Wood Street Clinic Blog

Here you will find a selection of RSS feeds and blog entries

Surgery with ultrasound treats high blood pressure in trial

A minimally invasive surgical procedure that targets nerves leading to the kidneys could one day offer a safe way for some people to reduce their blood pressure medications.
older lady looking at blood pressure results with doctor
Scientists find a new way to optimize blood pressure control.

Investigators have announced the 6-month results of an international clinical trial on the safety and effectiveness of renal denervation by ultrasound as a treatment for mild to moderate high blood pressure.

The findings featured recently at the American College of Cardiology Conference in New Orleans and in a study paper in the journal Circulation.

Surgeons carry out the procedure, which takes about 1 hour, under local anesthetic. It decreases activity in nerves that link the brain to the kidneys and carry signals that regulate blood pressure.

The 2-month results from the randomized, controlled trial had already shown that the procedure resulted in a more significant reduction in blood pressure, compared with a "sham operation."

None of the people in the trial took their blood pressure drugs during the first 2 months. They then resumed blood pressure medication in a managed way, as necessary.

Now, the more recent results reveal that the participants who underwent the ultrasound surgery maintained their reduced blood pressure for 6 months.

Compared with those who had the sham operation, fewer participants who had the surgery needed to resume blood pressure medication, and those who did required fewer drugs at lower doses.

"These results," says lead trial investigator in the United Kingdom Melvin D. Lobo, a professor at Queen Mary University in London and also of Barts Health NHS Trust, both in the U.K., "point towards an exciting future for this new technology."

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Hypertension and kidney nerves

High blood pressure, or hypertension, is a growing global health issue. According to a report in The Lancet, between 1975 and 2015, the number of adults living with high blood pressure rose from 594 million to 1.13 billion.

Having high blood pressure increases the risk of heart disease, heart failure, and other conditions.

Some people can keep their blood pressure under control by watching their weight, doing plenty of exercise, and maintaining a healthful diet. Others may need to supplement these measures with medication.

However, some people struggle to control high blood pressure even with lifestyle changes and medication.

The kidneys have a rich system of nerves for sending and receiving messages.

Scientists have discovered that overactivity in this system can raise blood pressure through its interaction with the body's sympathetic nervous system.

Renal denervation by ultrasound is a treatment that aims to relieve high blood pressure by disrupting the nerves leading to the kidneys.

The procedure involves inserting a device through a catheter in the groin to reach up into the artery of a kidney. The device emits ultrasound waves that then heat up and damage some of the nerve fibers that surround the artery.

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6-month results look promising

The 6-month results report a comparison of the procedure with a sham operation in 140 people at 51 sites in Belgium, France, Germany, the Netherlands, the United Kingdom, and the United States.

After 6 months, 58 percent of those who underwent the procedure had maintained their lower blood pressure compared with 42 percent who had received the sham operation.

Overall, most of the participants needed to resume their medications to maintain blood pressure control. However, 35.8 percent of the renal denervation group were still not taking drugs at the 6-month point compared with only 15.5 percent in the sham operation group.

Those who underwent renal denervation also showed a greater reduction in blood pressure. After 6 months, the average reduction was 18.1 millimeters of mercury (mm Hg) in the treatment group and 15.6 mm Hg in the sham operation group.

There were no safety issues among any of the participants.

It is important to know that the company that manufactures the renal denervation device that the surgeons used in this trial also funded the study.

"If long-term safety and efficacy are proven in larger trials which are currently underway, we hope that renal denervation therapy could soon be offered as an alternative to many lifelong medications for hypertension."

Prof. Melvin D. Lobo

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Why your gut may hold the key to cardiovascular health

New research, which appears in The Journal of Physiology, examines the role that gut bacteria might play in preserving the health of our arteries.
illustration of a heart
Your gut may control the health of your arteries and heart, suggests new research.

An increasing number of studies suggest that the bacteria in our guts hold the key to healthy aging.

For instance, a recent conference that Medical News Today reported on featured research in the worm Caenorhabditis elegans. The results suggested that colonizing the gut with specific strains of bacteria, for example, can delay aging and prevent a host of age-related chronic diseases.

Now, research in mice strengthens the idea that gut bacteria mediate the aging process. Specifically, scientists have examined the link between the composition of the gut microbiota in mice and vascular aging.

Vienna Brunt, a postdoctoral researcher in the Department of Integrative Physiology at the University of Colorado, Boulder, is the study's lead author. Doug Seals, a professor and the director of the university's Integrative Physiology of Aging Laboratory, is the senior author.

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Studying gut bacteria and vascular health

Brunt and colleagues administered a "cocktail of broad‐spectrum, poorly absorbed antibiotics" to a group of young mice and a group of old mice. They added the antibiotics to the drinking water of the rodents for a period of 3–4 weeks to suppress their gut microbiota.

Next, the researchers examined the health of the rodents' vascular systems by measuring their arterial stiffness and the health of the endothelium — that is, the layer of cells that line the inside of the arteries.

Brunt and her team also examined the rodents' blood samples for markers of inflammation and oxidative stress, such as harmful free radicals.

Oxidative stress occurs when the body produces too many free radicals and does not have enough antioxidants to degrade them. Studies indicate that this phenomenon contributes to hypertension, cardiovascular disease, and aging in general.

The researchers also measured levels of nitric oxide, a compound that expands the blood vessels. Finally, they examined the "age-related changes" in each rodent's gut microbiota.

At the end of the study period, the scientists found that the old mice benefited greatly from the antibiotic treatment, while the intervention had no effect on young mice.

Specifically, "When you suppressed the microbiome of the old mice, their vascular health was restored to that of young mice," reports Prof. Seals.

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How old age influences gut health

Next, the scientists set out to identify certain age-related changes in the microbiota of rodents. Their aim was to understand how suppressing the microbiota may preserve vascular health.

To do so, they genetically sequenced the fecal samples of another group of old mice and compared them with those of young mice.

"In general, in the old mice, we saw an increased prevalence of microbes that are pro-inflammatory and have been previously associated with diseases," says lead author Brunt.

These included taxa of microbes that previous studies had linked with gut dysbiosis — an imbalance between the "friendly" bacteria in our guts and other pathogens.

For example, the study found that the old mice had a higher concentration of proteobacteria — a major class that includes well-known pathogens such as Escherichia coli, Salmonella, and Campylobacter bacteria.

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The scientists also analyzed blood plasma levels of a compound called trimethylamine N‐oxide, or TMAO. This is a "gut-derived metabolite," which means that it is a compound produced when microorganisms in the gut break down nutrients from food.

Although the role of TMAO in chronic disease remains uncertain, some previous studies found high levels of TMAO in people with "cardiovascular disease, kidney disease, type 2 diabetes mellitus, and cancer."

Specifically, recent studies have suggested that TMAO interacts with platelets and raises the risk of stroke and heart attack.

In the current study, the old mice had three times as much TMAO in their blood as the young mice, and the researchers found that antibiotic treatment suppressed TMAO levels.

Brunt and her team conclude:

"The results of the present study provide the first evidence for the gut microbiome being an important mediator of age-related arterial dysfunction and oxidative stress."

Fountain of youth may lie in the gut

The findings, continue the authors, also indicate "that therapeutic strategies targeting gut microbiome health may hold promise for preserving arterial function and reducing cardiovascular risk with aging in humans."

The researchers suggest that eating foods rich in probiotics, such as kefir, yogurt, or kimchi, may help preserve cardiovascular health well into old age.

Prof. Seals comments on the results, saying, "We have long known that oxidative stress and inflammation are involved in making arteries unhealthy over time, but we didn't know why arteries begin to get inflamed and stressed. Something is triggering this."

"We now suspect that, with age, the gut microbiota begins producing toxic molecules, including TMAO, which get into the bloodstream, cause inflammation and oxidative stress, and damage tissue," he continues.

In other words, say the authors, "The fountain of youth may actually lie in the gut."

"This is the first study to show that changes in the gut microbiome with aging have an adverse impact on vascular health. [...] It opens up a whole new avenue of potential interventions to prevent cardiovascular disease."

Vienna Brunt, Ph.D.

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10 minutes of leisurely activity per week may lower death risk

New research suggests that adults over the age of 40 who engage in leisurely physical activity — such as dancing, gardening, or going for a walk — for even a short amount of time each week may have a lower risk of death from multiple causes.
two mature women dancing together
Even short amounts of leisurely physical activity, such as dancing, may reduce a person's death risk.

Previous research has shown that engaging even in low-level physical activity — including leisurely tasks, such as gardening — may help protect brain health and cardiovascular health, among other benefits.

Now, a recent observational study, working with tens of thousands of people aged 40 and over has found a link between a lower risk of death from different causes and low levels of physical activity.

This was a collaborative study by researchers from the Shandong University in Jinan, China, the University of Texas Medical Branch in Galveston, and the University of Minnesota in Minneapolis, as well as from other research institutions.

The research — whose results appeared yesterday in the British Journal of Sports Medicine — indicate that people who spend even a short time each week being physically active have a lower risk of death linked to cardiovascular, cancer, and all-cause mortality.

At the same time, the study authors note that participating in more intense types of exercise, including running and cycling, do have the potential to bring more significant health benefits.

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Even low-level activity cuts death risk

The researchers analyzed data collected through the National Health Interview Surveys — a series of yearly surveys that ask people from the United States to offer information about their health and lifestyle habits.

First author Min Zhao and colleagues looked at information gathered in 1997–2008 from 88,140 adults in the U.S., with ages ranging from 40 to 85. They also collated that data, which referred to health and physical activity practices, with information from national death registers, available up to the end of 2011.

For reference, the team estimated that 1 minute of vigorous exercise would equate to 2 minutes of moderate-intensity activity, such as gardening, dancing, or going for a brisk walk. In their analysis, the researchers only included physical activities that lasted for 10 or more minutes at one time.

The researchers found that, unlike people who were very physically inactive, individuals who engaged in 10–59 minutes of moderate, leisurely physical activity per week had an 18 percent lower risk of all-cause death.

People who engaged in moderate physical activity for a little longer — between 150 and 299 minutes per week — saw an even steeper drop in all-cause death risk, of 31 percent.

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And those who spent 1,500 minutes or more being physically active in their leisure time each week experienced a 46 percent decrease in their overall mortality risk.

The researchers observed similar associations between increased levels of physical activity and the risk of death related to cancer.

Finally, individuals who spent 10–59 minutes per week doing leisurely physical activities saw a 12 percent lower risk of death tied to cardiovascular events, and people who were active for 120–299 minutes every week had a 37 percent lower risk of death due to cardiovascular causes.

However, the researchers note that engaging in physical activities for much longer than 1,500 minutes per week did not bring any extra benefits in this respect.

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More is not better, but more vigorous is

Although the authors acknowledge that this was an observational study that cannot determine cause and effect relationships, they also note that the considerable cohort size is representative and that their current findings support existing notions about the benefits of engaging in moderate physical activity.

Nevertheless, the results also showed that people who opted for vigorous rather than lighter physical activity had a much lower mortality risk.

The authors do note that participating in 1,500 or more minutes of moderate physical activity per week "is difficult to achieve for a working adult," so they advise that "[p]articipation in vigorous-intensity activity is more time-efficient than moderate-intensity activity."

