Wood Street Clinic Blog

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Sinus tachycardia: Everything you need to know

Tachycardia is when the heart beats faster than normal. There are different types of tachycardia, depending on the cause. Sinus tachycardia is when the sinus node, which is the natural pacemaker of the heart, fires electrical impulses abnormally quickly.People can have either normal or inappropriate sinus tachycardia. Normal sinus tachycardia refers to a physiological increased heart rate that occurs in response to specific factors, such as stress, exercise, or a fever.Inappropriate sinus tachycardia has no known cause. People who have it may have an increased heart rate all of the time, even at rest.In this article, we discuss sinus tachycardia, including its symptoms, types, causes, and treatment options.
a woman getting her heart rate checked to make sure she doesn't have Sinus tachycardiaShare on PinterestA person with sinus tachycardia may experience irregular heartbeats.Sinus tachycardia refers to an increased heart rate that exceeds 100 beats per minute (bpm). The sinus node, or sinoatrial node, is a bundle of specialized electrical cells in the right upper chamber of the heart.These cells act as the natural pacemaker of the heart by sending electrical impulses to the surrounding tissue. These impulses cause the heart to contract.A properly functioning sinus node regulates the rhythm and speed of a person's heart. A normal heart rate should usually be 60–80 bpm at rest, but it can sometimes range between 60 and 100 bpm, according to the American Heart Association.In people with a heart rate that exceeds 100 bpm, the sinus node is sending electrical signals at a faster-than-normal rate.
Sinus tachycardia occurs when the heart rate is above 100 bpm.In addition to a fast heart rate, people with sinus tachycardia may experience the following symptoms:
People can develop sinus tachycardia for different reasons. The underlying cause will determine the likely outcome of a person with this condition.The types of sinus tachycardia are:Normal sinus tachycardia, which occurs when the heart rate increases due to an identifiable reason, such as exercise, stimulants, or emotional distress.Inappropriate sinus tachycardia (IST), which has no identifiable cause. People who have IST may experience an increased heart rate while resting. IST can be the result of an inappropriately high "set point" for the heart.According to the authors of a 2017 case report, doctors can sometimes misdiagnose IST as a symptom of mental health conditions, such as depression.Most of the time, sinus tachycardia is a normal response of the cardiovascular system to triggers that increase the heart rate. Normal sinus tachycardia may occur as part of the body's response to certain conditions, such as intense physical activity or emotional distress.During exercise, the heart rate typically increases as it needs to pump more oxygen to the muscles.Emotional stress or anxiety can trigger an increase in neurotransmitters, such as dopamine and epinephrine, which make the heart beat faster.Other potential causes of normal sinus tachycardia include:Less common causes of sinus tachycardia include:damage to cardiac tissuethyroid problemsanemiaIST typically occurs without a known cause.A doctor can diagnose sinus tachycardia by reviewing a person's medical history, performing a physical examination, and carrying out other medical tests.Other tests that a doctor can use to diagnose sinus tachycardia include:If a doctor needs more information about how a person's heart functions, they may ask the individual to use a wearable medical device called a Holter monitor for at least 24 hours.The basic diagnostic criteria for IST include:having a resting heart rate higher than 100 bpm and an average resting heart rate above 90 bpm during Holter monitoring for 24 hoursincreased heart rate and heart palpitations that result in emotional distressTreatments for sinus tachycardia vary depending on the underlying cause, but they usually involve a combination of lifestyle changes, medication, and, in very rare instances, surgery.Doctors address the underlying cause or condition when treating normal sinus tachycardia and do not often treat the tachycardia itself. Treating IST can be more challenging.Treatments for sinus tachycardia may include:reducing caffeine intakequitting smoking and avoiding other sources of nicotineexercising regularlydrinking enough waterconsuming less than 2,300 milligrams of sodium per daySinus tachycardia is usually a benign condition, but if it is persistent, it can lead to weakness of the heart over time. Doctors refer to this as tachycardia-induced cardiomyopathy. Sometimes, a doctor may prescribe medications, such as beta-blockers, calcium channel blockers, or ivabradine, to reduce the heart rate and treat symptoms.In a small clinical study, researchers gave people with ITS ivabradine twice a day for 6 months. Ivabradine reduced the participants' average daytime heart rate from 103 bpm to 84 bpm.A doctor may recommend more invasive forms of treatment, such as catheter ablation, for people with IST who do not respond to lifestyle changes or medication.Catheter ablation delivers heat to the portions of heart tissue that cause rapid or irregular heartbeats. This procedure can help return the heart rate to normal. However, every procedure has complications, and people may still experience recurring tachycardia after catheter ablation.People can discuss the risks and benefits of catheter ablation with a doctor.Tachycardia occurs when the heart beats more than 100 times per minute, whether at rest or with exercise. People develop sinus tachycardia when the sinus node in the heart sends electrical impulses more quickly than normal.It can occur as a result of a particular trigger, such as exercise, caffeine, or stress. However, sinus tachycardia without a physiologic trigger can be a result of an arrhythmia called inappropriate sinus tachycardia.Treatments for sinus tachycardia focus on lowering the heart rate to normal by treating the underlying cause, such as infection or low blood pressure. Doctors may also recommend lifestyle changes, medications, and medical procedures, such as catheter ablation.People who have sinus tachycardia can learn more about their treatment options by speaking with a doctor. A doctor can offer advice on ways to improve overall cardiovascular health to lower the resting heart rate.
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Heart attack protein may raise early death risk

New research finds that raised levels of a protein called troponin are a "highly clinically meaningful" indicator of death risk, regardless of age or underlying cause.

doctor listening to patient's heartShare on PinterestA protein that functions as a heart attack biomarker may indicate early death risk, new research suggests.

Heart disease is responsible for 1 in 4 deaths in the United States, with more than 600,000 people dying as a result of this condition each year.

Coronary heart disease is particularly common, claiming at least 370,000 lives annually. Heart attacks are also widespread, with 735,000 adults in the U.S. experiencing one every year.

The medical community recognizes the protein troponin as a biomarker for diagnosing heart attacks. Furthermore, previous studies have found a link between higher troponin levels and plaque rupture, acute coronary obstruction, and poorer myocardial perfusion — a measure of how well blood circulates through the heart.

Troponins are regulatory proteins that play a key role in the heart's muscle contractions.

Now, new research finds that even a slight increase in the levels of this protein is consistently associated with a higher risk of death among all age groups.Amit Kaura is the lead author of the new research and a clinical research fellow at Imperial College London in the United Kingdom. His and his team's findings appear in the BMJ.Kaura and colleagues examined the data of more than 250,000 people in an effort to gauge the link between age, troponin level, and mortality.Between 2010 and 2017, doctors had measured the troponin levels of each of the study participants, whose ages ranged from 18 years to over 90 years. The scientists clinically followed these individuals for 3 years.Overall, the researchers found a dose-response link between high levels of troponin in the blood and early death risk, meaning that the higher the troponin levels were, the higher the risk of death. This association held regardless of age.When looking specifically at different age groups, the analysis revealed that young adults — that is, those between the ages of 19 and 29 years — with raised troponin levels were 10 times more likely to die than those whose blood did not have elevated levels of the protein.The risk declined gradually with age, with people over the age of 90 years with raised troponin levels being 1.5 times more likely to die than others of a similar age.However, almost half of the participants with high troponin levels who were over 80 years of age died within 3 years, note the researchers, confirming the notion that high troponin levels signal a higher likelihood of dying.Finally, the results also revealed a paradox: In people who had experienced a heart attack, extremely high levels of troponin were linked with a lower death risk.The researchers explain that this may be because a higher proportion of these participants were suitable candidates for an operation that improves blood flow to the heart.Overall, the authors conclude, "A positive troponin result is, therefore, highly clinically meaningful, regardless of age, with the excess mortality associated with a raised troponin level being heavily concentrated in the first few weeks."The findings, say the researchers, emphasize the fact that troponin levels may be a useful tool for assessing longevity, even in those who have not had a heart attack.Furthermore, the research team is currently working on a clinical trial to examine whether cardiovascular treatments such as statins improve the heart health of those with raised troponin levels.Kaura comments on the findings, saying, "There have been many advances in treating heart disease, yet it remains the leading cause of death in the U.K. and around the world.""This is the first study to address the implications of raised troponin in a real-world large sample of patients across a wide range of ages," the researcher adds."Doctors will be able to use this information to help identify the risk of early death in patients who have a troponin level measured; this could lead to interventions at a much earlier stage in a wider group of patients than are currently treated."Amit Kaura
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Exercise after the age of 60 may prevent heart disease, stroke

A study finds that increased activity over the age of 60 can significantly reduce the risk of cardiovascular disease.

seniors doing physical activityShare on PinterestNew research examines the impact of physical activity in people over the age of 60.

In 2015, 900 million people, globally, were over the age of 60. By 2050, the World Health Organization (WHO) expect that number to reach 2 billion.

While it is common for people to become less active as age takes a toll on one's physical capabilities, a study just published in the European Heart Journalfinds that either maintaining levels of activity or becoming more active at this stage of life is important for reducing the risks of heart attack and stroke.

The researchers found that study participants who reduced their levels of exercise over time had a 27% greater likelihood of developing heart and blood vessel issues. Those who became more active reduced their risk by as much as 11%.

Studying physical activity in older age

The authors of the study — led by Kyuwoong Kim, of the Department of Biomedical Sciences, at Seoul National University, in South Korea — analyzed data from 1,119,925 men and women 60 years or older.

