to confirm and clarify a child's symptoms by conducting a physical examination or by running blood tests, an ultrasound, CT scans, or an MRI. Diagnosis Periumbilical pain is a symptom of many conditions, so a doctor will ask about a person's full medical history. Blood tests and imaging techniques, such as X-rays, CT scans, ultrasounds, and MRIs, are useful tools when the doctor is uncertain of the diagnosis. Periumbilical pain may not always suggest the presence of a condition involving the abdominal tract. For example, an abdominal aortic dissection can cause periumbilical pain but is a problem with blood flow. Treatment Treatment for periumbilical pain depends on the underlying cause. Surgery is the usual treatment for an umbilical hernia. However, people with umbilical hernias may develop another one, even after successful surgery. If the cause is acute appendicitis, a surgeon will need to remove the appendix immediately. Fluids, pain relievers, and antibiotics are also part of the treatment plan. People with mesenteric artery ischemia will also require surgery. Doctors will give a person fluids and antibiotics to help prevent an infection. After the operation, they will prescribe anticoagulants to prevent recurrence. Once a doctor confirms that a person has an abdominal aortic dissection, emergency surgery is necessary. Doctors will also usually prescribe beta-blockers. People with gastritis, esophagitis, or peptic ulcer disease do not require surgery. Doctors will treat these conditions using medications that can reduce the amount of acid in the stomach. Thank you for supporting Medical News Today When to see a doctor a patient with hyperkalemia speaking to doctor in office
A person should talk to a doctor if they have periumbilical pain, as a diagnosis is often difficult. People with periumbilical pain should seek medical attention, as it is often difficult to determine what is causing it. Some causes of periumbilical pain — such as appendicitis, small bowel obstruction, hernias, and aortic dissection — require surgery. People should always take children with periumbilical pain to a doctor. Certain conditions, including appendicitis, must receive prompt treatment. This is because the risk of complications increases over time. Gastritis, esophagitis, and peptic ulcer disease may not require emergency medical attention, but people should speak with a doctor about how to relieve symptoms and reduce the risk of complications. Summary People experiencing periumbilical pain should speak to a doctor, who can help determine the underlying cause. Doctors may find it challenging to diagnose periumbilical pain because it is a symptom of a variety of conditions. People with periumbilical pain may have a condition that affects a structure of the abdominal tract or a problem with blood flow to these structures. Many conditions that cause periumbilical pain require surgery to treat them. People with gastritis, esophagitis, and peptide ulcer disease may not require emergency medical care but should still seek advice from a doctor.
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7 'simple' steps for heart health may also stave off dementia

New research suggests that "Life's Simple 7" steps for maintaining heart health may also be a useful tool for predicting dementia risk and preventing the neurological condition.
senior monitoring his blood pressure
Managing your blood pressure is one of the seven actionable steps people in their 50s can take to maintain their cardiovascular health.

The lead author of the new study is Séverine Sabia, of the department of Epidemiology of Ageing and Neurodegenerative Diseases at Inserm, a public research institution affiliated with the Université de Paris in France.

Sabia and her colleagues set out to examine the link between the American Heart Association's (AHA) guidelines for optimal cardiovascular health — which they dub "Life's Simple 7" — and the risk of developing dementia later in life.

"Life's Simple 7" are modifiable risk factors which, according to the AHA, can help keep heart disease at bay.

Making lifestyle changes along these seven parameters can improve a person's cardiovascular health, the AHA advises. Life's Simple 7 are:

manage blood pressure manage cholesterol lower blood sugar stay physically active follow a healthful diet lose weight stop smoking (or don't start)

In the new research, Sabia and her team looked at how well people adhered to these steps at 50 years of age. They also examined the link with dementia over the following 25 years. The research team published its findings in The BMJ.

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Studying heart health and dementia risk

As the authors note in their paper, previous studies have already pointed to Life's Simple 7 as potential guidelines for preserving brain health into older age. However, the existing evidence has so far been inconclusive.

So, for the current study, Sabia and team examined data on 7,899 participants who were 50-year old British men and women. All of the individuals had taken part in the Whitehall II Study — an analysis of sociobehavioral factors on long term health.

At the start of the study, the participants were in perfect cardiovascular health and did not have dementia. The Whitehall II Study started in 1985–1988 and Sabia and team followed the dementia cases through to 2017.

Over the average follow-up period of 25 years, 347 of the 7,899 participants developed dementia at an average of 75 years old.

The researchers measured the adherence to the seven parameters by using a three point score for each of them.

In total, the "cardiovascular health score was the sum of seven metrics (score range 0–14), and the researchers categorized these into poor (scores 0–6), intermediate (7–11), and optimal (12–14) cardiovascular health."

A healthy heart may keep the brain healthy

After adjusting for potential confounders, the research revealed that a high adherence score to the seven cardiovascular parameters correlated with a lower risk of dementia later.

Specifically, in the group with a poor cardiovascular score, dementia occurred at a rate of 3.2 cases per 1,000 person years.

In the group with an intermediate cardiovascular score, the rate was 1.8 per 1,000 person years, while only 1.3 cases of dementia occurred per 1,000 person years among those who scored the highest.

Importantly, higher adherence to Life's Simple 7 at 50 years of age also correlated with a higher brain volume and higher grey matter volume at the average age of 70 years, as MRI scans reflected.

However, the study is observational and cannot establish causality. The participants also reported their own adherence to the cardiovascular parameters, which may have increased bias.

Nevertheless, "Our findings suggest that the Life's Simple 7, which comprises the cardiovascular health score, at age 50 may shape the risk of dementia in a synergistic manner," write the authors.

"Cardiovascular risk factors are modifiable, making them strategically important prevention targets," add Sabia and colleagues, concluding:

"This study supports public health policies to improve cardiovascular health as early as age 50 to promote cognitive health."

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Do rising obesity levels explain cardiovascular mortality trends?

For decades, deaths caused by cardiovascular events, such as stroke, had been on the decline in high income countries. Recently, however, this decline has come to a halt, and some countries are even experiencing rising rates of stroke and heart disease-related deaths. Why?
crowd of people in movement
In some high income countries, cardiovascular-related mortality rates are increasing, and researchers are wondering why this is happening.