"Assuming causality of the associations we observed, both low and high levels of [physical activity] have beneficial effects on all-cause and cause-specific mortality risk," the authors conclude, adding:

"Importantly, vigorous [physical activity] has added benefits for reducing mortality compared with moderate [physical activity]. Promoting [physical activity] of any intensity and amount is an important approach to reducing mortality risk in the general population."

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Higher cholesterol, egg consumption linked to heart disease

A recent study has linked higher consumption of eggs or dietary cholesterol to a higher risk of cardiovascular disease and premature death. The finding is likely to rekindle the debate on eggs and heart health.
close-up of hands preparing eggs in a pan
New research suggests that people should restrict their daily egg intake as part of a healthful diet.

For example, the new study seems to contradict the decision in the United States to omit specific limits on daily intakes of dietary cholesterol and eggs from official advice on healthful eating.

Researchers from Northwestern University Feinberg School of Medicine in Chicago, IL, and other institutions pooled and analyzed data from six U.S. cohort studies covering a total of 29,615 people. Of these, 45 percent were male and 31 percent were black.

They compared eating patterns at baseline, when the average participant age was 52 years, with cardiovascular diseases and deaths that occurred during a follow-up that lasted up to 31 years and whose midpoint was 17 years.

The team describes the findings in a JAMA paper.

Co-corresponding study author Norrina B. Allen Ph.D., an associate professor of preventive medicine at Northwestern, says that the "take-home message" of the study "is really about cholesterol, which happens to be high in eggs and specifically yolks."

"People who consume less cholesterol have a lower risk of heart disease," she adds.

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Guidelines do not limit cholesterol or eggs

According to the Centers for Disease Control and Prevention (CDC), heart disease is the "leading cause of death" in the U.S.

For decades there has been a debate about whether consumption of eggs or dietary cholesterol raises the risk of heart disease and early death.

The official recommendation in the U.S. before 2015 was that people should limit their daily egg consumption to no more than 300 milligrams (mg), which is less than two large eggs.

The more recent Dietary Guidelines for Americans 2015–2020, however, no longer provide limits on dietary cholesterol and egg intake. They include weekly intake of eggs as part of a healthful diet.

"Adequate evidence," they claim, "is not available for a quantitative limit for dietary cholesterol specific to the Dietary Guidelines."

The revised guidelines do, however, retain the message that the choice to drop specific limits does "not suggest that dietary cholesterol is no longer important to consider when building health[ful] eating patterns."

Only foods of animal origin — including dairy products, eggs, shellfish, poultry, and meat — contain dietary cholesterol.

Of the foods most typical of the U.S. diet, eggs contain the most cholesterol. There are around 186 mg of cholesterol in the yolk of a large egg.

The average U.S. adult consumes about 300 mg of dietary cholesterol per day and about three or four eggs per week.

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Higher risk of heart disease and death

Dr. Allen believes that the problem with studies that have found no links between egg consumption and higher risk of cardiovascular disease is that they used less diverse samples and shorter follow-ups, and that they were less able to adjust for other items in the diet.

"Our study," she notes, "showed if two people had [the] exact same diet and the only difference in diet was eggs, then you could directly measure the effect of the egg consumption on heart disease."

The dietary data for the new study came either from completion of questionnaires or interviews that took place during a single visit. These yielded details of what each person had eaten either in the previous year or month.

Around 5,400 cardiovascular events and 6,132 deaths from all causes occurred over the follow-up period. Examples of cardiovascular events include diagnoses of heart disease, stroke, and heart failure.

The scientists found that for "each additional" intake of 300 mg of dietary cholesterol per day, there was a significant 17 percent higher risk of cardiovascular disease and 18 percent higher risk of death from any cause.

The team also calculated the "absolute risk differences" for these results. These were 3.24 percent and 4.43 percent, respectively.

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In other words, for every 1,000 participants in their study, there were 32 additional diagnoses of cardiovascular disease and 4 deaths for every extra 300 mg of cholesterol consumed per day.

The analysis also showed that for each additional half egg eaten per day, there was a 6 percent higher risk of cardiovascular disease and an 8 percent higher risk of all-cause death.

The overall quality of people's diet, the type and amount of fat that they ate, and the amount of exercise that they undertook appeared to have no effect on these links.

"These results," explain the study authors, "should be considered in the development of dietary guidelines and updates."

Single snapshot of diet pattern

Among the study's strengths are the fact that it used a large and diverse sample of people from the U.S., and that there was a long follow-up period.

However, one limitation worth noting is that it only used a single snapshot of egg and cholesterol consumption, and that was at the beginning of the follow-up. People can change their eating habits, and 17–31 years offers plenty of opportunity to do so.

Commenting on the findings, Tom Sanders — who is a professor of nutrition and dietetics at King's College London in the United Kingdom — points out that because the study is prospective, it cannot establish cause and effect; it can only suggest links.

"However," he adds, "the take-home message supported by the accompanying editorial would support the view that a typical [U.S.] diet, which contains lots of meat and plenty of eggs, is associated with poor cardiovascular health and that the [country's] dietary guidelines should reinstate its recommendation that cholesterol intake should not exceed 300 mg per day."

"As part of a healthy diet, people need to consume lower amounts of cholesterol."

Norrina B. Allen Ph.D.

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Common blood pressure drug may increase cardiac arrest risk

A preliminary study concludes that a drug that doctors commonly prescribe to treat angina and blood pressure might increase the risk of sudden cardiac arrest.
Woman with chest pain sitting on a bench
A recent study looked at the risk factors behind cardiac arrest.

Cardiac arrest occurs when the heart stops pumping blood around the body. If a person does not receive treatment, cardiac arrest can be lethal within minutes.

According to the American Heart Association (AHA), in the United States, around 475,000 people die from cardiac arrest each year.

It claims more lives than colorectal cancer, breast cancer, prostate cancer, pneumonia, influenza, vehicle accidents, firearms, HIV, and house fires combined.

The AHA describe cardiac arrest "as one of the most lethal public health problems in the U.S." So, because cardiac arrest is both serious and common, understanding the risk factors involved is essential.

To this end, the European Resuscitation Council set up a project that collects data on cardiac arrest, called the European Sudden Cardiac Arrest network (ESCAPE-NET).

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A new risk factor?

A recent study using ESCAPE-NET data investigated whether a common group of drugs might play a role in cardiac arrest.

Healthcare providers use dihydropyridines to treat high blood pressure and angina, which is chest pain related to reduced blood flow to the heart. The project focused on two dihydropyridines: nifedipine and amlodipine.

The scientists had access to data from the Dutch Amsterdam Resuscitation Studies registry and the Danish Cardiac Arrest Registry, both of which form part of ESCAPE-NET.

The researchers presented their findings at EHRA 2019, the annual congress of the European Heart Rhythm Association, which is taking place in Lisbon, Portugal.

In total, they had access to data from more than 10,000 people who were taking dihydropyridines and 50,000 controls.

Their analysis showed that those who took high-dose nifedipine were significantly more likely to have an out-of-hospital cardiac arrest than those who were not taking dihydropyridines or who were taking amlodipine.

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Why might this be happening?

The scientists moved into the laboratory to examine why the actions of the two drugs differed. Both use the same mechanism, so why does one increase the risk of cardiac arrest while the other appears to make no difference?

Dihydropyridines work by blocking L-type calcium channels. When these channels are blocked, the action potential of cardiac cells becomes shorter.

The phrase "action potential" describes a change in the charge of a membrane associated with the transmission of an impulse. They occur in nerves and muscle cells.

This change could, potentially, drive the arrhythmias that lead to cardiac arrests.

Interestingly, these in vitro experiments matched the findings of the population study. High doses of nifedipine shortened action potentials significantly more than high-dose amlodipine.

"Nifedipine and amlodipine are often used by many cardiologists and other physicians, and the choice often depends on the prescriber's preference and personal experience."

ESCAPE-NET project leader Dr. Hanno Tan

Dr. Tan adds, "Both drugs are generally considered to be equally effective and safe and neither has been associated with sudden cardiac arrest."

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"This study suggests that high-dose nifedipine may increase the risk of sudden cardiac arrest due to fatal cardiac arrhythmia while amlodipine does not."

It is important to note that because this is a new line of investigation, it will be vital to replicate the findings using more participants and other demographics.

As Dr. Tan concludes, "If these findings are confirmed in other studies, they may have to be taken into account when the use of either drug is considered."

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CPR steps: A visual guide

People without first aid training can still save a life by performing CPR.

Performing CPR on someone having a cardiac or breathing emergency can help keep them alive until the emergency services arrive.

If a person carries it out immediately after a person's heart stops beating, CPR can double or even triple the chances of them surviving. CPR works by keeping the blood flowing until healthcare professionals can help them.

Use CPR when an adult is not breathing or when they are only gasping occasionally, and when they are not responding to questions or taps on the shoulder.

In children and infants, use CPR when they are not breathing normally and not responding.

