Wood Street Clinic Blog

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What causes shortness of breath when lying down?

Shortness of breath, or breathlessness, describes difficulty or discomfort when breathing. A person may feel tightness in the chest or feel as though they cannot get enough air. The medical term for shortness of breath is dyspnea. Potential causes include congestive heart failure, obesity, and respiratory issues.

Sometimes, people find it hard to breathe when they are lying down flat. The medical term for this is orthopnea. People who experience this will often need to prop themselves up on pillows so that they can sleep.

There are several possible causes of orthopnea, such as carrying excess weight or having an underlying health condition such as heart failure.

In some cases, the feeling of breathlessness can wake the person up suddenly. The medical term for this is paroxysmal nocturnal dyspnea. A few things, including snoring and certain sleep disorders such as obstructive sleep apnea (OSA), can cause paroxysmal nocturnal dyspnea.

This article will look at some of the more common causes of and treatments for shortness of breath when lying down.

1. Heart failure woman with shortness of breath when lying down.
Possible causes of orthopnea are heart failure, emphysema, and obesity.

One of the most common causes of orthopnea is heart failure.

In heart failure, the heart can no longer pump blood to the rest of the body as well as it should. Or, it has trouble relaxing after squeezing. So, the pressures in the heart increase, which can cause the fluid to back up into the lungs, abdomen, or legs.

Heart failure can result in fatigue, shortness of breath, leg swelling, and, in some cases, coughing. Everyday activities such as walking and climbing stairs can become more difficult.

Some signs and symptoms of heart failure include:

shortness of breath persistent coughing or wheezing a buildup of excess fluid in the feet, ankles, legs, or abdomen weight gain lack of appetite nausea confusion or impaired thinking increased heart rate or heart palpitations

There is no cure for heart failure, but people can usually manage the condition by using medications and making healthful lifestyle choices.

Typical medications for heart failure include:

angiotensin-converting enzyme inhibitors, such as lisinopril or enalapril angiotensin II receptor blockers, such as candesartan or losartan angiotensin-receptor neprilysin inhibitors, such as sacubitril/valsartan beta-blockers, such as metoprolol or carvedilol aldosterone antagonists, such as spironolactone or eplerenone diuretics or water pills, such as furosemide and bumetanide

To treat orthopnea, a doctor may need to adjust a person's diuretic medication to remove the fluid buildup from the lungs and reduce intracardiac pressures.

