Wood Street Clinic Blog

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What to know about amlodipine

Amlodipine is an oral medication that doctors prescribe to treat some cardiovascular conditions. In the United States, it commonly goes under the brand name Norvasc.

Amlodipine is a type of calcium channel blocker. Doctors commonly prescribe these drugs to treat people with high blood pressure. A doctor may also prescribe amlodipine for coronary artery disease and angina.

In this article, we look at what doctors prescribe amlodipine for and its recommended dosage. We also cover the side effects, interactions, warnings, and considerations for amlodipine as well as some alternative drugs.

What is it used to treat? packages of Norvasc, brand name of amlodipine. image credit: Kimivanil, 2015.
Amlodipine is usually known as Norvasc in the U.S.
Image credit: Kimivanil, 2015.

The U.S. Food and Drug Administration (FDA) first approved amlodipine in 1987. The FDA consider amlodipine safe and effective for treatment of:

high blood pressure, which doctors refer to as hypertension coronary artery disease angina, which is chest pain resulting from reduced blood flow to the heart

Doctors sometimes also prescribe amlodipine to treat people with other conditions. This is known as "off-label" treatment because the FDA has not yet approved the drug for these uses.

According to one source, off-label uses of amlodipine include:

Dosage guide The dosage for amlodipine depends on the person's condition and how well their symptoms respond to treatment. The doctor will also take into account an individual's age and medical history when recommending a dosage. According to the FDA's prescribing information leaflet, amlodipine is available in tablets and capsule form and in a range of strengths, including 2.5 milligrams (mg), 5mg, and 10mg quantities. Doctors prescribe amlodipine for a variety of conditions, and the FDA recommend the following dosages: For treating high blood pressure: For adults: starting with 5 mg once daily with a maximum dose of 10 mg daily. For older people or those with liver problems: 2.5mg once daily. For children aged 6–17 years old: 2.5mg or 5 mg once daily. The FDA also recommend that doctors adjust a person's dosage according to blood pressure goals, but wait between 7 and 14 days between changes. For treating chronic stable or vasospastic angina: For adults: 5 mg to 10 mg once daily. Most people will need to take 10 mg for the drug to treat their angina effectively. For older people or those with liver problems: 5 mg once daily. For treating chronic artery disease: For adults: 5 to 10mg once daily. For older people or those with liver problems: 5 mg once daily. For some people who have difficulty swallowing, such as children and older people, a doctor may administer amlodipine as an intravenous injection or drip. Thank you for supporting Medical News Today Side effects Side effects of amlodipine can include drowsiness.
Side effects of amlodipine can include drowsiness. According to the FDA, researchers have used clinical trials to evaluate the safety of amlodipine in over 11,000 people. These studies found that the drug rarely caused problems in dosages up 10 mg daily. However, common side effects include: edema, which is a swelling that occurs in different parts of the body, particularly the feet or ankles dizziness flushing palpitations, which are feelings of a fast or irregular heartbeat Less common side effects include: Interactions Amlodipine can potentially interact with some other medications, including: Simvastatin. The FDA recommends limiting the dosage of simvastatin to 20mg daily while also taking amlodipine. CYP3A4 inhibitors. Medications that inhibit an enzyme called CYP3A4 can increase the concentration of amlodipine in the blood. These drugs include diltiazem, ketoconazole, itraconazole, and ritonavir. The FDA recommend that doctors monitor people who are taking both CYP3A4 inhibitors and amlodipine for symptoms of edema and low blood pressure. Cyclosporine. In people who have had a kidney transplant, taking amlodipine and cyclosporine together may increase the levels of cyclosporine in the body. It is essential that people inform their doctors about all the medications, herbs, and supplements they are currently taking before starting amlodipine or any other new medicines. Warnings The FDA have issued several warnings for doctors to take note of when prescribing amlodipine. These include: Hypotension Amlodipine can cause hypotension, or low blood pressure, in some people, particularly those with severe aortic stenosis. Symptoms of hypotension include feeling faint, tired, and nauseous. Increased angina or myocardial infarction When starting or increasing the dosage of amlodipine, it can worsen symptoms of angina and increase the risk of heart attack in some people, particularly those with severe obstructive coronary disease. However, this is rare. Liver problems The liver extensively metabolizes amlodipine, so doctors need to be cautious when prescribing this drug to people with liver conditions. The FDA recommend that doctors closely monitor these individuals and increase the dosages of amlodipine slowly. Thank you for supporting Medical News Today Considerations The FDA have also highlighted some considerations that both the prescribing doctor and the person taking amlodipine need to be aware of. These include: Pregnancy There is a lack of research into the safety of taking amlodipine during pregnancy. The FDA recommend that doctors should only prescribe amlodipine to pregnant women if the potential benefits outweigh the risks to the fetus. Breastfeeding Scientists have not yet determined whether amlodipine can enter a woman's breast milk. Because of this, the FDA recommend that women do not take amlodipine while breastfeeding. Children under 6 years Due to a lack of studies, doctors do not know how safe or effective amlodipine is in children under the age of 6 years. Alternative drugs Alternative medications are available.
Alternative medications are available. Possible alternative medications to amlodipine include other calcium channel blockers, such as nicardipine, clevidipine, and nifedipine However, doctors often prescribe amlodipine over some other medications because a person usually only needs to take one dose per day. If a person experiences side effects on amlodipine, they should speak to a doctor about changing medication. Summary Amlodipine is an oral medication that doctors prescribe to treat high blood pressure, coronary artery disease, and angina. It is generally a safe and effective drug, but it may cause side effects in some people. However, a doctor may recommend a lower dosage and close monitoring for some individuals taking amlodipine, such as older people, pregnant women, and people with liver conditions. Amlodipine can also interact with some other medications. A person should speak to their doctor if they have any concerns about taking amlodipine or are experiencing any troubling side effects.
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What to know about a slow heart rate

A person's heart rate generally slows with age and while resting. However, athletes may also have slow heart rates. Anyone with concerns about their heart rate should talk to a doctor for help in determining whether bradycardia suggests a problem.

Heart rate changes with a person's activity level. During intense physical exertion, the heart has to pump faster and harder, so the rate goes up.

In most adults, a slow heart rate is below 60 beats per minute (bpm). However, athletes and people who are asleep may have a heart rate of below 60 bpm.

Symptoms Person having their pulse measured by nurse for bradycardia
Bradycardia can cause a heart rate of less than 60 bpm.

The primary symptom of bradycardia is a slow heart rate. Some people have no other symptoms.

Other people do experience symptoms. In these cases, a slow heart rate is more likely to be due to a serious issue.

Some common bradycardia symptoms include:

feelings of exhaustion and weakness fainting or dizziness confusion shortness of breath trouble breathing when working out

When a serious medical condition causes bradycardia, and a person does not seek treatment, more severe symptoms may appear.

Those include:

Thank you for supporting Medical News Today Measuring heart rate A person can find out their heart rate by taking their pulse. To accurately test for a slow heart rate, a person must measure their resting heart rate. To achieve this, they must avoid checking the pulse shortly after exercising or waking up. To check the pulse, a person should sit in a comfortable and relaxed position and feel for the pulse at the wrist. If unable to locate the pulse at the wrist, they should try feeling for the pulse on the side of their neck. To work out their heart rate, the person counts heartbeats for 10 seconds, then multiplies the number by six. For a more accurate pulse, the person can count the number of beats for a full minute. This figure is the resting pulse. If the number is lower than 60, a person has bradycardia. Children and young people have more rapid heart rates than adults. In young people, normal heart rates are as follows: Newborns: 100 to 180 bpm Infants: 80 to 150 bpm Children ages 2 – 6: 75 to 120 bpm Children ages 6 – 12: 70 to 110 bpm A slow heart rate in a child, especially a newborn, is a medical emergency. What are the causes? Woman athlete by the sea in outdoor swimmer wetsuit, going swimming.
People who engage in intense cardiovascular activity may have a slow heart rate, as their hearts are efficient. Some people have only moderate bradycardia. Others only experience occasional bradycardia. Although it is vital that anyone with a slow heart rate seeks medical guidance, not everyone will require treatment. When bradycardia causes no other symptoms, and when a person does not have an underlying condition, a slow heart rate may be a harmless or minor issue. The heart rate tends to decline with age, which means older people may experience episodes of bradycardia. While this is typical, it still warrants investigation by a doctor. Exercise strengthens the heart. Athletes, especially those who engage in intense cardiovascular activity, tend to have more efficient hearts. This may slow their pulse because their heart does not have to pump as hard or as fast to supply blood to the rest of their body. Some medical conditions may also cause a slow heart rate. These include the following: Problems with the heart's natural pacemaker The heart's natural pacemaker, or sinoatrial node, helps regulate heartbeat. Problems affecting this can cause a person's heart to beat unusually slow or fast, which doctors call tachycardia. A condition that doctors call sick sinus syndrome refers to problems with the natural pacemaker. Typically, another heart health problem, such as scar tissue in the heart, complications of diabetes, or coronary artery disease, causes these problems. Other heart electrical issues The heart communicates by sending electrical signals. For example, one chamber of the heart sends electrical signals to another, telling it how and when to squeeze blood into the next chamber. The pacemaker helps regulate this electrical system. If the heart is not able to send the correct electrical signals, due to a blockage or heart disease, it can cause bradycardia. Complete heart block is a type of electrical issue that makes it impossible for electrical signals to travel from the atria — the top two chambers of the heart — to the ventricles, which are the bottom two chambers. In complete heart block, the top two chambers may have totally different rhythms to the bottom two. Metabolic problems Some metabolic disorders can slow the heart rate. One of the most common is hypothyroidism, in which the thyroid does not produce enough thyroid hormones. Hypothyroidism can affect the health of the blood vessels, which may slow the heart rate. People with hypothyroidism may also have a high diastolic blood pressure — a diastolic measurement identifies the pressure in the arteries between heartbeats, and is the bottom number on a blood test reading. A person has a high diastolic blood pressure if the test shows a reading above 80. Thyroid disorders are common and may affect young and otherwise healthy people. Between 4 and 10 percent of people in the United States have hypothyroidism. Heart disease Damage to the heart from congestive heart failure, coronary artery disease, previous heart attacks, and other heart problems may affect the heart's electrical system, making the heart pump more slowly and less effectively. Heart medication Some medications, including medications for heart disease and high blood pressure, may lower heart rate. Beta-blockers, which doctors prescribe for a rapid heart rate and some other heart conditions, may also slow heart rate. People taking a new medication who experience symptoms of bradycardia should contact a doctor. Oxygen deprivation Doctors use the term hypoxia when the body cannot get enough oxygen, which may slow down the heart rate. Hypoxia is a medical emergency, and it can occur when a person is choking or having a severe asthma attack. Chronic medical conditions, such as chronic obstructive pulmonary disease, may also cause hypoxia. When hypoxia lowers the heart rate, it is essential to treat the underlying cause. Thank you for supporting Medical News Today When to see a doctor A person should speak to a doctor if they notice their heart rate is slow.
A person should speak to a doctor if they notice their heart rate is slow. When a baby has a low pulse, a parent or carer should take them to the emergency room. Adults and children who have a low pulse and experience severe symptoms, such as chest pain or fainting, should also go to the hospital. A person should see a doctor for bradycardia when: they experience an unexplained change in heart rate that lasts for several days they have bradycardia and other heart health risk factors, such as diabetes or smoking they have heart disease and bradycardia they experience bradycardia and other symptoms, such as fainting spells they experience episodes of bradycardia and tachycardia Treatment options A doctor may not always need to treat a slow heart rate. However, when a slow heart rate causes serious health problems or when heart disease slows the heart, it is essential that people receive treatment. An artificial pacemaker, which is an electrical device that a doctor inserts into the heart to promote regular rhythms, can help. Depending upon the cause, a doctor might also recommend: changing heart medications taking medication to treat thyroid or other metabolic disorders making lifestyle changes, such as eating a low-fat diet, doing more exercise, or quitting smoking monitoring heart rate or blood pressure frequently Thank you for supporting Medical News Today Takeaway Heart disease is the leading cause of death in the U.S., accounting for 1 out of every 4 deaths. It is crucial that a person takes any changes in heart health, blood pressure, or pulse seriously. However, a slow heart rate is not always a reason for concern. In many cases, a slow heart rate is merely a variation of normal. It may even be a sign of heart health and indicate good levels of fitness. Only a doctor can evaluate an individual's cardiovascular risk factors. People should see a doctor for guidance and reassurance.
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How your flu medicine can affect your heart