cpr step-by-step visual-guide illustration
CPR steps: Quick reference Check that the area is safe, then perform the following basic CPR steps: Call 911 or ask someone else to. Lay the person on their back and open their airways. Check for breathing. If they are not breathing, start CPR. Perform 30 chest compressions. Perform two rescue breaths. Repeat until an ambulance or automated external defibrillator (AED) arrives. Read on for more detailed descriptions of how to perform CPR in adults, children, and infants. Thank you for supporting Medical News Today
CPR step-by-step There are two main stages to CPR: the preparation stage and the CPR stage. Preparation steps Before performing CPR on an adult, use the following preparation steps: Step 1. Call 911 First, check the scene for factors that could put you in danger, such as traffic, fire, or falling masonry. Next, check the person. Do they need help? Tap their shoulder and shout, "Are you OK?" If they are not responding, call 911 or ask a bystander to call 911 before performing CPR. If possible, ask a bystander to go and search for an AED machine. People can find these in offices and many other public buildings. Step 2. Place the person on their back and open their airways Place the person carefully on their back and kneel beside their chest. Tilt their head back slightly by lifting their chin. Open their mouth and check for any obstruction, such as food or vomit. Remove any obstruction if it is loose. If it is not loose, trying to grasp it may push it farther into the airway. Step 3. Check for breathing Place your ear next the person's mouth and listen for no more than 10 seconds. If you do not hear breathing, or you only hear occasional gasps, begin CPR. If someone is unconscious but still breathing, do not perform CPR. Instead, if they do not seem to have a spinal injury, place them in the recovery position. Keep monitoring their breathing and perform CPR if they stop breathing. CPR steps Use the following steps to perform CPR: Step 4. Perform 30 chest compressions Place one of your hands on top of the other and clasp them together. With the heel of the hands and straight elbows, push hard and fast in the center of the chest, slightly below the nipples. Push at least 2 inches deep. Compress their chest at a rate of least 100 times per minute. Let the chest rise fully between compressions. Chest compressions in CPR visual guide infographic
Step 5. Perform two rescue breaths Making sure their mouth is clear, tilt their head back slightly and lift their chin. Pinch their nose shut, place your mouth fully over theirs, and blow to make their chest rise. If their chest does not rise with the first breath, retilt their head. If their chest still does not rise with a second breath, the person might be choking. CPR rescue breaths visual guide illustration
Step 6. Repeat Repeat the cycle of 30 chest compressions and two rescue breaths until the person starts breathing or help arrives. If an AED arrives, carry on performing CPR until the machine is set up and ready to use. CPR for children and infants The CPR steps for children and infants are slightly different to the steps for adults, as below. Preparation steps To perform CPR on an infant or child, use the following preparation steps: Step 1. Call 911 or give 2 minutes of care First, check the surrounding area for factors that could put you in danger. Next, check the child or infant to see whether they need help. For children, tap their shoulder and shout, "Are you OK?" For infants, flick the sole of their foot to see if they respond. If you are alone with the child and they are not responding, give them 2 minutes of care and then call 911. If there is a bystander, ask them to call 911 while you give 2 minutes of care. If possible, ask a bystander to go and search for an AED machine. Offices and other public buildings tend to house these. If the child does respond, call 911 to report any life-threatening conditions. Step 2. Place them on their back and open their airways Place the child or infant carefully on their back and kneel beside their chest. Tilt their head backward slightly by lifting their chin. Open their mouth. Check for any obstruction, such as food or vomit. If it is loose, remove it. If it is not loose, do not touch it, as this may push it farther into their airways. Step 3. Check for breathing Place your ear next to their mouth and listen for around 10 seconds. If you do not hear breathing, or you only hear occasional gasps, begin to administer CPR. Changes in an infant's breathing patterns are normal, as they usually have periodic breathing. Keep monitoring their breathing and perform CPR if they stop breathing. CPR steps Use the following steps to perform CPR on a child or infant: Step 4. Perform two rescue breaths If the child or infant is not breathing, perform two rescue breaths with their head tilted backward and their chin raised. For a child, pinch their nose shut and place your mouth over theirs. Breathe into their mouth twice. For an infant, place your mouth over their nose and mouth and blow for 1 second to make their chest rise. Then, deliver two rescue breaths. If they are still unresponsive, begin chest compressions. Step 5. Perform 30 chest compressions Kneel beside the child or infant. For a child, use one of your hands. Place the heel of the hand at their sternum, which is in the center of the chest, between and slightly below their nipples. Press down hard and fast around 2 inches deep, or one-third the depth of the chest, at least 100 times per minute. For an infant, use two fingers. Place your fingers in the center of their chest, between and slightly below the nipples. Perform 30 quick compressions around 1.5 inches deep. Step 6. Repeat Repeat the cycle of rescue breaths and chest compressions until the child starts breathing or help arrives. Thank you for supporting Medical News Today When to use CPR and when not to CPR chest compressions being performed on unconscious man
Performing CPR when a person is not breathing can help prevent brain damage. Use CPR when an adult is not breathing at all. For a child or infant, use CPR when they are not breathing normally. Always use CPR if the adult or child is not responding when you talk to them or tap them. If someone is not breathing, giving CPR can ensure that oxygen-rich blood reaches the brain. This is important, as without oxygen, someone can sustain permanent brain damage or die in under 8 minutes. A person might need CPR if they stop breathing in any of the following circumstances: a cardiac arrest or heart attack choking a road traffic accident near-drowning suffocation poisoning a drug or alcohol overdose smoke inhalation electrocution suspected sudden infant death syndrome Only perform CPR if the adult is not breathing, or in children and infants, when they are not breathing normally, and their blood is not circulating. This is why it is important to ensure that the person does not respond to verbal or physical calls to attention before starting the CPR process. Summary CPR is a life-saving first aid procedure. It can significantly improve someone's changes of surviving if they suffer a heart attack or stop breathing following an accident or trauma. The steps vary depending on whether the person is an infant, child, or adult. However, the basic cycle of chest compressions and rescue breaths will remain the same. Only use CPR when an adult has stopped breathing. Check the person to see whether they respond to verbal or physical stimuli before starting CPR.
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Heart failure: New drug could halt disease and improve heart function

Heart failure occurs when the heart loses its ability to pump blood effectively. Current treatments can slow or stop the disease getting worse, but they can't regress it. Now, scientists have designed a molecule that could not only curb heart failure but also improve the heart's blood pumping ability.
a scientist designs a new molecule to treat heart failure
A new molecule could help prevent heart failure.

The researchers in Brazil and the United States who developed and tested the experimental drug have named it "SAMβA," which is short for "selective antagonist of mitofusin 1-β2PKC association."

When the researchers gave it to rats with heart failure, the molecule not only stopped the disease from progressing but also reduced its severity by improving the ability of heart muscle to contract.

The journal Nature Communications has now published a paper on how the researchers developed SAMβA and tested it on heart cells and rodent models of heart failure.

"The drugs in current use," says first study author Julio C. B. Ferreira, who is a professor in the Biomedical Science Institute at the University of São Paulo in Brazil, "halt [the] progression of the disease but never make it regress."

SAMβA works by blocking a specific interaction between the proteins mitofusin 1 (Mfn1) and beta II protein kinase C (β2PKC) whose association impairs mitochondria in heart muscle cells, causing the cells to die. Mitochondria are tiny compartments inside cell bodies that make the chemical energy cells need to function and live.

"We showed that by regulating this specific interaction, we could both halt [the] progression and make the disease regress to a less severe stage," Prof. Ferreira explains.

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Heart failure and causes

According to the most recent figures from the Centers for Disease Control and Prevention (CDC), in 2016 there were around 5.7 million people in the United States living with heart failure.

The body's organs and tissues require a constant supply of oxygen- and nutrient-rich blood to function and stay in good health.

Heart failure arises when the heart's ability to pump blood does not match the body's needs.

In a healthy heart, the heart muscle contracts and pumps freshly oxygenated blood into the aorta from where it travels to the rest of the body.

In a person with heart failure, the heart muscle is weak or damaged and does not fully contract, leaving some blood left to pool inside the organ.

People with heart failure often feel tired and fatigued and may experience shortness of breath as they go about their everyday lives. They can also struggle to breathe when they lie down, and they can put on weight due to swelling in the stomach, ankles, feet, or legs.

The most common causes of heart failure are diseases and conditions that weaken or damage the heart. These include coronary artery disease, heart attacks, high blood pressure, and diabetes.

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SAMβA 'is selective'

Failing hearts overproduce the protein β2PKC. Previous work by some of the researchers in Brazil had shown that blocking the protein improved heart function in people with heart failure.

However, while the β2PKC inhibitor that they used improved heart function, it also stopped the protein from doing other things that help the heart.

What the new study shows is that SAMβA "is more selective." It only blocks one specific interaction, and that is the one that β2PKC has with Mfn1 — the one that affects the function of mitochondria. It does not affect β2PKC's other interactions.

To show this, the team carried out a series of tests in cells, rodents, and samples of heart tissue from people with heart failure.

It reveals that β2PKC builds up on the outer wall of mitochondria and chemically alters the function of Mfn1 by adding a phosphate group to it. This leads to "buildup of fragmented and dysfunctional mitochondria in heart failure," note the study authors.

Scientists call the process through which β2PKC alters Mfn1 phosphorylation, and it is one of the "most common" mechanisms in cells for altering the function of proteins.

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The team experimented with various compounds to find candidate molecules that could block this interaction between β2PKC and Mfn1 to prevent the ensuing damage to mitochondria.

They identified six molecules that could block the β2PKC-Mfn1 interaction, but of these, only SAMβA did it in a way that did not affect β2PKC's other interactions.

Tests using human heart cells showed that, like the drugs already in use for the treatment of heart failure, SAMβA could curb the progression of the disease.

However, unlike conventional treatments, many of which have been around since the 1980s, SAMβA went a step further: it enhanced the ability of heart cells to contract, which is essential for effective pumping of blood.

The researchers observed that SAMβA also reduced a marker of oxidative stress in the heart cells. Oxidative stress can trigger cell death if the cell cannot defend itself against it.

In a final set of tests, the team induced heart failure in rats by provoking a heart attack. Unlike the rats that received a placebo, those that received SAMβA stopped showing signs of heart failure and showed improvement in heart function.

To make progress toward a clinical treatment, other teams now need to test the molecule independently. There is also a need to check its compatibility with other heart failure drugs.

"Validation and reproduction of our findings by other groups are critical to the process of developing SAMβA for use in treating heart failure. We will be seeking partners in the private and public sectors for this purpose."

Prof. Julio C. B. Ferreira

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What to know about mustard oil

Mustard oil comes from the seeds of mustard plants. It is rich in monounsaturated fatty acids, which appear to reduce the likelihood of developing cardiovascular disease. However, cooking with the oil may pose a serious risk, especially for children.

People have long used mustard oil in cooking and alternative medicine. It is common in Asian, notably Indian, cuisines. The oil's strong taste comes from a compound that is also present in horseradish and wasabi.

Mustard oil is rich in monounsaturated fatty acids, which could mean that it benefits cardiovascular health. It also contains a compound that may have anti-inflammatory properties.

However, the use of mustard oil is controversial, and the potential risks are so great that the Food and Drug Administration (FDA) have prohibited its use in cooking.

This article will discuss the benefits and risks of using mustard seed oil.

Cardiovascular benefits Mustard seed oil in glass jar surrounded by mustard seeds on table
Mustard oil may help lower the risk of cardiovascular disease.

Mustard oil is rich in monounsaturated fatty acids. Researchers have consistently found that including monounsaturated fatty acids in the diet can reduce the risk of cardiovascular disease.

One systematic review found that people with diets rich in monounsaturated fatty acids had lower blood pressure and less body fat than others who consumed fewer of these acids. A high proportion of body fat and high blood pressure increase the risk of cardiovascular disease.

While mustard oil contains high levels of these fatty acids, avocados and olive oil contain more.

It is important to note that these potential benefits are likely to be very small, compared with other factors that influence cardiovascular risk. Consuming mustard oil will not compensate for a broadly unhealthful diet or a lack of physical activity.

Thank you for supporting Medical News Today Anti-inflammatory potential Mustard oil contains a compound that could be useful for reducing inflammation: allyl isothiocyanate. One study found that allyl isothiocyanate has anti-inflammatory potential. The study's authors noted this effect in cell cultures, which are cells that researchers grow in a controlled setting. However, they also found that the anti-inflammatory effect was much smaller in mice. Results of a more recent study indicate that allyl isothiocyanate reduced inflammation and had a range of other benefits in mice with colitis, a condition that causes inflammation in the colon. Inflammation is a characteristic of a wide range of health issues, and it can cause a host of symptoms. If allyl isothiocyanate can reduce inflammation, mustard oil could help treat these issues. However, there is currently very little evidence to support the idea. Nutritional content Mustard is a plant native to Europe. There are several varieties, and the seeds are ingredients in many foods and condiments. Producing mustard oil involves pressing or grinding these seeds. The oil is much more potent than the condiment called mustard. Mustard oil is predominantly made up of monounsaturated fatty acids. In 100 grams (g) of mustard oil, there are: 59 g of monosaturated fatty acids 21 g polyunsaturated fatty acids 11 g saturated fatty acids The allyl isothiocyanate in the oil gives mustard its strong taste and may contribute some health benefits. This compound is also present in foods such as horseradish and wasabi. Thank you for supporting Medical News Today Dangers and side effects Woman preparing food in kitchen for cooking recipe while child in foreground plays on tablet
Mustard oil is not safe for use as a cooking oil. Mustard oil may pose a serious risk because it contains high levels of erucic acid. This monounsaturated fatty acid is present in several oils. In small doses, erucic acid is safe, but higher levels may be dangerous. Research in animals indicates that, over long periods, erucic acid may cause a heart condition called myocardial lipidosis. It is unclear whether humans experience the same effect, but high levels of erucic acid could pose risks to certain groups, such as children. In 2016, the FDA issued a warning that mustard oil is not safe to use in cooking because of its high erucic acid content. This means that the FDA do not permit its use as a cooking oil in the United States. How to use It is never safe to use pure mustard oil in cooking or to take it as a dietary supplement. It is best to avoid eating or drinking it. Topical application of mustard oil Mustard oil is available as an essential oil. The safest method of using it is to dilute it in a carrier oil and apply it to the skin. People should not diffuse mustard essential oil close to anyone who may be allergic to it. Taken orally, mustard essential oil is toxic. Thank you for supporting Medical News Today Takeaway Mustard oil is rich in monounsaturated fatty acids and could have some health benefits. However, there is little direct scientific evidence to support the idea. Mustard oil may pose a serious health risk, and the FDA prohibit its use in cooking. In the future, more research may better determine the safety of using mustard oil. Until then, it is best to avoid the product.
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Is high blood pressure always bad?