Thank you for supporting Medical News Today 2. Emphysema Emphysema is a type of lung condition comprising chronic obstructive pulmonary disease (COPD). This condition damages the air sacs in the lungs and makes the breathing tubes narrower, making it more difficult to breathe. Smoking causes most cases of emphysema. Passive smoking and poor air quality can also play a role. People with this condition will usually find it difficult to breathe when carrying out physical activities. In advanced emphysema, people may also experience shortness of breath when sitting or lying down. The main symptoms of COPD include: chronic cough shortness of breath while doing everyday activities frequent respiratory infections blueness of the lips or fingernail beds fatigue producing a lot of mucus wheezing It is not possible to reverse the lung damage that emphysema causes. However, quitting smoking can stop the damage from getting any worse. Treatments for COPD tend to focus on preventing further damage and improving the symptoms. They include: inhalers that can relax the airways, such as bronchodilators inhalers that can reduce airway inflammation and mucus production, such as steroid inhalers pulmonary rehabilitation programs, which tend to combine education, exercise training, nutrition advice, and counseling supplemental oxygen or oxygen therapy lung surgery, which can help improve breathing for some people complementary therapies such as yoga, massage, and acupuncture, which may help improve quality of life 3. Obesity a woman running in the park
Regular exercise and a healthful diet can help ease orthopnea. People who carry excess weight or have obesity may have difficulty breathing when lying down due to the compressive effects of the weight on their abdomen. Called "pannus," this phenomenon prevents the lungs from inflating fully. Around 93.3 million adults in the United States had obesity in 2015–2016. Obesity has links to health conditions including: Losing weight can help ease orthopnea. The best way to lose weight is to get plenty of exercise and follow a healthful, balanced diet. To adopt a healthful diet, try eating: several servings of fruits and vegetables per day whole-grain bread and cereals healthful fats from nuts, seeds, and olive oil lean protein from poultry, fish, and beans limited amounts of red meat People who follow a healthful diet often have lower rates of heart disease, diabetes, and some other chronic health conditions. 4. OSA OSA is a sleep disorder that can cause breathing difficulties while sleeping. A common sign of OSA is snoring that is interspersed with gasping and choking sounds. People with OSA may also pause their breathing. Other symptoms of OSA may include nocturia (or getting up to urinate during the night), depression, irritability, nocturnal palpitations, and sexual dysfunction. 5. Anxiety or panic disorder teenage boy having a panic attack on a sofa.
Anxiety or panic attacks can cause shortness of breath. Panic attacks and anxiety attacks can come on at any time and be very frightening. Although these episodes do not fit within the typical orthopnea bracket, they can cause shortness of breath when lying down. People tend to describe these attacks as the abrupt onset of intense fear or discomfort that reaches a peak within minutes. Symptoms of a panic or anxiety attack might include: shortness of breath heart palpitations sweating trembling or shaking feelings of choking pain or discomfort in the chest nausea feeling dizzy or lightheaded feeling very hot or very cold a numbness or tingling sensation called paresthesia feelings of unreality or of being detached fear of loss of control fear of death There are treatments available for panic disorder and anxiety, including counseling, psychotherapy, and cognitive behavioral therapy. Thank you for supporting Medical News Today When to see a doctor Shortness of breath that is not related to strenuous exercise, exposure to extreme temperatures, poor air quality, obesity, or high altitude could be a cause for concern. Sudden shortness of breath accompanied by chest pain or pressure, fainting, or nausea could be a sign of a more serious medical condition. If a person suddenly begins experiencing shortness of breath, they should seek medical evaluation. Outlook Orthopnea is the medical term for shortness of breath when lying down. People who experience this condition often have to sleep with their heads propped up on pillows. Many conditions, including obesity and heart failure, can give rise to orthopnea. Treatments tend to depend on the underlying cause. Anyone who finds it difficult to breathe because they have obesity may find that the problem eases when they lose weight. Unexplained shortness of breath or breathing difficulties that are accompanied by chest pain or pressure, fainting, or nausea could be a sign of a more serious medical condition. Anyone who experiences this should speak to a doctor.
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How calcium in coronary arteries can predict future heart health

According to one new study, having high levels of calcium in the coronary arteries could be responsible for detrimental changes to the structure of the heart.
Heart anatomy model
A new study investigates calcium and heart disease.

"Heart disease is the leading cause of death for men and women," according to the Centers for Disease Control and Prevention (CDC).

Being able to identify people at risk is therefore a crucial public health issue.

One way to determine a person's risk of heart disease, stroke, or heart attack is by looking at their coronary artery calcium (CAC) levels.

Calcium plays a number of roles in the body, including keeping bones healthy. However, calcium present in coronary arteries can lead to the accumulation of plaque.

Over time, this calcified substance can cause atherosclerosis, or a narrowing of the arteries. Atherosclerosis restricts blood flow and oxygen supply to vital organs, potentially resulting in a heart attack or stroke.

High cholesterol levels can indicate that a person is at risk; but scientists can also test CAC levels directly.

Using a CT scan to take numerous sectional pictures of the heart, doctors can see specks of CAC. A person's scores tend to range from zero to over 400. The higher the score, the higher the risk of developing cardiovascular disease.

Cholesterol guidelines from 2018 recommend a CAC scan for people ages 40–75 whose risk status is "uncertain," note the American Heart Association (AHA).

A new study, the results of which now appear in the journal Circulation: Cardiovascular Imaging, has examined the CAC scores of younger people and drawn some interesting conclusions.

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Heart abnormalities

The scientists used data from almost 2,500 people to track CAC and heart structure differences between young adulthood and middle age. Women made up 57% of the group, and 52% of participants were white.

They took data from participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in the 1980s with the aim of identifying young adult risk factors for cardiovascular disease.

"We looked at early adulthood to middle age because this is a window in which we can see abnormalities that might not be causing symptoms, but could later increase the risk of heart problems," explains study co-author Dr. Henrique Turin Moreira.

The researchers compared test results from years 15 and 25 of the CARDIA study period. At the 25-year mark, the average age of the group was around 50.

When it came to their CAC results, 77% of participants had a score of zero in year 15 of the study. However, in year 25, this had dropped to 72%.

A number of factors were linked to a rise in CAC scores, including being older, being male, being black, smoking, having higher cholesterol levels, and having higher systolic blood pressure.