January is at the heart of the cold and flu season, and whenever the sneezing and coughing hits, we tend to stock up on anti-inflammatories and decongestants to help us fight these symptoms. However, the American Heart Association warn that these drugs can have unwanted effects on the heart.
person with the flu
Some of the most common drugs used to treat colds and flu could influence our cardiovascular risk, experts warn.

Over-the-counter drugs are most people's go-to solution for the relief of aches, mild fever, a blocked nose, and other symptoms of the flu or a seasonal cold.

Such medicines include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and decongestants that include pseudoephedrine and phenylephrine.

While these drugs are typically safe to take as long as you follow the recommended dosages, specialists from the American Heart Association (AHA) and other institutions warn that they could worsen the cardiovascular health of certain at-risk individuals.

"People with uncontrolled high blood pressure or heart disease should avoid taking oral decongestants," cautions Sondra DePalma, who is a physician assistant at the PinnacleHealth CardioVascular Institute at UPMC Pinnacle in Harrisburg, PA, and one of the specialists behind the AHA's and American College of Cardiology's (ACC) guidelines for the management of high blood pressure.

"And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a healthcare provider," DePalma also advises.

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Increased cardiovascular risk

According to the AHA and ACC guidelines, both NSAIDs and decongestants can increase blood pressure due to the way in which they act on the body. Decongestants, particularly, tighten the blood vessels in the nose, which helps reduce inflammation in that area.

"But if you have high blood pressure or heart disease, the last thing you need is constricting blood vessels. It can exacerbate or worsen the condition," notes Dr. Erin Michos, the associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, MD.

Dr. Michos explains that the people most at risk if they were to use decongestants are those with unmanaged high blood pressure, those with heart failure, as well as individuals who have had a heart attack or stroke.

As for NSAIDs, existing studies show that they can also place people at higher cardiovascular risk.

One study paper that the AHA cite — and which the Journal of Infectious Diseases published in 2017 — focused on a cohort of 9,793 individuals who had taken treatments for respiratory infections and ended up in hospital following a heart attack.

The participants averaged 72 years of age when they experienced their heart attacks, and many of them had preexisting cardiovascular risk factors, such as high blood pressure or diabetes.

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Prevention is the best approach

According to the study, those who took NSAIDs to treat their respiratory infections were in excess of three times more at risk of a heart attack within 1 week than they had been during the same period the year before when they did not use NSAIDs.

To avoid exposure to such risks, Dr. Michos advises using NSAIDs and decongestants sparingly or opting for an alternative solution where possible, such as antihistamines.

"There are effective therapies that are less risky and definitely should be tried first," notes DePalma.

"If other over-the-counter medications are needed, use them cautiously. And if someone finds they are having problems like high blood pressure or other things like heart palpitations, they should talk with their healthcare provider," she urges.

Finally, the best approach when it comes to colds and flu is prevention, and the AHA point to the Centers for Disease Control and Prevention (CDC) recommendations, which suggest getting a flu shot each year.

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What to know about hypokalemia

Hypokalemia describes a person having too little potassium in their blood. If it is severe, it can lead to muscle weakness, which can have many health consequences. The cause is usually a person's body excreting too much potassium.

Hypokalemia is always a symptom of another illness or a side effect of a medication. It is not an illness in itself. Therefore, the underlying condition requires treatment to resolve the hypokalemia. A medical professional can diagnose hypokalemia by taking a person's medical history and carrying out tests.

A person may not be aware of mild hypokalemia. However, if hypokalemia is moderate or severe, the individual is likely to have other signs of being unwell, for example, vomiting or diarrhea. If a person feels ill for an extended period, they should see a doctor.

In this article, we look at the symptoms, causes, diagnosis, and treatment of hypokalemia, as well as the outlook for people with low potassium levels.

Symptoms Person having their blood pressure measured
Hypokalemia can cause symptoms such as low blood pressure and muscle weakness.

When a person's hypokalemia is mild, they will often not experience any symptoms.

However, people who have moderate or severe hypokalemia, are older, or have heart or kidney issues can experience symptoms that relate to severe muscle weakness.

According to the National Organization for Rare Disorders, these symptoms can include:

muscle weakness that can result in paralysis respiratory failure low blood pressure muscle twitching cramping during exercise feeling very thirsty excessive urination loss of appetite nausea heart irregularities

However, people should note that experiencing any symptoms with hypokalemia is rare.

A study in the European Journal of Emergency Medicine looked at the data of 4,826 people who presented to the emergency department of a hospital with hypokalemia.

The researchers found that just 1 percent of these individuals had severe hypokalemia, and only half of the people in this subgroup had any symptoms.

Thank you for supporting Medical News Today What are the causes? Prolonged diarrhea or vomiting can cause loss of potassium.
Prolonged diarrhea or vomiting can cause a loss of potassium. The usual cause of hypokalemia is a person losing potassium too quickly. In rare cases, it can occur because someone is not getting enough potassium. A person may also not get sufficient potassium if they have a diet that contains very small amounts of it. However, it is unusual for this to be the cause of hypokalemia. Many foods contain potassium, and the kidneys are usually capable of reducing the excretion of potassium if the body is not getting enough. A person might lose potassium too quickly for several different reasons. According to a 2018 clinical update, these can include: persistent diarrhea prolonged vomiting kidney issues side effects of diuretic drugs Hypokalemia can also occur when there is an "intracellular shift" of the potassium in the body, which stops the correct transmission of potassium between cells. It can occur as a side effect of various medications. Diagnosis Hypokalemia is not an illness in itself, so when a person receives a diagnosis, the doctor will need to identify what is causing the loss of potassium. In most cases, this is relatively straightforward. A doctor will check for: recent vomiting recent diarrhea associated heart problems particular medications, such as insulin, beta agonists, or diuretics If a doctor suspects that a person is hypokalemic, they may run tests to measure the amount of potassium in their body. They will usually do this by checking the potassium level in a person's urine. Thank you for supporting Medical News Today Treatment Banana slices and honey drizzled in a bowl of porridge
Bananas are a natural source of potassium. Once a doctor has determined the underlying issue that is causing hypokalemia, they can recommend a suitable treatment. For example, if a person has hypokalemia as a result of prolonged vomiting, treating the cause of the vomiting will also address the hypokalemia. Alternatively, if a particular medication is making a person hypokalemic, then reducing or replacing that medication may resolve the problem. If a person's hypokalemia is severe or causing muscular issues, they may receive a prescription for additional potassium supplements to respond to these symptoms immediately. The supplement will often be in the form of tablets, but intravenous delivery might be necessary if the hypokalemia is severe. Doctors may also instruct people to eat foods that are rich in potassium, such as bananas, avocados, chard, and other plant-based foods. However, the authors of an article in the journal American Family Physician note that, although changing the diet can be beneficial, it is usually far less effective than taking potassium supplements. Outlook The outlook for a person with hypokalemia will depend on the underlying illness or side effect that is causing them to have low potassium. In some cases, this may be simple to resolve by changing medication or dealing with an illness that responds quickly to treatment. However, the cause may also be more complex. In the rare instances when severe hypokalemia is symptomatic, potassium supplements will usually resolve it.
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Stair-climbing exercise 'snacks' boost health

Time is no longer an excuse for not exercising, as new research finds that even a few minutes of stair climbing at intervals every day is enough to improve cardiovascular and overall health.
woman exercising on stairs
New research finds that even brief bouts of stair climbing can bring unexpected health benefits.

Several recent studies have pointed out the many health benefits of short bursts of exercise.

For instance, a review of existing studies, which Medical News Today reported on, shows that an acute period of exercise can immediately protect the heart against future ischemic episodes.

Results of another recent study indicate that 10 minutes of physical activity is enough to give the brain a boost, improving attention, working memory, and cognitive flexibility, among other mental skills.

Now, research suggests that even intervals of stair climbing that last a few minutes, with recovery periods between, can improve cardiorespiratory health.

Martin Gibala, Ph.D., a professor of kinesiology at McMaster University in Hamilton, Canada, is the senior author of the new study, which appears in the journal Applied Physiology, Nutrition, and Metabolism.

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Prof. Gibala and the team set out to investigate whether sprint interval training — that is, short bouts of intense exercise separated by a few minutes of recovery, amounting to about 10 minutes in total — can improve cardiorespiratory fitness.