Hypertension, or high blood pressure, is a risk factor for several health conditions, including cardiovascular problems, diabetes, and other metabolic issues. However, is high blood pressure always a cause for concern? New findings question that assumption.
senior woman checking blood pressure
Having high blood pressure may sometimes have a protective effect.

Up to 75 million adults in the United States have high blood pressure, according to the Centers for Disease Control and Prevention (CDC).

What is high blood pressure? Well, it is hard to accurately answer that question, as specialists are still debating what counts as normal blood pressure.

Different organizations currently offer different guidelines on high blood pressure.

For instance, the National Heart, Lung, and Blood Institute explain that, among adults, hypertension is a "consistent systolic reading of 140 mm Hg [millimiters of mercury] or higher."

However, the American Heart Association (AHA) suggest that hypertension occurs when a person has a systolic blood pressure of 130 mm Hg or above. Meanwhile, the CDC consider people with systolic blood pressure of 120–139 mm Hg as being only "at risk" of hypertension.

Generally speaking, doctors advise their patients — especially older adults — to keep monitoring their own blood pressure and keep it in check.

This is to make sure that it does not reach the threshold for hypertension, which many healthcare professionals consider to be a risk factor for heart disease and stroke, among other things.

Now, however, a study that researchers at Charité - Universitätsmedizin Berlin in Germany carried out suggests that some older people may not face other health problems if they have high blood pressure.

In fact, the researchers note, some people in their 80s may even see some benefits.

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The new study — the findings of which appear in the European Heart Journal — looked at a cohort of 1,628 women and men with a mean age of 81 years. All were 70 or older when they joined in 2009, and they were all following antihypertensive treatments.

Researchers collected data about the participants' health status through the Berlin Initiative Study, a Charité research project. They questioned participants every 2 years and assessed their blood pressure, among other health measurements.

At the 6-year mark, the investigators performed a statistical analysis to find out how blood pressure could affect a person's mortality risk. They also adjusted for potential confounding factors, such as sex, lifestyle choices, body mass index (BMI), and how many drugs for high blood pressure each person took.

They saw that people aged 80 and over who had a lower blood pressure — of 140/90 mm Hg or under — actually had a 40 percent higher mortality risk than peers with blood pressure exceeding those thresholds.

Even people who'd already had a stroke or a heart attack presented a similar link between blood pressure levels and mortality risk.

The team also emphasizes that people with blood pressure lower than 140/90 mm Hg had a 61 percent higher risk of death than those whose blood pressure remained high in spite of their antihypertensive drug regimen.

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"Our results show clearly that, within these groups of patients, antihypertensive treatment should be adjusted based on the needs of the individual," notes first study author Dr. Antonios Douros.

"We should move away from the blanket approach of applying the recommendations of professional associations to all groups of patients."

Dr. Antonios Douros

In the future, the scientists aim to have a more in-depth look at blood pressure-lowering medication to establish when it is actually most likely to help.

"As a next step, we want to study which groups of patients actually benefit from antihypertensive treatment," concludes study co-author Prof. Elke Schäffner.

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Napping may be as good as drugs for lowering blood pressure

A midday nap may be just what you need, not just to boost your energy levels but also to lower high blood pressure. This, at least, is what new research from Greece suggests.
older woman taking a nap on the sofa
Napping could effectively help lower your blood pressure, new findings reveal.

When the afternoon slump hits in the middle of a busy workday, many of us may feel tempted to catch some shut-eye in a quiet corner.

Daytime napping can definitely help boost our energy levels and productivity for the rest of the workday, but does it bring any other health benefits?

A new study that investigators from the Asklepieion General Hospital in Voula, Greece conducted now suggests that taking a nap at midday can effectively help people lower their blood pressure levels.

One of the study researchers, Dr. Manolis Kallistratos, is due to present the findings at the American College of Cardiology's 68th Annual Scientific Session in New Orleans, LA next Monday.

"Midday sleep appears to lower blood pressure levels at the same magnitude as other lifestyle changes. For example, salt and alcohol reduction can bring blood pressure levels down by 3 to 5 [millimeters of mercury (mmHg)]," reports Dr. Kallistratos.

In this study, the investigators worked with 212 participants who had a mean blood pressure of 129.9 mm Hg. According to guidelines from the National Heart, Lung, and Blood Institute, a person has high blood pressure if their readings of systolic blood pressure (pressure during a heartbeat) are 140 mm Hg or higher, and their readings of diastolic blood pressure (pressure between heartbeats) are 90 mm Hg or higher.

The participants were, on average, 62 years old, and close to one in four of them smoked, had a diagnosis of type 2 diabetes, or both.

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Significant drop in blood pressure

Dr. Kallistratos and team split the participants into two groups — one that practiced midday napping and one that did not take up this practice.

Over 24 consecutive hours, the researchers took note of the participants' blood pressure measurements, the duration of their midday naps, their general lifestyle choices (such as alcohol consumption and physical activity), and their pulse wave velocity, which measures artery stiffness.

To obtain accurate blood pressure measurements from the participants throughout the day, the investigators asked them to wear ambulatory blood pressure monitoring devices.

Dr. Kallistratos and colleagues also adjusted for potential confounding factors that could affect blood pressure, such as age, biological sex, prescription medication, and lifestyle choices. They noted that there were no significant differences between how many blood pressure drugs participants in the two groups took.

The researchers found that people who took a daytime nap saw a 5.3 mm Hg drop in systolic blood pressure, which, the researchers explain, is about as much as someone could expect when taking blood pressure medication or making certain lifestyle changes to lower blood pressure.

Moreover, the team adds that each additional 60 minutes of napping time reduced average 24-hour systolic blood pressure by 3 mm Hg. Dr. Kallistratos explains that taking low doses of specialized drugs can lower a person's blood pressure levels by about 5–7 mm Hg on average.

"These findings are important because a drop in blood pressure as small as 2 mm Hg can reduce the risk of cardiovascular events, such as heart attack, by up to 10 percent," says the researcher.

"Based on our findings, if someone has the luxury to take a nap during the day, it may also have benefits for high blood pressure," he adds, noting that "[n]apping can be easily adopted and typically doesn't cost anything."

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Researchers are confident in their findings

The researchers note that this is the first time that anyone has studied the effects of daytime naps on a person's blood pressure levels. Although the team encourages further research to replicate and validate the current results, its members are confident that their study offers important new information.

Dr. Kallistratos and colleagues explain that they made an effort to recruit study participants who reasonably controlled their blood pressure levels to ensure that their findings would be credible.

"The higher the blood pressure levels, the more pronounced any effort to lower it will appear," explains Kallistratos.

He continues, "By including people with relatively well-controlled blood pressure, we can feel more confident that any significant differences in blood pressure readings are likely due to napping."

The researchers observe that the results of their study should provide grounds for people to indulge in midday naps with less of a sense of guilt.

"We obviously don't want to encourage people to sleep for hours on end during the day," says Dr. Kallistratos, "but, on the other hand, they shouldn't feel guilty if they can take a short nap, given the potential health benefits."

"Even though both groups [of participants] were receiving the same number of medications and blood pressure was well controlled, there was still a significant decrease in blood pressure among those who slept during midday."

Dr. Manolis Kallistratos

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What to know about heart pacemakers

A pacemaker is a device that helps keep the heart beating regularly. It can represent a life-changing treatment for heart conditions such as arrhythmias, which involve the heart beating irregularly.

Inserting a pacemaker into the chest requires minor surgery. The procedure is generally safe, but there are some risks, such as injury around the site of insertion.

This article will discuss the purpose of a heart pacemaker, the insertion surgery, and the risks.

Purpose Close up image of a heart pacemaker
Doctors use pacemakers to treat heart conditions.

A pacemaker is a small electronic device for treating heart conditions, such as arrhythmias. This refers to a group of conditions that disrupt the rhythm of the heart.

The heart has two upper and two lower chambers. The upper chambers contract, pulling blood into the heart's lower chambers.

When the ventricles contract, they push this blood out of the heart so it can circulate throughout the body. This contraction is a heartbeat, and electrical signals are responsible for controlling the rhythm.

Cells in the upper chambers generate these electrical signals, which travel down the heart and coordinate its activity. An arrhythmia disrupts this electrical signaling, causing the heart to beat irregularly.

Tachycardia involves the heart beating too quickly, and bradycardia involves the heart beating too slowly. The heart can also beat irregularly in other ways.

Arrhythmias can prevent the heart from supplying blood properly. This can cause symptoms such as:

fatigue weakness fainting a rapid heartbeat shortness of breath chest pain

Severe cases can cause lasting damage to internal organs or cardiac arrest. A pacemaker can help reduce these symptoms by using electrical pulses to influence the rhythm of the heart. Depending on the problem, a pacemaker can speed up, slow down, or stabilize the heartbeat.

Pacemakers can address specific problems, such as atrial fibrillation. In this form of arrhythmia, the heart's upper chambers do not contract properly, and the ventricles are unable to pump enough blood out of the heart.

A pacemaker can ensure that the upper chambers contract properly. If a pacemaker is treating an arrhythmia, it is usually permanent.

Doctors can use pacemakers to monitor these types of conditions, and the devices can record a range of important health indicators, including heart activity. A pacemaker can automatically adjust the heart's electrical pulses, according to the information it records.

Otherwise, a person may need a temporary pacemaker, typically in response to acute heart trauma, such as a heart attack or drug overdose.