Middle-aged people who had higher CAC scores also showed a 9% increase in left ventricular volume and a 12% increase in left ventricular mass.

When the left ventricle changes in this way, the heart has to put more effort into pumping blood. This, in turn, leads to a thickening of the heart, which increases the risk of heart failure.

The study authors also note that these abnormalities were more significant among black people. For these people, every one-unit change in their CAC score correlated with quadruple the increase in their left ventricular mass.

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Future implications

It is unclear why people exhibited such differences depending on their race. Dr. Moreira explains that it could be "due to genetic factors or perhaps greater exposure to cardiovascular risk factors that usually appear earlier" in black people.

What that do already know, however, is that black people are already more likely to develop cardiovascular disease. Although just 43% of white women and 50% of white men have cardiovascular disease, it affects 57% of black women and 60% of black men.

Further research, explains Dr. Moreira, will be needed to "examine the link between coronary artery calcium and heart health" — especially in relation to race. However, documenting the relationship between CAC and heart failure risk factors in a younger age group is significant.

"Given the burden of morbidity and mortality associated with heart failure, these are important findings," says Dr. Salim Virani, a co-author of the AHA's 2018 cholesterol guidelines.

"Prior studies from this cohort have also shown that a better risk factors profile in young adulthood is associated with much lower CAC and therefore, these results further highlight the importance of primordial prevention and risk factor modification in early adulthood."

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What to know about cardiac muscle tissue

Cardiac muscle tissue, or myocardium, is a specialized type of muscle tissue that forms the heart. This muscle tissue, which contracts and releases involuntarily, is responsible for keeping the heart pumping blood around the body.

The human body contains three different kinds of muscle tissue: skeletal, smooth, and cardiac. Only cardiac muscle tissue, comprising cells called myocytes, is present in the heart.

In this article, we discuss the structure and function of cardiac muscle tissue. We also cover medical conditions that can affect cardiac muscle tissue and tips for keeping it healthy.

What is cardiac muscle tissue? Senior man running in the park
A person can strengthen cardiac muscle tissue by doing regular exercise.

Muscle is fibrous tissue that contracts to produce movement. There are three types of muscle tissue in the body: skeletal, smooth, and cardiac. Cardiac muscle is highly organized and contains many types of cell, including fibroblasts, smooth muscle cells, and cardiomyocytes.

Cardiac muscle only exists in the heart. It contains cardiac muscle cells, which perform highly coordinated actions that keep the heart pumping and blood circulating throughout the body.

Unlike skeletal muscle tissue, such as that which is present in the arms and legs, the movements that cardiac muscle tissue produces are involuntary. This means that they are automatic, and that a person cannot control them.