"In high income countries, the very substantial decline in [cardiovascular] mortality over the past half-century has been a major, yet often unheralded, global public health achievement."

This is what Prof. Alan Lopez and Tim Adair, Ph.D. write in the introduction to a new study paper, published in the International Journal of Epidemiology. The journal reviews current trends in mortality associated with stroke, heart disease, and other cardiovascular diseases (CVD).

Prof. Lopez and Adair, from the University of Melbourne in Parkville, Australia, note that "recent evidence from national vital statistics systems in these countries suggests that the long term decline in CVD and specifically heart disease mortality may be stagnating, with rates even rising in some populations, particularly at ages [of under] 75 years."

The researchers looked at vital statistics recorded from 2000 onwards in 23 high income countries. These are Australia, France, Japan, Spain, Austria, Germany, the Netherlands, Sweden, Belgium, Greece, New Zealand, Switzerland, Canada, Ireland, Norway, United Kingdom, Denmark, Israel, the Republic of Korea, the United States, Finland, Italy, and Singapore.

These statistics all came from the World Health Organization (WHO) Mortality Database and included mortality rates related to cardiovascular events.

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Obesity trends may play key role

Lopez and Adair found that the rate of decline in CVD-related mortality has slowed down 'considerably' in 12 of the high income countries they investigated in their study. This, in particular, was the case for adults aged 35–74.

Moreover, the most recent data show that CVD death rates have increased for females in the U.S. and Canada over the last year. In Australia, the U.K., and New Zealand, the decline in cardiovascular mortality has slowed down from year to year.

So, why are people once more at an increased risk of premature death due to events such as stroke and heart disease, even in the richer countries of the world?

Prof. Lopez and Adair have a theory. They believe that part of the answer lies in the ever increasing rates of obesity that coincide with the trends in stroke and heart disease mortality.

"Each of these countries has very high levels of obesity. In Australia, close to one-third of adults are obese," notes Prof. Lopez.

"These increases in obesity levels mean that a significant portion of the population has been exposed to the cardiovascular disease risks associated with being overweight for several decades," he continues.

However, not all high income countries face an obesity epidemic. For instance, the researchers point out that Italy and France report the lowest number of cases of obesity among the 23 countries featured in the current study.

A threat to future life expectancy rates

This is why the researchers believe that obesity may only be one part of the problem. The rest may come down to the prevalence of other risk factors for cardiovascular problems, such as smoking, high blood pressure, and high cholesterol.

"Obesity, of course, is likely to be only a partial explanation; Italy and France, where the deceleration in [cardiovascular] mortality in recent years is among the most notable [...], each has below-average obesity levels but higher smoking prevalence among both men and women," the researchers write in their paper.

Going forward, the two authors suggest that countries should invest more in inputting preventive strategies and advising their citizens on the most healthful lifestyle choices.

"In order to combat this, significant investment in preventive health measures is needed, particularly those aimed at increasing physical activity, improving diet and reducing obesity," says Adair.

"Failure to address these issues could confirm the end of the long term decline in cardiovascular disease deaths and threaten future gains in life expectancy."

Tim Adair, Ph.D.

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Why older adults need regular metabolic risk screening

The Endocrine Society have revised their clinical practice guideline on identifying adults at higher risk for heart disease and type 2 diabetes.
doctor talking to senior patient
New guidelines recommend that older adults should undergo regular screening for metabolic risk.

The previous edition of the guideline was in 2008. The recent revision looks at metabolic risk in the light of the latest research on blood pressure and blood fats.

The emphasis is on measures to identify and decrease the risk of developing type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD) rather than on defining metabolic syndrome.

ACSVD is a type of heart or artery disease that develops as a result of atherosclerosis, a condition in which fatty deposits build up inside artery walls and cause them to narrow and impede blood flow. This process can lead to stroke and heart attack.

While the focus is on people aged between 40 and 75 years, the guide also applies to older and younger adults.

A recent paper in the Journal of Clinical Endocrinology & Metabolism details the new document.

The recommendations urge doctors to make regular checks of peoples' blood pressure, waist size, blood sugar, blood fats, and high density lipoprotein (HDL) cholesterol, which people sometimes call good cholesterol.

They urge doctors to measure waist size as a routine part of clinical exams. People should receive blood pressure checks at least every year, but more frequently if blood pressure is high.

The checks are in addition to the usual ones doctors use for assessing heart disease risk, such as smoking, family history, and low density lipoprotein (LDL) cholesterol, or bad cholesterol.

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Metabolic risk factors

The measurements assess five metabolic risk factors that can raise a person's risk of type 2 diabetes and ASCVD.

Waist size is a measure of abdominal fat, a high amount of which can indicate metabolic risk. Similarly, having low levels of HDL cholesterol, elevated blood sugar, and high levels of triglycerides (blood fats) are also potential indicators of metabolic risk.

"Doctors haven't been doing enough to measure waist circumference," says Dr. James L. Rosenzweig of the Hebrew Rehabilitation Hospital in Boston, MA, "but it's essential to identifying patients at metabolic risk earlier and preventing more cases of heart disease and diabetes."

Dr. Rosenzweig is chair of the panel that developed and wrote the guidelines.

People who have three or more of the five risk factors are at metabolic risk and therefore have a higher chance of developing type 2 diabetes and ASCVD.

The guideline suggests that doctors screen those with one or two risk factors every 3 years and those with three or more on a more frequent basis.

While the revised document discusses new medical options, it emphasizes that doctors should give priority to changing lifestyle and behavior.

Lifestyle and behavior changes

The guideline gives some specific recommendations on lifestyle and behavior changes.

For example, individuals at metabolic risk who have excess weight – according to body mass index (BMI), waist size, or both – should aim to lose 5% or more of their body weight during their first year of adopting a healthful lifestyle.

Another recommendation is that when treating people with prediabetes, doctors should prescribe lifestyle changes to reduce blood sugar before resorting to drug prescription.

Individuals at metabolic risk should also undergo "global assessment of 10-year risk for either coronary heart disease or atherosclerotic cardiovascular disease" to guide decisions on appropriate medical and drug treatments.

"Global risk assessment includes the use of one of the established cardiovascular risk equations," note the authors.

