Wood Street Clinic Blog

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Red meat compound linked to worse outcomes in heart failure patients

A new study finds that worse outcomes in patients with acute heart failure are linked to higher levels of TMAO - the major source of which is thought to be L-carnitine, a compound that is metabolized by gut bacteria during the digestion of red meat.
Diagram of chest showing heart and blood vessels
Heart failure develops when the heart muscle is unable to pump enough blood to meet the body's needs for nutrients and oxygen.

The new study - from the University of Leicester in the UK - is published in the journal Heart.

Previous studies have linked TMAO (trimethylamine N-oxide) with higher risk of death in chronic heart failure, note the researchers, but their study appears to be the first to find such a link in patients with acute heart failure.

Heart failure is a serious condition that carries a higher risk of death and developing other serious medical problems. It occurs when the heart muscle is unable to pump enough blood to meet the body's needs for nutrients and oxygen. The condition can be ongoing (chronic) or it can develop suddenly (acute).

Although not limited to seniors, heart failure is one of the most common reasons for hospital admissions among people aged 65 years and older.

In the new study, led by Toru Suzuki, a professor in the cardiovascular sciences department at Leicester, the researchers measured circulating levels of TMAO in 972 patients admitted with heart failure to University Hospitals of Leicester National Health Service (NHS) Trust.

The team looked for links between blood TMAO levels and events occurring within 1 year of obtaining the samples. These events included deaths during hospitalization (72 events), deaths due to any cause (268 events) and a composite of death or rehospitalization due to heart failure (384 events).

The results showed that acute heart failure patients who had higher levels of TMAO at the start of the period were the ones most likely to die or be rehospitalized with heart failure in the following 12 months.

Prof. Suzuki says:

Our study shows that higher levels of TMAO, a metabolite of carnitine derived from red meat, is associated with poorer outcomes associated with acute heart failure, one of the main diseases of the heart. This metabolic pathway provides a possible link between how red meat is associated with heart disease."

L-carnitine is one of a group of compounds with the generic name carnitine that are derived from an amino acid and are found in nearly all cells of the body. The name comes from the Latin for flesh - carnus - because it was first isolated from meat.

Red meat is not the only dietary source of carnitine - for example, milk, cheese, whole-wheat products and asparagus also contain it, but in much smaller concentrations. It is also a common ingredient of energy drinks.

Some research suggests the effect of bacteria metabolizing carnitine into TMAO and influencing heart risk appears to be more pronounced in people who consume meat than in vegans or vegetarians.

But it is early days, and the implications of these findings are not well understood and require more research.

For example, one area that is not clear is that while we know the process of converting L-carnitine into TMAO is different from person to person (depending on the microbe metabolism of their gut), does that mean we can say how much of the link to disease is due to diet (e.g. the red meat) and how much is due to the gut?

In a 2013 article, Medical News Today mentions how Cleveland Clinic researchers raise this point when they discuss their discovery of how the link between red meat and heart risk involves gut bacteria turning L-carnitine into TMAO.

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Hidradenitis suppurativa and risk of adverse cardiovascular events and death

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease marked by painful abscesses that develop in areas where there are large numbers of sweat glands. These ooze pus and have an unpleasant smell. The disease has been associated with cardiovascular risk factors, such as smoking and obesity, but the risk of cardiovascular disease in patients with HS is unknown. Alexander Egeberg, M.D., Ph.D., of the University of Copenhagen, Denmark and coauthors investigated cardiovascular risk in patients with HS.

Their study included 5,964 Danish patients with a hospital-based diagnosis of HS and 29,404 individuals from the general population without HS. The study analysis also compared patients with HS to 13,093 patients with severe psoriasis. The authors suggest HS was associated with increased risk of adverse cardiovascular outcomes and death from all causes; the risk of cardiovascular-associated death also was higher in patients with HS compared to the risk for patients with severe psoriasis.

The study suggests HS may be a risk factor for adverse cardiovascular outcomes. "The results call for greater awareness of this association and for studies of its clinical consequences," the study concludes.

Research: Risk of Major Adverse Cardiovascular Events and All-Cause Mortality in Patients With Hidradenitis Suppurativa, Alexander Egeberg, MD, PhD; Gunnar. H. Gislason, MD, PhD; Peter R. Hansen, MD, PhD, DMSc, JAMA Dermatology, doi:10.1001/jamadermatol.2015.6264, published 17 February 2016.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms of use.

Copyright Medical News Today: Excluding email/sharing services explicitly offered on this website, material published on Medical News Today may not be reproduced, or distributed without the prior written permission of Medilexicon International Ltd. Please contact us for further details.

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Researchers reveal new links between heart hormones, obesity and diabetes

Natriuretic peptide receptors proposed as new target for metabolic disorders.

A new research study has revealed an important relationship between proteins secreted by the heart and obesity, glucose intolerance, and insulin resistance. The findings, published in Obesity, offer a new approach to treating metabolic disorders, including type 2 diabetes, by targeting the pathway that controls the proteins' concentration in the blood.

"Our results illustrate how the regulation of cardiac natriuretic peptides (NPs) is altered in obesity, insulin resistance, and type 2 diabetes," said study co-author Sheila Collins, Ph.D., professor in the Diabetes and Obesity Research Center at Sanford Burnham Prebys Medical Discovery Institute (SBP). "When we examined fat (adipose) tissue from patients with these metabolic conditions, we found higher levels of the receptor that clears NPs from circulation, suggesting that if we can boost NP levels and/or reduce the level of its clearance receptor, we may be able to correct some of these conditions."

The double life of NP hormones

NPs are hormones produced by the heart that are primarily known for their ability to influence blood pressure. When the heart senses elevated pressure, it releases NPs, which go to the kidneys, triggering the body to release salt and water from the bloodstream to lower blood pressure. NPs prompt the response to blood pressure by signaling through an active receptor (NPRA), and are removed from the blood by a clearance receptor (NPRC). Both receptors contribute to the level of NP activity.

Almost two decades ago, NP receptors were unexpectedly found in human adipose tissue, suggesting that NP levels may play an additional role in metabolism and obesity. Indeed, subsequent studies have shown that circulating NP levels are lower in obese individuals and those with metabolic risk factors, including high glucose levels. More recently, research has shown that obese individuals have higher levels of the clearance receptor in adipose tissue.

Study findings

"We examined levels of NPRA and NPRC in adipose and skeletal tissue in individuals with a range of body mass index (BMI) values and insulin sensitivity," said study co-author Richard Pratley, M.D., director of the Florida Hospital Diabetes Institute and senior scientist at the Florida Hospital-SBP Translational Research Institute for Metabolism and Diabetes (TRI). "We found that higher BMI values are associated with elevated levels of the clearance receptor in adipose tissue.

"We also looked at NP receptor levels in patients with type 2 diabetes after taking pioglitazone, a drug used to improve insulin sensitivity and control blood sugar in patients with type 2 diabetes. Interestingly, we found that these patients had a significant reduction in the level of the clearance receptor in adipose tissue, further reinforcing the link between NPs, insulin resistance, and obesity.

Next steps

"Overall, our results suggest that drugs that target the pathway(s) that lead to increased NP levels may be a new way to treat metabolic disorders, including obesity, insulin resistance, and potentially type 2 diabetes.

"Since we already have access to FDA-approved drugs to control blood sugar, and we know that these drugs impact NP levels, we may be able to redesign these drugs to specifically target other metabolic conditions including obesity," said Collins.