Cardiorespiratory fitness refers to "the ability of the heart, lungs, and vascular system to deliver oxygen-rich blood to working muscles" during intense physical exercise.

Research has suggested that greater respiratory fitness brings several health benefits, including better cardiovascular health, improved insulin resistance, and a lower risk of premature death.

For the current study, a group of 12 sedentary young participants climbed three flights of stairs three times a day, with 1–4 hours of recovery between sessions.

The participants engaged in this regimen three times a week for 6 weeks, while a control group of 12 age-matched, sedentary individuals did not exercise.

At the end of the intervention period, cardiorespiratory fitness "was higher in the climbers [...] suggesting that stair-climbing 'snacks' are effective in improving cardiorespiratory fitness," report the authors.

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The climbers were also stronger at the end of the intervention, and they performed better in a maximal cycling test, compared to the controls.

"We know that sprint interval training works, but we were a bit surprised to see that the stair snacking approach was also effective," says study co-author Jonathan Little, Ph.D., an assistant professor of kinesiology at the University of British Columbia in Okanagan, Canada.

"Vigorously climbing a few flights of stairs on your coffee or bathroom break during the day seems to be enough to boost fitness in people who are otherwise sedentary," Little explains.

"The findings make it even easier for people to incorporate 'exercise snacks' into their day," Prof. Gibala adds.

"Those who work in office towers or live in apartment buildings can vigorously climb a few flights of stairs in the morning, at lunch, and in the evening and know they are getting an effective workout."

Prof. Martin Gibala, Ph.D.

In the future, the team plans to test the effects of various exercise "snacking" regimens, varying the duration of the recovery intervals. They also wish to study the effects of these bouts of exercise on blood pressure and blood sugar.

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What role does the immune system play in hypertension?

Millions of people in the United States and across the world have hypertension, a condition that, without proper management, can contribute to the risk of heart disease and stroke.
woman getting her blood pressure checked
Specialist white blood cells play an important role in the regulation of blood pressure, a new study finds.

Data from the Centers for Disease Control and Prevention (CDC) indicate that approximately 75 million adults in the U.S. live with hypertension.

American Heart Association (AHA) guidelines from 2017 define "hypertension" as systolic blood pressure (during a heartbeat) of 130 millimeters of mercury (mm Hg) or higher and diastolic blood pressure (when the heart is resting) of 80 mm Hg or higher.

The AHA also name lack of physical activity, an unhealthful diet, high cholesterol, and stress as some of the primary modifiable factors that increase the risk of hypertension.

New research by scientists at the University of Edinburgh in the United Kingdom has now uncovered another factor that seems to play a role in the development of this condition.

The study, which the British Heart Foundation funded, found that a type of specialized immune cell could make a real difference to the risk of hypertension.

"Hypertension affects millions of people across the globe, including 70 percent of people over 70," says lead researcher Prof. Matthew Bailey.

"Our discovery sheds light on risk factors and, crucially, opens routes to investigate new drugs that could help patients," he adds.

Prof. Bailey and team's findings appear in the European Heart Journal, and they are available online.

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Cellular debris-eaters and blood pressure

In the new study, the researchers worked with mouse models and zeroed in on macrophages, a type of white blood cell that forms part of the immune system.

The role of macrophages is to identify and "eat up" foreign bodies that are present due to injury and infection. The immune cells also "eat" cellular debris, which consists of the remains of cells that are no longer functional.

The current research has now uncovered a new role that macrophages play. It seems that they also consume molecules of endothelin, which is a hormone that acts as a vasoconstrictor, meaning that it can stimulate blood vessels to narrow.

Prof. Bailey and colleagues explain that, by controlling blood levels of endothelin, macrophages can ensure that blood vessels properly relax, which helps lower blood pressure.

The researchers verified this mechanism by feeding mice with lowered blood macrophage levels a high-salt diet (which increases the risk of high blood pressure) and monitoring their physiological reactions.

These rodents, the researchers soon found, experienced high blood pressure. However, when the team allowed macrophage levels to return to normal, the mice's blood pressure became healthy again, which suggests that the specialist white blood cells had an important role to play.

When they repeated the experiment in mice that they had genetically modified to have poor endothelin system functioning, the findings remained consistent.

The researchers further verified the link between macrophages and blood pressure in rodents with drug-induced hypertension.

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A potential therapeutical target

To see whether these findings were also valid in humans, the research team analyzed macrophage activity in individuals who took drugs for the management of antineutrophil cytoplasmic antibody vasculitis, a condition that affects the immune system and damages blood vessels.

The scientists found that the drugs that lowered macrophage levels, such as cyclophosphamide, led to higher blood pressure readings in the people who took them.

These findings, note Prof. Bailey and team, could help doctors better identify people who are most at risk of hypertension, and they could also lead to new and improved therapies for high blood pressure.

Still, the researchers caution that further studies are necessary before the interaction between macrophages and endothelin can get the go-ahead as a therapeutic target.

"Our next steps will be to investigate the role of macrophages in people living with hypertension," says Prof. Bailey.

"[Undiagnosed high blood pressure] causes damage to the heart and blood vessels, putting you at risk of a potentially fatal heart attack or stroke. But, we still don't fully understand all the mechanisms that lead to high blood pressure," adds Jeremy Pearson, the associate medical director of the British Heart Foundation, who was not involved in the study.

"This study shows for the first time that macrophages — a type of cell that helps regulate our immune responses — can be involved in the control of blood pressure. More research is needed but these cells could be a new target for drugs to treat the condition."

Jeremy Pearson

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What is a stent? Everything you need to know

A stent is a tiny tube that a doctor places in an artery or duct to help keep it open and restore the flow of bodily fluids in the area.

Stents help relieve blockages and treat narrow or weakened arteries. Doctors may also insert stents in other areas of the body to support blood vessels in the brain or ducts that carry urine and bile.

A stent is usually a mesh-like metal tube, although fabric stents are also available. Sometimes, doctors will use dissolvable stents coated in medication as a temporary solution.

In this article, learn about why doctors use stents, as well as the benefits and possible risks.

Uses Doctor holding up heart stent
A stent can open up blood vessels with plaque blockages.

One of the most common uses for a stent is to open up a blood vessel that has a plaque blockage.

Plaque is a buildup of cholesterol, fat, and other substances found in the blood. When this plaque collects in the bloodstream, it sticks to the walls of the arteries.

Over time, this buildup narrows the arteries, limiting the amount of fresh blood that can reach the body.

A buildup of plaque in the arteries is a cause of coronary heart disease. Over time, people with narrowed arteries may begin to notice warning symptoms, such as chest pain. If people with the condition do not receive treatment, they may be at a higher risk of complications, such as a heart attack or stroke.

If the artery is at risk of collapsing or becoming blocked again, doctors may recommend inserting a stent to keep it open.

Doctors put a stent into an artery in a procedure known as a percutaneous coronary intervention (PCI), or angioplasty with stent.

During PCI, doctors will insert a catheter into the artery. The catheter has a small balloon with a stent around it on one end.

When the catheter reaches the point of the blockage, the doctor will inflate the balloon. When the balloon inflates, the stent expands and locks into place. The doctor will then remove the catheter, leaving the stent in place to hold the artery open.

A doctor will decide whether or not to insert a stent based on a few factors, such as the size of the artery and where the blockage occurs.

Doctors may also use stents for:

blood vessels in the brain or aorta that are at risk of an aneurysm bronchi in the lungs that are at risk of collapse ureters, which carry urine from the kidneys into the bladder bile ducts, which carry bile between the organs and small intestine Thank you for supporting Medical News Today Risks Surgeon looking at screen in operating theatre
A surgeon can explain the risks and benefits of PCI. PCI carries a small risk of complications, which include: bleeding from the catheter insertion site an infection an allergic reaction damage to the artery from inserting the catheter damage to the kidneys irregular heartbeat In some cases, restenosis may occur. Restenosis is when too much tissue grows around the stent. This could narrow or block the artery again. Doctors may recommend forms of radiation therapy or opt to insert a medication-coated stent to slow the growth of the tissue. People at risk of complications include: A stent can cause blood clotting, which may increase the risk of heart attack or stroke. The National Heart, Lung, and Blood Institute state that about 1 to 2 percent of people who have stented arteries develop a blood clot at the site of the stent. Doctors will usually prescribe one or more drugs to prevent clotting. Anti-clotting medications may carry their own risks and can cause irritating side effects, such as rashes. In rare cases, a person's body may reject the stent, or they may have an allergic reaction to the material in the stent. Anyone who has a known reaction to metals should talk to their doctor about alternatives. What to expect The surgeon will discuss the procedure with a person in advance, but it can help to know what to expect. Before the surgery A doctor will advise individuals on how they should prepare for a stent procedure. They will give them information on when to stop eating and drinking, as well as when to start or stop taking medications before the procedure. Anyone who has any other health conditions, such as diabetes or kidney disease, must tell their doctor. The doctor may then have to consider some additional steps. Doctors may also give the person prescriptions to fill before having the stent inserted, as they will need to start taking the medications as soon as the procedure is complete. During the surgery According to the National Heart, Lung, and Blood Institute, a stent procedure only takes about an hour and does not require general anesthesia. The person remains awake during the entire process so can hear any instructions the doctors may have. Doctors will administer medication to help the person relax. They will also numb the area where they insert the catheter. Most people do not feel the catheter threading through the artery. They may, however, feel a bit of pain as the balloon expands and pushes the stent into place. After placing the stent, doctors deflate the balloon and remove the catheter. They bandage the area where the catheter entered the skin and put pressure on the bandage to help prevent bleeding. After the surgery Most people will need to stay in the hospital for at least one night after having the procedure. This allows hospital staff to monitor the person. During the hospital stay, a nurse will regularly check the person's heart rate and blood pressure. They may also change the dressings or clean the wound. The person may leave the hospital the following day if there are no complications. As the insertion site heals, it will bruise and may develop into a small knot of tissue, which is normal. The area may remain tender for at least a week. Thank you for supporting Medical News Today Recovery Patient in hospital bed.
A person may have to rest for about a week after surgery. A successful stent surgery should reduce symptoms, such as chest pain and shortness of breath. Many people may be able to return to work and most normal activities within a week of a successful stent surgery. During recovery, doctors will prescribe antiplatelet drugs to help prevent blood clots from forming near the stent. Aspirin is an antiplatelet drug that a person will need to take daily for an indefinite period after having a stent inserted. Doctors may also recommend a drug called a P2Y inhibitor. P2Y inhibitors include clopidogrel, ticagrelor, and prasugrel. They will also provide the person with special recovery instructions, such as avoiding strenuous work or exercise while the body heals. Long-term use Most stents remain in the artery permanently to keep it open and prevent collapse and potentially life-threatening complications. Some stents are temporary. Doctors may use stents coated in particular medications that help break down plaque or prevent it from building up in the area. These stents will dissolve over time. While a stent may relieve symptoms, such as chest pain, it is not a cure for other underlying issues, such as atherosclerosis and coronary heart disease. Even with a stent, a person with these conditions may need to take steps to prevent further complications. Doctors will recommend healthy lifestyle changes after inserting a stent to help prevent plaque building up in the body. These recommendations often include: eating a healthful diet exercising regularly maintaining a healthy weight quitting smoking and tobacco use reducing stress Stents are often just one part of treatment. Doctors may also prescribe medications for any underlying conditions. If anyone experiences any bothersome side effects, it is best to talk to a doctor. They may recommend alternative medications or change the dose to help relieve side effects. Do not stop taking any medications without consulting a doctor first, however. Thank you for supporting Medical News Today Outlook Doctors commonly insert stents to widen arteries and prevent complications from coronary heart disease and other conditions. While a stent may provide relief, it is only one part of a treatment program. Even with a stent, it is possible for severe complications to occur. Always follow a doctor's advice about medications and recovery.
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Our guide to the Mediterranean diet

Many doctors and dietitians recommend a Mediterranean diet to prevent disease and keep people healthy for longer.