Thank you for supporting Medical News Today Procedure X-ray showing a heart pacemaker
The surgery to insert a heart pacemaker is a straightforward procedure. Surgery is necessary to insert a pacemaker into the chest. When preparing for the procedure, the doctor will assess the person's medical history and take blood tests. There will be forms to fill out, and the person will also need to fast. Before the surgery, a healthcare provider will insert an intravenous drip into a vein in the arm or hand. This will deliver a sedative and any other necessary medications. The doctor will then clean the injection site, which is near the shoulder. Next, they will insert a needle into a vein just below the collarbone. The doctor will use this needle to thread the wires that control the pacemaker through the veins, toward the heart. There are between one and three wires, depending on the type of pacemaker. The doctor will use fluoroscopy to guide the needles correctly. This involves continuous X-ray imaging that feeds live pictures to a monitor. They will test the wires to ensure that they are working properly before proceeding. The doctor then makes a small cut in the chest and inserts the pacemaker's generator and battery, which may resemble a small box. Finally, they will seal the incision and use an electrocardiogram to test the device. After surgery, it is often necessary to stay overnight in the hospital. This allows doctors and nurses to ensure that the device is working properly. Risks Inserting a pacemaker is a relatively safe procedure. A person is likely to feel some pain or tenderness around the area of insertion, but this should be temporary. Other risks involve: swelling or bleeding at the site of insertion infection blood vessel or nerve damage a collapsed lung a reaction to medications Thank you for supporting Medical News Today Outlook Inserting a heart pacemaker is a fairly straightforward and safe surgical procedure. A period of rest will be necessary, but a person can usually return to their regular routine within a few days. For the first 8 weeks, it is important to avoid sudden movements that involve moving the arms away from the body. Living with a pacemaker will require some adjustments. These include: avoiding putting pressure on the pacemaker knowing the pacemaker's upper and lower heart rate limits and ensuring that the heart rate stays within these limits remaining physically active, but stopping before getting too tired restricting contact with devices that can interfere with the pacemaker, such as mobile phones and microwave ovens visiting a doctor for checkups and if any problems occur An arrhythmia is a lifelong condition that can become severe. Pacemakers are a highly effective form of treatment, and they can help people with the condition lead relatively regular lives.
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New drug limits damage to heart muscle from heart attack

An experimental drug has shown great promise in limiting the damage that a heart attack can inflict on the heart. It targets a protein that plays a central role in the death of heart muscle cells.
medical illustration of a heart
New experiments in mice find that a small molecule can restrict the damage to heart muscle that a heart attack can cause.

Tests on mice have revealed that the drug could markedly reduce heart injury from a heart attack.

The small-molecule drug blocks the protein MAP4K4, which relays the oxidative stress signals that cause the death of heart muscle cells and damage to tissue.

"There are no existing therapies," says lead investigator Dr. Michael D. Schneider, from Imperial College London in the United Kingdom, "that directly address the problem of muscle cell death, and this would be a revolution in the treatment of heart attacks."

Schneider and the team report their findings in a paper that now appears in the journal Cell Stem Cell.

There, they also describe how they grew heart tissue from human stem cells and developed a way of modeling a "heart attack in a dish" for testing the drug.

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Heart attack and heart failure

Heart attack is the common name for myocardial infarction, which means the death of heart muscle tissue due to a lack of oxygen and nutrients. It occurs when a clot obstructs one of the arteries that bring nutrient- and oxygen-rich blood to the heart.

When they don't get enough oxygen and nutrients, the heart cells become stressed, generate stress signals, and eventually die.

Loss of cells damages the heart muscle, causing the heart to pump less efficiently. This leads to heart failure, which is a condition wherein the heart cannot pump enough blood to meet the body's needs.

According to the Centers for Disease Control and Prevention (CDC), around 5.7 million adults in the United States have heart failure.

People with heart failure struggle with everyday activities and get out of breath easily. They feel weak and tired nearly all the time and have trouble breathing when they lie down. Other symptoms include weight gain and swelling in the feet, ankles, legs, and stomach.

Thanks to treatments such as drugs that break up blood clots and stents that keep arteries open, an increasing number of people are surviving heart attacks. This means that the number living with heart failure is also increasing.

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Reducing cell death from oxidative stress

The stress signals that a heart attack induces in heart muscle also occur following blood flow restoration.

So, while it is crucial to restore blood flow following a heart attack, there is also a need to add treatments that limit this "reperfusion injury." Scientists have been searching for such treatments for some time.

Dr. Schneider and his team are the first to uncover the role of MAP4K4 in the process through which a heart attack, by inducing oxidative stress, kills heart muscle cells.

In their investigation, they revealed that MAP4K4 is active in heart tissue of people with heart failure, and also in mice, following a heart attack.

They then devised a number of "highly selective" small-molecule blockers of MAP4K4 and demonstrated that their use can effectively protect human heart muscle cells from "lethal experimental injury."

They used chemicals to induce oxidative stress in heart cells and human heart muscle tissue that they had grown from human induced pluripotent stem cells.

The team observed how oxidative stress activated MAP4K4 and how raising levels of the protein also made heart muscle cells more sensitive to it. Blocking the protein, on the other hand, protected the cells from stress-induced death.

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First to test drug on human cells

Following the cell experiments, the scientists selected one candidate small molecule and took it forward "into further proof-of-concept studies in mice."

The team found that giving mice the drug 1 hour after restoring blood flow to the heart reduced reperfusion injury "by more than 50 percent."

The researchers hope that their findings will lead to an injection that doctors can give to people about to undergo balloon angioplasty to open a blocked artery following a heart attack.

Another possibility is that such a drug could also help limit heart muscle damage from heart attacks in regions with no rapid access to treatments that restore blood flow.

The team believes that, because they tested the drug in a model that they had developed using human stem cells, it should stand a good chance of succeeding in human clinical trials.

"One reason why many heart drugs have failed in clinical trials may be that they have not been tested in human cells before the clinic. Using both human cells and animals allows us to be more confident about the molecules we take forward."

Dr. Michael D. Schneider

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Vascular risk factors tied to brain health

New research uncovers a host of vascular risk factors that may affect the health of our brains as we get older.
doctor explaining something to older lady
New research finds that some risk factors that affect the health of our blood vessels can also influence the health of our brains into old age.

It is no secret that the global population is aging at an increasingly fast pace. According to the World Health Organization (WHO), there were approximately 900 million people across the globe who were aged 60 and above in 2015. The WHO expect this number to jump to 2 billion by 2050.

According to the Population Reference Bureau, the number of seniors in the United States over the age of 65 may more than double from 46 million today to more than 98 million by 2060.

The burden of age-related chronic disease is also increasing. For instance, the Centers for Disease Control and Prevention (CDC) warn that the burden of Alzheimer's disease will double by 2060 when 13.9 million people in the U.S. will have the disease.

In this context, it is more important than ever to understand the mechanisms and risk factors behind age-related cognitive impairment.

New research, published in the European Heart Journal, examines the role that vascular risk factors, such as smoking, hypertension, or obesity, may play in brain health.

Dr. Simon Cox, a senior research associate at the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh in the United Kingdom, led the new research.

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Vascular risk tied with 'worse brain structure'

Cox and colleagues examined the brain scans of 9,772 people who were between 44 and 79 years old. They looked for any connections between the participants' brain structure and the following vascular risk factors: "smoking, hypertension, pulse pressure, diabetes, [high cholesterol], body mass index (BMI), and waist-hip ratio."

The study's senior author explains the methods used in the study, "We compared people with the most vascular risk factors with those who had none, matching them for head size, age, and sex."

The study found that all of these vascular risk factors — apart from high cholesterol — correlated with greater brain atrophy, less gray matter, and poor white matter health.

"We found that, on average, those with the highest vascular risk had around 18 [milliliters (ml)], or nearly 3 [percent], less volume of grey matter," reports the lead author, "and one-and-a-half times the damage to their white matter — the brain's connective tissue — compared to people who had the lowest risk; 18 ml is slightly more than a large tablespoon-full, or a bit less than a small, travel-sized toothpaste tube."

Gray matter is brain tissue located mostly on the surface of the brain that contains most of the neurons (nerve cells). White matter is tissue found deeper in the brain. White matter declines with age and previous studies have linked the loss of white matter integrity with "slower processing speed and poorer executive function."

The study's senior author further details the findings, saying, "We found that higher vascular risk is linked to worse brain structure, even in adults who were otherwise healthy."

"These links were just as strong for people in middle-age as they were for those in later life, and the addition of each risk factor increased the size of the association with worse brain health."

"Importantly," continues the researcher, "the associations between risk factors and brain health and structure were not evenly spread across the whole brain; rather, the areas affected were mainly those known to be linked to our more complex thinking skills and to those areas that show changes in dementia and 'typical' Alzheimer's disease."

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Lifestyle changes may improve brain aging

Of all the vascular risk factors the team investigated, smoking, hypertension, and diabetes had the most consistent associations with changes in brain structure.

Because it is possible to modify some of these vascular risks, the findings point to lifestyle changes that could improve brain health and ensure healthy cognitive aging.

"Lifestyle factors are much easier to change than things like your genetic code — both of which seem to affect susceptibility to worse brain and cognitive aging. Because we found the associations were just as strong in mid-life as they were in later life, it suggests that addressing these factors early might mitigate future negative effects."

Dr. Simon Cox

"These findings might provide an additional motivation to improve vascular health beyond respiratory and cardiovascular benefits," concludes the researcher.

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How yo-yo dieting impacts women's heart health

New research reveals worrying associations between yo-yo dieting and seven well-established markers of cardiovascular health.
woman eating breakfast
New research looks into how yo-yo dieting may affect a woman's cardiovascular health.

As if losing weight wasn't hard enough, up to 80 percent of people who manage to lose more than 10 percent of their body weight end up regaining the weight within a year.

Losing weight for a short period and then regaining it bears the name of yo-yo dieting, which some people refer to as "weight cycling."

Previous research has pointed out the potentially damaging effects of these repeated cycles of weight loss and weight gain.

Some studies have suggested that yo-yo dieting raises the risk of mortality from any cause, while others have pointed to an increased risk of death from heart disease in particular.

Another study suggested that yo-yo dieting can lead to a cardiometabolic "roller coaster" in which cardiovascular health remarkably improves with just a few weeks of healthful dieting, but the negative cardiovascular effects are immediate once the individual abandons the diet.

Now, scientists have turned their attention to the cardiovascular effects of yo-yo dieting in women.

Dr. Brooke Aggarwal, who is an assistant professor of medical sciences at Columbia University Vagelos College of Physicians and Surgeons in New York, led a team examining the effects of weight cycling on seven heart disease risk factors.

Dr. Aggarwal and her colleagues presented their findings at the American Heart Association's (AHA) Epidemiology and Prevention | Lifestyle and Cardiometabolic Health 2019 Scientific Sessions, which took place in Houston, TX.

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The researchers examined 485 women who had an average age of 37 years and a median body mass index (BMI) of 26.

The study participants reported how often in their lives they had lost at least 10 pounds and then regained the weight within a year.

The researchers assessed the women's health using "Life's Simple 7" — the risk factors that the AHA use to define ideal cardiovascular health.

"Life's Simple 7" uses seven modifiable risk factors to measure a person's heart health. These factors are: "smoking status, physical activity, weight, diet, blood glucose, cholesterol, and blood pressure."

Overall, 73 percent of the women in the study said that they had experienced at least one episode of weight cycling. These women were 82 percent less likely to have a healthy BMI, which the medical community defines as being between 18.5 and 25, than the women who had not had any episodes of yo-yo weight loss.

These women were also 65 percent less likely to fall within the "optimal" range of "Life's Simple 7." The AHA note that people in the optimal range have a much lower risk of heart disease and stroke than those who fall in the "poor" ranges.

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In the current study, the negative effects of yo-yo dieting were more noticeable in the women who had never been pregnant.

"The women without a pregnancy history were likely younger and might be those who started weight cycling at an earlier age," explains Dr. Aggarwal.

"We need to identify critical periods for the effect of weight fluctuation on heart disease risk over the life course to find out whether it is worse when women start on a dieting roller coaster at an early age," she continues.

However, the senior author emphasizes that the study cannot establish causality. The team was unable to determine whether yo-yo dieting negatively affects a person's ability to adhere to "Life's Simple 7" or whether the reverse is true.

"We hope to extend the study 5 to 10 years to confirm these results and look at long-term effects," Dr. Aggarwal says.

Although the current findings are not generalizable to men, "there has been prior research that showed similar results in men, with those who weight cycled having twice the risk of cardiovascular death in middle age," the author explains.