"This project is a great example of taking research from bench to beside, and highlights the strength of the partnership between SBP and TRI--a partnership that accelerates the delivery of lab discoveries to the clinic," added Pratley.

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Science on salt is polarized, study finds

Slightly more than half of papers support the idea that salt is bad for your health.

An analysis of scientific reports and comments on the health effects of a salty diet reveals a polarization between those supportive of the hypothesis that population-wide reduction of salt intake is associated with better health and those that were not. In all, 54 percent were supportive of the hypothesis; 33 percent, not supportive; and 13 percent inconclusive.

The new article in the International Journal of Epidemiology is co-authored by Ludovic Trinquart, Columbia University Epidemiology Merit Fellow at the Mailman School of Public Health; David Johns, a doctoral student in Sociomedical Sciences at the Mailman School of Public Health and an affiliate of the Data & Society Research Institute; and Sandro Galea, dean of the Boston University School of Public Health and adjunct professor of Epidemiology at the Mailman School.

The researchers systematically reviewed 269 academic reports published between 1979 and 2014, including primary studies, meta-analyses, clinical guidelines, consensus statements, comments, letters, and narrative reviews. Each was classified according to whether it supported or refuted the link between reduced sodium intake and lower rates of heart disease, stroke, and death. More than half of the reports were published since 2011--suggesting an increasing level of interest in the question, even if there was no emerging consensus.

A citation analysis found papers on either side of the hypothesis were more likely to cite reports that drew a similar conclusion than to cite reports drawing a different conclusion. Dominating the literature were a small number of influential papers that presented strong evidence for and against.

"There are two almost distinct bodies of scholarship--one supporting and one opposing the claim that salt reduction in populations will improve clinical outcomes," says Johns. "Each is driven by a few prolific authors who tend to cite other researchers who share their point of view, with little apparent collaboration between the two 'sides.'"

"We pay quite a bit of attention to financial bias in our work," says Galea. "We seldom pay attention, however, to how long-held beliefs bias the questions we ask and the results we publish, even as new data become available."

An analysis of systemic reviews revealed very little consistency in the selection of primary studies. If a primary study was selected by a review, the chance that another review would select the same study was less than a third. The finding points to uncertainty and disagreement about what should count as evidence, the authors argue. Moreover, choices about which studies to cite as primary evidence directly influenced the conclusions of systematic reviews.

Even while the scientific debate over salt continues, public health officials, from the local to the global level, have enacted policies to lower consumption. World Health Organization guidelines recommend limiting salt intake. In December 2015, New York City became the first U.S. city to require chain restaurants to label foods high in sodium.

"Decision-makers often must choose a course of action in the face of conflicting, uncertain evidence," says Trinquart. "Both the misuse of uncertainty and the exaggeration of certainty can shape the outcomes of public health decision-making processes."

The authors say the citation analysis method used in the study represents a new way of understanding the relationships between academic research papers and authors. In the future, the same method could be applied to other topics, including controversial issues such as e-cigarettes as well as topics on which there is greater agreement.

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Older mothers may face increased risk of stroke, heart attack

Having a baby at a later age has been linked to increased risk of complications for both mother and child. Now, a new study suggests there may be other downsides to a later pregnancy: having a baby aged 40 or older may increase the risk of heart attack, stroke and cardiovascular death later in life.
[A pregnant woman holding her back]
Researchers say women who have a later pregnancy should be aware of the cardiovascular risks.

Lead researcher Dr. Adnan I. Qureshi, director of the Zeenat Qureshi Stroke Institute in St. Cloud, MN, and colleagues say their findings are of great importance, given that more women are opting to have children after the age of 40.

A 2013 report from the Centers for Disease Control and Prevention (CDC) revealed that the pregnancy rate in the US for women aged 40-44 increased from 11 per 1,000 women in 1990 to 19 per 1,000 in 2009.

"We already knew that older women were more likely than younger women to experience health problems during their pregnancy," says Dr. Qureshi. "Now, we know that the consequences of that later pregnancy stretch years into the future."

To reach their findings - recently presented at the American Stroke Association's International Stroke Conference 2016 in Los Angeles, CA - the team analyzed data of 72,221 women aged 50-79 who were part of the Women's Health Initiative Study.

Of these women, 3,306 reported becoming pregnant at the age of 40 or older.

Rates of stroke, heart attack and death from cardiovascular diseases were assessed over a period of 12 years and compared between women who became pregnant aged 40 and older and those who had children at a younger age.

Compared with women who had a pregnancy at a younger age, those who became pregnant at the age of 40 or older were found to have a 1.4% higher risk of ischemic stroke and a 0.5% higher risk of hemorrhagic stroke.

Ischemic stroke - where blood flow to the brain is blocked - is the most common form of stroke, accounting for around 87% of all cases. Hemorrhagic stroke accounts for the remaining 13% of cases, occurring when a blood vessel in the brain ruptures and bleeds.

Fast facts about stroke

Each year, more than 795,000 people in the US have a stroke Around 610,000 of these are first-time strokes Stroke costs the US approximately $34 billion every year.

Learn more about stroke

Additionally, the researchers found that women who had a later pregnancy had a 0.5% greater risk for heart attack and a 1.6% greater risk of death from all forms of cardiovascular disease.

Other risk factors for cardiovascular disease - including high blood pressure, high cholesterol and diabetes - could account for the increased risks of ischemic stroke, heart attack and cardiovascular death among women with later pregnancies, according to the team.

However, they note that such risk factors were unable to explain the increased risk of hemorrhagic stroke among women with later pregnancies, suggesting that the link between the two warrants further investigation.

At present, later pregnancy is not considered a risk factor for cardiovascular problems. But Dr. Qureshi says their findings should make women aware of the possible increased risks they face and encourage them to take steps to improve their cardiovascular health.

"And their doctors need to remain vigilant years later in monitoring these women's risk factors through physical examination and, perhaps more tests and earlier interventions to prevent stroke and other cardiovascular events," he adds.

Earlier this month, Medical News Today reported on some good news for expectant mothers; a study suggested that eating chocolate daily during pregnancy may benefit fetal growth and development.

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Insulin Resistance: Causes, Symptoms and Prevention

An idea emerging from the fields of diabetology, cardiology and public health medicine, the science of insulin resistance has developed relatively recently.

It was not until the beginning of this millennium that insulin resistance and prediabetes began to receive heavy medical research focus.

There has been the terminology of insulin resistance syndrome, metabolic syndrome and even syndrome X, to denote the cluster of risk factors that is associated with insulin resistance.

By contrast, the classic urination and thirst of full diabetes have been understood since the 1600s, and the discoveries were made over a century ago for the roles of the pancreas and insulin in full diabetes.

Insulin resistance is now established as what lies behind the development of type 2 diabetes, but this is a bit more complex than it sounds. What is insulin resistance exactly, and why does it develop?

This page will look at the current understanding of insulin resistance and explain how it is a risk factor for both diabetes and other conditions. The article will also outline what can be done about it.

Fast facts on insulin resistance

Here are some key points about insulin resistance. More detail and supporting information is in the main article.