The data had been collected by the National Health Insurance Service (NIHS), which provides healthcare to about 97% of South Korea's population. The average age of participants was 67, and 47% were men.

The NIHS conducted two health checks of the individuals, one in 2009–2010 and one in 2011–2012. The researchers collected data about these participants until 2016.During each check, the healthcare providers asked the participants about their levels of physical activity and their lifestyles. The researchers defined moderate physical activity as 30 minutes or more per day of dancing, gardening, or brisk walking. Twenty minutes or more of running, fast cycling, or aerobic exercise daily counted as vigorous exercise. In their second NIHS health check, the participants reported how their levels of activity had changed since the first checkup.A majority of the participants, about two-thirds, were inactive at the times of both checks. About 78% of women were physically inactive at the first health check, and this figure at the second check was roughly the same, at 77%.Men were less inactive both times: 67% at the first screening and 66% at the second.Just 22% of the overall group had increased their levels of activity between checks, while 54% of participants who had been exercising regularly five or more times per week had become inactive by the time of the second screening.The researchers also analyzed national heart disease- and stroke-related medical claims and hospital records from January 2013 to December 2016.By the end of the study period, 114,856 cases of heart disease or stroke had been reported among the cohort. The researchers adjusted for factors such as socioeconomic status, age, gender, other medical conditions, and lifestyle details such as smoking and alcohol use.The impact of activity over the age of 60The study's analysis revealed that people who had increased their levels of activity from continuously inactive to moderately or vigorously active three to four times a week had lowered their risk of heart attack and stroke by 11%.Those who had been active one or two times per week at the first check then increased to five or more times per week by the second check had lowered their risk by 10%.People with disabilities also benefited from increasing their activity levels, reducing their risk of cardiovascular events by 16%. Participants with chronic conditions such as hypertension or diabetes saw a 4–7% reduction in their chances of experiencing a heart problem or stroke.Meanwhile, the risk of cardiovascular problems had increased by 27% among participants who had reduced their levels of exercise between screenings."The most important message from this research is that older adults should increase or maintain their exercise frequency to prevent cardiovascular disease."Kyuwoong Kim"While older adults find it difficult to engage in regular physical activity as they age, our research suggests that it is necessary to be more physically active for cardiovascular health, and this is also true for people with disabilities and chronic health conditions," he continues.There are some limitations to this study. First, it considered only older adults in South Korea, and the applicability of the findings to older populations in other areas cannot be assumed.Second, it strongly relies on self-reporting of activity levels, and the findings depend on the accuracy of each individual's responses.Finally, the NIHS questions did not encompass all forms of activity — for instance, the researchers did not include housework and other muscle-strengthening activities.What to do with this informationNonetheless, the study's conclusions present compelling evidence that exercise remains important as we age.The findings make the case that physical activity should become a significant, daily priority for older adults as our bodies grow in fragility, and discomfort becomes more common.Our health services could be doing more to encourage this idea, suggests Kim, adding, "We believe that community-based programs to encourage physical activity among older adults should be promoted by governments.""Also, from a clinical perspective, physicians should 'prescribe' physical activity along with other recommended medical treatments for people with a high risk of cardiovascular disease." Kyuwoong Kim
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The link between insomnia and cardiovascular disease

Sleeping problems can affect both mental and physical health. Now, a large-scale analysis in China highlights how insomnia might lead to potentially life threatening cardiovascular diseases.

man having trouble sleepingShare on PinterestNew research points to concerning links between insomnia and cardiovascular problems.

Insomnia is a relatively widespread problem. When a person has insomnia, they often struggle to fall asleep or stay asleep. Some people experience both.

Around 1 in 4 adults in the United States experience short-term, or acute, insomnia every year, according to research carried out at the University of Pennsylvania, PA. Acute insomnia typically means that a person experiences sleep problems for just a short period, perhaps due to stress or worry.

Approximately three-quarters of these people return to their regular sleeping patterns. Others, however, go on to develop chronic insomnia.

Chronic insomnia refers to a person who experiences problems sleeping for at least 3 nights a week for no less than 3 months.

Both acute and chronic insomnia can result in daytime drowsiness, concentration and memory problems, and a lack of energy.But studies have found more worrying links. One recent analysis, appearing in Sleep Medicine Reviews, linked insomnia to the onset of depression, anxiety, and alcohol misuse. Other studies have found a relationship between insomnia and heart disease.Now, authors of a new study, published in Neurology, point out that previous research has failed to define insomnia correctly and has included people who may not have the disorder. So they set out to find a stronger association.Tracking insomniaThe results of the new paper suggest that identifying insomnia, particularly in young people, may reduce cardiovascular disease risk later on in life.The researchers used data from the China Kadoorie Biobank, which investigates and tracks the leading causes of chronic diseases in China.The participants, aged between 30 and 79, had no history of heart disease or stroke when the study commenced.In the new study, the researchers analyzed three symptoms of insomnia, where the symptoms lasted at least 3 days a week. The symptoms were: problems falling asleep or staying asleep, waking too early, or struggling to focus during the day because of disrupted sleep.The data show that 11% of the participants reported trouble falling or staying asleep, and 10% had problems with waking up early. Only 2% of the participants reported having focusing issues during the day.The researchers followed all of the volunteers for about a decade. During that time, they identified 130,032 incidences of heart attack, stroke, and comparable diseases.A higher chance of cardiovascular diseaseAfter taking into account other risk factors, such as smoking and alcohol consumption, researchers identified several significant findings.The new study identified that the participants who reported experiencing all three insomnia symptoms had an 18% increased chance of developing cardiovascular diseases compared with those who did not experience the symptoms.Those who reported trouble focusing during the day were 13% more likely to develop heart attack, stroke, and comparable diseases than people who did not have problems focusing.Researchers identified that the people who found it difficult to fall asleep or stay asleep had a 9% higher chance of developing these diseases, while those who woke up too early were 7% more likely to experience a stroke, heart attack, or similar.Despite these results, the researchers point out that they have not established a cause and effect between insomnia and cardiovascular illnesses. The findings simply highlight an association between the two.Notably, this link "was even stronger in younger adults and people who did not have high blood pressure at the start of the study," says study author Dr. Liming Li of Beijing's Peking University in China.The researchers note that the participants in the study self-reported their symptoms of insomnia, which may mean the data are not entirely accurate. However, further analyses, enlisting medical professionals to track symptoms of insomnia rather than relying on self-reporting, would strengthen the relationship."These results suggest that if we can target people who are having trouble sleeping with behavioral therapies, it's possible that we could reduce the number of cases of stroke, heart attack, and other diseases later down the line."Dr. Liming Li
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Atrial fibrillation: Height could predict risk

Researchers from the University of Pennsylvania have found that people who are taller also have a higher risk of developing atrial fibrillation, a common heart condition, and that there may be a genetic link.

image of tall and short person standing next to each otherShare on PinterestBeing tall can make a person more prone to atrial fibrillation, new research confirms.

Atrial fibrillation is a condition characterized by an abnormal heartbeat — the heart may beat too fast, too slow, or the beats may be irregular.

According to the Centers for Disease Control and Prevention (CDC), around 2.7–6.1 million people in the United States have atrial fibrillation.

Though some people are unaware that they have it, due to a lack of obvious symptoms, atrial fibrillation can increase a person's risk of stroke.

Meanwhile, over 750,000 people end up in the hospital each year because of this heart problem, as per CDC data.

Recent research has shown that cases of atrial fibrillation have been on the rise, forecasting an "epidemic." But if people know that they are at risk of developing this condition, they can take steps to prevent it. They can also be better prepared to manage it, if it does develop.Some recognized risk factors for atrial fibrillation include high blood pressure, obesity, diabetes, and heart disease, as well as some nonclinical factors, such as being older and being of European descent.Now, a new study from Penn Medicine — a combined effort of the University of Pennsylvania Health System and the university's Perelman School of Medicine, in Philadelphia — suggests that being tall may be another risk factor for atrial fibrillation."Our findings suggest it may be beneficial to incorporate height into risk-prediction tools for [atrial fibrillation]," says lead study author Dr. Michael Levin.He and colleagues will present their findings later this week at the American Heart Association's 2019 Scientific Sessions, in Philadelphia, PA.The researchers report that for every 1-inch increase relative to average height — which they give as 5 feet and 7 inches, or approximately 1 meter and 70 centimeters — a person's risk of atrial fibrillation increases by approximately 3%.However, this finding is not surprising, since past observational studies have also suggested an association between height and atrial fibrillation risk.The issue that most interested the research team was whether there might be a causal relationship between height and atrial fibrillation risk.To answer this question, the researchers analyzed genetic data from two large databases. One was that of the Genetic Investigation of Anthropometric Trials consortium. The investigators accessed this database to analyze the genes of 700,000 participants, looking for genetic variants associated with increased height.The other was the database of the Atrial Fibrillation Genetics consortium, which allowed the researchers to analyze the genetic information of over 500,000 people, searching for genetic variants linked to a higher risk of atrial fibrillation.Putting two and two together, the investigators found that many of the genetic variants associated with increased height were also linked to a higher risk of atrial fibrillation.This relationship remained in place, even after the investigators adjusted for confounding factors, including heart disease, high blood pressure, and diabetes, which led the team to conclude that there may be a causal relationship between height and atrial fibrillation risk.This notion was backed up by further analysis: When the researchers analyzed the data of an additional cohort of almost 7,000 participants enrolled in the Penn Medicine Biobank, they once more saw that a person's height, as well as genetic variants specifically associated with increased height, were strongly linked to an increased risk of atrial fibrillation.Once again, these associations remained in place, even after the team adjusted for confounding factors, such as other known risk factors for atrial fibrillation.These findings have led the study authors to suggest that, going forward, medical professionals may want to start including height on their list of important risk factors to consider in the context of heart health."While current guidelines advise against widespread screening for [atrial fibrillation], our findings show that a certain group of patients — specifically very tall patients — may benefit from screening."Dr. Michael LevinSenior author Dr. Scott Damrauer adds that "These analyses show how we can use human genetics to help us better understand causal risk factors for common disease.""They also illustrate how we can combine summary-level statistics from large published studies with individual-level data from institutional biobanks to further our understanding of human disease," Dr. Damrauer explains.
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What are the health benefits of yerba maté tea?