Thank you for supporting Medical News Today How does cardiac muscle tissue function? The heart also contains specialized types of cardiac tissue containing "pacemaker" cells. These contract and expand in response to electrical impulses from the nervous system. Pacemaker cells generate electrical impulses, or action potentials, that tell cardiac muscle cells to contract and relax. The pacemaker cells control heart rate and determine how fast the heart pumps blood. How is it structured? Cardiac muscle tissue gets its strength and flexibility from its interconnected cardiac muscle cells, or fibers. Most cardiac muscle cells contain one nucleus, but some have two. The nucleus houses all of the cell's genetic material. Cardiac muscle cells also contain mitochondria, which many people call "the powerhouses of the cells." These are organelles that convert oxygen and glucose into energy in the form of adenosine triphosphate (ATP). Cardiac muscle cells appear striated or striped under a microscope. These stripes occur due to alternating filaments that comprise myosin and actin proteins. The dark stripes indicate thick filaments that comprise myosin proteins. The thin, lighter filaments contain actin. When a cardiac muscle cell contracts, the myosin filament pulls the actin filaments toward each other, which causes the cell to shrink. The cell uses ATP to power this contraction. A single myosin filament connects to two actin filaments on either side. This forms a single unit of muscle tissue, called a sarcomere. Intercalated discs connect cardiac muscle cells. Gap junctions inside the intercalated discs relay electrical impulses from one cardiac muscle cell to another. Desmosomes are other structures present within intercalated discs. These help hold cardiac muscle fibers together. What conditions affect it woman with shortness of breath holding chest in pain looking out of window
Difficulty breathing or shortness of breath may be a symptom of cardiomyopathy. Cardiomyopathy refers to a group of medical conditions that affect cardiac muscle tissue and impair the heart's ability to pump blood or relax normally. Some common symptoms of cardiomyopathy include: difficulty breathing or shortness of breath fatigue swelling of the legs, ankles, and feet inflammation in the abdomen or neck irregular heartbeat heart murmurs dizziness or lightheadedness Factors that can increase a person's risk of cardiomyopathy include: A heart attack due to a blocked artery can cut off the blood supply to certain areas of the heart. Eventually, the cardiac muscle tissue in these areas will start to die. The death of cardiac muscle tissue can also occur when the heart's oxygen demand exceeds the oxygen supply. This causes the release of cardiac proteins such as troponin into the bloodstream. Read more about how raised troponin levels can indicate heart damage here. Some examples of cardiomyopathy include: Dilated cardiomyopathy Dilated cardiomyopathy causes the cardiac muscle tissue of the left ventricle to stretch and the heart's chambers to dilate. Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is a genetic condition in which the cardiomyocytes are not arranged in a coordinated fashion and are instead disorganized. HCM can interrupt blood flow out of the ventricles, cause arrhythmias (abnormal electrical rhythms), or lead to congestive heart failure. Restrictive cardiomyopathy Restrictive cardiomyopathy (RCM) refers to when the walls of the ventricles become stiff. When this happens, the ventricles cannot relax enough to fill with an adequate amount of blood. Arrhythmogenic right ventricular dysplasia This rare form of cardiomyopathy causes fatty infiltration in cardiac muscle tissue in the right ventricle. Transthyretin amyloid cardiomyopathy Transthyretin amyloid cardiomyopathy (ATTR-CM) develops when amyloid proteins collect and form deposits in the walls of the left ventricle. The amyloid deposits cause the ventricle's walls to stiffen, which prevents the ventricle from filling with blood and reduces its ability to pump blood out of the heart. This is a form of RCM. Tips for healthy cardiac muscle tissue Children playing basketball
Children should do 60 minutes of moderate- to high-intensity physical activity each day. Doing regular aerobic exercise can help strengthen the cardiac muscle tissue and keep the heart and lungs healthy. Aerobic activities involve moving the large skeletal muscles, which causes a person to breathe faster and their heartbeat to quicken. Doing these types of activities often can train the heart to become more efficient. Some examples of aerobic exercises include: running or jogging walking or hiking cycling swimming jumping rope dancing jumping jacks climbing stairs The Department of Health and Human Services (DHHS) make the following recommendations in their Physical Activity Guidelines for Americans: Children aged 6–17 years old should do 60 minutes of moderate- to high-intensity physical activity each day. Adults aged 18 years and older should do 150 minutes of moderate-intensity, or 75 minutes of high-intensity, aerobic exercise each week. Pregnant women should try to do at least 150 minutes of moderate-intensity aerobic activity per week. The DHHS also suggest that a person should try to spread aerobic activity throughout the week. Adults with chronic conditions or disabilities can replace aerobic exercise with at least two muscle-strengthening sessions per week. Thank you for supporting Medical News Today Summary Cardiac muscle tissue is a specialized, organized type of tissue that only exists in the heart. It is responsible for keeping the heart pumping and blood circulating around the body. Cardiac muscle tissue, or myocardium, contains cells that expand and contract in response to electrical impulses from the nervous system. These cardiac cells work together to produce the rhythmic, wave-like contractions that is the heartbeat. Regular aerobic exercise can help strengthen cardiac muscle tissue and lower the risk of heart attack, stroke, and other cardiovascular conditions.
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Why do women face higher heart disease risk after breast cancer?

New research warns that, after completing breast cancer treatment, women aged 45 and over have a heightened risk of developing cardiovascular disease.
doctor checking patients blood pressure
Women who have undergone breast cancer treatment should take measures to prevent heart disease, new research suggests.

According to the World Health Organization (WHO), breast cancer is the most common form of cancer that doctors diagnose among women across all the world's populations.

At the same time, however, it is also one of the most treatable forms of cancer, with a 5-year relative survival rate of 91% among white women, and a 78% survival rate among black women — and these rates are on the increase.

Yet although life expectancy is on the rise for females who undergo breast cancer treatment, they, nevertheless, face a number of health risks in the aftermath of therapy.

Late side effects can include damage to the bones, premature menopause symptoms, and poor heart health.