The purpose of a global risk assessment of a disease is to guide efforts to prevent it by assessing its major risk factors. The risk factor measurements go into an equation that calculates the risk of experiencing a major disease event in a certain period.

For example, a 10-year global risk assessment for coronary heart disease uses equations that bring together risk factors, such as cholesterol levels and blood pressure, to calculate the percentage risk of experiencing a significant health event in the next 10 years.

A 10% global 10-year risk of coronary heart disease, for instance, means that there is a 1 in 10 chance of having a heart attack or dying in the next 10 years.

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Future directions and genetic risk

The guideline document also has a section on knowledge gaps that warrant further research.

One such gap concerns the "identification and analysis of genetic markers for metabolic risk" and how they relate to ASCVD and type 2 diabetes.

In an extensive discussion about this topic, the authors conclude that while genetic markers appear able to predict ASCVD and type 2 diabetes, the risk prediction equations have not yet incorporated them.

They also point out that by changing their lifestyle to a more healthful one, a person can reduce the risk of ASCVD and type 2 diabetes "at any level of genetic risk and may have slightly greater benefits for individuals at higher genetic risk."

Currently, however, there is no data to back up the hypothesis that when people know their genetic risk, they are likely to change behavior and adopt more healthful lifestyles, add the authors.

"We emphasize the importance of lifestyle, dietary, and behavioral changes as the first line treatment. However, treatment with medication is appropriate if goals are not met with lifestyle changes alone."

Dr. James L. Rosenzweig

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Stopping statins may increase cardiovascular risk

A large new study following thousands of participants found that older people who stop taking statins have a significantly increased risk of hospital admission due to cardiovascular problems.
older man taking medication
New research suggests that interrupting statin use may increase the risk of poor cardiovascular health in older people.

Statins are a class of drugs that people take to keep their blood cholesterol levels under control.

Aside from this, they also have another use — that of protecting against heart disease and other cardiovascular conditions and events.

However, statins' effectiveness in protecting the heart health of older individuals has remained a matter of debate.

Knowing this, Dr. Philippe Giral, from Pitié-Salpêtrière Hospital in Paris, France, and a team of specialists set out to investigate how giving up statins could affect the health of healthy individuals aged 75 years and over.

"A particularly relevant practical question is whether existing statin therapy can be stopped in older people with no history of cardiovascular disease," write Dr. Giral and colleagues in their study paper, which appeared today in the European Heart Journal.

"This issue," the researchers add, "currently concerns a large proportion of the population over the age of 75 years, as well as large numbers of people under the age of 75 years, currently taking evidence-based treatment with statins and reaching ages for which only limited evidence of efficacy is available."

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In the current study, the team analyzed the health information of 120,173 participants living in France. All of these individuals reached the age of 75 years between 2012 and 2014, had no history of cardiovascular disease, and had been taking statins regularly in the 2 years prior to joining the study.

The team followed the participants' health developments over a maximum of 4 years, with an average follow-up period of 2.4 years.

During this time, the researchers noted that 17,204 individuals (14.3% of the total number of participants) stopped taking statins altogether for at least 3 months. In total, 5,396 (4.5%) of the study participants had to go to the hospital due to cardiovascular issues.

The researchers found that people who stopped taking statins had a 33% increase in the risk of requiring hospital admission for cardiovascular problems.

More specifically, older people who discontinued statin use had a 46% higher risk of experiencing heart problems and a 26% higher risk of experiencing a vascular event, such as a stroke.

"We estimated that an extra 2.5 cardiovascular events per 100 people would occur within 4 years among those who discontinued their statins at the age of 75 years compared to those who continued taking their statins," notes Dr. Giral.

Based on the study findings and the team's ensuing estimates, Dr. Giral advises older individuals not to halt their statin treatment later in life. Equally, the researcher suggests that doctors encourage their patients to continue taking any prescribed statins as a preventive therapy.

"To patients, we would say that if you are regularly [taking] statins for high cholesterol, we would recommend you don't stop the treatment when you are 75. To doctors, we would recommend not stopping statin treatment given for primary prevention of cardiovascular diseases in your patients aged 75."

Dr. Philippe Giral

While they say that the current study's findings provide some evidence to support the importance of statin use well into older age, the authors also caution that their investigation was observational. Thus, it shows an association between interrupting the use of statins and an increased risk of cardiovascular events.

Future work needs to determine whether this relationship is truly causational, the researchers note. Nevertheless, they believe that the current research can contribute to improving general guidelines regarding the use of statins as a preventive therapy.

"While we wait for results from randomized controlled trials, carefully conducted observational studies such as this can provide useful information for doctors and patients and can contribute to establishing more precise guidelines on the use of statins for primary prevention in the elderly," says co-author Prof. Joël Coste.

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Both blood pressure numbers may predict heart disease

According to new research, both high systolic and high diastolic blood pressure can lead to heart attack and stroke.
nurse taking patient's blood pressure
New research suggests that both blood pressure readings are equally important.

Heart disease and stroke are the leading causes of death worldwide. In the United States, more than 600,000 people die of heart disease every year. According to the Centers for Disease Control and Prevention (CDC), nearly one-quarter of deaths due to cardiovascular disease are preventable.

Blood pressure readings are critical for analyzing and monitoring blood pressure. These tests record blood pressure using two measurements: systolic and diastolic blood pressure. Understanding these numbers is key to controlling blood pressure.

The systolic pressure shows how much pressure the blood places on the arteries when the heart beats, while the diastolic blood pressure shows the pressure while the heart is resting between beats. The American Heart Association (AHA) advise that blood pressure numbers below 120/80 millimeters of mercury (mm Hg) are normal.

When readings range from 120–129 mm Hg systolic and less than 80 mm Hg diastolic, the person has elevated blood pressure. Hypertension occurs when blood pressure is consistently over 130 mm Hg systolic or more than 80 mm Hg diastolic.

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Which number is more important?

When doctors evaluate the risk of high blood pressure, they usually pay more attention to systolic blood pressure, which they consider a major risk factor for cardiovascular disease in older adults.