Yerba maté is a caffeinated tea made from the leaves of Ilex paraguariensis, a type of holly found in the South American rainforest. In addition to its distinct flavor, yerba maté is rich in vitamins, amino acids, and polyphenols, which are plant compounds that may improve health.The research on yerba maté tea's health benefits is still emerging, but some studies suggest that yerba maté may improve cardiovascular health, counteract the health effects of obesity, and more.Keep reading to learn about five of the health benefits of yerba maté, some possible risks and side effects, and how to consume and prepare it.
According to a 2011 analysis, foods such as ginseng, yerba maté, and soybeans contain an actinobacterium, a type of bacteria that may change the way the body digests fat. This may help a person gain less weight or even lose weight.Research on animals supports the role of yerba maté in fighting obesity and counteracting its effects. A 2012 study on rats who ate a high-fat diet found that yerba maté changed lipid metabolism. It also lowered some common side effects of obesity, including serum triglycerides and blood glucose. A 2013 study found that yerba maté could reduce inflammation in obese rats.
Yerba maté, like many other plant products, is an antioxidant. This means that the chemicals in yerba maté may be able to counteract the effects of free radicals.Free radicals play a role in oxidative damage, which has links to numerous health issues, including cancer and heart disease. Many of yerba maté's health benefits may exist because it is an antioxidant.Learn more about antioxidants here.
Research increasingly points to the role of caffeine in improving heart health, but studies on yerba maté suggest it may offer additional benefits.Chronic inflammation may damage blood vessels and the heart, leading to heart disease or even heart failure. A handful of animal studies, including a 2013 study on rats, suggests that yerba maté may ease inflammation, especially inflammation related to obesity.Yerba maté may also help lower low-density lipoprotein cholesterol, which is a type of cholesterol linked to heart disease. A 2011 review suggests that it may even be possible to use yerba maté to increase the effectiveness of statins, a type of medication used to lower cholesterol.Osteoporosis is a leading cause of bone fractures. According to Centers for Disease Control and Prevention, 5.1 percent of men and 24.5 percent of women over 65 in the United States have osteoporosis.A 2012 study compared women who drank at least 1 liter of yerba maté per day for 4 years to those who did not. Even after controlling for other factors that might affect bone mineral density, researchers found that women who drank yerba maté had less bone loss in their spine and neck. This correlates with a lower risk of osteoporosis and a decreased incidence of fractures.Although the caffeine in yerba maté offers a number of health benefits, it also presents some risks. These risks include:an increased risk of pregnancy loss, especially when consumed at high dosestemporary elevations in blood pressurehigher blood lipidsPeople with severe heart disease, uncontrolled high blood pressure, or heart arrhythmias should talk to a healthcare provider before drinking yerba maté.A 2010 study found an increase in oral and esophageal cancers among frequent drinkers of yerba maté. However, the study's authors caution that it is unclear if these effects are the result of hot tea generally, or specific ingredients in yerba maté.More recent research, including a 2019 study, has linked hot drinks to oral cancers. Therefore, to reduce the risk, people who enjoy yerba maté tea should consider drinking their tea warm or cold instead of hot.To get the most benefits from yerba maté tea, prepare the tea with boiling water, then allow it to cool. Warm and cold teas are not associated with an increased risk of oral cancers, so try drinking the tea with ice or after chilling it in the refrigerator.People who prefer sweet tea should sweeten the tea with sugar, honey, agave, or another sweetener while it is still hot.Making yerba maté from loose tea leaves may lead to a fresher tasting tea. It also offers more control over the strength of the tea. Start with a tablespoon of yerba maté per cup of hot water, then adjust to taste.Many traditional societies prefer sharing yerba maté as part of a community event. Drinking yerba maté from a gourd, which is a special container, facilitates sharing and may improve the taste and experience.Try preparing the tea in a yerba maté tea gourd, then drinking immediately for best flavor.The research on the health benefits of yerba maté tea is very promising. However, there is no evidence that yerba maté can cure any specific medical condition, nor that it can or should replace a person's usual medication or treatment regimen.Instead, people interested in trying yerba maté should use it as a supplement to their other medications.People with chronic medical conditions or who use prescription drugs should talk to a doctor who is knowledgeable about herbal medicine before trying yerba maté.Pregnant or breastfeeding people should speak with a doctor or healthcare provider before trying yerba mate.
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Listening to music while driving may help calm the heart

Driving can be very stressful, particularly if you are stuck in heavy traffic or are an inexperienced driver, and this stress will eventually take its toll on the heart. However, researchers now confirm that there is a simple fix for this problem: listening to the right music while driving.

woman drivingShare on PinterestIf we listen to relaxing music while driving, this may help relieve stress and protect the heart, a new study suggests.

Past research has shown that experiencing frequent psychological stress can be a significant risk factor for cardiovascular disease, a condition that affects almost half of those aged 20 years and older in the United States.

One source of frequent stress is driving, either due to the stressors associated with heavy traffic or the anxiety that often accompanies inexperienced drivers.

Does this mean, though, that people who drive on a daily basis are set to develop heart problems, or is there a simple way of easing the stress of driving?

According to a new study by researchers from São Paulo State University in Marília, Brazil, Oxford Brookes University in the United Kingdom, and the University of Parma in Italy, there is.

In a study paper that features in the journal Complementary Therapies in Medicine, the researchers report the encouraging results of a study involving inexperienced drivers, noting that listening to music while driving helps relieve the stress that affects heart health."We found that cardiac stress in the participants in our experiment was reduced by listening to music while they were driving," says principal investigator Prof. Vitor Engrácia Valenti.For their study, the researchers recruited five female volunteers between the ages of 18 and 23 years who were in good health, were not habitual drivers — they drove no more than twice a week — and had received their driver's license 1–7 years before the start of the study."We opted to assess women who were not habitual drivers because people who drive frequently and have had a license for a long time are better adapted to stressful situations in traffic," explains Prof. Valenti.The researchers asked the volunteers to take part in two different experiments. On one day, the participants had to drive for 20 minutes during rush hour on a 3 kilometer route in one of the busiest parts of the city of Marília. On this day, the participants did not play any music in the car as they were driving.On another day, the volunteers had to go through the same motions, with one exception: This time, they listened to instrumental music while driving.In both instances, the participants drove cars that were not their own. This measure was necessary, the investigators explain, to make sure that there was no reduction in stress due to the volunteers being familiar with the cars."To increase the degree of traffic stress, we asked them to drive a car they did not own. Driving their own car might help," says Prof. Valenti.To measure the effect of stress on the heart in each experimental condition, the investigators asked the participants to wear heart rate monitors able to record heart rate variability in real time.The activity of two key systems — the sympathetic nervous system and the parasympathetic nervous system — influences heart rate variability. The sympathetic nervous system is responsible for regulating the flight or flight response, which is the automatic bodily reaction to stressful, anxiety-inducing situations. Meanwhile, the parasympathetic nervous system is responsible for "rest and digest" processes."Elevated sympathetic nervous system activity reduces heart rate variability, whereas more intense parasympathetic nervous system activity increases it," explains the lead investigator.The researchers then analyzed the measurements that they had collected through the heart rate monitors on the two occasions. They found that when the participants had listened to music while driving under stressful conditions, they had higher heart rate variability than when they had driven under stressful conditions without any music."Listening to music attenuated the moderate stress overload the volunteers experienced as they drove," says Prof. Valenti.To readers who may be wondering why the researchers turned specifically to female participants in their study, the lead investigators explain that, at this stage, they wanted to be able to rule out the potential influence of sex-specific hormones."If men, as well as women, had participated, and we had found a significant difference between the two groups, female sex hormones might have been considered responsible," notes Prof. Valenti.The results of the small-scale experiments, the researchers argue, suggest that listening to relaxing music could, indeed, be an easy way of preventing stress levels from escalating and affecting the heart when someone finds themselves stuck in traffic."Listening to music could be [...] a preventive measure in favor of cardiovascular health in situations of intense stress, such as driving during rush hour."Prof. Vitor Engrácia Valenti
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Specialists call for 'aggressive' measures against e-cigarettes

After uncovering a key mechanism that could explain how e-cigarettes harm the lungs, brain, and cardiovascular system, a team of researchers now calls for much stricter regulation of these electronic devices.

young person using electronic cigaretteShare on PinterestMore researchers are pressing for even tighter regulation of e-cigarettes, citing dangers to health.

Electronic cigarettes — e-cigarettes, for short — were developed as a safer alternative to traditional cigarettes, in an effort to help wean smokers off their harmful habit.

However, evidence has increasingly come to light that the liquid that goes into an e-cigarette and the materials of the devices themselves contain dangerous levels of toxic substances that can harm health.

Moreover, researchers have found that e-cigarettes can provide a gateway to smoking and other addictive behaviors among teenagers, who may see these devices as a social trend.