A new study from the Botucatu Medical School at Paulista State University in Sao Paulo, Brazil, confirms that women of more than 45 years of age who have undergone breast cancer treatment have a heightened risk of developing cardiovascular problems.

The study's findings — which appear online ahead of print in the journal Menopause of the North American Menopause Society (NAMS) — also explain why women who have experienced breast cancer are more at risk of heart disease.

"In addition to toxicity from chemotherapy or radiation therapy, many women go on antiestrogens if they have an estrogen sensitive breast cancer. Loss of estrogen may be associated with higher risk of heart disease," Dr. JoAnn Pinkerton, the executive director of NAMS — although not involved in the current study — explained for Medical News Today.

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In the study, first author Dr. Daniel de Araujo Brito Buttros and colleagues worked with 288 female participants. Of these, 96 had successfully completed breast cancer treatment, while 192 were completely healthy, and had never experienced breast cancer.

All the women were 45 years old and over, and had gone through menopause. None of them had established cardiovascular disease.

The researchers' analysis revealed that, when they compared them with women over 45 who never experienced breast cancer, those who had received breast cancer treatment had a much higher likelihood of having metabolic syndrome, diabetes, atherosclerosis, hypertriglyceridemia (elevated blood levels of fatty molecules), as well as abdominal obesity.

All of these conditions are top risk factors for developing cardiovascular disease. Moreover, these women's risk of cardiovascular, event-related death was increased, matching death rates that experts associate with a breast cancer diagnosis.

"About 1 in 8 women (about 12%) [in the United States] will develop invasive breast cancer over the course of their lives. In 2019, an estimated 268,600 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 62,930 new cases of noninvasive (in situ) breast cancer," Dr. Pinkerton told MNT.

"As of January 2019, there are more than 3.1 million women with a history of breast cancer in the U.S. This includes women currently being treated and women who have finished treatment," she continued.

Since so many women are likely to receive breast cancer treatment, it is important that they speak to their doctors to receive advice about any late side effects or health risks, so that they can take adequate measures to prevent these.

"Heart-healthy lifestyle modifications can decrease both the risk of recurrent breast cancer and the risk of developing heart disease. Thus women should be evaluated for heart disease risk, as they are being treated for breast cancer, and continue to be followed for increased risk after treatment for breast cancer."

Dr. JoAnn Pinkerton, executive director of NAMS

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Atrial fibrillation may raise dementia risk by 50%

A large study concludes that atrial fibrillation does, indeed, raise the risk of dementia even in people who did not have a stroke and that anticoagulants may reduce this risk.
stethoscope on blue background
An irregular heartbeat may be a sign of A-fib, which may, in turn, raise dementia risk.

Atrial fibrillation (A-fib) is a condition in which the heart beats irregularly. More specifically, the atria of the heart — the chambers that receive blood and pump it out to the heart's ventricles and the rest of the body — beat at an irregular rhythm.

A-fib is the most common form of arrhythmia, affecting between 2.7 and 6.1 million adults in the United States.

Previous research has shown that people with A-fib have a higher risk of dementia, and also that people can take blood thinners to reduce this risk.

New research confirms that the above is true, even in people who never experienced a stroke. The new study is the largest of its kind ever conducted.

Boyoung Joung, who is a professor of cardiology and internal medicine at Yonsei University College of Medicine in Seoul, Republic of Korea, is the leading author of the paper, which appears in the European Heart Journal.

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A-fib raises dementia, Alzheimer's risk

In the new research, Prof. Joung and team examined 262,611 adults aged 60 and older who did not have A-fib or dementia at baseline, in 2004.

The scientists accessed the data from the Korea National Health Insurance Service Senior cohort and followed the study participants until 2013.

During the study period, 10,435 participants developed A-fib. Of these, 24.4% also developed dementia. However, only 14.4% of the participants without A-fib developed dementia.

"We found that the people who developed atrial fibrillation had a 50% increased risk of developing dementia compared [with] those who did not develop the condition," reports Prof. Joung.

"[T]his increased risk remained even after we removed those who suffered a stroke from our calculations. This means that among the general population, an extra 1.4 people per 100 of the population would develop dementia if they were diagnosed with atrial fibrillation. The risk occurred in people aged younger and older than 70 years."

Prof. Boyoung Joung

"We also found that atrial fibrillation increased the risk of Alzheimer's disease by 30% and more than doubled the risk of vascular dementia," continues Prof. Joung.