Insulin resistance is a "silent" risk factor alongside other risk factors for diabetes and cardiovascular problems Insulin resistance remains a problem when it is no longer silent but behind the raised blood sugar levels of type 2 diabetes The phenomenon is complex and has only relatively recently become better understood in the science of diabetes Insulin resistance itself does not present any signs or symptoms when it appears alone without the development of prediabetes or diabetes Blood sugar levels with insulin resistance alone are also normal The process is instead assumed to be a risk factor for people who are also obese or overweight, have hypertension or a history of diabetes in the family, among others in a "cluster" of diabetes and cardiovascular risk factors Insulin resistance alone is not treated, but prevention of the 5-year and 10-year risks can be achieved through lifestyle and medical measures.
What is insulin resistance? [heart and vessels diagram]
Diabetes shares some of the risk factors for cardiovascular disease.

Insulin resistance happens well before type 2 diabetes is diagnosed but it is still part of the full condition.1

It is a relatively new idea in medical science - insulin resistance is the phenomenon that is thought to raise the chances of developing prediabetes, the raised blood sugar level that can in turn eventually become high enough for type 2 diabetes to be diagnosed.2-5

There are estimates that around 15-30% of people with prediabetes go on to be diagnosed with full diabetes within 5 years, according to figures from the Centers for Disease Control and Prevention (CDC).6

The American Heart Association (AHA) highlights a longer outlook - the 10-year risk. They say that about half of people with high blood sugar go on to develop type 2 diabetes within a decade. But the AHA also point out that this means half of these people do not develop diabetes - "your choices make a difference."7

What the public health experts and specialist doctors mean by these statistics is that anyone with high blood sugar, insulin resistance, prediabetes, obesity or "metabolic syndrome" can reduce their future chances of developing full type 2 diabetes by taking some preventive steps.

These preventive steps, outlined on the next page, are a combination of lifestyle measures and medical help and monitoring that can reduce the established risks for diabetes. Not only that, but these steps can also reduce the risk of a range of other potential problems grouped under cardiovascular disease.

How does insulin resistance develop? While there have been the developments of the past 10-15 years, the question of how and why insulin resistance develops (the pathogenesis of it) remains complex and not fully understood.1,4 What is established is that people with risk factors, including genetic and lifestyle factors:1,4 Might develop a resistance to the effects of the hormone insulin, which is secreted from the pancreas Insulin is essential for the regulation of the glucose circulating in the blood - it induces glucose to be taken up by the cells Insulin is also the chemical messenger that signals to the liver to hold on to its glucose rather than release it into the blood (glucose is packaged up for liver storage in the form of glycogen) Insulin normally maintains a fine balance that is just right for the amount of energy we need at the right time, and so keeps a predictable blood sugar level at different times between eating and activity, never allowing the blood level to rise too much for too long However, resistance to the hormone can develop Resistance initially results in the pancreas simply secreting more insulin, however, to maintain safe blood glucose levels and keep symptoms at bay - this is the picture when insulin resistance is unaccompanied by additional illness However, insulin resistance can eventually be accompanied by the persistently higher glucose levels of prediabetes, and then the persistent hyperglycemia of full diabetes; the release of extra insulin cannot be maintained in compensation for the increasing insulin resistance. There is great complexity in how insulin resistance develops, and especially for why it develops, but the good news is that there are plenty of ideas about how to prevent it. And when type 2 has not been prevented, it can be managed. On the next page, we look at the signs of insulin resistance, associated risk factors and methods of prevention.
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Closing PFO "hole in the heart" may prevent strokes linked to this heart defect

Stroke survivors who also have patent foramen ovale (PFO), a hole in the heart, could benefit from a device that closes the PFO to help prevent future strokes, according to research presented at the American Stroke Association's International Stroke Conference 2016.

Researchers studied 980 stroke survivors, ages 18 to 60, who had strokes that were determined to be of unknown cause (cryptogenic) but had a PFO. A PFO results when a hole between the heart's chambers does not close at birth. It is thought that blood clots from a vein may travel through the PFO, block an artery in the brain and cause a stroke. Researchers implanted a PFO closure device in half the patients and prescribed blood thinning medications to the other half to determine which treatment might be better for preventing subsequent strokes.

In a long-term follow-up, researchers found:

Forty-two patients had recurrent strokes, including 18 in the group that received the device and 24 in the medicine group. 56 percent of the device group's recurrent strokes were cryptogenic and the remainder were unrelated to their PFO. 79 percent of the medication group's recurrent strokes were cryptogenic. The size and location of the recurrent strokes also tended to be different. Those without the device tended to have large strokes more often than those with the device, and they were more often on the edges of the brain than deep inside.

Researchers said the device can only prevent strokes related to PFO. PFO-related strokes tend not to have another cause, are larger and on the edge of the brain. There were fewer such strokes in the device group than in the medical group, lending support to the probability that the PFO device prevents PFO recurrences.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms of use.

Copyright Medical News Today: Excluding email/sharing services explicitly offered on this website, material published on Medical News Today may not be reproduced, or distributed without the prior written permission of Medilexicon International Ltd. Please contact us for further details.

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Migraine with aura linked to clot-caused strokes

People who have migraines with aura are more likely to have strokes caused by either a blood clot in the heart (cardio-embolic stroke) or a clot within the brain's blood vessels (thrombotic stroke), compared to those that don't have migraines with aura, according to research presented at the American Stroke Association's International Stroke Conference 2016.

Some people with migraines experience neurological symptoms (aura) such as flashes of light, blind spots, or tingling in the hand or face. In adults, symptoms usually happen before the headache itself. Migraines with aura account for less than 20 percent of all migraines, researchers said.

In a 25-year ongoing study of 12,844 adults (age 45-64) in four U.S. communities, 817 participants were identified as having an ischemic strokes (clot or a mass clogs a blood vessel, cutting off the blood flow to brain cells).

When they compared migraine with aura patients to those who had migraine without aura, researchers found:

Overall, migraine with aura patients were 2.4 times more likely to have an ischemic stroke. Migraine with aura patients were three times more likely to have an ischemic stroke caused by a mass or a clot that forms in the heart, dislodges and travels to the brain (cardio-embolic stroke). Migraine with aura patients were twice as likely to have an ischemic stroke caused by a clot that develops in a clogged part of the blood vessel supplying blood to the brain (thrombotic stroke). There was no significant association between migraine with aura and ischemic stroke caused by blockage of small arteries that supply blood to deep brain structures (lacunar stroke).

Since migraines alter the blood vessels in the brain, the greater incidence of strokes caused by blood clots in the heart or the brain's blood vessels suggests that migraine also affects blood vessels in the heart and neck. That's what possibly leads to these specific subtypes of stroke, said Souvik Sen, M.D., M.P.H., study author and a neurologist at the University of South Carolina School of Medicine in Columbia, South Carolina.

"If we are going to prevent people with migraines with aura from having a stroke, it's important to know what types of stroke they're having and then be vigilant about it," Sen said.

Ischemic stroke accounts for about 87 percent of all stroke cases in the U.S. There are three major subtypes of ischemic strokes: thrombotic strokes, cardio-embolic strokes and lacunar stroke. Previous studies have shown a link between migraine with aura and ischemic strokes, but this is the first study to look at subtypes associated with migraine with aura, Sen said.

Researchers also noted that strokes linked to migraines with aura often affect people who are younger than the typical stroke patient. A stroke at a younger age means disability and loss of productivity much earlier in life and may be more impactful than in the elderly.