And recently, various media outlets have reported several cases of adolescents being hospitalized with severe health problems from e-cigarette use.

The most recent report involves a 17-year-old who experienced such serious lung damage from e-cigarette use that he needed a double lung transplant.

"According to the [United States] Centers for Disease Control and Prevention, over 3.6 million children in the U.S. use e-cigarettes, with a jump of 78% — from 11.7% to 20.8% — among U.S. high school students reporting e-cigarette use from 2017 to 2018," reports Dr. Thomas Münzel, of the University Medical Centre Mainz, in Germany. He continues, "And in the [United Kingdom], 1.6% of those aged 11–18 use e-cigarettes more than once a week, compared with 0.5% in 2015."In light of these figures and the reports of dangers associated with e-cigarette use, Dr. Münzel and colleagues have conducted their own study — in humans and mice — to learn more about how and why these devices can damage vital organs.In response to their findings, which appear in the European Heart Journal, the researchers now actively encourage policymakers to take more decisive measures in regulating e-cigarettes.Uncovering underlying mechanismsAs part of their research, Dr. Münzel and the team first looked at how e-cigarette vapors would affect blood flow and artery stiffness in 20 "otherwise healthy smokers" both before they used an e-cigarette and 15 minutes after they had used one.This experiment showed that using an e-cigarette just once increased participants' heart rates, made their arteries stiffer, and affected the functioning of their arterial lining, known as the endothelium, which plays a complex role in circulatory health.Among other functions, the endothelium helps ensure that vessels dilate and constrict correctly, that toxic substances do not pass into the bloodstream, and that inflammation and blood clotting are regulated, when necessary.The next step in the research was to find out more about the underlying mechanisms by which e-cigarettes affect health. To do this, the investigators exposed 151 mice to e-cigarette vapor for 20 minutes, six times a day over a period of 1, 3, or 5 days.In doing so, the researchers found that the artificial vapors caused blood vessel damage in the rodents. The damage was general and, in blood vessels that oxygenate the lungs or brain, it occurred via an enzyme called NOX-2. This, the team explains, may be because NOX-2 plays a key role in regulating cellular health.In mice that the researchers had engineered not to produce NOX-2, the e-cigarette vapors did not have the same effects. This may be because NOX-2 plays a key role in regulating cellular health.Next, the investigators treated some mice with macitentan, a drug used to treat endothelial dysfunction and high blood pressure, and others with bepridil, a drug designed to prevent abnormal cell death attributed to high blood pressure or angina.These mice did not experience endothelial dysfunction, abnormal cell death, or abnormal inflammation when exposed to e-cigarette vapors."The results of the present studies identified several molecular mechanisms whereby e-cigarettes can cause damage to the blood vessels, lungs, heart, and brain," says Dr. Münzel."This," he goes on to explain, "is a consequence of toxic chemicals that are produced by the vaping process and may also be present at lower concentrations in the liquid itself. Importantly, we identified an enzyme, NOX-2, that mediated all the effects of e-cigarettes on the brain and cardiovascular system, and we found that a toxic chemical called acrolein, which is produced when the liquid in e-cigarettes is vaporized, activated the damaging effects of NOX-2.""The beneficial effects of macitentan and bepridil indicate that e-cigarettes have the capacity to trigger constriction of blood vessels and to impair our cells' antioxidant and survival systems," the researcher adds.Study 'should serve as a warning'In conclusion, Dr. Münzel emphasizes that, according to the current findings, e-cigarettes are harmful. Because of this, he calls on policymakers to regulate these devices much more strictly."Our data may indicate that e-cigarettes are not a healthy alternative to traditional cigarettes, and their perceived 'safety' is not warranted. In addition, we still have no experience [of] the health side effects of e-cigarettes arising from long term use," the researcher notes."The e-cigarette epidemic in the U.S. and Europe, in particular among our youth, is causing a huge generation of nicotine-addicted people who are being endangered by encouragement to switch from traditional cigarettes to e-cigarettes. Research like ours should serve as a warning [...] and aggressive steps should be taken to protect our children."Dr. Thomas MünzelThe investigators also warn against trusting biased studies funded by e-cigarette producers, which may attempt to reassure the public about the supposed safety of e-cigarettes."Recent studies indicate that e-cigarette industry funding is more likely to lead to results that indicate that e-cigarettes are harmless," the researchers write in their study paper, mentioning that the current study did not receive any financial backing from stakeholders in the e-cigarette industry.
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What to know about the BNP test

A brain natriuretic peptide (BNP) test is a type of blood test. Doctors use the BNP family of tests as an indicator of how well the heart is pumping blood around the body. Many doctors find it useful in helping to diagnose or monitor heart failure.Read on to find out more about BNP and the levels of BNP that medical experts consider normal. We also outline the BNP test procedure and what the results can tell a person about their heart health.
a nurse preparing a man for BNP test.Share on PinterestDoctors use a BNP test to measure levels of BNP in the blood.A BNP test measures levels of BNP in the blood.Other names for BNP or related tests include:B-type natriuretic peptideN-terminal pro b-type natriuretic peptideproBNPnatriuretic peptidesBNP is a hormone that the left ventricle of the heart produces to help regulate blood volume.The left ventricle is the part of the heart that is chiefly responsible for pumping oxygenated blood around the body. If a person's heart has difficulty pumping blood, it releases more BNP than usual. For this reason, doctors often use the BNP test as an indicator of how efficiently the heart is pumping.
Doctors often order the BNP test for people they suspect may experiencing heart failure. Heart failure is where a person's heart does not pump blood efficiently enough to support their body's needs or when the heart does not relax normally, leading to elevated pressure in the heart.However, any factors that can increase the pressure in the heart or stretch the atria chambers of the heart, such as blood clots in the lungs (pulmonary embolism), can cause elevated BNP levels.Some signs that a person may be experiencing heart failure include:feeling easily fatiguedexperiencing shortness of breathexperiencing unexplained swelling in the ankles, feet, legs, and stomachweight gainshortness of breathDoctors usually use one of the BNP tests in combination with other blood tests that can help detect heart failure. Doctors can also use the test to help with prognoses, as elevated levels of BNP can increase the risk of adverse outcomes, even in people without heart failure.Doctors may also use the BNP test to assess how well a person's heart failure treatments are working.
The BNP test follows a standard blood test procedure.A doctor, nurse, or phlebotomist will perform the blood test. A phlebotomist is a person trained in drawing blood.The medical professional will:apply a tight band, or tourniquet, around the arm to make the veins more prominent and easier to identifyclean the skin over and around the veininsert a small, hollow needle into the vein and collect the blood in a tuberemove the tourniquet and apply gauze or bandage to the area to stop any bleedingMost people can resume their normal activities immediately after the blood test.A person does not usually need to make any preparations for the test, such as fasting. However, a doctor will advise individuals on any specific requirements.Experts agree that there is a healthy range for BNP levels. The cut-off point can vary by laboratory, but commonly, the healthy range is less than 100 picograms of BNP per milliliter (pg/ml) of blood. This means that a result of more than 100 pg/ml indicates the possibility of heart failure.Values can vary by age, however, so people should always discuss their results with their doctor.It is important to note that some tests can result in false negatives, which might indicate normal values of BNP when a person does have heart failure.According to the European Heart Journal, several factors can influence a person's BNP levels. These include:Age: A person's BNP levels tend to get higher as they get older.Gender: Women tend to have slightly higher BNP levels than men, according to an article in theCertain medications: Drugs such as ACE inhibitors and diuretics reduce BNP concentrations, while drugs called beta-blockers can cause levels of BNP to vary.Certain medical conditions: The presence of other medical conditions, such as renal failure, can affect BNP levels.Ultimately, many factors can affect BNP levels. A doctor will interpret a person's results alongside those of other tests. They will also consider the person's overall health and whether or not they have any symptoms.Doctors typically use the BNP test as an indicator of whether a person is experiencing heart failure. If a test shows low or normal levels of BNP, the doctor may rule out the possibility of heart failure.If a person's BNP levels are higher than normal, the doctor may recommend additional tests.Examples of these tests include:The BNP is one of a family of blood tests that measure levels of brain natriuretic peptide in the blood. It is one of several tests that doctors may use to help diagnose heart failure.If a person's BNP levels are higher than normal, a doctor may order additional blood tests to check for heart failure.A person should talk to their doctor if they have questions or concerns about their BNP test results.
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Is there a link between muscle mass and cardiovascular risk?

A new study has found a link between lower muscle mass and a higher risk of cardiovascular events — at least in males aged 45 and over. This association, the research indicates, is valid even for males with no history of heart disease.

physiotherapist working with older manShare on PinterestMuscle mass loss is linked to a higher risk of cardiovascular problems in males aged 45 and over.

Some loss of skeletal muscle mass occurs naturally as people age. This process especially affects males.

In fact, research shows that after the age of 30, muscle mass tends to decrease by 3–5% per decade in males.

People can prevent and minimize this loss by staying active. If they do not, it may contribute to poor health and well-being.