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Why do doctors underdiagnose these 3 conditions in women?

International Women's Day prompts us to celebrate women and womanhood. However, recent research suggests that women may face more than their fair share of challenges, including in receiving appropriate medical care. What are some of these challenges, and why do they occur?
blonde woman facing man
Why do women still have to fight to receive the correct diagnosis?

Women have played a vital role in the improvement of medical care across clinical fields.

Figures such as Dorothea Dix, who helped change the face of mental health care, Rosalind Franklin, who contributed to the discovery of human DNA structure, and Dr. Virginia Apgar, who put together the evaluation criteria assessing the health status of newborn infants, have revolutionized medicine.

Despite this, women and girls across the world still face challenges and discrimination in medical settings.

Only last year, for instance, senior staff from the Tokyo Medical School, as well as from Juntendo and Kitasato Universities in Japan, admitted to manipulating entrance exam scores so that fewer women candidates would qualify for their courses.

These admissions spurred endless debates about the degree to which women who choose medical care as a profession keep on facing waves of discrimination.

Such problems, however, do not stop at women trying to build a career in medical sciences. According to some reports, women also face discrimination as patients. Sometimes, their doctors fail to diagnose conditions they are struggling with, or offer them the wrong diagnosis and consequently, the wrong kind of therapy.

In this Spotlight feature, we will look at some of the conditions that doctors underdiagnosed in women and explore some of the possible reasons behind these lacks in medical care.

1. Endometriosis

One of the chronic conditions that many women struggle with for a long time before they manage to receive a correct diagnosis — if they ever do — is endometriosis.

woman in pain holding her abdomen
Women have to wait to get their endometriosis diagnosed for 'a disturbingly long time.'

Endometriosis is a progressive gynecological condition, which doctors currently consider incurable. Endometriosis occurs when the type of tissue that usually only lines the uterus grows in other parts of the body. This can include the ovaries, fallopian tubes, urethra, but also the bowel, kidneys, and other organs.

Symptoms of this condition include debilitating pain in the pelvic area, as well other parts of the body, heavy and persistent menstrual bleeding, spotting between periods, pain during sex with vaginal penetration, nausea and vomiting, severe headaches, and persistent fatigue.

These symptoms can often have a severe impact on an individual's quality of life, affecting their productivity, other aspects of their physical and mental health, and their relationships.

Estimates in the journal Fertility and Sterility indicate that 10–15 percent of women of reproductive age live with this condition, and 70 percent of women who experience chronic pelvic pain actually have endometriosis.

Researchers from the Endometriosis Association, which is an international research and advocacy organization, write, "The time from the onset of symptoms to diagnosis is disturbingly long." Two-thirds of the people they spoke to begin to experience symptoms of endometriosis during adolescence. However, most of these people do not seek medical attention immediately, and once they do, it can take doctors 10–12 years to make a correct diagnosis.

Typically, doctors can only diagnose endometriosis by conducting a laparoscopy. This is a minor surgical procedure in which a doctor inserts a tiny camera into the abdomen to look for lesions and abnormalities.

A doctor may prescribe pain relief medication or hormonal therapy for the management of endometriosis, but since this condition is progressive, many people require multiple and regular surgeries to remove the abnormal tissue growth.

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'So validating to know I wasn't weak or crazy'

One woman, aged 25, who spoke to Medical News Today, explained that she lived with severe endometriosis symptoms for years before she received a correct diagnosis.

Primarily, this was because both she, her family, and the doctors that she consulted, thought that her disabling symptoms were nothing more than "bad period pains," or else they mistook them for other health problems.

"I thought it was totally normal to have excruciating pain and 10-day-long heavy periods," she told us. "My mom, aunt, and grandmother all had the same experience, so I was always told 'that's just how it is for women in our family,'" she added.

"I thought maybe I was weak and not able to handle the pain as well as other girls. Last year I was diagnosed with deep infiltrating endometriosis and finally had an explanation and, most importantly, a treatment plan. It was so validating to know I wasn't weak or crazy, just dealing with a chronic condition."

She also told us that her journey towards a diagnosis was difficult and long-winded. "I've gone through three [general practitioners] and two gynecologists in 2 years," she explained. She added that because her condition affected several organs, she received many different — and incorrect — diagnoses before the doctors eventually identified the real issue.

"I have endometriosis on my bladder, urethra, kidneys, and bowel, so I wound up with many doctors saying 'you have [irritable bowel syndrome]' and 'you have [pelvic inflammatory disease],' when I knew this wasn't the case."

2. Coronary heart disease

Another health problem that doctors often fail to spot in women is coronary (or ischemic) heart disease (CHD). This disease occurs when the arteries that deliver oxygenated blood into the heart, so that the heart can pump it out to the other organs, become unable to "service" the heart effectively.

woman pressing her chest
Since researchers conduct most clinical trials in men, we still lack a clear idea of how heart disease manifests in women.

The symptoms of CHD vary from person to person, which can make the condition challenging for doctors to spot. However, more generally, symptoms also differ between men and women, and more women thus go undiagnosed until the condition becomes exacerbated.

The National Heart, Lung, and Blood Institute explain that symptoms can also vary between different types of CHD, and some people do not experience any symptoms at all. However, some common symptoms include angina (pressure in the chest area, especially during physical activity), neck pain, and fatigue.

They also state that "[h]eart disease is the leading cause of death for women," and that women are more at risk than men of developing non-obstructive CHD. This condition can occur when the arteries that go into the heart abnormally tighten or are "squeezed" by the surrounding tissue.

Unlike obstructive CHD, which is more likely to be characterized by tell-tale chest pain, non-obstructive CHD is often "silent" and may go unnoticed for a long time.

Past research published in the BMJ has argued that doctors often miss CHD in women because of the different set of symptoms and because women themselves do not seek medical attention early on.

"Women may have more atypical symptoms than men — such as back pain, burning in the chest, abdominal discomfort, nausea, or fatigue — which makes the diagnosis more difficult," the researchers write.

Moreover, they add that: "Women are less likely to seek medical help and tend to present late in the process of their disease. They are also less likely to have appropriate investigations, such as coronary angiography and, together with late presentation to hospital, this can delay the start of effective treatment."

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'Research has focused primarily on men'

Specialists have been trying to find better ways of assessing and diagnosing women with heart problems, but they acknowledge there is still a long way to go in this respect.

One review, which appears in the journal Circulation Research, notes, "For the past 3 decades, dramatic declines in heart disease mortality for both men and women have been observed, especially in the [over] 65 years age group."

"However," its authors add, "recent data suggest stagnation in the improvements in incidence and mortality of coronary heart disease, specifically among younger women."

But why is this the case? The study authors argue that it may all be down to the underrepresentation of female populations in clinical studies for heart and vascular problems. They write:

"For many decades, [cardiovascular disease] research has focused primarily on men, thus leading to an underappreciation of sex differences from an etiologic, diagnostic, and therapeutic perspective. As long as women are underrepresented in clinical trials, we will continue to lack data to make accurate clinical decisions on 51 [percent] of the world's population."

3. Attention deficit/hyperactivity disorder

Women do not just miss out on physical health diagnoses; this problem also extends to other conditions, such as behavioral conditions, and more specifically, attention deficit/hyperactivity disorder (ADHD).

two girls in tutus holding rag dolls
Girls and women with ADHD may never receive a diagnosis.

The National Institute of Mental Health define ADHD as "a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development."

Typically, doctors see ADHD as a problem specific to childhood, and the Centers for Disease Control and Prevention (CDC) note that in 2016 — the latest year for which data are available — around 6.1 million children in the United States had received an ADHD diagnosis.

Furthermore, according to the Anxiety and Depression Association of America, while approximately 60 percent of children with ADHD in the U.S. continue to experience the symptoms of this condition as adults, less than 20 percent of adults with ADHD receive the correct diagnosis.

If adults, in general, struggle to receive a diagnosis, the situation is even worse in the case of women. Research has shown that both families and healthcare professionals are biased towards believing that boys and men are more likely to have ADHD, and they are more likely to ignore similar symptoms in girls and women.

In fact, some sources indicate that up to three-quarters of all women with ADHD never receive a diagnosis, and in the case of children, doctors diagnose fewer girls than boys with ADHD.

Moreover, girls have to wait longer than boys to receive a diagnosis of ADHD. While boys, on average, receive a diagnosis at age 7, girls have to wait until they reach the age of 12 to get the same clinical attention.

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Some women think 'it is too late'

In a review published in The Primary Care Companion for Central Nervous System Disorders, researchers explain that in boys and men, ADHD manifests as hyperactivity and impulsiveness; in girls and women, this condition takes a different guise. In women and girls, the primary symptom of ADHD is inattentiveness, which doctors may struggle to spot. Often doctors take this less seriously.

The same source also suggests that girls and women with ADHD may develop ways of masking their symptoms. Some may appear to have better coping strategies than boys and men with the same condition.

Also, because people with ADHD sometimes have other mental health problems, such as anxiety, depression, and obsessive-compulsive disorder, the review authors point out that existing evidence indicates that doctors will much more eagerly diagnose women as living with a mental health condition, but deny them an ADHD diagnosis.

One woman — now in her 50s — who spoke to MNT told us that although she fits ADHD criteria and has lived with ADHD symptoms for a long time, she still has not received an official diagnosis.

"Therapists are pretty sure I have ADHD, the [national health services] still do not diagnose ADHD in adults and in particular women, and [only] direct you to do online tests," she explained, adding:

"[After] reading an article by a man in the United Kingdom that [said] it took years for him to get a diagnosis, I stopped worrying about it. It is too late to take medication for it at my age; as they say, [it would be like] shutting the stable door after the horse has bolted."

Although medical systems across the globe have come a long way in terms of providing better quality care at an appropriate time, such accounts make one issue very apparent, namely that discrimination is still present in clinical research and health care. To fight it, we must all learn how to listen — really listen.

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How TV and breakfast may impact heart health

Leading a sedentary lifestyle can be bad for our health. However, how much TV do we have to watch to negatively impact our cardiovascular health? Does eating a high-energy breakfast every morning affect our heart health? New research explores.
a tray with breakfast foods seen from above
Eating a breakfast rich in calories may keep heart disease at bay.

Previous studies have linked sedentarism with a range of adverse health effects.

These include obesity, type 2 diabetes, cancer, heart disease, and premature death.

Scientists suggest that sitting for long periods can impair the body's ability to regulate blood pressure and reduce blood flow.

They also argue that it can affect blood sugar metabolism and increase inflammation and oxidative stress, which scientists have linked to aging and disease. However, there are some ways to counter the negative effects of sedentarism.

New research has found that reducing the amount of time we spend watching TV and making sure we eat an energy-rich breakfast lowers the risk of heart disease and stroke. They can also reduce the amount of plaque that tends to build up in the arteries over time.

Dr. Sotirios Tsalamandris — who is a cardiologist at the First Cardiology Clinic at the National and Kapodistrian University in Athens, Greece — led the new study, which consisted of two parts.

The researchers presented their findings at the American College of Cardiology's 68th Annual Scientific Session, which this year takes place in New Orleans, LA.

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How watching TV affects heart health

In the first part of the study, Dr. Tsalamandris and his colleagues evaluated the various markers of cardiovascular health and lifestyle habits of 2,000 people, aged 40–99, from Greece.

The study participants included people who were at risk of developing heart disease or who had already developed the condition, as well as healthy individuals.