How blood thinners can help

"However, among people who developed atrial fibrillation and who took oral anticoagulants, such as warfarin, or non-vitamin K anticoagulants, such as dabigatran, rivaroxaban, apixaban, or edoxaban, the risk of subsequently developing dementia reduced by 40% compared [with] patients who did not take anticoagulants."

On the point of anticoagulants, or blood thinners, Prof. Joung thinks that "non-vitamin K anticoagulants, which have a significantly lower risk of cerebral hemorrhage than warfarin, may be more effective than warfarin in terms of dementia prevention and this will be answered by an ongoing clinical trial."

The researcher also thinks that more investigations are necessary to determine "whether aggressive rhythm control, such as catheter ablation, helps to prevent dementia."

"Our study suggests that the strong link between atrial fibrillation and dementia could be weakened if patients took oral anticoagulants. Therefore, doctors should think carefully and be readier to prescribe anticoagulants for atrial fibrillation patients to try to prevent dementia."

Prof. Gregory Lip, study co-author

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Strengths and limitations of the study

The researchers explain that this is the largest study of its kind due to the high number of participants and the long follow-up period.

"With these large figures, we can be sure of our findings," comments study co-author Gregory Lip, who is a professor of cardiovascular medicine at the University of Liverpool, United Kingdom.

"We also believe that our results can be applied to other populations too, as they confirm similar findings of a link between atrial fibrillation and dementia in studies of people in Western and European countries," adds Prof. Lip.

The authors caution that the research only shows a link between A-fib and dementia but does not suggest causality.

However, they speculate that a possible mechanism behind the association could be that people with A-fib often have altered blood vessels in the brain, which may have been the result of symptomless ministrokes.

Such brain damage may, over time, lead to dementia, suggest the researchers. Prof. Joung and team go on to point out further limitations to the study.

For instance, they note that they could not identify whether the study participants had paroxysmal or persistent A-fib. Also, A-fib can take place without any noticeable symptoms, so the study may have omitted some cases.

Also, the scientists did not know whether the patients were receiving treatment for A-fib and suggest that successful treatment may have affected dementia risk differently. They also lacked information on the participants' blood pressure. Finally, the researchers say, there may have been "unidentified confounding factors" that they did not account for.

Prof. Joung concludes, "Dementia is an untreatable disease, and so prevention is important."

"This study confirms that atrial fibrillation is a risk factor for the development of dementia. Therefore, the prevention of atrial fibrillation may be a means to reduce the incidence of dementia."

Prof. Boyoung Joung

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What is end-diastolic volume?

End-diastolic volume is the amount of blood that is in the ventricles before the heart contracts. Doctors use end-diastolic volume to estimate the heart's preload volume and to calculate stroke volume and ejection fraction. These different measurements indicate the health of a person's heart.

In this article, we explain what end-diastolic volume is and how doctors use it. We also discuss some conditions that can affect end-diastolic volume.

What is it? End diastolic volume is the measure of blood in the left or right ventricle before the heart contracts.
End-diastolic volume is the measure of blood in the left or right ventricle before the heart contracts.

End-diastolic volume refers to the quantity of blood in the left or right ventricle at the end of diastole, just before systole starts.

The heart consists of four chambers: two atria and two ventricles. The chambers contain valves that open and close in sequence so that blood flows in one direction through the atria and ventricles.

The veins carry oxygen-poor blood into the right atrium, which connects to the right ventricle. From here, the heart pumps blood into the lungs for oxygenation.

The newly oxygenated blood enters the left atrium and flows into the left ventricle, which contracts, forcing blood up through the aorta. The aorta is the largest artery in the body, and it supplies the entire body with oxygen-rich blood.

Diastole occurs when the heart muscle relaxes, and the chambers fill with blood. Blood pressure decreases during diastole.

Systole occurs when the ventricles contract, pushing blood out of the right ventricle into the lungs and out of the left ventricle to the rest of the body. Blood pressure increases during systole.