Decades of research have indicated that high systolic blood pressure is more likely than diastolic pressure to predict heart disease, but now, a new study finds that both numbers in blood pressure readings have a strong association with heart attack and stroke risk.

Researchers at Kaiser Permanente, a healthcare company in Oakland, CA, carried out the study, which appears in the New England Journal of Medicine.

The research involved more than 36 million blood pressure readings from 1.3 million people. The results challenged previous findings and showed the importance of both systolic and diastolic blood pressure.

"This research brings a large amount of data to bear on a basic question, and it gives such a clear answer," says Kaiser Permanente stroke specialist Dr. Alexander C. Flint, who is the lead author of the study.

The study's senior author is Dr. Deepak L. Bhatt, executive director of Interventional Cardiovascular Services at Brigham and Women's Hospital and professor of medicine at Harvard Medical School — both in Boston, MA.

Large amounts of data reveal the answer

Dr. Flint explains that previous research has influenced cardiology guidelines, which have focused primarily on systolic pressure to predict the risk of heart disease. Some experts even argue that it might be possible to ignore the diastolic number.

The new study is the largest of its kind. The findings confirmed that systolic pressure has a greater effect, but they also demonstrated that both systolic and diastolic pressure can predict the risk of heart attack or stroke.

The researchers analyzed the effects of systolic and diastolic hypertension on a variety of adverse outcomes, such as "myocardial infarction, ischemic stroke, or hemorrhagic stroke," over 8 years and found that both components independently predicted heart attack and stroke.

The recently updated American College of Cardiology and AHA guidelines now recommend more closely monitoring people at increased risk of high blood pressure. The findings of the new study that both systolic and diastolic hypertension have an effect at the lower threshold of 130/80 mm Hg support this change.

The National Institutes of Health's Systolic Blood Pressure Intervention Trial (SPRINT) has also produced similar results.

"This analysis, using a very large amount of longitudinal data, convincingly demonstrates that both are important, and it shows that in people who are otherwise generally healthy, lower blood pressure numbers are better."

Dr. Deepak L. Bhatt

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Vitamins and supplements for increased blood flow

Good blood flow delivers oxygen and vital nutrients to cells, tissues, and organs throughout the body.

Poor blood flow can give rise to many symptoms, including:

numb, tingling, or cold hands and feet swollen abdomen, legs, ankles, or feet digestive problems fatigue muscle cramping or joint pain paler or blueish skin slow healing time erectile dysfunction chest pain confusion or lightheadedness

Taking medications that improve blood flow may help manage conditions that cause poor circulation. However, some vitamins and supplements might also help increase circulation or contribute to healthy blood flow.

Learn about them, and what the research says, in this article.

Vitamins and supplements for blood flow Although there is no solid scientific evidence to support their use, many preliminary studies and research articles suggest that certain vitamins and supplements may improve blood flow. Examples include: Vitamin B-3 taking vitamins with B12 to increase blood flow
Vitamin B-3 may help increase blood vessel function and reduce blood levels of 'bad' cholesterol.

Vitamin B-3, or niacin, can help improve blood flow in several ways. For example, it can:

Inflammation in the blood vessels can lead to the development of conditions such as atherosclerosis, which can damage them or cause them to narrow.

As the National Institutes of Health (NIH) point out, vitamin B-3 may help lower cholesterol levels and triglycerides. However, it does not directly reduce the risk of heart attack or stroke.

It is essential not to take too much vitamin B-3, as it can cause adverse effects. The upper limit for adults is 35 milligrams (mg) per day.

Vitamin B-3 is available in capsules and as a powder in drugstores and online.


The body needs iron to make hemoglobin, the protein within blood that carries oxygen. The body also needs iron to make myoglobin, a protein that carries oxygen from the lungs to muscles.

The body also uses iron to make connective tissues, including those within blood vessels that allow them to control blood pressure.

Adults should never consume more than 45 mg of iron per day. Taking too much iron can cause serious side effects, such as vomiting and fainting. Taking a very high dose can lead to a coma and even be life threatening.

People can buy iron supplements at a pharmacy or online.

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L-arginine is a semi-essential amino acid present in some meats and nuts. It helps stimulate the release of nitric oxide, a compound that causes the smooth muscles lining blood vessel walls to relax.

The author of a 2016 review found some evidence for the use of L-arginine supplements to reduce both systolic and diastolic blood pressure, but he cautioned that the study was limited and the evidence was weak.

To get blood flow benefits, it may be important to consume L-arginine alongside B vitamins. Some research suggests that L-arginine cannot promote the release of nitric oxide without sufficient levels of folic acid and vitamins B-6 and B-12.

The same study looked at 80 adults, ages 40–65, with mild to moderately high blood pressure. The participants took 2.4 grams (g) of l-arginine, 3 mg of vitamin B-6, 0.4 mg of folic acid, and 2 micrograms of vitamin B-12.

After 3 months, those taking the supplements experienced significant improvements in blood vessel health and a reduction in blood pressure compared with those who took a placebo.

L-arginine is available for purchase online.

Omega-3 fatty acids

omega 3 pills on a black table.
A person can buy omega-3 fatty acids in most local pharmacies and online.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 fatty acids that encourage the release of nitric oxide. Nitric oxide relaxes blood vessels and improves blood flow.

In a 2014 study, healthy men who consumed 2.2 g of EPA and 1.4 g of DHA in a fish oil supplement once daily for 4 weeks experienced increased blood flow to their legs after exercise.

However, the Food and Drug Administration (FDA) recommend that people take no more than 3 g per day of EPA and DHA combined, from both dietary sources and supplements.

Look for omega-3 fatty acids in drugstores and online.


Compounds called capsaicinoids, which are present in some hot peppers, may improve blood flow because they:

reduce free radical damage and inflammation increase vascular health lower blood pressure reduce cholesterol levels reduce inflammatory chemicals within blood vessels

Many people take capsaicin as a supplement, but it is also present in many peppers, especially chilli peppers and cayenne peppers.

People should be aware that capsaicin can cause bothersome side effects, even in small doses. These include:

stomach pain burning sensations nausea bloating

Capsaicin is available to purchase in some drugstores and online.


Antioxidants called flavonoids may help reduce the risk of cardiovascular events.