"If you get migraines with aura, make sure your stroke risk factors are assessed by your doctor," Sen said. Stroke risk factors, including high blood pressure, diabetes, smoking and high cholesterol, need to be treated. People with migraine and a stroke should be screened for hardening of blood vessels and irregular heartbeat - two factors linked to the mechanisms that cause cardio-embolic and thrombotic ischemic strokes.

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Rising pollution levels linked to increased strokes

It may seem like an obvious link; inhaling polluted air simply cannot be good for the cardiovascular system. But science demands measurable outcomes to make a conclusion, and rightly so. New research shows that climate change and overall air quality - including higher pollution levels - are linked to a higher number of strokes.
Pollution in China
The researchers used data from China and the US - "the world's two largest emitters of greenhouse gases," according to Dr. Longjian Liu.

The latest results were presented at the American Stroke Association's International Stroke Conference 2016, which takes place February 17th-19th, in Los Angeles, CA.

Each year in the US, stroke kills nearly 130,000 people, which is 1 out of every 20 deaths. And worldwide, stroke is the second leading cause of global death, trailing heart disease.

To conduct their study, researchers used data from "the world's two largest emitters of greenhouse gases," which are responsible "for about one third of global warming to date," says lead study author Dr. Longjian Liu, from Drexel University in Philadelphia, PA.

The two countries are the US and China.

Dr. Liu and his colleagues explain that their study is one of the first to look into the interaction between air quality and stroke prevalence alongside temperature.

Regional differences in air quality, stroke prevalence

To carry out their research, the team looked at air quality data collected in 2010-2013, from 1,118 counties in 49 states in the US - and from 120 cities in 32 Chinese provinces.

Fast facts about stroke

In the US, stroke kills almost 130,000 people each year On average, every 4 minutes, one American dies from stroke Each year, stroke costs the US $34 billion.

Learn more about stroke

They explain that particulate matter (PM) is air particles including dust, dirt, smoke and water droplets. The greatest health risks arise from particles that are less than 2.5 μm in diameter (PM2.5).

Such particles are 1/30th the diameter of a human hair, are not visible to the human eye and are created from car, power plant and forest fire combustion.

After studying the data, the researchers observed that the total number of strokes increased by 1.19% for each 10 μg/m3 increase of PM2.5. Furthermore, they found significant regional differences in PM2.5 levels linked to stroke prevalence.

In detail, southern America had the highest average annual PM2.5. Interestingly, the South has the highest prevalence of stroke, at 4.2%.

Conversely, the West had the lowest average annual PM2.5, and this region of the US has the lowest stroke prevalence, at 3%.

Findings provide proof for policy makers

An additional finding from their study revealed that temperature impacts air quality and stroke risk. Dr. Liu says climate changes can be partially accountable for seasonal air quality variations:

"In the summer, there are lots of rainy and windy days, which can help disperse air pollution. High temperatures create a critical thermal stress that may lead to an increased risk for stroke and other heat- and air quality-related illnesses and deaths."

He also notes that "patients with stroke are in danger of dehydration due to high temperatures in the summer, and are in danger of suffering from pneumonia, influenza and other respiratory diseases in winter."

Of course, we are not able to control air quality, but Dr. Liu says their findings provide proof to policy makers and leaders of public health. From this research, he hopes they will be able to develop better models for monitoring and predicting climate change so patients can be prepared.

Another group that is particularly vulnerable to stroke risk as a result of air quality is women and the elderly.

Medical News Today recently reported on a study that suggested air pollution is linked to premature birth.

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Antibody-coated drug-eluting stents for coronary heart disease: No hint of benefit

Patient-relevant benefit of antibody-coated drug-eluting stents is unclear / Data insufficient for most outcomes.

In patients with coronary heart disease requiring a stent implantation, the benefit of treatment with antibody-coated drug-eluting stents (ABC-DES) versus drug-eluting stents without antibody coating (DES) is still unclear. This is the result of a final report published on 20 November 2015, which the German Institute for Quality and Efficiency in Health Care prepared on behalf of the Federal Joint Committee (G-BA).

The only two studies available comparing ABC-DES with DES were too small to be able to infer reliable conclusions on patient-relevant outcomes, and the data are insufficient for most outcomes. No comparative studies with treatment options other than DES were identified, nor did the commenting procedure after the preliminary report yield any information gain. There is thus no hint of a benefit of ABC-DES versus DES.

ABC-DES are supposed to render blood thinners superfluous

ABC-DES are coated with immunosuppressive drugs on their outer side (the side towards the wall of the blood vessel). On their inner side (the side towards the lumen of the blood vessel), they are coated with antibodies to promote adherence of endothelial cells to the mesh of the stent.This is supposed to shorten the duration of treatment with blood thinners, without increasing the risk of re-narrowing of the vessel (restenosis) or formation of blood clots (thrombosis).

Treatment with blood thinners over several months is the standard after DES implementation, but can be problematical in some patient groups, for example, in those who are scheduled to undergo major surgery. In addition, DES implantation is often inadvisable in patients who already have to take blood thinners permanently due to a different disease, as then 3 blood thinners would usually be required in parallel. It would thus be helpful if stents with the efficacy of DES, but without the need for long-term blood thinners, were available.

Available studies do not show a relevant difference

The results in the only two studies available (REMEDEE and REMEDEE OCT) do not show relevant differences between ABC-DES (tradename Combo) and the stents coated with drugs alone (DES) produced by different manufacturers.

In the REMEDEE study it was to be shown that ABC-DES (test group: 124 patients) were non-inferior to DES (control group: 59 patients). In the REMEDEE OCT study the superiority of ABC-DES over DES (29 patients vs. 31 patients) was to be shown. Neither of the two studies was designed to assess the patient-relevant benefit; tissue integration of ABC-DES versus DES was assessed instead.

Both studies provided data on the patient-relevant outcomes of mortality, myocardial infarction, cardiac bypass surgery, overall rate of serious adverse events, vascular complications, cerebrovascular events, and bleeding events. However, the data are insufficient for several outcomes and in many respects uncertain. Due to the different drug coatings of the various DES types, it is also unclear what impact antibody coating actually had on the study results.

Benefit or harm of ABC-DES versus DES is unclear

In patients requiring a stent implantation due to coronary heart disease, the benefit or harm of the new generation of stents (ABC-DES) versus DES is thus still unclear.

In patients with a high risk of restenosis, a previous assessment by IQWiG in October 2012 (rapid report N12-01) showed indications of a lesser benefit of ABC stents solely coated with antibodies versus DES. In March 2013, the G-BA subsequently excluded implantations with ABC stents from reimbursement by statutory health insurance in those patients who were also eligible for DES implantation.

For patients with coronary heart disease in whom a stent is indicated, it remains open whether the currently ongoing HARMONEE and RECOVERY studies can answer the question with regard to the benefit and harm of ABC-DES versus DES. None of the ongoing studies is designed to assess the patient-relevant benefit.

DES dominate stent implantations in patients with coronary heart disease

In Germany in 2013, a DES was used in nearly 80% of patients in whom a stent implantation was indicated; bare metal stents (BMS) were used in the remaining 20%. BMS are primarily suitable if treatment with blood thinners is problematical due to concomitant diseases of the patient. In contrast, ABC-DES have so far not played a relevant role in clinical practice and, for example, are given little attention in German or international guidelines.