Some past studies have suggested that people with cardiovascular disease who experience higher loss of muscle mass also have a higher risk of premature death.However, to date, little to no research has looked into the possible associations between muscle mass and cardiovascular risk in people without preexisting heart or circulatory problems.Now, specialists from the Centro de Investigación Biomédica en Red de Salud Mental in Madrid, Spain, the University of Canberra in Australia, and the University of Athens in Greece have conducted a study with the aim of filling in that research gap.The new study — the results of which appear in the Journal of Epidemiology & Community Health, and whose first author is Stefanos Tyrovolas — has analyzed the data of a cohort of male participants aged 45 and over covering a follow-up period of 10 years.Its findings suggest that, in males at least, maintaining muscle mass may help keep cardiovascular problems at bay.The team analyzed the medical information of 2,020 participants — of whom half were male and half were female — over a period of 10 years. All but one of the particpants were aged 45 and over, and all were free of heart disease at baseline.At baseline, the participants provided data regarding their lifestyle choices, such as diet and exercise, as well as measurements of circulating blood fats, systemic inflammation biomarkers, weight, and blood pressure.The researchers explain that all these values are important, since they can affect a person's risk of cardiovascular problems. In addition to these data, the investigators also calculated the participants' skeletal muscle mass adjusted in accordance with every individual's weight and height.Over the 10 year follow-up period, the researchers recorded 272 cardiovascular events — both fatal and nonfatal — that included stroke and minor stroke. These cases all occurred among the working sample of 1,019 participants who had been 45 or over at baseline.The team found that males were about four times more likely to develop cardiovascular disease than females. Moreover, they saw a link between lower muscle mass volume and a higher risk of cardiovascular problems in the case of males.At the other end of the spectrum, males with the highest muscle tissue volume at baseline had an 81% lower risk of events such as stroke and heart attack, compared with those with the lowest muscle mass at the start of the study period.The team also found that males with the highest muscle tissue volume at baseline had a lower prevalence of other risk factors for cardiovascular issues, such as high blood pressure, diabetes, or obesity.It remains unclear why the association between cardiovascular problems and muscle mass was significant only in the case of males, though the researchers hypothesize that hormonal differences between males and females as they age may explain the discrepancy.Although the authors admit that their observational study cannot establish any cause and effect relationships, they maintain that its findings "point to the importance of [skeletal muscle mass] preservation in relation to [cardiovascular disease] risk."In their study paper, they conclude that:"The prevention of [skeletal muscle mass] decline, which is becoming increasingly prevalent among middle-aged and older populations, may constitute an effective means of promoting [cardiovascular] health."
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Which jobs affect women's heart health the most?

Some occupations are likely to affect female heart health more negatively than others, but which ones? This question is what one new study set out to answer.

health care professional at workShare on PinterestFemales in some professions face a higher risk of developing heart health problems than others, according to a new study.

Heart problems are a widespread health issue, especially among older populations.

And while researchers know that several lifestyle factors can increase the risk of heart disease — including an unhealthful diet, lack of physical activity, and smoking — there is one risk factor that does not receive as much attention as it perhaps deserves, namely, someone's occupation.

Recent studies have shown that it is possible to link a person's occupation with an increased risk of heart disease or other cardiovascular problems.

For instance, one study that researchers conducted on a cohort from Japan found that individuals in managerial positions, regardless of industry, face a higher risk of heart diseaseHowever, the Centers for Disease Control and Prevention (CDC) note that it remains unclear just how occupational risk factors may contribute to heart problems, and they encourage further research in this area.At this year's American Heart Association's (AHA) Scientific Sessions — which takes place in Philadelphia, PA, between November 16–18 — Bede Nriagu and colleagues from Drexel University in Philadelphia will present research adding to the evidence that certain types of work have an association with heart disease.In their presentation at the Scientific Sessions, the researchers will explain which occupations show links with a higher risk of health problems in females, according to their study.The researchers looked for possible associations between heart health status and different occupations in a cohort of more than 65,000 females whose average age was 63 years, and who had already experienced menopause. The team accessed these participants' data through the Women's Health Initiative study.As part of their research, the investigators classified the participants according to the AHA's cardiovascular health measurements.These metrics look at lifestyle factors, such as smoking status, weight, physical activity, and nutrition, plus health risk factors, including total cholesterol, blood pressure, and fasting blood sugar. The research team also took into consideration 20 of the most common occupations among the participants.In total, the researchers noted that almost 13% of the females in the study cohort had poor cardiovascular health. They also found an association between specific jobs and an increased risk of heart health problems in these individuals.More specifically, women who performed social work were 36% more likely to experience heart health problems than those with other occupations, and retail cashiers had a 33% higher risk of cardiovascular issues.Nurses, psychiatrists, and home health aides had an up to 16% higher likelihood of developing heart problems. Among these, nurses, in particular, had a 14% higher risk of cardiovascular problems.Yet the team also found an association between some occupations and a lower risk of cardiovascular health issues.Thus, female real estate brokers and sales agents had a 24% lower risk of heart problems than those in other lines of work, while administrative assistants had an 11% lower risk of cardiovascular issues.These associations remained in place after the researchers made adjustments for confounding factors, such as the participants' age, marital status, education, and race."Several of the professions that had high risk of poor cardiovascular health were health care providers, such as nurses and home health aides. This is surprising because these women are likely more knowledgeable about cardiovascular health risk factors," notes Nriagu."We interpret this to mean that it's important to look beyond individual factors, such as health knowledge, to better understand the context of health care and other jobs that negatively impact cardiovascular health in women."Bede NriaguThe researchers argue that looking at the current finding, doctors may want to start considering their patients' occupations when they assess their risks of cardiovascular problems.
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Late evening eating may compromise women's heart health

New research finds that eating more calories in the evening is associated with poorer cardiovascular health in women.

woman eating in front of computerShare on PinterestEating more of the day's calories after 6 p.m. is linked with poorer heart health in a new study.

Evidence is accumulating that meal times can impact cardiometabolic health.

One recent study, for example, showed that eating meals earlier in the day can help people lose weight, while eating later in the day may promote weight gain and slow down metabolism.

These studies also showed that later mealtimes raise inflammatory markers that are usually associated with diabetes and heart disease.

Other studies, in mice and human participants, showed that setting strict mealtimes can help control blood sugar levels.

Now, new research adds to this mounting evidence and suggests that eating more calories in the evening may negatively affect women's cardiovascular health.The new research is preliminary and will be presented at the American Heart Association's (AHA's) Scientific Sessions 2019, which is taking place in Philadelphia, PA.Nour Makarem, Ph.D., an associate research scientist at the Columbia University Vagelos College of Physicians and Surgeons, in New York, is the lead author of the study.Studying eating patterns and heart healthMakarem and colleagues recruited 112 healthy women, who were 33 years old, on average, to participate in the study. The researchers examined the participants' cardiovascular health at baseline and 1 year later using Life's Simple 7 — a measure of cardiovascular health that comprises seven modifiable risk factors, as established by the AHA.Life's Simple 7 account for blood pressure, cholesterol, blood sugar, physical activity, diet, weight, and smoking status. Based on these factors, the researchers calculated a cardiovascular health score for each participant. The women also used food diaries on their cell phones to track and report how much, what, and when they ate for 1 week at baseline and another week 12 months later.The researchers used the data from the electronic diaries to calculate the relationship between cardiovascular health and the timing of the meals.Fewer late calories may boost heart healthThe research revealed that participants who consumed more calories after 6 p.m. tended to have poorer cardiovascular health.In fact, for each 1% increase in caloric intake after 6 p.m., the cardiovascular health score declined. Blood pressure and body mass index tended to rise, and blood sugar control tended to be poorer. The analysis yielded similar results for every 1% increase in calories after 8 p.m.Hispanic women, in particular — who made up 44% of the participants — had higher blood pressure when they ate more calories in the evening.The study's lead author comments on the findings saying, "So far, lifestyle approaches to prevent heart disease have focused on what we eat and how much we eat.""These preliminary results indicate that intentional eating that is mindful of the timing and proportion of calories in evening meals may represent a simple, modifiable behavior that can help lower heart disease risk."Nour Makarem, Ph.D.The lead researcher also points out that for the findings to be more reliable, they would have to be replicated in a larger sample and in different populations.Dr. Kristin Newby, a professor of medicine and cardiology at Duke University, in Durham, NC, who was not involved in the research, comments on the results."I think it's an important study," she says. "It's foundational more than definitive at this point, but I think it provides some really interesting insights into an aspect of nutrition and how it relates to cardiovascular risk factors that we really haven't thought about before."
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E-cigarettes just as, if not more, harmful than traditional cigarettes

Are e-cigarettes less harmful than conventional cigarettes that contain tobacco? From a cardiovascular point of view, at least, new research answers with a resounding "no." In fact, says one study author, "e-cigs may confer as much and potentially even more harm to users" than traditional cigarettes.

woman using e-cigaretteShare on PinterestDespite popular perception, e-cigarettes may not be a safer alternative to tobacco.

In light of the recent lung injury outbreak that some researchers have linked to vaping products and electronic cigarettes, two new studies presented at the American Heart Association's Scientific Sessions 2019 in Philadelphia, PA, further highlight the potentially hazardous effects of e-cigarettes on health.

The two new studies examine the effect of e-cigarettes on cardiovascular health, more specifically. In this respect, there appears to be insufficient evidence to draw a firm conclusion.

However, the two new studies emphasize the possibility that e-cigarettes are just as, if not more harmful than regular cigarettes.

Dr. Sana Majid, a postdoctoral fellow in vascular biology at the Boston University School of Medicine in Massachusetts, is the lead author of the first study, which looked at cholesterol, triglycerides, and glucose levels in cigarette smokers.