The cardiovascular markers that the researchers examined included carotid-femoral pulse wave velocity (which detects atherosclerosis) and the thickness of the arterial walls (which indicates plaque buildup and stroke risk).

Based on the participants' TV-watching habits, the researchers divided them into three groups:

the low group, wherein people watched TV for 7 hours or under per week the moderate group, wherein people watched TV for 7–21 hours per week the high group, wherein people watched TV for more than 21 hours per week

The research found that people in the high group had almost double the chances of plaque buildup in their arteries compared with those in the low group.

Also, watching more TV correlated with a higher risk of hypertension and diabetes. People in the high TV-watching group were 68 percent more likely to have hypertension and 50 percent more likely to have diabetes than those who watched TV for 7 hours or under per week.

Dr. Tsalamandris says, "Our results emphasize the importance of avoiding prolonged periods of sedentary behavior."

"These findings suggest a clear message to hit the 'off' button on your TV and abandon your sofa. Even activities of low energy expenditure, such as socializing with friends or housekeeping activities, may have a substantial benefit to your health compared [with] time spent sitting and watching TV."

Dr. Sotirios Tsalamandris

"[P]erforming recreational activities, weight lifting, stretching bands, or treadmill exercise while watching TV may be a health[ful] alternative," he adds.

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The importance of a high-energy breakfast

For the second part of the study, the researchers grouped the participants according to how many calories they took from their breakfast:

Individuals in the high-energy breakfast group took over 20 percent of their daily calories from their breakfast. Participants in this group tended to consume milk, cheese, cereals, bread, and honey for the first meal of the day. Those in the low-energy group derived 5–20 percent of their daily calorie intake from their breakfast, usually by consuming coffee or low-fat milk along with bread with butter, honey, olives, or fruit. One group consisted of people who did not have breakfast at all.

Overall, the participants who ate a high-energy breakfast on a regular basis were more likely to have more healthful arteries than people in the other two groups. "A high-energy breakfast should be part of a health[ful] lifestyle," says Dr. Tsalamandris.

"Eating a breakfast constituting more than 20 percent of the total daily caloric intake may be of equal or even greater importance than a person's specific dietary pattern, such as whether they follow the Mediterranean diet, a low-fat diet, or other dietary pattern[s]."

Dr. Sotirios Tsalamandris

However, the authors caution that because almost all of the participants followed a Mediterranean diet, the results may not be generalizable to a wider population.

They also speculate on the possible mechanisms behind their observational findings. One possible explanation, they say, could be that people who do not skip breakfast tend to have more healthful dietary habits overall, as well as more healthful lifestyles.

A second explanation could be that the foods eaten by those in the high-energy breakfast group, such as dairy, may in themselves have cardioprotective effects.

In the future, Dr. Tsalamandris and colleagues plan on following these participants for at least a decade to assess whether any environmental exposures also affect the results.

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How does smoking affect the body?

Smoking cigarettes can have many adverse effects on the body. Some of these can lead to life-threatening complications.

In fact, according to the Centers for Disease Control and Prevention (CDC), smoking cigarettes increases the risk of dying from all causes, not just those linked to tobacco use.

Smoking cigarettes affects the respiratory system, the circulatory system, the reproductive system, the skin, and the eyes, and it increases the risk of many different cancers.

In this article, we look at 10 possible effects of smoking cigarettes.

Effects on the body smoking <br>Image credit: Stephen kelly, 2019</br>
Image credit: Stephen Kelly, 2019
1. Lung damage Smoking cigarettes affects lung health because a person breathes in not only nicotine but also a variety of additional chemicals. Cigarettes are responsible for a substantial increase in the risk of developing lung cancer. This risk is 25 times greater for men and 25.7 times greater for women. The CDC report that roughly 9 out of 10 lung cancer deaths is linked to smoking. Smoking cigarettes also presents a greater risk of developing and dying from chronic obstructive pulmonary disorder (COPD). In fact, the American Lung Association report that smoking causes 80 percent of COPD deaths. Cigarettes are also linked to developing emphysema and chronic bronchitis. They can also trigger or exacerbate an asthma attack. 2. Heart disease Smoking cigarettes can damage the heart, blood vessels, and blood cells. The chemicals and tar in cigarettes can increase a person's risk of atherosclerosis, which is the buildup of plaque in the blood vessels. This buildup limits blood flow and can lead to dangerous blockages. Smoking also increases the risk of peripheral artery disease (PAD), which occurs when the arteries to the arms and legs start to narrow, restricting blood flow. Research shows a direct link between smoking and developing PAD. Even those who used to smoke face a higher risk than people who never smoked. Having PAD increases the risk of experiencing: 3. Fertility problems Smoking cigarettes can damage a female's reproductive system and make it more difficult to get pregnant. This may be because tobacco and the other chemicals in cigarettes affect hormone levels. In males, the more cigarettes a person smokes and the longer they smoke for, the higher the risk of erectile dysfunction. Smoking can also affect the quality of the sperm and therefore reduce fertility. Thank you for supporting Medical News Today
4. Risk of pregnancy complications Woman smoking a cigarette in her car
Smoking can increase the risk of ectopic pregancy and reduce the baby's birth weight. According to the CDC, smoking can affect pregnancy and the developing fetus in several ways, including: increasing the risk of ectopic pregnancy reducing the baby's birth weight increasing the risk of preterm delivery damaging the fetus's lungs, brain, and central nervous system increasing the risk of sudden infant death syndrome contributing to congenital abnormalities, such as cleft lip or cleft palate 5. Risk of type 2 diabetes The CDC report that people who smoke regularly have a 30–40 percent higher risk of developing type 2 diabetes than those who do not. Smoking can also make it more difficult for people with diabetes to manage their condition. 6. Weakened immune system Smoking cigarettes can weaken a person's immune system, making them more susceptible to illness. It can also cause additional inflammation in the body. 7. Vision problems Smoking cigarettes can cause eye problems, including a greater risk of cataracts and age-related macular degeneration. Other vision problems related to smoking include: Thank you for supporting Medical News Today 8. Poor oral hygiene People who smoke have double the risk of gum disease. This risk increases with the number of cigarettes a person smokes. Symptoms of gum disease include: swollen and tender gums bleeding when brushing loose teeth sensitive teeth Smoking tobacco can limit a person's ability to taste and smell things properly. It can also stain the teeth yellow or brown. 9. Unhealthy skin and hair Smoking tobacco can affect a person's skin and hair. A person who smokes may experience prematurely aged, wrinkled skin. They also have a higher risk of skin cancer, "especially on the lips." Smoking can cause the hair and skin to smell of tobacco. It can also contribute to hair loss and balding. 10. Risk of other cancers In addition to the well-documented link with lung cancer, smoking cigarettes can also contribute to other forms of cancer. The American Cancer Society report that cigarette smoking causes 20–30 percent of pancreatic cancers. People who smoke are also three times as likely to develop bladder cancer than people who do not. Smoking cigarettes can also double a person's risk of stomach cancer. Tobacco is especially linked to stomach cancers that occur near the esophagus. Cigarettes can also increase the risk of: Secondhand smoke man smoking at his computer
Secondhand smoke can increase the risk of colds, make asthma worse, and damage the heart. The ill effects of smoking cigarettes do not only affect people who smoke. Secondhand smoke can also have significant health effects on family members, friends, and coworkers. Effects of exposure to secondhand smoke include: increasing the risk of colds and ear infections making asthma worse raising blood pressure damaging the heart reducing levels of high-density lipoprotein, or "good," cholesterol Thank you for supporting Medical News Today Quitting While quitting smoking can be challenging, the CDC report that today, there are more people who used to smoke than people who currently smoke. Once a person stops smoking, the benefits start accumulating. These include clearer skin, improved oral health, more stable hormones, a stronger immune system, and a reduced risk of many types of cancers. Some other benefits of quitting smoking include: After 20 minutes–12 hours: Heart rate and carbon monoxide in the blood drop to normal levels. After 1 year: The risk of a heart attack is much lower, as is blood pressure. Coughing and upper respiratory problems begin to improve. After 2–5 years: The risk of stroke drops to that of someone who does not smoke, according to the CDC. After 5–15 years: The risk of mouth, throat, esophagus, and bladder cancer is reduced by half. After 10 years: The risk of lung cancer and bladder cancer is half that of someone who currently smokes. After 15 years: The risk of heart disease is similar to that of someone who never smoked. Nicotine is an addictive drug and can cause withdrawal symptoms when a person stops using it. These symptoms including cravings, increased appetite, and irritability. Cravings and other effects typically subside over time. A doctor or other healthcare professional can help a person take positive steps toward quitting smoking. Read about some simple steps to quit smoking here.
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Being overweight or obese may improve stroke survival

New research reveals that being overweight, obese, or severely obese may improve a person's chances of surviving after a stroke.
doctor explaining something to overweight woman
Being obese or overweight may have its advantages, suggests one new study.

Obesity is a "serious medical condition" that can lead to various complications.

These might include atherosclerosis and heart disease, diabetes, cancer, and even sleep disorders.

Being overweight may also raise the risk of all-cause mortality and mental health conditions such as depression and anxiety.

Despite this, some researchers maintain that excessive body fat can have a protective cardiovascular effect.

In fact, the authors of a 2002 reference paper coined the phrase "obesity paradox" to describe the observation that people with a higher body mass index (BMI) are less likely to die from cardiovascular conditions than people with a normal weight.

Since then, the theory has been the subject of much controversy. However, new evidence appears to support it.

Dr. Zuolu Liu — from the University of California, Los Angeles — and her colleagues wanted to see how the obesity paradox applies to stroke. Previous research into the same issue, explain the researchers, yielded mixed results.

They will present their new findings at the American Academy of Neurology's 71st Annual Meeting, which this year takes place in Philadelphia, PA.

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Dr. Liu explains the motivation for their study, saying, "It was first noticed that carrying extra weight may play a role in survival for people who had suffered from kidney and heart disease, so we felt the need to investigate whether it also was tied to improved stroke survival."

To do so, the researchers examined 1,033 people who had experienced an ischemic stroke — that is, a condition wherein the arteries that pump blood to the brain are blocked.

The participants were 71 years old, on average, and their average BMI was 27.5. People whose BMI is between 25 and 29.9 are considered overweight, while a BMI of over 29.9 indicates obesity.

Dr. Liu and team grouped the participants into five categories — "underweight, normal, overweight, obese, and severely obese" — according to their BMI. The researchers monitored the participants' survival and recovery for 3 months after their stroke.

Overall, people with severe obesity had a 62 percent lower chance of dying from a stroke than people with a normal BMI, people with obesity had a 46 percent lower chance of death, and those who were overweight had a 15 percent lower chance of dying.

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However, those who were underweight had a 67 percent higher chance of dying following a stroke than people with a normal BMI. Dr. Liu and colleagues conclude:

"Outcome from acute ischemic stroke is characterized by an obesity paradox: elevated BMI is associated with reduced 3-month mortality over all, and reduced disability over most weight ranges."

The study was observational, so it cannot account for causality. However, a "possible explanation is that people who are overweight or obese may have a nutritional reserve that may help them survive during prolonged illness," says Dr. Liu.

The researchers also caution that their results may not be applicable to the general population, as the study sample was limited to people from southern California.

"More research is needed to investigate the relationship between [BMI] and stroke," says Dr. Liu.

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Can mouthwash raise your blood pressure?