One reason for the increasing number of stent implantations is, among others, the continuous further development of stents. Stefan Sauerland, Head of IQWiG's Department of Non-Drug Interventions, describes the current situation in health care: "It has been shown that modern DES are also being increasingly used in patients who were previously treated exclusively with BMS. The characteristics of second-generation DES are also gradually changing recommendations on the duration of necessary dual anti-platelet therapy following implantation: The shortened treatment period for blood thinners increases the number of patients eligible for DES implantation, thus reducing the need for ABC-DES."

Process of report production

IQWiG published the preliminary results in the form of the preliminary report in July 2015 and interested parties were invited to submit comments. At the end of the commenting procedure, the preliminary report was revised and sent as a final report to the commissioning agency in September 2015. The written comments submitted were published in a separate document together with the final report. The report was produced in collaboration with external experts.

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Heart arrhythmia drug may fight plaque buildup in blood vessels

New research in mice provides convincing evidence that digoxin, a drug prescribed to treat atrial fibrillation, can help protect against atherosclerosis.

Investigators found that digoxin decreased the levels of total cholesterol, triglycerides and LDL-cholesterol by 41%, 54%, and 20%, respectively, in mice treated with high-dose digoxin compared with control mice.

The findings are published in the British Journal of Pharmacology.

Research: Digoxin reduces atherosclerosis in apolipoprotein E-deficient mice, Huairui Shi, Xiaobo Mao, Yucheng Zhong, Yuzhou Liu, Xiaoqi Zhao, Kunwu Yu, Ruirui Zhu, Yuzhen Wei, Jianghao Zhu, Haitao Sun, Yi Mao and Qiutang Zeng, British Journal of Pharmacology, doi: 10.1111/bph.13453, published online 16 February 2016.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

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Organic milk, meat contain more omega-3 than non-organic alternatives

We are eating more organic foods than ever before, but are they really better for us than the non-organic alternatives? When it comes to the levels of omega-3 in milk and meat, organic products might be the best choice, according to new research.
[Milk and meat]
Organic milk and meat contain more beneficial omega-3 than the non-organic alternatives, researchers found.

Organic foods are defined as those that are grown or produced in the most natural way, without the use of chemical fertilizers and pesticides, and with the use of animal-friendly farming techniques.

In order for livestock to be classified as organic, for example, the animals must have outdoor access and be given organic feed. The use of growth hormones, animal by-products or antibiotics should be avoided.

While the benefits of organic farming for the environment and animal welfare are clear, less is known about the health benefits of consuming organic foods.

With this in mind, study leader Prof. Carlo Leifert, of Newcastle University in the UK, and colleagues conducted two studies in which they reviewed more than 260 global papers on the nutritional content of milk and meat, with the aim of identifying any differences in the nutritional quality of organic and non-organic products.

The researchers publish the results of both of their studies in the British Journal of Nutrition.

50% more omega-3 in organic milk, meat

The team assessed 196 studies on milk and 67 studies on meat.

Compared with non-organic milk and meat products, the researchers found that the organic alternatives contained an average of 50% more omega-3 fatty acids.

Omega-3 fatty acids are believed to provide a number of health benefits, including reduced risk of heart disease and lower cholesterol.

Additionally, the team found that organic meat was lower in two saturated fats that promote poor heart health: myristic and palmitic acid.

Based on these findings, Prof. Leifert and colleagues suggest that switching to organic milk and meat may offer significant health benefits, noting that half a liter of organic full-fat milk would provide around 16% (39 mg) of the recommended dietary intake of long-chain omega-3 fatty acids, while the same measure of non-organic milk would provide 11% (25 mg).

"Several of these differences stem from organic livestock production and are brought about by differences in production intensity," says Prof. Leifert, "with outdoor-reared, grass-fed animals producing milk and meat that is consistently higher in desirable fatty acids such as the omega-3s, and lower in fatty acids that can promote heart disease and other chronic diseases."

Additionally, the team found that organic milk contains slightly higher levels of iron, Vitamin E and some carotenoids - naturally occurring pigments synthesized by plants.

More iodine in non-organic milk, but is this good?

However, there may also be an important health benefit to consuming non-organic milk; the researchers found that it contains around 74% more iodine than organic milk.

Iodine is an important nutrient for the human body, helping the cells to convert food into energy. We also need it for production of thyroid hormones and thyroid functioning.

The World Health Organization (WHO) recommend that teenagers and adults get an intake of around 150 mcg daily, while pregnant women should aim to get around 250 mcg daily. In order to help meet such recommendations, the US, China, Brazil and some European countries fortify salt with iodine.

But according to the researchers, this means that people in such countries who have high dairy intake may be at greater risk of excess iodine intake, which can lead to thyrotoxicosis - an overactive thyroid.

Their study results suggest that half a liter of non-organic milk would provide around 88% of the daily recommended intake of iodine, while half a liter of organic milk would provide around 53%.

The team says their findings build on their previous research in 2014 that revealed organic crops and crop-based foods are up to 69% higher in beneficial antioxidants than non-organic alternatives.

Commenting on what these studies mean, Prof. Leifert says:

"We have shown without doubt there are composition differences between organic and conventional food. Taken together, the three studies on crops, meat and milk suggest that a switch to organic fruit, vegetables, meat and dairy products would provide significantly higher amounts of dietary antioxidants and omega-3 fatty acids."

He says that further studies investigating the nutritional differences between organic and non-organic foods are warranted, noting that there is currently not enough information to make comparisons between the two.

"However," he adds, "the fact that there are now several mother and child cohort studies linking organic food consumption to positive health impacts shows why it is important to further investigate the impact of the way we produce our food on human health."

In 2014, Medical News Today reported on a study that found consuming organic foods does not lower women's likelihood of developing cancer.

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Heart attack patients with cardiogenic shock fair well 60 days post-discharge

Heart attack patients who experience cardiogenic shock have a higher risk of death or rehospitalization than non-shock patients in the first 60 days post-discharge, but by the end of the first year, the gap between the two groups narrows, according to a study published in the Journal of the American College of Cardiology.

Cardiogenic shock is low blood pressure that lasts for more than 30 minutes, often requiring the use of mechanical devices to sustain it at a safe level. The condition results in inadequate circulation of blood throughout the body.

Using data from the American College of Cardiology's National Cardiovascular Data Registry's ACTION Registry-GWTG linked with Centers for Medicare & Medicaid Services claims data, researchers examined records from 112,561 heart attack patients treated at 677 U.S. hospitals between January 2007 and September 2012. Of this group, almost 5 percent experienced cardiogenic shock during the initial hospitalization. These patients were younger than non-cardiogenic shock patients and were less likely to have had a previous heart attack, angioplasty, or coronary artery bypass graft surgery.

Researchers found that at 60 days, almost 34 percent of shock patients were rehospitalized or had died, compared with about 25 percent of non-shock patients. At the one-year mark, however, the difference was not as great: about 59 percent of shock patients were rehospitalized or had died, compared with about 52 percent of patients without shock.

After adjusting for patient characteristics such as age and gender; comorbid conditions, including high blood pressure, high cholesterol, and chronic lung disease; hospital region and size; and in-hospital events and interventions, the study demonstrated that patients who survive to 60 days have similar outcomes, regardless of shock status. For both groups, factors associated with one-year mortality include older age, discharge to a skilled nursing facility, and the number of hospitalizations in the year before the heart attack.