Dr. Florian Rader, M.S., medical director of the Human Physiology Laboratory and assistant director of the Non-Invasive Laboratory at the Cedars-Sinai Medical Center in Los Angeles, CA, led the second study, which looked at heart blood flow.E-cigarettes and cholesterolIn the first study, Dr. Majid and team compared markers of cardiovascular health among healthy adults who smoked regular cigarettes, adults who used e-cigarettes, healthy adults who did not smoke, and adults who smoked both e-cigarettes and conventional cigarettes.The 476 study participants were between 21 and 45 years old; they had no history of cardiovascular disease and were not taking any daily medication.The researchers accounted for potential confounders, such as age, race, and sex, in their analysis.They also adjusted their analysis to examine non-smokers, sole e-cigarette or traditional cigarette users, or dual users.The analysis revealed that people who used only e-cigarettes had higher levels of low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol, and lower levels of total cholesterol than non-smokers.High-density lipoprotein (HDL), or "good" cholesterol, was lower in people who smoked both traditional cigarettes and e-cigarettes."Although primary care providers and patients may think that the use of e-cigarettes by cigarette smokers makes heart health sense, our study shows e-cigarette use is also related to differences in cholesterol levels." Dr. Sana Majid"The best option is to use FDA-approved methods to aid in smoking cessation, along with behavioral counseling," Dr. Majid adds.Possibly even more harmful to usersIn the second study, Dr. Rader and his colleagues examined the heart blood flow of 19 adults aged between 24 and 32 before and after smoking traditional cigarettes or e-cigarettes.More specifically, they looked at the participants' coronary vascular function using myocardial contrast echocardiography (MCE) scans.MCE scans use gas-filled microbubbles that travel inside the vascular space, just like red blood cells, to assess myocardial microcirculation.The researchers used an MCE scan when the participants were resting and after they had simulated physiological stress with a handgrip exercise test.Dr. Rader reports, "In smokers who use traditional cigarettes, blood flow increased modestly after traditional cigarette inhalation and then decreased with subsequent stress. However, in smokers who use e-cigs, blood flow decreased after both inhalation at rest and after handgrip stress."Study co-author Dr. Susan Cheng, M.M.Sc., M.P.H., who is a director of Public Health Research at Cedars-Sinai Medical Center, says, "We were surprised by our observation of the heart's blood flow being reduced at rest, even in the absence of stress, following inhalation from the e-cigarette.""Providers counseling patients on the use of nicotine products will want to consider the possibility that e-cigs may confer as much and potentially even more harm to users and especially patients at risk for vascular disease."Dr. Susan Cheng
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Everything you need to know about shock

The word shock can describe several different situations. Medical shock happens when the body's cells do not get enough oxygen-rich blood. It is not a disease but a result of an illness or injury.A person may also feel shocked when they experience something unexpected. This shock is psychological and usually does not cause any medical problems.Another type of shock is an electric shock, which occurs when a person sustains an injury as a result of exposure to electrical energy. Causes of an electric shock include faulty electrical equipment, lightning strikes, and contact with electricity and water.Although many different problems can cause medical shock, its symptoms are often the same. Medical shock is always an emergency. Without treatment, shock may cause permanent organ damage or death.
a woman experiencing shock at a subway station.Share on PinterestA range of events can cause a person to experience shock.There are four different types of medical shock. The name of each type describes how it causes a decrease in blood flow to the cells and tissues.The four types are:Hypovolemic shock. Hypovolemia is a decreased volume of blood in the body, and it may happen if a person is bleeding heavily or becomes severely dehydrated. This type of shock is usually due to severe blood loss following a traumatic injury.Cardiac shock (also known as cardiogenic shock). This type of shock occurs when the heart is unable to pump enough blood. The causes of cardiac shock include a heart attack, heart failure, severe blood loss, or an injury to the chest that damages the heart.Obstructive shock. Obstructive shock happens when a blockage in the cardiovascular system, such as a pulmonary embolism, keeps blood from flowing to the body's tissues and organs.Distributive shock (also known as vasodilatory shock). In distributive shock, fluid may collect between the cells of the organs, making it hard for the blood to reach the tissues. The most common causes of distributive shock include anaphylaxis, which is a severe allergic reaction, and sepsis. Poisoning or toxicity from drugs can also cause this type of shock.
an infographic of effects on the body shock

Although medical shock has many different causes, its symptoms are generally the same. The symptoms are a result of the body's organs and tissues not getting enough oxygen.

Signs and symptoms of shock include:

cold, pale, or clammy skinexcessive sweatingfast heart rateshallow and rapid breathingdrowsinessfaintingblue or gray lips or fingernailsirritabilityanxietydizzinessenlarged pupilsnausea or vomitingIf a person is in shock, the first step is to call 911 or the local emergency number, even if the symptoms are mild.While waiting for the medical team, people can assist by:helping the person lie down and elevate their feet, if possibleavoiding moving the person if they may have injured their head, neck, or backperforming first aid on injuries if necessarykeeping the person warm with a blanket or coatrefraining from giving the person food or drinkchecking for breathing and a pulse at least every 5 minutes (if the person is not breathing, a trained person can perform cardiopulmonary resuscitation (CPR))turning the person on their side if they are choking or vomitingMedical professionals often recognize shock because of its characteristic signs, including low blood pressure.The treatment for shock will vary based on the underlying cause. For instance, a person experiencing anaphylaxis may need a shot of epinephrine, which can treat severe allergic reactions.If a person has sepsis, they may need antibiotics, oxygen, and intravenous (IV) fluids.People with hypovolemic shock may need a blood transfusion and IV fluids. Doctors may start blood transfusions or other measures to help restore proper blood flow, even if they do not know the underlying cause.The medical team may run various tests to determine the cause of shock, including:After a person receives treatment for shock, a doctor may help them put a follow-up plan in place to help prevent another event. Some examples include:People who have cardiogenic shock due to a blood clot may need additional treatment to break up the clot.A person who went into anaphylactic shock may need to carry epinephrine or other medications to help stop allergic reactions. They will also need to avoid contact with allergens in the future.A person who had a heart attack may require lifestyle changes and medications to help reduce the chances of another heart attack.It can take some time to recover from any type of medical shock. Shock can cause fatigue, muscle aches, and trouble with strength or mental function. Sometimes, these effects are long lasting.People may need rehabilitation, either in the hospital or in another facility. They may also need help with tasks at home as they recover.After septic shock, some people experience lingering side effects, such as pain or trouble concentrating or remembering things. Depression or anxiety may also occur. Talking to a doctor about these effects can help during recovery.Medical shock is a life threatening condition. It occurs when the organs in the body are not getting enough oxygen.Causes of shock include severe blood loss, dehydration, and a cardiac event. It is important to seek immediate medical care for any symptoms of shock, even if they are mild.
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What are the effects of lowering blood pressure targets?

In 2017, the American Heart Association (AHA) lowered the threshold for what constitutes hypertension. However, what is the impact of this, and is implementing these new guidelines cost effective? Two new studies set out to investigate.

doctor taking blood pressureShare on PinterestNew research examines the effects of lowering hypertension thresholds.

According to the AHA, around 103 million adults in the United States have high blood pressure. They expect that this number will continue to rise.

Meanwhile, the Centers for Disease Control and Prevention (CDC) estimate that around 1,100 people die of a condition related to hypertension each day, including heart disease and stroke. These are some of the leading causes of death in the U.S.

The healthcare costs of hypertension are not negligible, either. The CDC suggest that hypertension results in almost $50 billion per year in costs, including the price of medications and missed days of work.

What are some of the measures that people with high blood pressure and healthcare professionals can take to prevent these adverse outcomes and increase lifespan? In 2017, the AHA recommended lowering blood pressure thresholds and treating people at risk more intensively.

Now, two new studies — both of which featured at the AHA's Scientific Sessions 2019, which takes place in Philadelphia, PA — have investigated the costs and benefits of treating hypertension more intensively, and of tailoring treatment according to degrees of cardiovascular risk.