New research, published in the journal Frontiers in Cellular and Infection Microbiology, shows that an antiseptic compound found in mouthwash destroys "friendly" oral bacteria that help maintain normal blood pressure levels.
young man using mouthwash
New research finds that mouthwash could destroy 'friendly' oral bacteria, which may have important consequences for a person's cardiovascular health.

Scientists know that the bacteria in our guts influence overall health, but perhaps less obvious is the connection between oral bacteria and a variety of health conditions.

For instance, Medical News Today recently reported on a range of studies that linked gum disease and the buildup of certain bacteria in the mouth with Alzheimer's disease, cardiovascular disease, and respiratory conditions.

Another recent article showed how a specific oral bacterium could speed up the progression of colorectal cancer and make the disease more aggressive.

These studies focused on bacteria that cause disease, but, just like our guts, our mouths also contain "friendly" bacteria, which are necessary for maintaining good health.

An oral microbiome with a good balance between these different kinds of bacteria can keep disease at bay. Studies have found that when this balance is upset it "contributes to oral and whole-body systematic diseases" as diverse as inflammatory bowel disease, Alzheimer's, rheumatoid arthritis, obesity, atherosclerosis, and diabetes.

New research points out that a balanced oral microbiome helps maintain good cardiovascular health by helping the conversion of dietary nitrate into nitric oxide (NO) — a signaling molecule that helps maintain normal blood pressure.

Worryingly, however, the new study shows that chlorhexidine, an antiseptic substance in mouthwash, may kill NO-producing bacteria, which in turn, may raise systolic blood pressure.

Nathan Bryan, Ph.D., from the Department of Molecular and Human Genetics at Baylor College of Medicine in Houston, TX, led the new research.

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Bryan and colleagues used "16S rRNA gene sequencing and analysis" to examine whether using chlorhexidine antiseptic mouthwash twice a day for 1 week changed the oral bacterial communities and blood pressure levels in 26 healthy individuals.

After 1 week, the 26 study volunteers went back to their usual oral hygiene practices.

The researchers collected samples of the participants' saliva and tongue scrapings and measured their blood pressure at four different points throughout the study: at baseline, then 7, 10, and 14 days later.

Bryan and colleagues report that "twice-daily chlorhexidine usage was associated with a significant increase in systolic blood pressure after 1 week of use and recovery from use resulted in an enrichment in nitrate-reducing bacteria on the tongue."

"The demonstration that the presence of NO-producing bacteria in the oral cavity can help maintain normal blood pressure gives us another target to help the more than 100 million Americans living with high blood pressure," comments the study's senior author.

"Two out of three patients prescribed high blood pressure medication do not have their blood pressure adequately managed," he adds, and "this may provide an explanation as to why. None of the [current] drugs for management of hypertension are targeted towards these NO-producing bacteria."

The researcher continues to explain the mechanisms underlying the findings, saying that NO "is one of the most important signaling molecules produced in the human body."

Because of the "ubiquitous" nature of this molecule, "the systemic effects of orally produced bacteria may have other significant effects on human health beyond maintenance of blood pressure," Bryan says.

"We know one cannot be well without an adequate amount of NO circulating throughout the body. Yet, the very first thing over 200 million Americans do each day is use an antiseptic mouthwash, which destroys the 'good bacteria' that helps to create the NO. These once thought good habits may be doing more harm than good."

Nathan Bryan, Ph.D.

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February 2019: Nutrition research highlights

Our dietary habits play an important role in shaping our health and well-being, but there are still many unknowns about the diet's ultimate impact on minute biological mechanisms. In this Spotlight feature, we give an overview of some of the best nutrition research published in February 2019.
large plate of salad
What does the most recent nutrition research say about our dietary choices?

Last month on Medical News Today, we covered numerous peer-reviewed studies concerned with matters of nutrition.

Each asked and answered questions about how our dietary practices affect our well-being.

And you, our readers, have shown particular interest in which diets are best for health, as well as which foods may have unexpectedly negative effects.

There is no doubt about it and no use denying it: What we eat is at the heart of our daily existence. Food is a necessity for life, and eating well helps us feel well, have more energy, and become more productive.

In the essay "A Room of One's Own," writer Virginia Woolf even forcefully remarks that "One cannot think well, love well, sleep well, if one has not dined well."

But what does it mean to eat well? What should you eat, what should you avoid, and which dietary patterns should you choose?

Researchers are constantly hard at work to get a better understanding of these issues and offer suggestions for better dietary practices.

In this Spotlight feature, we look at some of the most important findings in nutrition research that were published last month.

Best dietary habits for health

Existing studies have suggested that intermittent fasting — in which a person fasts for a set number of hours each day but eats freely in the remaining hours — can help with losing weight and may provide other health benefits, including prolonging a person's lifespan and reducing harmful inflammation.

breakfast options
Having breakfast daily will probably not aid weight loss efforts.

Essentially, fasting triggers changes in the body — such as stimulating weight loss — by acting on metabolic processes.

Usually, our bodies rely on carbohydrates to produce energy, but when a person fasts and carbohydrates are no longer readily available, the body starts looking for and utilizing other resources.

A study published in the journal Scientific Reports early last month identified some metabolic changes triggered by fasting that researchers had not previously been aware of.

Specifically, the study's authors — who are based at the Okinawa Institute of Science and Technology Graduate University in Japan — found that fasting boosts levels of purine and pyrimidine, two organic compounds that act on gene expression and protein synthesis at a cellular level.

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"These [substances] are very important metabolites for maintenance of muscle and antioxidant activity," explains study author Dr. Takayuki Teruya. This means that by increasing levels of purine and pyrimidine, fasting can stimulate rejuvenating processes, potentially keeping the body younger for longer.

Other research published last month sought to debunk long-standing myths about dietary best practices. One such myth is that eating breakfast is important when it comes to achieving weight loss.

Some believe that eating a morning meal helps stimulate the metabolism so that more calories burn faster. Moreover, certain studies have found a correlation between obesity and a tendency to skip breakfast.

However, this not what a study published in the BMJ last month found. The researchers worked with some participants who reported usually having breakfast and others who, more often than not, preferred to skip it.

The team's findings contradict existing notions about breakfast and weight loss, as they indicate that the total daily energy (calorie) intake tends to be higher in people who regularly eat breakfast.

Moreover, the researchers found that individuals who tended to go without breakfast on a daily basis actually had less body weight than breakfast-eaters, on average.

In their study paper, the authors go so far as to warn that "Caution is needed when recommending breakfast for weight loss in adults, as it may have the opposite effect."

The protective effects of common foods

At the same time, researchers have been identifying additional benefits of common natural foods. One example is flaxseed, which many of us use to enrich our smoothies or add some extra crunch to crackers and granola bars.

bowl of blueberries
Blueberries may vie with specialized medication in lowering cardiovascular risk.

Flaxseed fiber reportedly helps balance cholesterol levels and lower blood pressure, among other benefits.

Now, a new study published in the American Journal of Physiology: Endocrinology and Metabolism suggests that flaxseed fiber can also lower obesity markers.

Flaxseed starts breaking down once it reaches the gut. The research, which the team conducted in a mouse model, showed that the fiber produces changes in the gut microbiota that lead to a more healthy bacterial population.

These changes affect metabolic processes, accelerating the consumption of energy, and thus lowering markers associated with obesity.

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In addition to this, they help boost glucose (sugar) tolerance, which may mean that they have a protective effect against features that define other metabolic conditions, such as diabetes, which is characterized by impaired glucose tolerance.

According to other research published last month, onions and garlic, two key ingredients in global cuisines, are also important allies when it comes to safeguarding our health.

Garlic already has a reputation as a natural antibiotic, as it has antibacterial properties, and many people traditionally use it to fight the flu or treat insect bites.

In a paper, published in the Asia-Pacific Journal of Clinical Oncology last month, researchers from the First Hospital of China Medical University report that these two vegetables have an anti-cancer effect.

Both garlic and onions belong to the family of allium vegetables, all of which have similarly pungent smells and flavors.

The present study looked at 833 individuals who had been diagnosed with colorectal cancer, assessing how many allium vegetables they tended to consume on a regular basis. The team then matched this group with that of an equal number of cancer-free individuals.

The researchers found that participants who ate the largest quantities of garlic and onions had a 79 percent lower risk of colorectal cancer, compared with people who consumed low quantities of allium vegetables.

Based on these results, the investigators concluded that "The greater the amount of allium vegetables, the better the protection," in the words of senior researcher Dr. Zhi Li.

Another well-loved food item that received positive attention in February is the blueberry. Blueberries are often hailed as a superfood because they are packed with antioxidants, substances that help protect cellular health and fend off disease.

Last month, researchers from King's College London in the United Kingdom found that the anthocyanins — pigments with antioxidant properties — in these berries could help lower a person's risk of cardiovascular problems.

Study participants who ate 200 grams of blueberries per day for a month saw a significant decrease in blood pressure, which, the investigators note, does not usually occur in the absence of specialized medication.

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Warnings about dietary choices

February also saw the publication of studies that warned that some dietary choices may be putting our health at risk.

selection of soft drinks
Low-calorie soft drinks with artificial sweeteners can contribute to the risk of stroke.

For example, research that appears in JAMA Internal Medicine cautions, once more, that eating ultra-processed foods could be extremely harmful.

This study was conducted by specialists from the Sorbonne University in Paris and the Avicenne Hospital, both in France.

The researchers explain that such foods — which include ready-made meals and processed meats — have high contents of fat, sugar, and sodium (salt) while being low in natural fiber.

This means that, while tasty, they are not nutritious and will cheat our stomachs into feeling satisfied, while failing to offer the real sustenance that we need.

At the same time, the investigators add, ultra-processed foods often contain artificial additives, which could increase our exposure to a range of diseases.

While specialists already understood that such foods exacerbate our vulnerability to disease, the effect on overall mortality risk remained unclear. In the present study, the authors have, for perhaps the first time, concluded that as little as a 10 percent increase in the amount of ultra-processed food that we eat leads to a 14 percent higher mortality risk.

Another study, featured in the journal Stroke, drew some bleak conclusions about the consumption of artificially sweetened diet drinks.

The team that conducted this research was specifically interested in seeing how diet drink consumption affected women over 50, so they analyzed data from 81,714 women in this age category.

The analysis revealed a worrying trend: Women who had two or more diet drinks per day had a 23 percent higher risk of stroke and a 29 percent higher risk of a heart attack or a similar event.

That being the case, the study authors urge us to reconsider whenever we feel tempted to reach out for a low-calorie soft drink and opt for an alternative.

Finally, a team of scientists from Flinders University in Adelaide, Australia, has turned its attention to the harms of alcohol, which, according to the team's new study — published in PLOS ONE — many people still ignore.

The Australian researchers chose to focus on alcohol's well-recognized status as a risk factor for breast cancer. They turned to women aged between 45 and 64, asking them how often and how much they drink and whether they are aware of the risks.

According to lead author Dr. Emma Miller, "There is a low level of awareness about the established link between alcohol and breast cancer," and women continue to actively put themselves at risk.

"[It's] really important to understand the patterns and drivers behind drinking behavior, in order to develop policies and interventions that might reduce the increasing burden on the women and our health system," Dr. Miller stresses.

One message emerges from the studies that top researchers have made available in February, namely: We all need to learn how to make our diets work for us, rather than against us, and make choices for which our bodies will be grateful.

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