Rashmee Shah, M.D., the study's lead author and assistant professor of medicine at the University of Utah in Salt Lake City, noted that since outcomes between shock and non-shock patients were similar after 60 days, "there is a need to address the vulnerable immediate post-hospital period." She said that "future investigations should identify reasons for this pattern so that interventions could be tailored to improve early survival and identify the sickest patients, who may be better served with palliative care or hospice."

"We have to better understand this pattern of early mortality versus late survivorship," said Valentin Fuster, M.D., Ph.D., JACC editor-in-chief. "We need to better understand the mechanism, in order to possibly convert these early mortality rates."

In an accompanying editorial, Adnan Kastrati, M.D., professor of medicine at the German Heart Centre in the state of Bavaria, said the findings support the theory that early survival is determined predominately by the extent of damaged muscle, while late survival is related to lower baseline risk. He noted that high mortality rates for shock patients should "motivate us to search for potentially modifiable factors that may lead to improved outcomes." He suggested further investigation of the best way to address multivessel coronary artery disease and the optimal strategy for reversing cardiogenic shock.

Concurring with Shah, Kastrati added that the study "should increase awareness of the importance of close medical surveillance of this population in the immediate post-hospital discharge period."

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An engineer's Valentine to children

Professor Flamini's computer models predict right-size heart valves.

What better way to celebrate Valentine's Day than help save a child's heart? That's what Vittoria Flamini, an industry assistant professor in Tandon's Department of Mechanical and Aerospace Engineering, has in mind.

Children born with a certain congenital heart defect often need a percutaneous pulmonary valve surgically inserted when they are 10 to 15 years old. Flamini has developed computer simulations to determine if that surgery will be successful and if the necessary valve will fit in the individual's heart -- before the surgery takes place.

"To make it simple, it's like buying jeans," Flamini says. "You need to try them on to see if they are going to fit." Similarly, the valve might or might not fit -- something surgeons would like to know before they perform the procedure.

The computer simulation project, a collaboration between Flamini and Puneet Bhatla, M.D., in the NYU Langone School of Medicine Department of Pediatrics, began in the summer of 2014 when Bhatla and others from Langone visited Tandon to talk about various biomedical challenges.

"We were already collaborating on some other heart disease problems, all involving simulations and biomechanics," Flamini says. "They came with problems, and we worked together on solutions." The simulation involves Dr. Flamini manipulating images of the patient's heart sent over by the medical team, a complex process that takes at least a day.

Since Dr. Flamini has a degree in biomedical engineering, she enjoys the process, noting that many surgeons have science or engineering backgrounds. "It seems like two very separate worlds but physicians are often very interested in technology. They can understand my language," she says. "A lot of medicine involves technology and innovation, and the drivers of medical technology are physicians, because they are interested in solutions to the problems they are faced with. It's great to work with them--they're so encouraging of technologies that are useful to them."

While still in the testing stage, Dr. Flamini hopes the methodology that could spare kids from unnecessary surgery will be ready for rollout in as little as a year, depending on funding. Although this simulation is for a very specific cohort, she expects that eventually it will be used for other types of surgeries.

Preliminary results of this project were supported by funding from the KiDS of NYU Foundation. Founded in 1991, KiDS of NYU is an organization of parents, physicians, and friends who support children's services at NYU Langone Medical Center through philanthropy, community service and advocacy.

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Eating the right fats could save 1 million lives per year

According to research carried out by the American Heart Association, replacing refined carbohydrates and saturated fats with vegetable oils could save 1 million lives per year.
[Heart-shaped earth]
New research plots the state of the world diet and its ramifications for global heart health.

The association between eating a diet high in saturated fats and heart disease is well documented.

The relationships between different types of fats and their consequences on health are a little more complex.

New research and analysis, carried out on a global scale, shows how changes in diet are necessary throughout the world if lives are to be saved.

In all, the team investigated diet and food availability information from 186 countries. They also reanalyzed and collated previous longitudinal studies looking at how specific fats impact heart disease.

For the first time, the global burden of heart disease has been measured in relation to the consumption of too many saturated fats compared with too little polyunsaturated fats.

Published in the Journal of the American Heart Association, senior study author Dr. Dariush Mozaffarian explains the findings:

"Worldwide, policymakers are focused on reducing saturated fats. Yet, we found there would be a much bigger impact on heart disease deaths if the priority was to increase the consumption of polyunsaturated fats as a replacement for saturated fats and refined carbohydrates, as well as to reduce trans fats."

The benefits of polyunsaturated fats

Not all fats are necessarily evil; none should be eaten to excess, but the physiological profiles of saturated, polyunsaturated and trans fats are different and need to be treated in different ways.

It is important to remember that fats are essential for the body to function. Fats are not only used as an energy source for cellular and physical activity, they also influence the inflammatory response, mood and are vital for intercellular communication.

Polyunsaturated fats are predominantly found in plant-based foods and oils. Consuming these oils can actually improve cholesterol levels in the blood, decreasing the risk of heart disease and stroke. There is also evidence that polyunsaturated fats can lower the risk of type 2 diabetes.

Polyunsaturated fats can be found in a myriad of foods, including soybean, sunflower oil, tofu, nuts, seeds and fatty fish (for instance, omega-6 oils).

[American Heart Association infographic about fats]
Image credit: American Heart Association

Fats and heart disease on a global scale

As one might imagine, a research project with such immense scope churned out a vast amount of information. Below are some of the most notable findings:

10.3% of the total heart disease deaths (711,800 people) worldwide are attributed to eating too little polyunsaturated fats as a replacement for saturated fats 3.6% of the total heart disease deaths (250,900 people) were attributed to excess consumption of saturated fats. The marked difference between these two figures is believed to be thanks to the protective properties of polyunsaturated fats 7.7% of the total heart disease deaths (537,200 people) were attributed to excess consumption of trans fats. These fats are found in baked and fried food as well as the cooking fat used in some countries The highest rates of heart disease deaths due to low consumption of omega-6 polyunsaturated fats were found in countries of the former Soviet Union, particularly Ukraine.

As part of the analysis, the team compared data from 1990 and 2010 to chart any significant differences in mortality rates:

Deaths due to insufficient omega-6 oils dropped by 9% Deaths due to high saturated fat consumption declined by 21% Deaths due to high consumption of trans fats rose 4%.

In relation to the global trends in heart disease caused by diet, Dr. Mozaffarian said:

"People think of trans fats as being only a rich country problem due to packaged and fast-food products. But, in middle- and low-income nations such as India and in the Middle East, there is wide use of inexpensive, partially hydrogenated cooking fats in the home and by street vendors.

Because of strong policies, trans fat-related deaths are going down in Western nations (although still remaining important in the United States and Canada), but in many low- and middle-income countries, trans fat-related deaths appear to be going up, making this a global problem."

The authors hope that their findings will help nations develop and refine their dietary guidelines. The report may only be a small step toward global health, but it underlines the importance of looking at the available data before deciding on overarching policy.

Medical News Today recently covered research showing that saturated fats are too often replaced with unhealthy alternatives.

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Novartis' new heart failure medicine now available in the UK

Sacubitril/valsartan (EntrestoTM) is now available for UK adults with symptomatic chronic heart failure with reduced ejection fraction.