Better blood pressure control lengthens lifeDr. Muthiah Vaduganathan, an instructor of medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital — both in Boston, MA — is the lead author of the first study.Dr. Vaduganathan and team used data from the well-known Systolic Blood Pressure Intervention Trial (SPRINT).The SPRINT examined the effects of lowering systolic blood pressure readings to a target of 120 milligrams of mercury (mm Hg) instead of the usual 140 mm Hg.The trial followed 9,361 participants, all of whom were over the age of 50 and at high cardiovascular risk. The SPRINT followed them for 6 years and concluded that lowering blood pressure targets reduced the risk of cardiovascular problems — such as heart attack, stroke, heart failure, and cardiovascular death — by 25%.The participants were at high risk of heart disease if they had had a cardiovascular disease that was not stroke, scored highly on the 10 year cardiovascular risk score, had chronic kidney disease, or were older than 75.For the new study, the researchers analyzed the data to project the lifespans of the participants who underwent intensive hypertension treatment to lower blood pressure to a target of 120 mm Hg. They compared these projected lifespans with those of participants who received the standard treatment that aimed for a blood pressure of lower than 140 mm Hg.The study revealed that intensive blood pressure treatment increased lifespan by 4–9%, compared with standard care."In contrast with the oldest patients, middle-aged patients had the greater absolute benefit because they start with a longer expected lifespan and can receive the intensive treatment over a longer period of time," explains Dr. Vaduganathan.Dr. Mitchell S. V. Elkind — the AHA president-elect and chair of the Advisory Committee of the American Stroke Association — comments on the results. He says, "This analysis of the [SPRINT] suggests that [there are] additional years of life that can be added by more aggressive control of blood pressure."He adds, "When you tell people that lowering their blood pressure is going to reduce their chance of having a stroke or a heart attack by 25%, which is what [the SPRINT] showed," the question that naturally ensues is "what does that number mean, in real terms?""This analysis suggests that for a man who is 50 years old, lowering blood pressure to [the lower] targets could extend your lifespan by 3 years, on average." Dr. Mitchell S. V. Elkind"High blood pressure has been implicated as one of the reasons for stalled progress in reducing heart disease-related deaths in the United States," Dr. Vaduganathan says. "These data reinforce that tighter blood pressure control, especially when started earlier in life, may meaningfully prolong lifespan."New guidelines to treat an extra 5.2 millionThe second study examined the best way to implement the new blood pressure guidelines issued by the American College of Cardiology (ACC) and the AHA.These new guidelines lowered blood pressure thresholds to define hypertension as anything from 130/80 mm Hg to 140/90 mm Hg.The new guidelines also recommend medication treatment for people with a blood pressure reading of 130/80 mm Hg to 139/89 mm Hg if they have a history of heart attack or stroke, or if they have a high 10 year risk of experiencing such an event.Joanne M. Penko — a research data analyst at the University of California, San Francisco — is the lead author of this second study.To assess the cost effectiveness of implementing the new guidelines, Penko and colleagues looked at healthcare costs and quality-adjusted life years (QUALY). They used the Cardiovascular Disease Policy Model, a well-known computer simulation model, to estimate healthcare costs over a 10 year period.Compared with the 2003 guidelines, the analysis revealed, the "2017 ACC/AHA guidelines would treat 5.2 million more adults 35–84 years of age, intensify treatment in another 11.7 million, and prevent about 257,000 [cardiovascular] events over 10 years."Intensifying treatment pays off over a 10 year period for men aged 65–84 and women aged 75–84 who already have cardiovascular disease. For others, however, the costs outweigh the benefits.Furthermore, treating people at high cardiovascular risk who had not had cardiovascular disease would only be intermediately cost effective for adults whose blood pressure readings are 140/90 mm Hg or higher at baseline. It would not be cost effective at all for those whose blood pressure readings are 130/80 mm Hg to 139/89 mmHg."Previous studies have shown that compared with no treatment, treating high blood pressure according to the 2003 Seventh Report is cost effective over 10 years," Penko says. "We were surprised to learn in our study that wasn't the case for all patients indicated for medication treatment in the 2017 guidelines.""The study's findings suggest an incremental approach to implementing the 2017 ACC/AHA hypertension guidelines, first focusing limited resources on treating the oldest, highest-risk adults to intensive blood pressure goals."Joanne M. Penko
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Could the eyes predict cardiovascular risk?

Doctors consider a variety of factors to determine a person's risk of experiencing cardiovascular events, including age, smoking history, and blood pressure. But changes to the blood vessels in the back of the eye may make for a more accurate prediction.

senior's eyes looking at the cameraShare on PinterestNew research suggests that eyes may hold the key to cardiovascular health.

They say that the eyes are the window to the soul. But, according to a team of researchers, they may also be the window to the heart.

Previous research has identified a link between changes in the eye and hypertension in adults, and similar retinal changes and high blood pressure in children.

"The data that we have is very clear that at a very early age, in children 6 to 8 years old who are otherwise healthy, you can already see vascular alterations due to blood pressure levels that are on the high end of normal," says Dr. Henner Hanssen, professor of preventive sports medicine and systems physiology at the University of Basel, Switzerland.

"We don't know if this predicts worse outcomes when they become adults, but we have seen similar alterations in adults that are predictive of cardiovascular mortality and morbidity," he continues.

Millions of blood vessel measurementsThis study is the largest to look at the relationship between the eye and cardiovascular diseases and has produced the most dependable measurements. It appears in the American Heart Association's Hypertension journal.The study found that small blood vessels at the rear of the eye were affected by artery stiffness and increased blood pressure.As lead author professor Alicia Rudnicka from London's St. George's University in the United Kingdom explains: "If what's happening in the rest of the body is reflected in what's happening at the back of the eye, what we see there could be a flag, taking retinal morphology assessment from being just a research tool to incorporating it into clinical practice."Almost 55,000 elderly or middle-aged people from the UK Biobank study formed the data set for the new research, and in total, the team had access to 3.5 million blood vessel sections.An automated program examined digital images of each participants' retinal blood vessels, providing the team with measurements relating to blood vessel diameter and curvature.The retinal link to heart diseaseAnalysis of these found that greater curvature of the retinal arteries equated to higher pulse pressure, higher average artery pressure during a heartbeat, and higher systolic blood pressure, which is the pressure that occurs when the heart contracts.This was not the only finding. The team also noticed a relationship between greater stiffness in artery walls, higher mean arterial pressure, and narrowing of the retinal blood vessels.None of these retinal effects impact a person's vision, but they "could potentially tell us very quickly whether you are on the road to cardiovascular disease," according to Prof. Rudnicka."What we have now is one piece of the puzzle," she adds."If we can link the retinal vessel measurements of the past to what happens to these people years later, this will tell us whether these vessel changes came before cardiovascular disease and go on to predict those who go on to have a cardiovascular event." Prof. Alicia RudnickaThe team's next study aims to determine whether these measurements can predict heart disease in the same person a decade later.Cardiovascular disease is the leading cause of death globally. Currently, experts estimate a person's risk factor using a range of factors, including age, sex, blood cholesterol levels, and blood pressure.Prof. Rudnicka's future study results may determine whether the eye becomes part of that list.
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How heavy lifting at work affects cardiovascular health

New research suggests that high intensity, sports based exercise has benefits for cardiovascular health, but continual heavy lifting at work may have a negative impact.

man lifting heavy boxesShare on PinterestNew research shows how strenuous physical activity affects artery health.

Health experts have consistently promoted the benefits of physical activity, particularly for preventing cardiovascular disease, the leading cause of premature fatalities worldwide.

A study in Hypertension has now begun to look at the effect of different types of exercise on a person's cardiovascular health.

The research finds that some physical activity might actually be detrimental to a person's health.

4 different types of physical activity

Jean-Philippe Empana of Inserm/Université de Paris, in France, working with colleagues from Australia, led the research.The authors analyzed data from the 10-year Paris Prospective Study III, which is tracking the health of 10,000 people from 50 to 75 years of age.As part of that study, participants filled out questionnaires in which physical activity was in four different categories:high intensity sports activitiesexertion from job-related tasks, such as lifting and moving heavy objectslow impact exercise from leisure activities, such as walking with friends, gardening, etctotal physical activity"Our idea was to look at whether all types of physical activity are beneficial, or whether, under some circumstances, physical activity can be harmful," says Empana."We wanted, in particular, to explore the consequences of physical activity at work, especially strenuous physical activity, such as routinely carrying heavy loads, which could have a negative impact."To track the cardiovascular health of the participants, the researchers examined their arteries, using ultrasound imaging of the carotid arteries in their necks.Specifically, they measured the sensitivity of the baroreflex mechanism; the baroreflex mechanoreceptors in the carotid and aorta blood vessels control the body's rapid response to — and accommodation of — changes in blood pressure.A compromised baroreflex system increases the likelihood of serious outcomes, including cardiac arrest.Two aspects of the baroreflex system were measured:Mechanical baroreflex, as reflected by arterial stiffness. Problems with this aspect of the system are often part of age-related cardiovascular problems.Neural baroreflex, or the neural impulses that the mechanoreceptors transmit on the artery wall." Neural baroreflex insufficiencies often lead to heart rhythm problems and cardiac arrest.The major takeawaysEmpana and his colleagues saw two significant trends from their results.First, sports based physical activity strengthens the neural baroreflex, thus reducing the chances of cardiac issues — as health experts have long been suggesting.On the other hand, they found that strenuous exertion at work has a negative effect on both arterial stiffness — the mechanical baroreflex — and the neural baroreflex, producing a higher risk for heart rhythm problems.The authors found no particular connection between leisure activity or total activity and either mechanical or neural baroreflex."Our findings," says Empana, "represent a valuable avenue of research for improving our understanding of the associations between physical activity and cardiovascular disease. They do not suggest that movement at work is harmful for health; instead, they suggest that chronic, strenuous activity (such as lifting heavy loads) at work may be."Next up for the researchers are attempts to see if these results are consistent across other groups of people."This study has major public health implications for physical activity at work," Empana concludes. "We now want to expand our analysis to further explore the interactions between physical activity and the health status of people in the workplace."
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Doctors call for end to daylight saving time transitions

Doctors writing in a leading medical journal have put forth a case for doing away with daylight saving time (DST) transitions. They argue that these annual transitions to and from DST misalign biological clocks, with long term consequences for health.

clocksShare on PinterestTransitioning to and from DST may adversely effect circadian rhythms.

In the United States, DST begins on the second Sunday of March, when most parts of the country "spring forward" and advance their clocks by 1 hour.

DST then lasts for 8 months, until the first Sunday of November. At this point, clocks "fall back" to standard time.

"It's not 1 hour twice a year," says Beth A. Malow, a professor of neurology at Vanderbilt University Medical Center in Nashville, TN. She adds, "It's a misalignment of our biologic clocks for 8 months of the year."

She explains that DST transitions can affect a number of brain functions, including alertness and energy levels.

"When we talk about DST [transitions] and the relationship to light," Prof. Malow continues, "we are talking about profound impacts on the biological clock, which is a structure rooted in the brain."

In a recent JAMA Neurology paper, she and her colleagues reviewed evidence on how DST transitions impact processes that involve the brain, heart, sleep patterns, and genes that control the sleep-wake cycle.

The paper's authors point out that they are concerned with the effects of annual transitions to and from DST, and not what might result from a permanent adoption of DST.