In some in vitro studies, a particularly strong flavonoid called quercetin — which is present in onions — had the ability to improve blood vessel wall dysfunction linked to atherosclerosis, one of the leading causes of heart attack.

In a small 2013 study, 23 healthy men who consumed 4.3 g of onion extract (51 mg of quercetin) once daily for 30 days showed improved blood vessel widening after meals.

People can look for quercetin capsules online or at a pharmacy.

Beetroot powder

Red beetroot powder contains nitrates, which are compounds that the body converts into nitric oxide. Nitric oxide helps relax blood vessels, increasing how much blood they can carry.

In a small 2017 study of seven women and five men ages 57–71, those who drank 140 millilitres of nitrate-rich beetroot juice had significantly reduced blood pressure and blood vessel inflammation 3 hours later, compared with those who drank a placebo.

People can buy beetroot powder supplements online.

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Cinnamon contains cinnamaldehyde and cinnamic acid, two compounds that might relax blood vessels by producing nitric oxide and reducing inflammation.

Preliminary research has suggested that cinnamon consumption could help reduce systolic and diastolic blood pressure.

However, the NIH state that studies have not proven that cinnamon can help treat any health condition.

Cinnamon supplements are available in many grocery stores and online.

Learn more about the health benefits of cinnamon here.


Garlic contains powerful antioxidants and anti-inflammatory agents, such as allicin, which may help relax and widen blood vessels.

In a 2017 randomized, placebo-controlled trial, adults with coronary artery disease consumed either garlic powder or a placebo twice daily for 3 months.

The garlic powder improved blood flow in the upper arm compared with a placebo. However, the researchers did not find the evidence to be statistically significant. More research is necessary to determine if garlic is beneficial to blood flow.

Learn about the other possible benefits of garlic in this article.

People can often find garlic at their local grocery store. Those who do not like the taste can try supplements, such as these available for purchase online.


Curcumin is a naturally occurring phenol, a type of antioxidant, present in the spice turmeric.

In a 2017 study, 39 healthy, middle-aged and older adults consumed either 2,000 mg per day of curcumin or a placebo for 12 weeks.

Those who had curcumin experienced an improvement in elements of blood vessel functioning.

Curcumin is available for purchase in some drugstores, health food stores, and online.

Thank you for supporting Medical News Today Do they work? Eating a vitamin-rich diet is essential to blood vessel and cardiovascular health. That means getting the daily recommend amount of essential vitamins, minerals, and other nutrients contributes to good blood flow. In most cases, however, there is not enough research to know precisely how specific vitamins and supplements impact blood flow. Also, everyone responds to nutrients differently, especially based on factors such as underlying health conditions, age, and lifestyle habits. It is crucial to note that the FDA do not regulate supplements, so people should only purchase reputable brands. Other treatments for blood flow woman swimming in pool
A person may improve blood flow through lifestyle adjustments, such as exercising more. Plenty of lifestyle adjustments may help improve blood flow, including: exercising regularly eating a healthful, balanced diet staying hydrated reducing or managing stress getting a gentle massage quitting smoking Summary Many vitamins, minerals, and other supplements have the potential to help increase blood flow. However, not a lot of research suggests that any specific vitamin or supplement can directly improve blood flow. That said, consuming a healthful array of nutrients is vital for overall health. For people with circulation issues, vitamins may not be an appropriate treatment option. These individuals should speak to a doctor about medical options. Some supplements can interact with other medications or make certain conditions worse. Always talk with a doctor before trying supplements or vitamins for blood flow problems. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above.
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Heart disease: Millions taking daily aspirin without doctor's advice

New research suggests that many adults in the United States who take low dose aspirin daily to prevent heart disease could be at risk of harm.
close up of woman's hands taking aspirin
New research finds that more than 6 million U.S. adults take aspirin to prevent heart disease without a recommendation from their doctor.

The individuals potentially at risk include older adults and those who have or have had peptic ulcers.

Peptic ulcers are open sores that can occur in the stomach and small intestine. These painful lesions, which are prone to bleeding, affect about 10% of people.

The recent study suggests that close to 6.6 million U.S. adults are taking aspirin every day to protect against heart disease without seeking medical advice.

Researchers at Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, both in Boston, MA, report these findings in a recent Annals of Internal Medicine paper.

The lead author is Dr. Colin W. O'Brien, who is a fellow at Harvard Medical School and also a senior resident in internal medicine at BIDMC.

He and his colleagues note that a key message of their findings is that people without a history of cardiovascular disease who are taking aspirin daily to prevent heart attack or stroke should talk to their doctor about whether it is wise for them to continue.

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Revised guidelines

Aspirin works by reducing the stickiness of blood platelets and, therefore, decreasing their ability to clot. However, this same property also raises the risk of bleeding.

Until recently, the medical community supported the daily use of low dose aspirin for the prevention of cardiovascular events — such as heart attack and stroke — by those at higher risk.

The view was that, for those individuals, the benefits outweighed the risks.

However, the publication of three major studies in 2018 revealed that for many people, the dangers of internal bleeding offset the few benefits of aspirin use.

Those findings prompted the American Heart Association and the American College of Cardiology to revise the guidelines on aspirin use for the prevention of cardiovascular disease.

The new guidelines now advise that adults aged 70 years and older should not use daily low dose aspirin for the primary prevention of cardiovascular disease. They define a daily low dose as 75–100 milligrams.

In addition, the guidelines explicitly recommend against daily low dose aspirin for the primary prevention of cardiovascular disease in people of any age who have a raised risk of bleeding.

The recommendations do not apply to individuals who have already experienced a heart attack or stroke or to those who have undergone procedures such as stent insertion or bypass surgery to prevent cardiovascular events.

In a message accompanying the revised guidelines, the American Heart Association advise that unless a doctor prescribes it, people should avoid taking aspirin every day.

Doctors should ask about aspirin use

Dr. O'Brien and colleagues sought to determine the extent of regular aspirin use for the prevention of cardiovascular disease in the U.S.

Their data came from the 2017 National Health Interview Survey and covered adults aged 40 years and older.

They found that 23.4% of adults aged 40 year and older — which equates to about 29 million individuals — who did not have cardiovascular disease reported that they were taking aspirin daily to prevent heart disease.