Largest heart failure study showed Entresto (sacubitril/valsartan) saves lives and reduces hospitalisation for people with heart failure when compared to enalapril, an ACE-inhibitor, and current gold standard, commonly used to treat the condition1,2 New treatments that can reduce hospitalisations and the number of people dying from heart failure are needed as the outlook for patients remains poor3 Heart failure costs the NHS £2.3 billion, and the figure is rising due to the UK's ageing population4,5

EntrestoTM (sacubitril/valsartan), a twice-a-day tablet for adult patients with symptomatic heart failure with reduced ejection fraction, is now available in the UK. Heart failure occurs when the heart muscle cannot pump a normal amount of oxygen-rich blood around the body, resulting in a substantial impact on patients' daily lives. The new treatment has been shown to save the lives of patients with heart failure when compared to the gold standard treatment, enalapril2,6.

"The availability of this new treatment in heart failure could change how heart failure patients are treated," said Professor Iain Squire, Professor of Cardiovascular Medicine, University of Leicester and Honorary Consultant Physician, University Hospitals of Leicester NHS Trust and Chair of British Society for Heart Failure. "For many patients with heart failure, outcomes remain poor and there is clear room for therapies that improve on what we have available at the moment. Doctors can now offer suitable patients an option that has been shown in a large clinical trial to cut the risk of death and reduce the number of hospitalisations."

Sacubitril/valsartan works in a unique way by reducing the strain on the failing heart. In the largest heart failure clinical trial conducted to date, it reduced the risk of death from cardiovascular causes, such as sudden death and worsening heart failure, compared to enalapril, an ACE inhibitor. ACE inhibitors are the most commonly used treatment for heart failure7.

Overall, sacubitril/valsartan reduced the risk of death from heart-related causes or of first hospitalisation for heart failure by 20% when compared to enalapril (absolute risk reduction: 4.7%)2. Patients on the trial were asked to report on how well they felt and the doctors caring for them how severe the patient's heart failure was: patients taking sacubitril/valsartan reported feeling better and having less severe symptoms in the sacubitril/valsartan group compared to patients taking enalapril2.The clinical trial stopped early as it showed a clear benefit of sacubitril/valsartan over enalapril.

"Patients with heart failure had a poor prognosis for many years, with survival rates being worse than certain types of cancer, such as breast and prostate," said Dimitrios Georgiopoulos MD, Chief Scientific Officer, Novartis Pharmaceuticals UK Ltd. "Our clinical trial showed that treatment with sacubitril/valsartan reduces the risk of death and hospitalisation for patients and the availability of this new treatment will give doctors a new option to manage many of their heart failure patients."

On average, a general practitioner looks after 30 patients with heart failure and will diagnose ten new heart failure patients annually. However, despite being such a common condition, most people fail to recognise the symptoms. Common symptoms include difficulty breathing, swollen limbs due to build-up of fluid, severe fatigue and weight gain due to fluid build-up8.

Heart failure is a highly debilitating, life-threatening condition, which affects around 550,000 people in the UK9. Heart failure is a considerable burden to the UK healthcare system. It costs the NHS about £2.3bn a year, accounts for 1 million inpatient bed days and 5% of all emergency and medical admissions to UK hospitals; hospital admissions are projected to rise by 50% over the next 25 years, largely as a result of an ageing population8. Hospitalisation is costly and heart failure patients are frequently readmitted; 70% of treatment costs for heart failure are due to hospitalisations10.

Novartis is working with NICE and the Scottish Medicines Consortium (SMC) to ensure as many eligible patients as possible will be able to benefit from sacubitril/valsartan once it has been appraised.

About sacubitril/valsartan

Sacubitril/valsartan is a twice-a-day tablet. In its pivotal study, PARADIGM-HF which compared sacubitril/valsartan to enalapril, the risk of dying from a heart-related cause or being hospitalised for the first time in the trial because of heart failure was reduced by a fifth in patients taking sacubitril/valsartan. Patients on sacubitril/valsartan reported feeling better than patients receiving treatment with enalapril.

Fewer patients on sacubitril/valsartan discontinued study medication for any adverse event compared to those on enalapril. The sacubitril/valsartan group had more hypotension and non-serious angioedema but less renal impairment, hyperkalemia and cough than the enalapril group2.

British Heart Foundation reaction to availability of sacubitril valsartan

Professor Peter Weissberg, Medical Director at the British Heart Foundation (BHF), said:

"The BHF welcomes NICE's proposed approval of the sacubitril valsartan (Entresto) treatment for a subgroup of heart failure patients. For a number of years, treatment of heart failure has changed little and relied on drugs that have been available for decades. Sacubitril valsartan introduces an entirely new class of drug with an unique mechanism of action therefore widening the therapeutic options available for patients with heart failure.

"As with any new drug, it will take time and further research to establish the true benefits of sacubitril valsartan and to learn which patients can and can't tolerate its potential side effects. It is therefore appropriate that NICE should recommend that it is prescribed and monitored by specialists working as part of a heart failure team.

"While promising, it's important to stress that this treatment is not a cure for heart failure, which affects over half a million people in the UK. We're continuing to fund research looking for treatments that could regenerate and repair the failing heart. A treatment like this would be game-changer for treating, and possibly curing, heart failure."

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Genetic variation may explain Asian susceptibility to Kawasaki disease

Scientists from the RIKEN Center for Integrative Medical Sciences (IMS) in Yokohama, Japan, in collaboration with researchers from a number of hospitals around Japan, have found two variations in a gene called ORAI1, one of which may help explain why people of Asian descent are more susceptible to Kawasaki disease, a poorly understand ailment that mostly afflicts young children. The work was published in PLOS ONE. The etiology of Kawasaki disease, which causes inflammation of blood vessels leading to symptoms such as fever and redness of the eyes, lips, and tongue, is a mystery, because it shows seasonal variations--hinting at an infectious or other environmental cause--but is also more prevalent in children of East Asian ancestry--suggesting that there are genetic factors behind it. Kawasaki disease is normally a self-limiting condition, improving over time, but in some cases it is accompanied with potentially fatal aneurysms of the coronary arteries.

Previous studies have linked Kawasaki disease to the calcium NFAT pathway, which regulates immune function in response to calcium signals, but which is also known to be involved in the development of the cardiac and other systems. Considering this, the RIKEN-led team decided to focus their work on ORA1, a gene within a chromosomal region where a positive linkage signal has been seen in a previous genome-wide linkage study and had shown to be involved in the activation of the calcium NFAT pathway.

To identify variations that might be associated with susceptibility to the disease, the group examined the genes of 729 Kawasaki disease patients and 1,315 healthy adults. To identify variations that were most strongly associated with the disease, they then looked at variations in a further 1,813 patients and 1,097 non-patients. From these analyses, they identified a single nucleotide polymorphism (SNP), rs3741596, that was much more common in the patients than in the healthy controls. This SNP had not been identified in previous studies on Kawasaki, but intriguingly, it had been found from genomic studies of populations (HapMap) that the variant is common in East Asian populations, and to a lesser extent in African populations, but was very rare elsewhere. They also discovered a second, rare variation that was also highly correlated with the diseases.

According to Yoshihiro Onouchi of the IMS Laboratory for Cardiovascular Disease, who led the study, "It has been suggested that a pathway involved in the immune response is associated with Kawasaki disease, and we knew from our previous work that the calcium NFAT pathway is somehow linked to the disease. It was interesting--and makes a lot of sense--that the common variation we discovered is common in East Asia."