"The effects of permanent DST have received less attention and are beyond the scope of this review," they note.The US adopted DST to save energyMany people believe that the government introduced DST to give farmers an extra hour of evening sunlight during the summer months.However, according to the U.S. Department of Energy (DOE), the purpose of DST is to help reduce the use of electricity in buildings.In 1966, Congress passed the Uniform Time Act, which established set dates for the start and end of DST. This decision came as a result of the confusion that ensued after World War II, during which the U.S. adopted DST for the second time and kept to it.For reasons of saving energy, further legislation that took effect in 2007 added 4 weeks to DST, bringing it to its current 8 month duration.The Department of Transport (DOT) is the body in the U.S. that is responsible for making sure that people follow DST, and for evaluating its impact.In 1974, the DOT reported to Congress that the potential benefits to energy conservation, violent crime reduction, and traffic safety from DST were "minimal."A 2008 DOE study that evaluated the impact of extended DST on national energy consumption found that it reduced it by 0.02%.The health impact of DSTOther studies have assessed the health impacts of these annual transitions to and from DST. They found that the effects of sleep loss build up over the years.Over time, DST reduces people's exposure to bright morning light. This early sunlight is critical for helping synchronize biological clocks.Scientists have linked disruption of this synchronizing process to an increased risk of heart attack, stroke, and other health conditions of reduced sleep.Another potential hazard is the increased risk of fatal traffic incidents that can result from an average sleep reduction of 15–20 minutes due to DST transitions.In their paper, Prof. Malow and colleagues cite large population studies as they summarize the public health case for ending the practice of DST.Although some individuals have biological clocks that can adjust quickly to DST transitions, others take longer and are more sensitive to the effects of these transitions.In addition to reviewing studies on DST and impacts on blood circulation in the brain and the rest of the body, Prof. Malow and colleagues highlight some of the genetic effects."It is well-established," they write, "that genetic factors help to regulate the sleep-wake cycle in humans by encoding the circadian clock, which is an autoregulatory feedback loop."Changes to gene expressionWhen a person's sleep time shifts, there is an accompanying change in gene expression. Even the short term reduction in sleep time that occurs as a result of DST transitions could be enough to disrupt the genetic profiles of circadian clock genes.Studies have yet to clarify how disruptive 1-hour DST transitions can be to those with good health.However, people with certain conditions and those whose brains are still developing are likely to be more susceptible to negative health effects from DST transitions.Prof. Malow is also a professor of pediatrics and the Michael Burry Chair in Cognitive Childhood Development at Vanderbilt University. Drawing on her expertise in researching autism and sleep, she comments that some autistic children can experience DST transition effects for several weeks, or even months.However, she and her colleagues observe that despite the weight of evidence and conviction about the biological effects of DST, its elimination faces political and legal challenges.Since 2015, at least 39 states have sought to alter their observance of DST.Some states want to do away with DST and stay with standard time all year round. Others are seeking to make DST permanent, which would require Congress to alter the 1966 Act.Although they admit that more research is necessary, the paper's authors are clear — given the evidence they have reviewed — about their conclusions."Based on these data," they write, "we advocate for the elimination of transitions to DST.""People think the 1-hour transition is no big deal, that they can get over this in a day, but what they don't realize is their biological clock is out of sync."Prof. Beth A. Malow
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Running, no matter how little, is linked to 27% lower death risk

Research has already shown that running is an activity that can help us stay healthy for longer, but how much do we have to run to extend our lifespan? A new review suggests that no matter how little or how much we run, the exercise is linked with a significantly lower risk of death from all causes.

person runningShare on PinterestAccording to a new review, there is an association between running and a longer lifespan, regardless of the frequency and duration of running.

Many studies have shown that running is a healthful form of aerobic exercise that has numerous benefits for both the body and the mind.

For example, the authors of a 2018 study argued that running could help protect brain health, while older research has tied this form of physical activity to slower aging.

But what link is there, if any, between running and mortality from all causes, and how does this activity affect the risk of death due to cardiovascular disease and cancer, in particular?Furthermore, if running can indeed lead to a longer lifespan, does that mean that more running offers an increased level of protection?These are the questions that researchers from Victoria University in Melbourne, the University of Sydney, and other academic institutions in Australia and elsewhere have recently aimed to answer.To this purpose, the investigators reviewed the relevant literature — including published papers, conference papers, and doctoral theses — looking at the potential links between running and death risk. Their findings appear in the British Journal of Sports Medicine.The systematic review included 14 studies that involved a total of 232,149 participants. The studies followed up the health outcomes of the participants for periods that ranged between 5.5 years and 35 years. Over the study periods, 25,951 participants died.When the researchers analyzed the data from the 14 studies, they found a link between any amount of running and a 27% lower risk of all-cause death. This finding applied to both females and males.Moreover, the team linked running with a 30% lower risk of death relating to cardiovascular disease and a 23% lower risk of cancer-related death.The significant association between running and lower death risk applied even to people who only ran once per week or less frequently. Individuals who ran at relatively low speeds of under 6 miles (9.7 kilometers) per hour and those who ran for less than 50 minutes also saw this reduced risk."The [World Health Organization] guidelines and national physical activity recommendations in many countries [...] suggest that adults should take part in at least 150 [minutes] of moderate-intensity or 75 [minutes] of vigorous-intensity physical activity a week," the researchers note in the study paper.However, the current review's findings suggest that running for less time may still carry health benefits. At the same time, the researchers add, there was no association between running for longer than the recommended amount and any additional health benefits or further reductions in the risk of death.The researchers caution that their investigation was observational and did not aim to establish cause. Moreover, they note that the studies that they looked at all varied in their methodology and cohort size, which may have affected the final results.Yet they remain confident that, generally speaking, running seems to help health, so they suggest that people consider taking it up. The authors conclude:"Increased rates of participation in running, regardless of its dose, would probably lead to substantial improvements in population health and longevity."
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Local vehicle exhaust may raise stroke risk

Even in environments with low air pollution, long term exposure to traffic exhaust near people's homes may heighten their risk of stroke, according to a new study from Sweden. The culprit appears to be a fine particle air pollutant called black carbon.
cars in a traffic jam
Exposure to exhaust fumes may raise the risk of stroke, new research suggests.

The researchers came to this conclusion after investigating links between exposure to different types of particulate matter and rates of heart disease and stroke in three cities in Sweden.

They report their findings in a recent Environmental Health Perspectives study paper.

The authors write that they observed "few consistent associations" between heart disease and stroke and different types of particulate matter and their sources.

"However," they conclude that "long term residential exposure to locally emitted [black carbon] from traffic exhaust was associated with stroke incidence."

Dr. Petter L. S. Ljungman is first author of the study paper and an associate professor at the Institute of Environmental Medicine at Karolinska Institutet in Stockholm, Sweden.

"This study," he says, "identifies local traffic exhaust as a risk factor for stroke, a common disease with great human suffering, high mortality and significant costs to society."

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Black carbon and particulate matter

Black carbon is a sooty material that comes from burning fossil fuels. According to the United States Environmental Protection Agency (EPA), it is a significant component of fine particle air pollution.

Vehicle and other engines that run on gas and diesel and power plants that run on coal and other fossil fuels emit black carbon along with other particulate matter.

Road traffic is the primary source of black carbon emissions in cities.

Scientists have tied black carbon inhalation to respiratory conditions, cancer, cardiovascular disease, and birth abnormalities.

Dr. Ljungman and colleagues from Karolinska Institutet and other research centers in Sweden used data on 114,758 people who were participants in other studies that had collected information about cardiovascular risk factors from examinations and questionnaires.

The participants, who lived in three cities in Sweden, were healthy and middle-aged at recruitment. The study period started in 1990 and lasted for around 20 years. The dataset included the history of the participants' residential addresses over the period.

Over the 20 years of follow-up, 5,166 individuals developed ischemic heart disease, and 3,119 experienced strokes.

Using emissions databases and dispersion models, the team estimated how much each type of emission source contributed to particulate matter, including black carbon, at specific residential addresses.

The sources that they included in the analysis were traffic exhaust, road wear, and residential heating. They included data for two grades of particulate matter: coarse, which includes particles under 10 micrometers (10μm) in diameter (PM10), and fine, which includes particles under 2.5 μm in diameter (PM2.5). Black carbon counts as PM2.5.

Black carbon and raised stroke risk

The analysis revealed that the risk of stroke went up by 4% for every additional 0.3 micrograms per cubic meter (μg/m3) of black carbon air pollutant from traffic exhaust.

The researchers found no link to stroke for black carbon emissions from residential heating.

Also, they observed no links between total levels of PM10 and PM2.5 particulate matter and either heart disease or stroke.

"There was some evidence," note the authors, "of an association between PM2.5 specifically from local emissions of residential heating and incidence of [ischemic heart disease] that warrant further investigation."

In their study background, the authors refer to research that has linked long term exposure to PM2.5 particles and atherosclerosis, the clogged artery condition that raises the risk of heart disease and stroke.

The residential areas that the new study covered were in the cities of Gothenburg, Stockholm, and Umeå. The annual averages during the study period for PM2.5 particulate matter in these cities ranged from 5.8 to 9.2 μg/m3. This range is below the 25 μg/m3 threshold in current EU standards.

Although the EU mention black carbon as a component of PM2.5 particulate air pollution, they have no specific threshold for black carbon.

"Black carbon from traffic exhaust could be an important measure to consider when assessing air quality and health consequences."

Dr. Petter L. S. Ljungman

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