Of these people, some 6.6 million were doing so without a doctor's recommendation.

The team was equally concerned to find that nearly 50% of those aged 70 years and older with no existing or previous cardiovascular disease were also taking aspirin to prevent heart disease.

The findings also revealed no significant link between lower use of aspirin and a history of peptic ulcers. This result is surprising given that doctors advise against regular use of aspirin if there is a history of peptic ulcer disease.

"Our findings show a tremendous need for healthcare practitioners to ask their patients about ongoing aspirin use and to advise them about the importance of balancing the benefits and harms, especially among older adults and those with prior peptic ulcer disease."

Dr. Colin W. O'Brien

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Paleo diet may be bad for heart health

New research has found that people who follow the Paleolithic, or Paleo, diet have high levels of a blood biomarker tied to heart disease. The finding raises some red flags about this type of diet, which, the researchers suggest, is not balanced enough to ensure good health.
image of steak and salad
Following the Paleo diet could threaten heart health, a new study finds.

The Paleolithic diet — often known as the Paleo diet, for short — claims to emulate what the ancestors of modern humans used to eat.

People who follow a Paleo diet have a high intake of meats, fruits, vegetables, nuts, and seeds, but no dairy, legumes, or whole grains.

This type of diet has been surrounded by controversy, and researchers have been debating whether or not it is safe and healthful.

For example, one study from 2016 suggests that the Paleo diet could protect against heart attacks and cardiovascular disease by raising blood levels of a protective molecule.

Yet, another study from the same year made a completely opposite discovery, concluding that this type of diet led to unhealthful weight gain and raised the risk of diabetes and cardiovascular problems.

Now, research conducted by a team from Australia points to more evidence suggesting that people who follow Paleo diets may be placing their heart health at risk.

The investigators hail from four different research institutions in Australia: the School of Medical and Health Sciences and the School of Science, both at Edith Cowan University, in Joondalup; the School of Molecular and Life Sciences, at Curtin University, in Bentley; PathWest Laboratory Medicine, in Nedlands; and CSIRO Health and Biosecurity, in Adelaide. The researchers' findings appear in the European Journal of Nutrition.

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High levels of heart disease biomarkers

The researchers — led by Angela Genoni, Ph.D. — worked with 44 participants who followed Paleo diets, as well as 47 participants who followed typical diets that met national dietary recommendations.

The follow-up period was over a year, during which the researchers collected biological samples from all the participants, assessed their diets, and compared results between the Paleo cohort and the control group.

Moreover, in order to be more precise in their assessment, the investigators split the participants who followed a Paleo diet into two further groups, according to their specific preferences:

strict Paleolithic (22 participants), including individuals who ate less than one serving per day of grains and dairy pseudo Paleolithic ( 22 participants), including individuals who ate more than one serving of grains and dairy per day

The researchers found that, across Paleo groups, individuals presented heightened blood levels of a compound that specialists associate with heart disease: trimethylamine N-oxide.

Trimethylamine N-oxide first forms in the gut, and its levels depend on a person's diet and the bacteria that populate their gut, among other factors.

"Many Paleo diet proponents claim the diet is beneficial to gut health, but this research suggests that, when it comes to the production of [trimethylamine N-oxide] in the gut, the Paleo diet could be having an adverse impact in terms of heart health."

Angela Genoni, Ph.D.

"We also found that populations of beneficial bacterial species were lower in the Paleolithic groups, associated with the reduced carbohydrate intake, which may have consequences for other chronic diseases over the long term," she adds.

Why Paleo might increase health risks

Genoni and the team argue that people following Paleo diets have such heightened levels of trimethylamine N-oxide because they do not consume whole grains. These are a great source of dietary fiber, and they help reduce a person's risk of cardiovascular problems.

"We found the lack of whole grains [was] associated with [trimethylamine N-oxide] levels, which may provide a link [with] the reduced risks of cardiovascular disease we see in populations with high intakes of whole grains," says Genoni.

"The Paleo diet excludes all grains and we know that whole grains are a fantastic source of resistant starch and many other fermentable fibers that are vital to the health of your gut microbiome," the lead researcher continues.

Moreover, the investigators point out that participants in the Paleo diet groups also had higher concentrations of the gut bacteria — Hungatella — that generate the compound.

"Because [trimethylamine N-oxide] is produced in the gut, a lack of whole grains might change the populations of bacteria enough to enable higher production of this compound," Genoni explains.

"Additionally, the Paleo diet includes greater servings per day of red meat, which provides the precursor compounds to produce [trimethylamine N-oxide]," she notes, "and Paleo followers consumed twice the recommended level of saturated fats, which is cause for concern."

In the conclusion to their study paper, the researchers warn that excluding whole grains from the diet can seriously impact gut health, with implications for heart health, as well. They also argue for the necessity of further studies into the role of vegetables and saturated fats in regulating key biological mechanisms in the gut.

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Misdiagnosis of the 'big three' results in 'serious harm'

Diagnostic mistakes are the most frequent medical error as well as the most serious, according to researchers from Johns Hopkins Medicine in Baltimore, MD.
doctor writing a prescription to a patient
New research identifies 15 conditions that doctors often misdiagnose.

It is not clear exactly how many people errors in diagnosis affect.

However, between 40,000 and 80,000 deaths in United States hospitals each year might be related to misdiagnosis, according to a new study.

Misdiagnosis may also play a role in 80,000–160,000 serious cases of harm to people's health each year.

To see which conditions doctors are most likely to misdiagnose and which may lead to death or disability, researchers analyzed over 11,000 cases from an extensive database of U.S. malpractice claims. The findings now appear in the journal Diagnosis.

"We know that diagnostic errors happen across all areas of medicine," explains first study author Dr. David Newman-Toker, Ph.D., director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence.

"There are over 10,000 diseases," he goes on, "each of which can manifest with a variety of symptoms, so it can be daunting to think about how to even begin tackling diagnostic problems."

However, the team's technique aimed to do something different. They classified the conditions according to a standard system, yet the grouping that followed was a new strategy.

"There are dozens of different diagnosis 'codes' that all represent strokes. The same is true for heart attacks and some of the other conditions as well," says Dr. Newman-Toker. "These differences often matter more for treatment than diagnosis."