The Mediterranean diet emphasizes fruits, vegetables, and whole grains, and it includes less dairy and meat than a typical Western diet.

In this article, we explain what the Mediterranean diet is and provide a 7-day meal plan for people to follow.

What is a Mediterranean diet? Foods from a Mediterranean diet
A Mediterranean diet includes fresh produce and some healthful fats and oils.

Essentially, following a Mediterranean diet means eating in the way that the people in the Mediterranean region traditionally ate.

A traditional diet from the Mediterranean region includes a generous portion of fresh produce, whole grains, and legumes, as well as some healthful fats and fish.

The general guidelines of the diet recommend that people eat:

a wide variety of vegetables, fruits, and whole grains healthful fats, such as nuts, seeds, and olive oil moderate amounts of dairy and fish very little white meat and red meat few eggs red wine in moderation

The American Heart Association note that the average Mediterranean diet contains a high percentage of calories from fat.

Although more than half of the calories from fat come from monounsaturated fats, such as olive oil, the diet may not be right for people who need to limit their fat intake.

Thank you for supporting Medical News Today Building a meal plan The Mediterranean diet puts a higher focus on plant foods than many other diets. It is not uncommon for vegetables, whole grains, and legumes to make up all or most of a meal. People following the diet typically cook these foods using healthful fats, such as olive oil, and add plenty of flavorful spices. Meals may include small portions of fish, meat, or eggs. Water and sparkling water are common drink choices, as well as moderate amounts of red wine. People on a Mediterranean diet avoid the following foods: refined grains, such as white bread, white pasta, and pizza dough containing white flour refined oils, which include canola oil and soybean oil foods with added sugars, such as pastries, sodas, and candies deli meats, hot dogs, and other processed meats processed or packaged foods 7-day meal plan Here is an example of a 7-day Mediterranean diet meal plan: Day 1 Greek yoghurt with blueberries and walnuts
One breakfast option is greek yogurt with blueberries and walnuts. Breakfast one pan-fried egg whole-wheat toast grilled tomatoes For additional calories, add another egg or some sliced avocado to the toast. Lunch 2 cups of mixed salad greens with cherry tomatoes and olives on top and a dressing of olive oil and vinegar whole-grain pita bread 2 ounces (oz) of hummus Dinner whole-grain pizza with tomato sauce, grilled vegetables, and low-fat cheese as toppings For added calories, add some shredded chicken, ham, tuna, or pine nuts to the pizza. Day 2 Breakfast 1 cup of Greek yogurt One-half of a cup of fruits, such as blueberries, raspberries, or chopped nectarines For additional calories, add 1–2 oz of almonds or walnuts. Lunch Whole-grain sandwich with grilled vegetables, such as eggplant, zucchini, bell pepper, and onion To increase the calorie content, spread hummus or avocado on the bread before adding the fillings. Dinner one portion of baked cod or salmon with garlic and black pepper to add flavor one roasted potato with olive oil and chives Day 3 Breakfast 1 cup of whole-grain oats with cinnamon, dates, and honey top with low-sugar fruits, such as raspberries 1 oz of shredded almonds (optional) Lunch boiled white beans with spices, such as laurel, garlic, and cumin 1 cup of arugula with an olive oil dressing and toppings of tomato, cucumber, and feta cheese Dinner one-half of a cup of whole-grain pasta with tomato sauce, olive oil, and grilled vegetables 1 tablespoon of Parmesan cheese Day 4 Breakfast two-egg scramble with bell peppers, onions, and tomatoes top with 1 oz of queso fresco or one-quarter of an avocado Lunch roasted anchovies in olive oil on whole-grain toast with a sprinkling of lemon juice a warm salad comprising 2 cups of steamed kale and tomatoes Dinner 2 cups of steamed spinach with a sprinkling of lemon juice and herbs one boiled artichoke with olive oil, garlic powder, and salt Add another artichoke for a hearty, filling meal. Day 5 Breakfast 1 cup of Greek yogurt with cinnamon and honey on top mix in a chopped apple and shredded almonds Lunch 1 cup of quinoa with bell peppers, sun-dried tomatoes, and olives roasted garbanzo beans with oregano and thyme top with feta cheese crumbles or avocado (optional) Dinner 2 cups of steamed kale with tomato, cucumber, olives, lemon juice, and Parmesan cheese a portion of grilled sardines with a slice of lemon Day 6 Breakfast two slices of whole-grain toast with soft cheese, such as ricotta, queso fresco, or goat cheese add chopped blueberries or figs for sweetness Lunch 2 cups of mixed greens with tomato and cucumber a small portion of roasted chicken with a sprinkling of olive oil and lemon juice Dinner oven-roasted vegetables, such as: artichoke carrot zucchini eggplant sweet potato tomato toss in olive oil and heavy herbs before roasting 1 cup of whole-grain couscous Day 7 Breakfast whole-grain oats with cinnamon, dates, and maple syrup top with low-sugar fruits, such as raspberries or blackberries Lunch stewed zucchini, yellow squash, onion, and potato in a tomato and herb sauce Dinner 2 cups of greens, such as arugula or spinach, with tomato, olives, and olive oil a small portion of white fish leftover vegetable stew from lunch Thank you for supporting Medical News Today Snacks Avocado on toast
Avocado on toast is a healthful snack for people on a Mediterranean diet. There are many snack options available as part of the Mediterranean diet. Suitable snacks include: a small serving of nuts whole fruits, such as oranges, plums, and grapes dried fruits, including apricots and figs a small serving of yogurt hummus with celery, carrots, or other vegetables avocado on whole-grain toast Health benefits The Mediterranean diet receives a lot of attention from the medical community because many studies verify its benefits. The benefits of a Mediterranean diet include: Lowering the risk of cardiovascular disease Evidence suggests that a Mediterranean diet may reduce the risk of cardiovascular disease. A study that featured in The New England Journal of Medicine compared two Mediterranean diets with a control diet for almost 5 years. The research suggested that the diet reduced the risk of cardiovascular issues, including stroke, heart attack, and death, by about 30 percent compared with the control group. More studies are necessary to determine whether lifestyle factors, such as more physical activity and extended social support systems, are partly responsible for the lower incidence of heart disease in Mediterranean countries than in the United States. Improving sleep quality In a 2018 study, researchers explored how the Mediterranean diet affects sleep. Their research suggested that adhering to a Mediterranean diet may improve sleep quality in older adults. The diet did not seem to affect sleep quality in younger people. Weight loss The Mediterranean diet may also be helpful for people who are trying to lose weight. The authors of a 2016 review noted that people who were overweight or had obesity lost more weight on the Mediterranean diet than on a low-fat diet. The Mediterranean diet group achieved results that were similar to those of the participants on other standard weight loss diets. Thank you for supporting Medical News Today Summary Following a Mediterranean diet involves making long-term, sustainable dietary changes. Generally speaking, a person should aim for a diet that is rich in natural foods, including plenty of vegetables, whole grains, and healthful fats. Anyone who finds that the diet does not feel satisfying should talk to a dietitian. They can recommend additional or alternative foods to help increase satiety.
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Could bone broth boost heart health?

Recently, bone broth has enjoyed a boost in popularity. To add to its new-found fame, a recent study concludes that it could have benefits for heart health, too.
Woman eating bone broth
Bone broth may be fashionable, but is it good for your heart?

Bone broth is a soup containing brewed bones and connective tissue.

Slowly cooking the bones in vinegar releases some of the nutrients that a person might otherwise discard with the rest of the carcass.

According to some quarters, drinking bone broth carries a multitude of benefits.

From reducing inflammation to improving sleep, bone broth can seemingly do no wrong.

Although some are hailing bone broths as "the new coffee," there is little evidence to support its benefits.

It is true that bone broth delivers nutrients, including amino acids and minerals, but not in any higher quantities than might be found in many other foods.

Bone broth contains collagen, leading some supporters to claim that bone broth improves skin health and joint function. However, collagen that we consume never reaches the skin or joints because it is broken down into amino acids by the digestive system.

The authors of the most recent study into bone broth published their findings in the Journal of Agricultural and Food Chemistry. They focused on the amino acids and peptides that the bone and connective tissue produce as they break down.

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Bone broth and cardiovascular health

In particular, the researchers were interested in how cooked bones might release proteins which, during digestion, are broken down further into smaller chains of amino acids, referred to as peptides.

Once broken down in this way, peptides can have very different properties from the original proteins.

The scientists, led by Leticia Mora, wanted to understand whether Spanish dry-cured ham bones could be a source of heart-beneficial peptides. To investigate, they simulated both cooking and human digestion.

Once they had the final product, they tested the resulting peptides to see if they might block particular enzymes known to be involved in heart disease.

The enzymes of interest included angiotensin 1-converting enzyme (ACE-1), endothelin-converting enzyme, dipeptidyl peptidase-4, and platelet-activating factor acetylhydrolase.