Thank you for supporting Medical News Today How do doctors use it? Doctors use end-diastolic volume to evaluate the condition of a person's heart and their general health. A doctor can measure end-diastolic volume using the following tests: Echocardiogram. In this noninvasive procedure, doctors use ultrasound technology to create detailed images of a person's heart. Left heart catheterization. This procedure involves threading a thin, flexible tube called a catheter through a large blood vessel and into the heart. Doctors can use the catheter to take blood samples and measure the pressure and oxygen content in the four chambers of the heart. Doctors use end-diastolic volume to calculate several different measurements of heart function, which we discuss below. Sometimes, they specifically use left ventricular end-diastolic volume, which is the amount of blood that is present in the left ventricle before contraction. Preload Doctors use left ventricular end-diastolic volume to estimate cardiac preload, which is how much the cardiac fibers of the ventricle stretch before contraction. Doctors are unable to test preload directly, so they use end-diastolic volume as a close estimate. Stroke volume Doctors use both end-diastolic volume and end-systolic volume to calculate stroke volume. End-systolic volume is the amount of blood remaining in the ventricle at the end of systole, after the heart has contracted. Stroke volume is the quantity of blood that the heart pumps out of the left ventricle with each beat. The formula for stroke volume is: Stroke volume = end-diastolic volume - end-systolic volume. According to a large 2017 study, normal stroke volume ranges are: 48.2–114.3 milliliters (ml) for people aged 18 to 29 years 39.1–98.5 ml for people aged 30 to 59 years 39.7–115.3 ml for people aged 60 years or older Ejection fraction Ejection fraction refers to the proportion of blood that leaves the left ventricle during systole relative to the end-diastolic volume. Essentially, it is the percentage of blood that the heart pumps out of the left ventricle during each beat. Doctors use ejection fraction to determine how well the heart is pumping blood and to help diagnose heart failure. The calculation for ejection fraction is: Ejection fraction = (stroke volume / end-diastolic volume) x 100. According to the American Heart Association, a healthy ejection fraction ranges between 50% and 70%. What conditions affect it? Certain health conditions can affect end-diastolic volume. These include: Cardiomyopathy A doctor may recommend an echocardiogram to measure end-diastolic volume.
A doctor may recommend an echocardiogram to measure end-diastolic volume. Cardiomyopathy is an umbrella term for medical conditions that affect the heart muscle. These conditions can cause the heart muscle to thicken, enlarge, or lose its elasticity. Cardiomyopathy affects the heart's ability to pump blood around the body, which can lead to an irregular heartbeat, heart failure, and other serious complications. There are several different types of cardiomyopathy. In people with dilated cardiomyopathy, the ventricles become enlarged, which increases the end-diastolic volume. Enlargement of the heart muscle can cause the ventricle walls to thicken, causing a condition called hypertrophic cardiomyopathy. This thickening can affect blood flow out of the left ventricle, which can lead to an increase in end-diastolic volume. Thank you for supporting Medical News Today Mitral valve regurgitation Mitral valve regurgitation occurs when blood leaks backward through the mitral valve, which connects the left atrium and ventricle. The left atrium may enlarge to accommodate the extra blood leaking through the mitral valve. An enlarged left atrium can lead to complications, such as atrial fibrillation, an irregular heartbeat, heart failure, and stroke. Summary End-diastolic volume is a useful indicator of a person's heart health. Doctors use end-diastolic volume to estimate preload and calculate the heart's stroke volume and ejection fraction. Certain conditions may affect end-diastolic volume, including cardiomyopathy and mitral regurgitation.
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Coronary heart disease may speed up cognitive decline

It is natural for a person's memory and thinking abilities, or cognitive function, to wane as they age — even if they are in good health. However, the rate of cognitive decline can speed up if they experience heart attack or angina, according to new research.
senior woman reading on a tablet
Cognitive decline may speed up after a heart attack or angina.

Studies that have explored the links between circulation problems and cognitive decline have tended to focus on conditions that affect the blood supply to the brain, such as stroke.

Few of these earlier studies, however, have looked at the long-term links between incident coronary heart disease (CHD), such as heart attack and angina, and cognitive decline.

The recent Journal of the American College of Cardiology study is unique; it tracked cognitive decline both before and after incident CHD.

"Incident CHD," its authors conclude, "is associated with accelerated cognitive decline after, but not before, the event."

They suggest that the findings highlight the long-term relationship between cognitive decline and CHD.

Lead and corresponding study author Wuxiang Xie, Ph.D., says that because there is not yet a cure for dementia, it is important to detect and treat the brain condition as early as possible in order to delay its progression.

"Even small differences in cognitive function can result in an increased risk of dementia in the long-term," explains Xie, who holds research posts at Peking University Clinical Research Institute in China and in the School of Public Health at Imperial College London in the United Kingdom.