"To my knowledge," he explains, "grouping these codes together to identify the most common harms from diagnostic error had not been done before, but doing so gives us an 'apples to apples' comparison of the frequency of different diseases causing harms."

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The 'big three'

The team saw that a "surprisingly small number of conditions" corresponded to the most significant diagnostic errors.

Three types of condition were responsible for nearly three-quarters of all "serious harm" related to misdiagnosis: infections, cancers, and vascular events. Combined, the researchers call these the "big three."

The scientists studied the severity and frequency of diagnostic errors in these conditions, along with where these faults took place.

Over one-third of the errors leading to death or permanent disability were linked to cancers. This figure reduced to 22% for vascular issues and 13.5% for infections.

Researchers broke down the "big three" into 15 specific conditions, the misdiagnosis of which often resulted in serious harm. Lung cancer, stroke, and sepsis came out on top.

The other 15 conditions included heart attacks, meningitis, pneumonia, blood clots in the legs and lungs, and cancers of the skin, prostate, and breast.

Most errors occurred during an emergency situation or in an outpatient setting. Cancer-related issues tended to occur in the latter location, while vascular and infection issues tended to occur in emergency departments.

"These findings give us a road map for thinking about what kind of problems we need to solve in which clinical settings," notes Dr. Newman-Toker.

The researchers' findings also showed the cause of most misdiagnoses: clinical judgment failures. There are a number of ways to combat this, according to the team, including improving teamwork skills and education, using technology to help with diagnosis, and giving people quicker access to medical specialists.

A funding fix

Dr. Newman-Toker says the findings will not provide "an easy or quick fix, but [they give] us both a place to start and real hope that the problem is fixable."

This fix, he says, will only become a reality if the government allocates enough funding.

"Our current annual federal investment to fix diagnostic errors is less than what we spend each year researching smallpox, a disease eradicated in the U.S. over half a century ago."

"If we devoted appropriate resources to tackling misdiagnosis of the 'big three' diseases we identified, we could potentially save half of the people who die or are permanently disabled from diagnostic errors."

Dr. David Newman-Toker, Ph.D.

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Study limitations and future research

However, the analysis did have a few limitations. The researchers remedied two of them — one that suggested a bias toward malpractice claims that are easier to bring forward, such as cancer, and the other being a dismissal of long term conditions that also cause serious harm.

The team corrected these biases by further analyzing previous studies that used data unrelated to malpractice claims.

This strengthened the validity of the "big three" findings but turned the tables to make vascular events and infections the most prominent.

However, they could not fix some of the other limitations. They based their analysis on malpractice cases rather than original medical records, which may have reduced accuracy and may be difficult to apply to the real world, where not all misdiagnoses result in a legal claim.

Future research could rectify this. In fact, Dr. Newman-Toker and his colleagues are planning to continue focusing on misdiagnosis, eventually using a national dataset to estimate how many people in the U.S. diagnostic mistakes detrimentally affect.

Before that, there will be a deeper dive into the "big three." Specifically, the researchers wish to examine the 15 conditions identified in the three categories, as well as how often doctors misdiagnose them.

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How an omega-6 fatty acid may keep heart disease at bay

New research in a mouse model zooms in on the cellular mechanisms that may explain the cardiovascular benefits of a specific kind of omega-6 fatty acid.
illustration of a heart
New research explains the potential benefit of an omega-6 fatty acid for heart health.

A plethora of studies have tackled the role of omega-3 fatty acids in heart health.

With about 18.8 million adults in the United States taking fish oil supplements in the hope that they stave off cardiovascular disease, omega-3 fatty acids have come under the scrutiny of several clinical trials and reviews.

However, their lesser-known cousin, the omega-6 fatty acid, has received less attention in the medical community; studies have yet to fully explore the cardiovascular effects of this essential fatty acid.

New research aims to fill this gap by looking at the effects of omega-6 on artery health. Specifically, the new study — led by Prof. Dipak Ramji, from the School of Biosciences at Cardiff University, in the United Kingdom — examines the effect of an omega-6 on atherosclerosis.

Atherosclerosis is a condition in which a buildup of plaque in the arteries makes them rigid and narrow. Over time, atherosclerosis can lead to clotting and blocking within the arteries. This can cause life-threatening events, such as strokes or heart attacks.

In fact, Prof. Ramji and colleagues mention in their paper, which appears in the journal Biochimica et Biophysica Acta — Molecular Basis of Disease, that "Atherosclerosis and its complications are responsible for 1 in 3 global deaths."

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Prof. Ramji and the team studied the effects of an omega-6 polyunsaturated fatty acid called dihomo-gamma-linolenic acid (DGLA) in a mouse model system of atherosclerosis.

Previous research showed that DGLA improved atherosclerosis in a model of mice that had been engineered to lack apolipoprotein E. But the mechanisms behind this effect were unclear.

So, this new research focused on the effects of DGLA on mouse immune cells called macrophages and found several mechanisms through which the essential acid may alleviate or prevent atherosclerosis.

Namely, DGLA attenuated "pro-inflammatory gene expression by three key cytokines: chemokine-driven monocytic migration; foam cell formation; and [vascular smooth muscle cell] migration," report the researchers.

"Our research indicates that the omega-6 fatty acid DGLA can have a positive effect on atherosclerosis at several stages, particularly by controlling key processes associated with inflammation and the ability of the cells to take up and process cholesterol."

Prof. Dipak Ramji

"We also observed the protective effects of DGLA on key atherosclerosis-associated processes in endothelial cells and smooth muscle cells — two other important cell types involved in the disease," the professor goes on to explain.

Finally, DGLA also improved mitochondrial function by reducing proton leak.

The researchers say that this is the first study to provide "detailed mechanistic insight" into the benefits of DGLA for atherosclerosis.

"This collaborative work opens up new and exciting avenues for research on the use of DGLA in the prevention and treatment of atherosclerosis. The challenge now is to take our findings and examine whether they translate into humans," concludes the researcher.

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What causes a pulse in the stomach?

For some people, feeling a pulse in the stomach may be a regular harmless occurrence. For others, it may be a sign of something more serious.