All of the enzymes above regulate aspects of the cardiovascular system. ACE-1 inhibitors, for instance, are used to treat high blood pressure and inflammation-based heart disease. If scientists could source these peptides from foods, this might be beneficial for people who have an elevated risk of developing these conditions.

According to the authors, "their inhibition can result in the reduction of high blood pressure and alleviation of disorders, including type 2 diabetes, obesity, atherosclerosis, and inflammatory diseases."

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Potential heart benefits

The scientists found that peptides — predominantly derived from hemoglobin and collagen — could block the enzymes related to heart disease, even after cooking and digestion.

Additionally, they measured the presence of other peptides; many of these were chains of just two or three amino acids, making them more likely to be able to travel through the intestinal wall and be active in the body. The authors conclude:

"These results suggest that dry-cured ham bones [used in] stews and broths could have a positive impact on cardiovascular health and a possible reduction of high blood pressure for consumers."

However, as the authors note, measuring these peptides under artificial conditions is not the same as assessing their impact on living organisms. Scientists will need to do much more work before they can confirm the heart benefits of bone broth.

Understanding the chemistry of foods is only one small step toward realizing their impact on health. These findings might further boost bone broth's popularity, but the trend will probably be over before conclusive evidence rolls in.

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7 simple steps for heart health also prevent diabetes

New research suggests that following the American Heart Association's guidelines for maintaining heart health can also drastically reduce the risk of developing type 2 diabetes.
woman drinking smoothie after exercising
Exercising and healthful eating are among the "simple 7" guidelines that the AHA recommend.

According to the American Heart Association (AHA), there are seven cardiovascular risk factors that people can change to improve their heart health.

Dubbed "Life's Simple 7," these risk factors are: "smoking status, physical activity, weight, diet, blood glucose, cholesterol, and blood pressure."

The AHA note that research has shown that maintaining a minimum of five of the seven factors at an ideal level can lower the risk of cardiovascular death by almost 80 percent.

New research, which features in Diabetologia, the journal of the European Association for the Study of Diabetes, finds that these seven modifiable risk factors can also stave off diabetes.

Coming up with new strategies for preventing diabetes is crucial as over 100 million people in the United States are currently living with the condition or with prediabetes.

According to the Centers for Disease Control and Prevention (CDC), untreated prediabetes can progress into full-blown type 2 diabetes within 5 years.

Dr. Joshua J. Joseph, an endocrinologist and assistant professor at The Ohio State University Wexner Medical Center in Columbus, led the new research.

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In the new study, Dr. Joseph and colleagues evaluated diabetes status in 7,758 individuals who participated in the REasons for Geographic and Racial Differences in Stroke Study.

The team used the AHA's seven factors to assess the cardiovascular health of the participants.

The analysis revealed that participants who had at least four out of the seven factors within the ideal range were 70 percent less likely to develop diabetes over the next 10 years.

"What's interesting," reports the study's lead researcher, "is [that] when we compared people who had normal blood glucose and those who already had impaired blood glucose, [...] [t]hose in normal levels who attained four or more guideline factors had an 80 percent lower risk of developing diabetes."

However, he notes that those who already had prediabetes and met four of the seven factors did not seem to benefit from the lifestyle changes. Instead, their risk of diabetes remained the same.

This is further proof, continues the researcher, that people should use the "simple 7" to prevent the onset of diabetes.

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"Healthy people need to work to stay healthy," says Dr. Joseph. "Follow the guidelines," he advises.

"Don't proceed to high blood sugar and then worry about stopping diabetes. By that point, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications to lower the risk of diabetes."

Dr. Joshua J. Joseph

The physician also stresses the importance of educating the public about preventing diabetes. He and his team are actively engaged in community outreach programs that inform people about healthful practices.

"We don't wait for people to come to us as patients," Dr. Joseph says. "We're very engaged in taking our work from the lab and applying it to our populations so we can help keep our communities healthy."

The video below further details the findings and zooms in on the case of Tim Anderson, a man who has recently received a diabetes diagnosis:

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Exercise can halve heart attack risk in healthy people

New research, appearing in the European Heart Journal, suggests that lack of physical activity can drastically increase the risk of a heart attack in the long-term, even if there are no symptoms at present.
woman stretching before running
Exercise that raises the heart rate, such as running, may cut heart attack risk by half, suggests a new study.

Cardiorespiratory fitness describes the body's ability to deliver oxygen to the muscles when we are engaged in physical activity. Specifically, the term refers to "the efficiency of the heart, lungs and vascular system."

A significant body of research has linked cardiorespiratory fitness with a variety of positive health outcomes, ranging from preventing cardiovascular disease and all-cause mortality to staving off diabetes and improving insulin resistance.

However, most of these previous studies have relied on the participants' self-reported levels of fitness.

New research uses more precise methods of measuring cardiorespiratory fitness and highlights another one of its benefits.

Higher fitness levels can halve the risk of heart attack, the new study finds. Conversely, suggest the researchers, poor fitness levels can raise future risk even in the absence of warning symptoms in the present.

Bjarne Nes, from the Norwegian University of Science and Technology's Cardiac Exercise Research Group in Trondheim, is the corresponding and last author of the study.

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Studying fitness levels and heart attack risk

Nes and his colleagues analyzed the cardiorespiratory fitness of more than 4,500 people who took part in an extensive health survey called HUNT3.

None of the participants had a history of cardiovascular disease, lung disease, cancer, or high blood pressure at the start of the study.

Just over 50 percent of the participants were women, and more than 80 percent of all of them were at "low risk" of developing cardiovascular disease over a 10-year period.

The scientists used a "gold-standard method" — or maximum oxygen uptake — to directly measure the participants' fitness levels.

Maximum oxygen uptake refers to the maximum amount of oxygen the body can absorb during exercise. According to Nes, it is "the most precise measure of fitness."

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High fitness halves the risk of heart attack

By the end of the study, 147 of the participants had heart attacks or had developed angina pectoris — two conditions caused by blocked or narrowed coronary arteries.

The analysis by the researchers revealed a correlation between declining cardiovascular risk and increased fitness levels.

"Even among people who seem to be healthy, the top 25 percent of the most fit individuals actually have only half as high a risk as the least fit 25 percent," reports Nes.

Furthermore, even a small improvement in cardiorespiratory fitness saw significant benefits for heart health. Namely, each fitness increase of 3.5 points correlated with a 15 percent lower risk of heart attack or angina.

"We found a strong link between higher fitness levels and a lower risk of heart attack and angina pectoris over the 9 years following the measurements that were taken," says Nes.

"We know that patients with low oxygen uptake are at increased risk of premature death and cardiovascular disease," he continues.

"Our study shows that poorer fitness is an independent risk factor for coronary artery disease, even among healthy women and men who are relatively fit."

Bjarne Nes

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'Use training as preventive medicine'

Dr. Jon Magne Letnes, the study's first author, also further comments on the findings. "Our results should encourage people to use training as preventive medicine," Dr. Letnes says.

"A few months of regular exercise that gets you out of breath can be an effective strategy for reducing the risk of cardiovascular disease."

Dr. Letnes explains that cardiorespiratory fitness offers insights into so much more than just endurance to exercise.

"Fitness isn't just a measure of how much you've trained in your life, but it also tells you what kind of genes you have," he says.

"Other factors like obesity may also affect fitness. So we measure a lot of the body's functions, and from other studies, we know that both genes and physical activity play a role in how your heart and blood vessels function," Dr. Letnes explains.

The study's first author thinks doctors should consider fitness measurements when evaluating heart disease risk.

"Although it may be inconvenient and difficult to measure oxygen uptake at the doctor's office, some simple and relatively accurate calculators exist that can provide a good estimate of fitness and disease risk," he advises.

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A good night's sleep could lower cardiovascular risk

Can the duration and quality of your sleep affect your cardiovascular health? A new study suggests there is a connection between how much sleep you get each night — and how well you sleep — and the risk of cardiovascular problems.
person asleep in bed
Are you getting enough sleep, and could this be affecting your cardiovascular health?

Many studies have emphasized the importance of sleep in maintaining our health and well-being in general. Increasingly, however, researchers are finding out how sleep quality affects specific aspects of a person's health.

For instance, one recent study that was covered by Medical News Today found that poor sleep could well be a telltale sign of the development of Alzheimer's disease. Another study tied sleep problems with high blood pressure, at least in women.

Now, research from the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, Spain, and Tufts University — with campuses in Medford and Somerville, MA — indicates that there is a link between sleep quality and the risk of atherosclerosis, a condition that doctors characterize by plaque buildup in the arteries.

"Cardiovascular disease is a major global problem, and we are preventing and treating it using several approaches, including pharmaceuticals, physical activity, and diet," says the new study's senior author, Dr. José Ordovás.

"But this study emphasizes we have to include sleep as one of the weapons we use to fight heart disease — a factor we are compromising every day," Dr. Ordovás explains.

The research team's findings now appear in the Journal of the American College of Cardiology.

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All about sleep duration and quality

The researchers analyzed the medical data of 3,974 individuals who averaged 46 years of age, were based in Spain, and who took part in the Progression of Early Subclinical Atherosclerosis (PESA) study.

Essentially, PESA recorded the prevalence and rate of progression of vascular problems that were not yet clinically relevant in the participants. None of the PESA-sourced volunteers had a diagnosis of heart disease at baseline, and two-thirds of them were male.

Besides allowing doctors to assess their vascular lesions, the participants also agreed to wear a sleep actigraph — a device that helps record a person's sleep patterns — for a period of 7 days.

Using the actigraph results, the researchers split the participants into four distinct groups:

people who slept under 6 hours per night people who slept 6–7 hours per night people who slept 7–8 hours each night people who slept longer than 8 hours.

All the participants also had 3-D heart ultrasounds, as well as cardiac CT scans, to check for the presence of heart disease. Moreover, the 3-D heart ultrasounds also measured atherosclerosis throughout the body.

The study found that — after the exclusion of other risk factors for heart disease — participants who slept under 6 hours every night had a 27 percent increase in the risk for atherosclerosis when the researchers compared them with people who slept between 7 and 8 hours each night.

Poor sleep quality — for instance, waking up often during the night — was associated with similar outcomes, increasing atherosclerosis risk by 34 percent.

Some researchers have emphasized that, even if you do end up sleeping less time, the quality of that sleep will have a noticeable impact on your health.

"It is important to realize that shorter sleep duration that is of good quality can overcome the detrimental effects of the shorter length," notes Dr. Valentin Fuster who is editor-in-chief of the Journal of the American College of Cardiology, in which the current study appears.