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Narrow arteries reduce blood supply

CHD, or coronary artery disease, can develop when the arteries that feed the heart become narrow and obstruct blood flow.

The arteries become narrow because fatty deposits, or plaques, build up inside their walls. Medical professionals call this process atherosclerosis.

The reduction in blood flow causes heart muscle to receive less oxygen, increasing the likelihood of a heart attack. The reduction in blood supply can also cause chest pain, or angina.

CHD is the leading cause of death worldwide, according to the World Health Organization (WHO). In 2016, it was responsible for more than 9 million deaths.

Xie and his colleagues believe that their study is one of the largest to investigate cognitive decline in the years before and after receiving a diagnosis of CHD.

Their analysis took in data from 7,888 participants, aged 50 and older, from the English Longitudinal Study of Aging (ELSA).

CHD and cognitive decline

The ELSA collected data twice per year between 2002 and 2017. None of the participants had a history of heart attack, angina, or stroke or a diagnosis of dementia or Alzheimer's disease at the start of the study period.

The researchers excluded people who did not complete all the cognitive assessments or who had a stroke during the median follow-up of 12 years.

Over the follow-up period, the participants underwent three tests of cognitive function, which the researchers conducted in eight waves. The tests assessed verbal memory, semantic fluency, and sense of time, or "temporal orientation."

During the study period, 5.6% of the participants experienced angina or heart attacks. Everyone in this group demonstrated a more rapid decline in cognitive function in the three tests compared with those who did not experience a CHD event.

Those who developed angina showed a faster decline in the tests of temporal orientation, while verbal memory and semantic fluency declined more rapidly in those who experienced heart attacks.

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The study authors note that they "found that incident CHD was significantly associated with faster rates of post-CHD-diagnosis cognitive decline, but not with cognitive changes in the years before or short-term changes following the event."

Speculating on the findings, they suggest that the reduction in oxygen to the brain is the likely reason for the link between CHD and faster cognitive decline.

Previous research linked CHD to interruptions of blood supply to the brain, or cerebral microinfarcts. Such links suggest that CHD might promote small vessel disease, which is a major contributor to dementia in older adults.

"Heart attack and angina patients need careful monitoring in the years following a diagnosis."

Wuxiang Xie, Ph.D.

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What to know about cardiorespiratory endurance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A doctor or nurse may recommend a physical to:

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

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

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

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

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

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

The doctor or nurse may ask about:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Analysis finds 396 medical reversals

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

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

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

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

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

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

Main takeaways from the results

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

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

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

Dr. Vinay Prasad

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Circadian rhythms and chronotypes

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

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

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

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

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

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

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

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

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

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More than 2 chronotypes?

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

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

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

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

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

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

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

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

Night owls: An endangered species?

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

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

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

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

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

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

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

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

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

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

Should owls turn into larks?

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

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

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

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

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

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

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

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

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

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

Not a black and white issue

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

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

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

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

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

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

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Low fruit and vegetable intake may account for millions of deaths

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

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

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

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

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

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

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The global impact of inadequate nutrition

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

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

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

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

Tracking death toll by region, age, and sex

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

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

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

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

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

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Estrogen, vitamin D may protect metabolic health after menopause

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

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

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

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

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

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

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Study results

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

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

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

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

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

Assessment of metabolic syndrome

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

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

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

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

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

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

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

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

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

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Major public health issue

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

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

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

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

Dr. JoAnn Pinkerton

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Common acne drug could prevent artery hardening

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

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

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

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

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

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

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

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

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

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Calcification and artery hardening

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

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

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

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

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

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

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

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

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

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

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

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Cells export PAR under stress

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

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

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

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

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

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

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Minocycline stopped artery hardening in rats

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

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

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

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

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

Prof. Jeremy Pearson

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

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

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

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

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

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

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

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

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

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

Dr. Jordana B. Cohen

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

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

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

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

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

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

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

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

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

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

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3 interventions could prevent millions of cardiovascular deaths

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Goodarz Danaei

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What causes lower back and hip pain?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Atherosclerosis in brief

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

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

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

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

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Another look at tomato juice

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

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

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

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

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

1 cup each day

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

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

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

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

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

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

No change for glucose or triglycerides

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

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

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

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

Sizable limitations

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

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

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

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

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

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

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

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

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Cardiovascular disease: 7 simple steps that lower future risk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Xiang Gao

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

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

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