In some cases, a pulse in the stomach, or abdomen, might be due to an abdominal aortic aneurysm. An aneurysm occurs when a weakened area of a blood vessel swells, forming a bulge. In people with an abdominal aortic aneurysm, this occurs in part of the aortic artery in the abdomen.

People with this condition rarely experience any other symptoms unless the swelling tears or ruptures, which is a medical emergency.

In this article, we outline the causes of a pulse in the stomach and explain when to see a doctor. We also provide information on abdominal aortic aneurysms, including the symptoms, risk factors, diagnosis, and treatment.

Common causes Holding the stomach to feel a pulse
A person who is at increased risk of cardiovascular problems should see a doctor if they can feel a pulse in the stomach.

Feeling a pulse in the abdomen can be normal for some people, particularly older adults with a healthy body mass index (BMI). These individuals may notice this sensation when they are lying down or if they gently press down between the ribs and the navel.

However, those who are at increased risk of cardiovascular problems, such as heart attack and stroke, should see a doctor if they have this symptom.

Many of the risk factors for cardiovascular problems overlap with those for aortic aneurysms. These include:

Thank you for supporting Medical News Today Abdominal aortic aneurysm An aortic aneurysm is when the aorta bulges outward. The aorta is the largest artery in the body. It begins at the heart and extends down through the chest and abdomen. The abdominal aorta is the section of the aorta that sits deep inside the abdomen, just in front of the spine. Certain factors, such as aging or disease, can lead to the walls of the aorta weakening. Blood pumping through the artery may cause the weakened section to bulge outward. If the bulging occurs in the abdominal aorta, it is called an abdominal aortic aneurysm. Without treatment, the aneurysm may weaken to the extent that it tears or ruptures. What causes it? Most abdominal aortic aneurysms are due to atherosclerosis, which is when fatty deposits build up along the insides of artery walls, restricting blood flow through the artery. Other causes include injury and infection. Risk factors The following factors may increase the risk of an abdominal aortic aneurysm: Sex, age, and lifestyle factors Senior man smoking
Older men who smoke may be most at risk from an abdominal aortic aneurysm. People with the highest risk appear to be men aged 65 years and over who smoke or have previously smoked. The Centers for Disease Control and Prevention (CDC) recommend that male smokers or ex-smokers aged 65–75 years get an abdominal ultrasound screening, even if they have no symptoms. The authors of a 2014 review concluded that these screenings lead to fewer incidents of abdominal aortic aneurysm rupture and a decrease in mortality rates relating to the condition. Family history According to the National Institutes of Health (NIH), 1 in 10 people who develop an abdominal aortic aneurysm have a family history of the condition. People who have a first degree relative, such as a parent or sibling, with the condition have a 20% chance of developing the condition. Other risk factors Other risk factors include: high cholesterol high blood pressure atherosclerosis inflamed arteries emphysema, a lung condition Marfan syndrome Ehlers-Danlos syndrome Symptoms Abdominal aortic aneurysms usually develop gradually over many years. Most people who develop one do not experience any symptoms besides a pulse in the stomach, although even this is rare. For this reason, experts recommend ultrasound screenings for people with specific risk factors. When symptoms do occur, they are often sudden. The following symptoms are usually the result of a tear or leak in the aorta: intense or persistent pain in the abdomen or back pain that radiates down to the buttocks and legs a rapid heart rate low blood pressure difficulty breathing fainting nausea and vomiting feeling sweaty or clammy dizziness sudden weakness on one side of the body shock A severe tear or rupture in the aorta is an emergency, so anyone who has the above symptoms or witnesses someone else experiencing them should call for immediate medical help. Diagnosis Senior man having an abdominal ulrasound
A doctor may order an ultrasound to diagnose an abdominal aortic aneurysm. People should see a doctor if they suspect that they have an abdominal aortic aneurysm or if they have a higher risk of developing one. A doctor will examine the abdominal area and may listen to the abdomen with a stethoscope. To confirm the diagnosis, the doctor may order one or more of the following diagnostic tests: Abdominal ultrasound: This imaging technique uses sound waves to see tissues inside the body and can help determine the size of the aneurysm. Doppler ultrasound: This type of ultrasound uses sound waves to assess blood flow through arteries and veins. Abdominal and pelvic CT scan: This scan combines a series of X-ray images to give a detailed picture of tissues inside the body. It helps determine the size and extent of an aneurysm. Angiography: This test combines X-ray, CT, or MRI scans with a contrast dye to show major blood vessels inside the body. Thank you for supporting Medical News Today Treatment Treatment options will vary depending on the size and location of the aneurysm. The doctor will also take other factors into account, such as the person's age and health. For people with an aneurysm that is smaller than 5 centimeters (cm) in diameter, a doctor may recommend the following treatment plan: follow-up ultrasounds or CT scans every 6–12 months medications to control high blood pressure medications to lower cholesterol treatments to help with quitting smoking A doctor may recommend surgery for an aneurysm that is more than 5 cm in diameter or is growing rapidly or leaking. Surgical options include open surgical repair (OSR) and endovascular aortic repair (EAR). When to see a doctor Some people with a healthy body weight may be able to feel a pulse in their stomach. This symptom is often harmless, especially in those without any cardiovascular problems. However, feeling a pulse in the stomach could indicate an abdominal aortic aneurysm. People should see a doctor if they are concerned about their risks, especially because this condition often causes no symptoms. Having regular medical check-ups is vital for people who are at increased risk of developing aneurysms. Thank you for supporting Medical News Today Summary In some cases, feeling a pulse in the stomach is not a cause for concern. Many people who are at a healthy weight and do not have risk factors for cardiovascular issues can feel their pulse in their abdomen. In other cases, it may indicate a serious issue called an abdominal aortic aneurysm. People who have an abdominal aortic aneurysm rarely experience any symptoms before it ruptures, and they may not know that they have the condition. Not being aware of an aneurysm is dangerous because they usually weaken over time and become more prone to tearing or rupturing. People should see a doctor if they experience symptoms of an abdominal aortic aneurysm, are at a higher risk of developing one, or have a family history of the condition. A doctor may recommend managing the condition with medication, or they may suggest surgery to repair the weakened artery.
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