Intriguingly, the study also found some evidence that people who slept more than 8 hours per night — especially women — also had a heightened risk of atherosclerosis, though few people reported overly long slumber times.

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The first study of its kind

The study researchers also noted that participants who reported getting less sleep each night were more likely to drink more caffeinated and alcoholic drinks.

"Many people think alcohol is a good inducer of sleep, but there's a rebound effect," explains Dr. Ordovás. "If you drink alcohol," he adds, "you may wake up after a short period of sleep and have a hard time getting back to sleep. And if you do get back to sleep, it's often a poor-quality sleep."

As for the effects of coffee, the study's senior author notes that these are, most likely, down to an individual's genetic makeup, and how their body breaks down caffeine.

"Depending on your genetics, if you metabolize coffee faster, it won't affect your sleep, but if you metabolize it slowly, caffeine can affect your sleep and increase the odds of cardiovascular disease," he notes.

Dr. Ordovás believes that the current study is more accurate than previous efforts to map out the relationship between sleep and cardiovascular risk.

For one, the current study was larger than previous research. Most importantly, it reported on actigraph data to determine sleep patterns, rather than on self-reports from participants, which are subjective and can be unreliable.

"What people report and what they do are often different," Dr. Ordovás points out.

"This is the first study to show that objectively measured sleep is independently associated with atherosclerosis throughout the body, not just in the heart."

Dr. José Ordovás

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Metoprolol tartrate vs. metoprolol succinate

Metoprolol tartrate and metoprolol succinate are different salt forms of the same active ingredient, metoprolol. Although these medications are similar, they have slightly different uses and effects.

Metoprolol belongs to a class of drugs called beta-blockers. These drugs work by slowing down a person's heart rate and lowering their blood pressure.

Doctors often prescribe beta-blockers for people with cardiovascular conditions or those who have had a heart attack. Both metoprolol tartrate and metoprolol succinate are prescription-only drugs.

In this article, we explore the differences and similarities between these two drugs.

Uses Woman taking a pill
Metoprolol tartrate and metoprolol succinate can both treat high blood pressure and angina.

Doctors prescribe metoprolol tartrate to treat people with the following health conditions:

They use metoprolol succinate to treat the following health conditions:

Both drugs are effective in treating people with high blood pressure and angina. However, doctors prescribe only metoprolol tartrate to prevent further heart attacks in people who have already experienced a heart attack. For heart failure, they prescribe only metoprolol succinate.

Forms and dosage The appropriate dosage of both metoprolol tartrate and metoprolol succinate depends on a person's condition and how well that condition responds to the medication. Metoprolol tartrate Metoprolol tartrate is available either as an immediate-release tablet, as an intravenous injection, or in liquid form. People using the immediate-release tablet may need to take it several times a day, and doctors advise that they do so either with or directly after a meal. The recommended dosage of metoprolol tartrate ranges between 100–450 milligrams (mg) daily. One full dose of the intravenous injection provides 15 mg of the drug. If an individual tolerates this dose, the doctor may recommend that they switch to using metoprolol tartrate tablets instead. Metoprolol succinate Metoprolol succinate is available as an extended-release tablet, which means that people only have to take one tablet a day. The initial dosage of metoprolol succinate ranges from 25–100 mg per day. If the person experiences no problems on the initial dosage, a doctor may increase the dosage to a maximum of 200 mg per day. Thank you for supporting Medical News Today Who might benefit from these medications? A person may benefit from taking metoprolol tartrate if they have: experienced a heart attack high blood pressure angina Metoprolol succinate may benefit people who have: high blood pressure angina class II or III heart failure Side effects Woman with a headache and fatigue at her desk
Side effects of metoprolol tartrate can include fatigue and dizziness. Although beta-blockers are generally safe and effective drugs, they may cause unwanted side effects in some people. However, the side effects of metoprolol tartrate and metoprolol succinate are usually mild and temporary. Side effects of metoprolol tartrate can include: Side effects of metoprolol succinate can include: very low blood pressure dizziness difficulty sleeping fatigue difficulty breathing depression sexual dysfunction rash constipation nausea vomiting dry mouth rash Risks While metoprolol tartrate and metoprolol succinate are both generally very safe, people may experience problems if they abruptly stop taking them. Suddenly stopping beta-blockers can lead to worsening chest pain, increased blood pressure, and heart attack. If someone wishes to end their treatment, they should speak to a healthcare professional first. A doctor will usually advise people to lower the dosage gradually over 2 weeks. People who have diabetes may need to take care when taking any form of metoprolol medication because it can conceal symptoms that indicate low blood sugar, such as a rapid heartbeat. However, research has shown that beta-blockers can help control high blood pressure in people with diabetes. Beta-blockers can also affect how the heart responds to general anesthesia. A doctor may recommend temporarily withdrawing from beta-blocker treatment before undergoing major surgery. People should always consult their doctor before stopping or starting any new medications or supplements. Thank you for supporting Medical News Today Drug interactions Metoprolol tartrate and metoprolol succinate contain the same active ingredient, so these medications have similar drug interactions. People should inform a healthcare professional if they are taking any other prescription or over-the-counter drugs or supplements. Metoprolol tartrate and succinate can interact with a range of medications, including: Blood pressure drugs: amlodipine (Norvasc) hydralazine (Apresoline) ephedrine guanethidine betanidine clonidine Heart condition medications: digoxin (Lanoxin) furosemide (Lasix) quinidine gluconate Antipsychotics: haloperidol (Haldol) chlorpromazine (Thorazine, Largactil) fluphenazine (Prolixin) Antidepressants: phenelzine (Nardil) selegiline (Eldepryl) escitalopram (Lexapro) fluoxetine (Prozac) paroxetine (Paxil) Other medications: atorvastatin calcium (Lipitor) aspirin abiraterone acetate (Zytiga) acetaminophen (Tylenol) ergot alkaloid fingolimod (Gilenya) guaifenesin (Theocon Elixir, Brondelate) insulin glargine (Lantus) sildenafil (Viagra) Summary Metoprolol tartrate and metoprolol succinate belong to a class of drugs known as beta-blockers. Both drugs are different salts of the same active ingredient, metoprolol. However, despite being similar, they do have different uses. Both drugs are effective in treating people with high blood pressure and angina. However, doctors prescribe metoprolol tartrate for people who have had a heart attack and metoprolol succinate to treat individuals with type II and III heart failure. The two medications share similar drug interactions, so it is essential that people make their doctor aware of any medications or supplements that they are currently taking. Both forms of medication also share similar warnings. People should not stop taking these medications abruptly as this can lead to worsening symptoms and even heart attacks in some people. People with diabetes should take care when using beta-blockers because these medications can mask some symptoms of low blood sugar.
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Personal income may increase risk of heart disease

Income levels, if they are unstable, can easily turn into a stressor. However, the volatility of personal income could be having a more serious effect on people's heart health.
Money heart
Does how much money we earn affect cardiovascular health?

It is often expected that a person's income will constantly rise until they reach retirement age.

However, this isn't always the case. In fact, incomes have become so unpredictable that their volatility has reached an all-time high since 1980.

When a person's income fluctuates, it can alter many other factors in their life.

It can affect everything from mental health to diet, which could result in potentially serious health problems.

A new study suggests that personal income may even be associated with an increased risk of heart disease and death.

What is most surprising is that this link is present in relatively young people. We know this because an ongoing study has been tracking the health of young people living in four cities around the United States for nearly 3 decades.

The Coronary Artery Risk Development in Young Adults (CARDIA) study started in 1990. The four cities are Minneapolis, MN, Chicago, IL, Oakland, CA, and Birmingham, AL. Each participant was aged 23–35 years when the researchers first examined them.

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The risk of low income

The researchers behind the new study analyzed data from the CARDIA study to see whether there was a link between income fluctuations and risk of cardiovascular events as well as death. They first studied income levels taken from five assessments in 1990–2005.

They defined income volatility as a percentage change from one income figure to the next. They also looked at income drop, or an income decrease of 25 percent or more from the previous assessment figure.

They then tracked the number of people who experienced cardiovascular events — both fatal and non-fatal — or died of any cause in 2005–2015.

There were 106 cardiovascular events and 164 deaths. The team took into account factors such as pre-existing heart risk and sociodemographic background.

The results, now published in the journal Circulation, found that substantial fluctuations in personal income were associated with a higher risk of death and cardiovascular diseases in the decade following this income change.

The highest levels of income volatility were linked with almost double the risk of death and over double the risk of conditions such as strokes, heart failure, or heart attacks.

These findings were all compared with those of people who fell into a similar category but who had less of an alteration in their personal income.

Some people were more likely to experience high income volatility. Such people included women, African-American people, those who are unemployed, people who are not married, people who smoke, those with less than a high school education, and people with signs of depression.

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Why money matters

Lead study author Tali Elfassy, Ph.D., at the University of Miami Miller School of Medicine in Florida, says that income volatility "presents a growing public health threat, especially when federal programs, which are meant to absorb unpredictable income changes, are undergoing continuous changes, and mostly cuts."

"While this study is observational in nature and certainly not an evaluation of such programs, our results do highlight that large negative changes in income may be detrimental to heart health and may contribute to premature death."

Tali Elfassy, Ph.D.

It is not clear what exactly prompts income volatility to result in an elevated risk of cardiovascular problems, death, or both. It could be that fluctuations in a person's income result in unhealthful behaviors, such as excessive alcohol consumption, a lack of exercise, stress, and high blood pressure.

All of these things are linked to lifespan and cardiovascular health.

The researchers hope that other scientists will carry out further research to understand the cause of this newly found association. They list biologic and psychosocial pathways as being two potential reasons to explore.

They also see these findings as a way to more effectively screen people, especially those who are younger, for cardiovascular disease risk.

However, these results cannot currently be applied to all identities. Other ethnic groups and people living outside of cities will also need to be studied to see whether the same association is present.

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Study reveals how much fiber we should eat to prevent disease

A new meta-analysis examines 40 years' worth of research in an attempt to find out the ideal amount of fiber that we should consume to prevent chronic disease and premature mortality.
person eating cereals and fruit
Whole grain cereals and fruit are excellent sources of fiber.

Researchers and public health organizations have long hailed the benefits of eating fiber, but how much fiber should we consume, exactly?

This question has prompted the World Health Organization (WHO) to commission a new study. The results appear in the journal The Lancet.