He continues, "These findings give added credence to the idea that the NFAT pathway is involved in the etiology of Kawasaki disease, and will help us to understand the causes and mechanisms behind it. We hope also that it could lead to treatments for the disease, which in some cases has devastating consequences."

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Omega-3s: could genetically modified oil seed crops replace fish?

Instead of using fish oil as a primary source of omega-3s, we could be using oil from genetically modified oil seed crops, says research published in The Journal of Nutrition.
[omega 3 linseed]
Omega-3 derived from seeds could replace fish sources to boost supplies.

The novel oil, "Camelina," is part of an ongoing research program to examine the sources and sustainability of omega-3 fatty acids and their impact on health and risk of chronic disease.

Camelina oil was developed by the UK's Biotechnology and Biological Sciences Research Council (BBSRC), as part of a drive toward sustainability.

The long chain omega-3 polyunsaturated fatty acid EPA, or eicosapentaenoic acid, is beneficial for cardiovascular and cognitive health and for fetal development in pregnancy.

Recommendations from the American Heart Association (AHA) suggest a minimum dietary intake of 500 mg of preformed EPA plus docosahexaenoic acid (DHA) a day. This is equivalent to 1-2 portions of oily fish a week. To protect against cardiovascular diseases (CVD), a dose of 1 g is required, or 2.4 g as a therapy for lowering triglycerides (TG).

However, to provide enough for everyone, 1.3 million metric tons of EPA would have to be produced each year.

New supplies needed to ensure cardiovascular health

Supplies of fish are finite, even of currently plentiful species like the Arctic Krill, which is a popular source of omega-3 for supplements. Lead researcher Prof. Anne-Marie Minihane - from the Medical School of the University of East Anglia (UEA) in Norwich, UK - says that "there is a large deficit between supply and demand."

Fish currently supplies only 40% of the EPA and DHA that is needed to allow all individuals globally to meet this minimum intake. Therefore, alternative, sustainable sources are needed.

Alternative sources of omega-3 already include nuts and seeds - such as walnuts and pumpkin seeds - vegetable oils - for instance rapeseed and linseed - or soya and soya products, including beans, milk and tofu. Green leafy vegetables also contain omega-3.

Researchers from UEA studied mice that had followed a diet of feed enriched with oil from genetically engineered Camelina sativa, commonly known as false flax. The crops were grown in glasshouses.

They wanted to know whether mammals can absorb and accumulate EPA from this source, and whether oil from genetically modified plants could be used as a substitute for fish oil.

The mice were given a control diet, similar to a Westernized human diet, and supplements of EPA from genetically engineered Camelina sativa or fish oil, for 10 weeks.

Benefits of EPA from Camelina successfully absorbed

Scientists then examined levels of EPA in various organs of the body by carrying out tests on tissue concentrations of fatty acids in liver, muscle and brain tissue. They also studied the effect of Camelina on the expression of genes involved in regulating EPA status and its physiological benefits.

The benefits were similar to those derived from fish oils, indicating that mammals can efficiently accumulate the key health-beneficial omega-3 fatty acid EPA.

Prof. Minihane believes that the genetically engineered oil is a bioavailable source of EPA, with comparable benefits for the liver to eating oily fish.

She told Medical News Today:

"We need alternative non-marine sources. In the future, this new Camelina oil is likely to represent a viable terrestrial source of these beneficial omega-3 fatty acids, which would ease the current demands on global fish production."

Medical News Today recently reported that omega-3 can help prevent rheumatoid arthritis.

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Irregular heartbeat is riskier for women

An irregular heartbeat, also known as atrial fibrillation, appears to be a stronger risk factor for heart disease and death in women than in men, according to research published in The BMJ.
[Woman and heart problem]
The prognosis for a woman who experiences atrial fibrillation may be worse than for a male counterpart.

Atrial fibrillation (AF) is associated with a higher risk of stroke and death generally, with an estimated 33.5 million people affected globally in 2010, and an age-adjusted mortality rate of 1.7 per 100,000 people.

The prevalence is increasing in both developed and developing countries.

Evidence is now emerging that women and men experience risk factors, such as diabetes and smoking, differently for cardiovascular disease (CVD).

This could have significant implications for estimating the AF burden, targeting treatment to manage it and for future research into gender differences.

An international team of researchers set out to estimate the association between AF and CVD and death in women and men and to compare the genders.

In a meta-analysis of 30 studies published between January 1966 and March 2015, they analyzed data for over 4 million participants.

All the studies had a minimum of 50 participants with AF and 50 without, which reported sex-specific associations between AF and all-cause mortality, cardiovascular mortality, stroke, cardiac events - including cardiac death and non-fatal myocardial infarction - and heart failure.

They took into consideration the differences in study design and quality in order to minimize bias.

AF was linked to a 12% higher relative risk of all-cause mortality in women and a much stronger risk of stroke, cardiovascular mortality, cardiac events and heart failure. The reason for the gender differences is not known.

With respect to clinical care, the results support the development of a specific risk score for AF in women and more aggressive treatment of risk factors in women, as recently recommended by the American Heart Association (AHA).

In relation to public health policy, the researchers say estimation of the global and regional burden of AF should be independent of sex, while "allocation of public health resources for prevention and treatment of AF should also consider the differential effects of AF by sex."

Finally, they say future research should aim to determine the underlying causes of the observed sex differences.

In view of the findings, the authors conclude:

"It might be appropriate for clinicians to consider more aggressive treatment of risk factors in women with AF as they seem to be at higher proportional risk of death and cardiovascular disease."

Medical News Today previously reported on research showing that there is no link between coffee consumption and atrial fibrillation.

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Researchers urge screening of stroke patients for silent heart disease to prevent thousands of deaths

A new study has revealed that more than a third of stroke patients with no known history of heart disease have significant tightening of the arteries around their heart (coronary artery disease) and three percent will go on to suffer a heart attack within a year.

The research, led by Professor Pankaj Sharma at the Institute of Cardiovascular Research at Royal Holloway, University of London and Ashford and St Peter's Hospital, Surrey, reviewed data from 50,000 individuals to establish the risk of heart disease and heart attack in stroke patients with no medical history of heart problems.

The research, published in BMJ Open, establishes that stroke patients are significantly at risk of coronary artery disease and heart attack even in the absence of symptoms associated with the disease. Those with silent heart disease do not experience any symptoms and therefore can remain undiagnosed, without access to treatment that can help manage the symptoms and reduce the future chance of a heart attack.

In the largest study of its kind, researchers found that one in three stroke patients have 50 percent coronary stenosis - meaning that plaque build-up is constricting the inner diameter of the artery by half, restricting the flow of blood and oxygen to the heart. In 3 percent of cases, patients will experience a heart attack within one year of their stroke - higher than previously thought.

The researchers recommend that following a stroke all patients should be assessed by cardiologists and screened for silent heart disease and this new protocol should be mandated by the NHS, something not routinely done in the UK.

Lead researcher Professor Pankaj Sharma from the Institute of Cardiovascular Research at Royal Holloway, said: "Following a stroke most stroke patients go on to die of heart disease rather than their stroke. Our research findings go a long way to explaining why this is the case. We are urging the NHS to screen all stroke patients for silent heart disease to prevent the deaths of thousands of patients each year.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms of use.

Copyright Medical News Today: Excluding email/sharing services explicitly offered on this website, material published on Medical News Today may not be reproduced, or distributed without the prior written permission of Medilexicon International Ltd. Please contact us for further details.

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