The new research aimed to help develop new guidelines for dietary fiber consumption, as well as reveal which carbs protect the most against noncommunicable diseases and can stave off weight gain.

Noncommunicable diseases are also called chronic diseases. They typically last for a long time and progress slowly. According to WHO, there are "four main types of noncommunicable diseases:" cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.

Professor Jim Mann, of the University of Otago, in New Zealand, is the corresponding author of the study, and Andrew Reynolds, a postdoctoral research fellow at Otago's Dunedin School of Medicine, is the first author of the paper.

Prof. Mann explains the motivation for the study, saying, "Previous reviews and meta-analyses have usually examined a single indicator of carbohydrate quality and a limited number of diseases, so it has not been possible to establish which foods to recommend for protecting against a range of conditions."

To find out, the researchers performed a meta-analysis of observational studies and clinical trials.

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Daily intake of 25–29 grams of fiber is ideal

Reynolds and colleagues examined the data included in 185 observational studies — amounting to 135 million person-years — and 58 clinical trials which recruited over 4,600 people in total. The studies analyzed took place over almost 40 years.

The scientists investigated the incidence of certain chronic diseases, as well as the rate of premature deaths resulting from them.

These conditions were: coronary heart disease, cardiovascular disease, stroke, type 2 diabetes, colon cancer, and a range of obesity-related cancers, such as breast cancer, endometrial cancer, esophageal cancer, and prostate cancer.

Overall, the research found that people who consume the most fiber in their diet are 15–30 percent less likely to die prematurely from any cause or a cardiovascular condition, compared with those who eat the least fiber.

Consuming foods rich in fiber correlated with a 16–24 percent lower incidence of coronary heart disease, stroke, type 2 diabetes, and colon cancer.

Fiber-rich foods include whole grains, vegetables, fruit, and pulses, such as peas, beans, lentils, and chickpeas.

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The analysis also revealed that the amount of fiber that people should consume daily to gain these health benefits is 25–29 grams (g). By comparison, adults in the United States consume 15 g of fiber daily, on average.

The authors also suggest that consuming more than 29 g of fiber per day may yield even more health benefits.

However, they do caution that, while the study in itself did not find any adverse health effects of consuming fiber, eating too much of it may be damaging for people with insufficient iron or minerals.

Eating large amounts of whole grains can further deplete the body of iron, explain the researchers.

Finally, the clinical trials included in the study also revealed that consuming more fiber correlates strongly with lower weight and lower cholesterol levels.

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Why fiber is so good for you

Prof. Mann comments on the significance of the findings, saying, "The health benefits of fiber are supported by over 100 years of research into its chemistry, physical properties, physiology, and effects on metabolism."

"Fiber-rich whole foods that require chewing and retain much of their structure in the gut increase satiety and help weight control and can favorably influence lipid and glucose levels," he adds.

"The breakdown of fiber in the large bowel by the resident bacteria has additional wide-ranging effects including protection from colorectal cancer."

"Our findings provide convincing evidence for nutrition guidelines to focus on increasing dietary fiber and on replacing refined grains with whole grains. This reduces incidence risk and mortality from a broad range of important diseases."

Prof. Jim Mann

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What are the benefits of CoQ10?

Coenzyme Q10 is an essential chemical that the body produces naturally. A deficiency of this chemical can have adverse effects, and coenzyme Q10 supplements may offer health benefits.

In this article, we discuss the health benefits and risks of taking coenzyme Q10 (CoQ10) supplements.

What to know about CoQ10 young woman looking at complementary medicine
CoQ10 is a naturally produced chemical that is available as a supplement.

CoQ10 is an antioxidant that the body produces naturally and stores in components of the cell called mitochondria. It has associations with energy, protecting cells, and providing heart benefits.

CoQ10 plays a few critical roles in the body. For example, the body's cells need this compound to produce the energy that allows them to function.

As an antioxidant, CoQ10 also protects the cells in the body by neutralizing free radicals, which reduces oxidative stress in the body. Oxidative stress can cause tissue damage, inflammation, and cellular apoptosis, or cell death. There are links between oxidative stress and a range of disorders, including Alzheimer's disease and Parkinson's disease.

Naturally occurring levels of CoQ10 decrease with age. Scientists have identified associations between CoQ10 deficiency and heart disease and cancer.

There is currently not enough evidence to support using CoQ10 to either prevent or treat cancer or Parkinson's disease. However, it might help treat certain heart conditions and prevent migraines.

Researchers have also looked at the effects of CoQ10 on a variety of other conditions, but the results are inconclusive. These conditions include ALS, Down syndrome, Huntington's disease, and male infertility.

Thank you for supporting Medical News Today Health benefits of CoQ10 CoQ10 has many varied uses. We discuss its possible benefits below. Improving heart health CoQ10 might help treat specific heart conditions, such as congestive heart failure and high blood pressure, particularly among older individuals. Research on the effectiveness of CoQ10 for heart problems has provided mixed results. However, one study reported that CoQ10 was an important factor in the survival of older adults with chronic heart failure. Other research showed that CoQ10 might help people recover from some types of heart surgery. Reducing migraines According to both the American Academy of Neurology and the American Headache Society, CoQ10 may be effective in preventing migraines, although the research to support this is still limited. It is possible that CoQ10 has this effect because it keeps the mitochondria in the cells healthy. Easing statin side effects Some research suggests that CoQ10 might help ease muscle weakness that is due to taking cholesterol-lowering medications, known as statins. However, the results of another trial showed that treatment with CoQ10 did not reduce muscle pain in people who were also using statins to control their cholesterol levels. Sources and dosages People can obtain CoQ10 by eating certain meats and grain proteins, but the quantity present in these foods is too small to increase CoQ10 levels in the body significantly. Foods that contain CoQ10 include: organ meats, such as kidney and liver chicken beef pork fatty fish, such as sardine and trout spinach broccoli soybeans whole grains CoQ10 supplements are available to take either by intravenous (IV) injection or as capsules or tablets. Studies have used daily doses of CoQ10 ranging from 50 milligrams (mg) to 1,200 mg in adults. A typical daily dose for someone who has a CoQ10 deficiency is 100–200 mg, while the observed safe level is 1,200 mg per day. People should talk to their doctor before starting any new supplements or medications. Thank you for supporting Medical News Today Side effects and risks man suffering from insomnia
Although generally well-tolerated, CoQ10 supplements may cause insomnia. CoQ10 supplements appear to be safe and well-tolerated. Some mild side effects may include: Drug interactions Taking statins may reduce the amount of CoQ10 in a person's blood. Studies have shown a significant reduction in plasma CoQ10 concentrations following treatment with statins. Additionally, CoQ10 may reduce the effectiveness of blood-thinning drugs, such as warfarin, and this may increase the risk of blood clots. CoQ10 may also interfere with insulin and some chemotherapy medications. Thank you for supporting Medical News Today Summary Coenzyme Q10 (CoQ10) is a naturally occurring antioxidant that is present in almost every cell in the human body. Scientists have linked low levels of CoQ10 with various medical conditions, including heart disease and cancer. People usually tolerate CoQ10 supplementation well, and the supplements produce few, if any, side effects. However, there is limited research to support the health benefits that CoQ10 might offer. People can buy CoQ10 supplements in drug stores or online. It is essential to speak with a healthcare professional before taking any new dietary supplements, including CoQ10. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above.
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6 incredible cases of autosurgery

In this Spotlight, we will discuss six examples of self-surgery. The stories that follow are gruesome and unusual. Although they are not for the fainthearted, they are fascinating.
Surgical implements
Self-surgery is uncommon, thankfully.

Surgery is normally a skillful, delicate procedure that involves a surgeon and a patient.

However, over the years, for many reasons, one of the players in this classic duet has been absent.

In some cases, a surgeon's dedication to understanding the human body goes far beyond the walls of the library, inspiring them to cut themselves open.

In other cases, extreme situations have made extreme actions the only viable option.

Self-surgery, or autosurgery, is certainly not a frequent occurrence — especially in modern times. However, it does happen, and below are six extreme examples.

1. Cardiac catheterization

Werner Theodor Otto Forssman was studying medicine in Germany in the 1920s when a professor of his planted a question in his mind. That question was: Is it possible to reach the heart through the veins or arteries without the need for traumatic surgery?

Back then, the only way to access the heart was by conducting a fairly risky surgical procedure.

Forssman came across an article describing how a veterinarian had reached a horse's heart with a catheter via the internal jugular vein. This transports blood from the brain, face, and neck to the heart.

He came to the conclusion that in humans, he could use a ureteric catheter to reach the heart via the cubital vein, which lies close to the surface of the arm and travels to the heart.

Werner Theodor Otto Forssmann
Werner Theodor Otto Forssmann.

Excited, Forssman told the chief of surgery that he planned to attempt the procedure on a patient.

The chief was rightly concerned for the patient's safety and blocked his plans. So, Forssman asked if he could carry out the procedure on himself. Once again, the chief responded in the negative.

Undeterred, the young surgeon spoke with the operating room nurse; as the keeper of the equipment, he would need to have her permission.

She was impressed with the idea and offered herself as a test subject. Despite her courage, Forssman was still determined to carry out the procedure on himself.

He strapped the nurse down and pretended to make an incision on her, but he anesthetized his own cubital vein. He managed to advance the catheter 30 centimeters up his arm before the nurse realized that she had been duped.

Forssman asked her to call in an X-ray nurse so that he could chart the catheter's internal voyage from his arm to his heart.

While they were taking pictures of the catheter, a colleague saw what Forssman had done and attempted to pull the catheter out of his arm. However, Forssman won the ensuing tussle and continued his procedure.

The first images from the X-ray showed that the catheter had reached the level of his shoulder, so he continued feeding it through. Eventually, he achieved his goal: he could see the tip of his right ventricle cavity.

The procedure was a success, but Forssman had gone against the grain and was dismissed from his residency. Unable to find any surgical position, he turned to urology.

Then, 17 years later, alongside two others, he won the Nobel Prize for Physiology or Medicine for his part in the invention of cardiac catheterization.

Forssman's self-surgery was all in the name of medical advancement, but the next was a fight for survival.

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2. A most troublesome appendix

In 1960, Leonid Rogozov was a member of the 6th Soviet Antarctic expedition. He was the team's only medical professional.

Several weeks into the expedition, the 27-year-old surgeon noticed some of the telltale signs of appendicitis: fever, weakness, nausea, and significant pain in his right lower abdomen.

Drugs were not improving his situation; surgical intervention was needed. In his diary, he wrote:

"I did not sleep at all last night. It hurts like the devil! A snowstorm whipping through my soul, wailing like a hundred jackals."

Antarctica view
Although beautiful, Antarctica is not the ideal setting for auto-surgery.

As winter deepened and the sea froze, Rogozov had no hope of returning to civilization for treatment. His only option was to carry out an appendectomy on himself.

This was an operation that he had completed many times, but certainly not under these circumstances.

"Still no obvious symptoms that perforation is imminent," he wrote, "but an oppressive feeling of foreboding hangs over me...This is it...I have to think through the only possible way out: to operate on myself...It's almost impossible...but I can't just fold my arms and give up."

He recruited three of his colleagues to assist him: one held the mirror and adjusted the lamp, one handed him the surgical implements as he requested them, and one acted as a reserve in case either of the others should faint or become nauseous.

Rogozov also explained how to revive him with epinephrine in case he lost consciousness.

At 2 a.m. on May 1, 1961 — after medicating himself with local anesthetic — he made the first 10–12-centimeter long incision in his abdomen. After around 30 minutes, Rogozov became weak and needed to take regular breaks, but he persevered.

His self-surgery was successful, and after 2 weeks, he was back to full health.

3. Self-cesarian

Most of these examples involve medically trained men, but this one bucks that trend. The woman in question had no medical training.

This example of autosurgery took place in March 2000 in a remote Mexican village, where access to healthcare is virtually nonexistent. A 40-year-old mother of eight was carrying her ninth child.

Around 2 years before this case of autosurgery, the woman had lost a child during labor due to an obstruction.

After hours of unproductive labor, she was concerned that she might lose the baby again. So, in a desperate attempt to prevent this from happening again, she decided to perform a cesarian on herself.

First, she drank three strong alcoholic drinks. Then, using a kitchen knife, she opened her abdomen with three strokes. According to a paper that describes the procedure, "[S]he used her skills at slaughtering animals." In all, the procedure took 1 hour.

Once free, the newborn boy breathed immediately. The woman then asked one of her children to fetch a local nurse to patch her up. The nurse repositioned the woman's intestines and sewed up the wound using a standard sewing needle and cotton.

Then, finally, she arrived at the nearest hospital — some 8 hours away by road. She did require extensive treatment, but she recovered enough to be released after 10 days.

In the paper mentioned above, the authors write:

"The natural, innate maternal instinct for preservation of offspring may result in the mother's disregard for self-safety, and even for her own life."

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4. Another troublesome appendix

Dr. Evan O'Neill Kane was the owner of Kane Summit Hospital in Pennsylvania. While awaiting the removal of his own appendix, he decided to do it himself.

Although the medical staff were less than comfortable with his decision, he was their boss, and they reluctantly allowed him to indulge in autosurgery.

Appendicitis illustration
An inflamed appendix (depicted here) can be incredibly painful.

In 30 minutes, Dr. Kane injected adrenalin and cocaine into his abdominal wall, cut himself open, found his appendix, and removed it.

In fact, he claimed he could have completed the surgery quicker had his staff not been so nervous.

During the surgery, Dr. Kane leaned a little too far forward and his intestines slipped through the wound in his abdomen.

Though his colleagues were shocked, he remained calm and simply pushed them back to where they belonged.

Just 2 weeks later, Dr. Kane had fully recovered and was operating again. When someone asked him why he had decided to embark on self-surgery, he told them that he wanted to know what it felt like.

Also, and perhaps more importantly, he wanted to demonstrate that it was possible to undergo minor procedures without the use of relatively dangerous general anesthetics.

This wasn't Dr. Kane's only foray into self-surgery; at age 70, he decided to repair his inguinal hernia under local anesthetic, and this time, he invited members of the press to attend.

The operation was successful, but Dr. Kane never recovered his full strength. He died of pneumonia within just 3 months.

5. The sixth stone

M. Clever Maldigny, a military surgeon, was plagued by kidney stones. By age 27, he had endured no less than five operations to remove them.

Some of these procedures had caused long-lasting complications, so, in 1824, Maldigny decided that he would remove the sixth stone himself.

Using a mirror and guided by the scars of previous procedures, he opened himself up. He located the neck of the bladder and found the offending article lodged among the scars formed by previous surgeries.

The self-surgery was successful and, according to Maldigny, 3 weeks later "he was tranquil and cheerful as if he had never been a sufferer."

When a seventh kidney stone appeared some years later, he opted for a new and minimally invasive surgery wherein a surgeon crushes the stone via a small hole.

He did not carry out the procedure himself.

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6. An egg-sized hernia

Our final example of self-surgery comes from Romanian surgeon called M. Alexandre Fzaicou. He had developed an inguinal hernia, in which some of the contents of the abdominal cavity push through a weak spot in the wall of the abdomen and form a painful swelling in the groin area.

According to Fzaicou, his hernia was the size of a hen's egg.

After many attempts at anesthetizing the region with strychnine-stovain, he finally found the right injection point in the groin and got to work.

The surgery took around 1 hour and was a success. Following the procedure, Fzaicou reported headache, insomnia, and pain in the upper abdomen, which lasted 1 week. He had returned to work in just 12 days.

If nothing else, these stories remind us of the amazing things that humans are capable of.

Although it probably goes without saying, Medical News Today do not suggest or imply that autosurgery is the best course of action for anyone.

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Heart failure: Flu vaccine could save lives

People with heart failure are more susceptible to flu complications than other people. However, a new study has revealed that flu vaccinations may have a significant impact on lifespan.
Vaccine flu older adult
The importance of the flu vaccine receives a further boost in a new study.

Most doctors, scientists, and other medical professionals consider flu vaccinations to be a safe and effective way of protecting people against influenza, or the flu.

The vaccine, usually given in the form of an injection, contains small amounts of deactivated flu viruses.

These viruses are not harmful in this state but do trigger the human body to produce antibodies to fight against them. This means that the next time the virus enters the body, it can produce the same response quickly.

The Centers for Disease Control and Prevention (CDC) advise that everyone over the age of 6 months has a flu vaccination. However, certain individuals are more at risk of experiencing flu-related complications or even death.

This includes people over 65 years old and over, those who are pregnant, and those who have medical conditions, such as heart disease.

A new study has examined just how much of an impact a flu shot can have on the survival rate of people diagnosed with heart failure. This group of individuals are often older and are also likely to have a range of other health issues. For these people, getting the flu can be a severe problem.

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The analysis

A team of researchers from the University of Copenhagen in Denmark analyzed data from a total of 134,048 Danish people who had recently received a diagnosis of heart failure. The researchers gathered the data from several national registries that store information on hospital diagnoses, prescriptions, and causes of death.

Each person born in Denmark receives a unique personal identification number, and this number allowed researchers to follow particular people for 12 years, from 2003 to 2015.

Many findings from the study came to light. The data analysis, now published in the American Heart Association's journal Circulation, firstly showed that the number of people getting flu vaccinations had increased.

In 2003, 16 percent of people with heart failure had the flu vaccine. In 2015, this had risen to 52 percent of people.

The researchers also found a link between flu vaccinations and "an 18 percent reduced risk of premature death." This reduction existed even after taking other factors, such as medications, other health issues, and financial situations, into account.

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The importance of vaccines

The research also identified the importance of having regular flu shots. For example, having an annual flu vaccination after a diagnosis of heart failure showed a 19 percent reduction in cardiovascular death and all-cause death compared to those who did not get vaccinated.

Having the flu shot less than once a year resulted in an 8 percent reduction in the risk of cardiovascular death and "a 13 percent reduced risk of all-cause death" when compared to people who had never had the vaccination.

The final factor that the researchers identified was the timing of the flu vaccination. The team found a reduction in the number of cardiovascular and all-cause deaths when people received the vaccine at the beginning of the flu season, which is usually around September or October, rather than in November and December, for example.

Heart failure's future

Scientists expect heart failure to become an increasing problem in future years, making these results potentially useful for a human population that is now living longer. One limitation of this research, however, is that the scientists only studied people newly diagnosed with heart failure. Lead author of the study Daniel Modin says:

"While this research only looked at patients with newly diagnosed heart failure, the protection from a flu shot likely benefits any patient with heart failure."

Daniel Modin

He continues, "I hope that our study can assist in making physicians and cardiologists who care for patients with heart failure aware of how important influenza vaccination is for their patients. Influenza vaccination may be regarded as a standard treatment in heart failure similar to medications."

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How does yo-yo dieting affect our heart health?

Sticking to a strict diet can be challenging, so our eating patterns can fluctuate wildly. A new study looks at how these changes might impact cardiovascular health.
Avocado heart
How does eating well intermittently affect our heart?

As we roll into 2019, many people will be trying out new diet regimes.

For many of us, sticking to a nut-filled, burger-free, fish-heavy Mediterranean-style diet will only last a matter of days before we return to the realms of cheesecake and cheese boards.

Though eating right over the long-term reduces the risk of cardiovascular problems, we know much less about how a fluctuating dietary regime impacts our heart health.

Because so many people choose a diet and then gradually stray from it, researchers are interested in how yo-yo dieting might influence markers of cardiovascular disease.

A team led by Prof. Wayne Campbell, of Purdue University in West Lafayette, IN, set out to investigate. The scientists recently published their findings in the journal Nutrients.

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Altering eating patterns periodically

To investigate, the scientists inspected data from two previous studies into dietary interventions carried out by the same group of researchers at Purdue University.

The participants of these studies followed one of two eating patterns: a Mediterranean diet or a Dietary Approaches to Stop Hypertension (DASH) diet.

Lead study author Lauren O'Connor explains these two eating patterns, saying, "Our DASH-style eating pattern focused on controlling sodium intake, while our Mediterranean-style focused on increasing healthy fats. Both eating patterns were rich in fruits, vegetables, and whole grains."

Participants followed their eating pattern for 5 or 6 weeks. After this period, the scientists assessed their cardiovascular risk by measuring a range of parameters.

These included blood pressure and levels of fats, glucose, and insulin in the blood.

Following the 5–6 weeks of dieting, participants went back to their standard eating patterns for a further 4 weeks. Then, after another cardiovascular assessment, they were restarted on DASH or Mediterranean diet plans for an additional 5–6 weeks. Finally, they had one more checkup at the end of this period.

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A cardiometabolic 'rollercoaster'

The analysis showed that, as expected, the cardiovascular markers improved when the individual stuck to the diet. Then, once they had returned to a less healthful eating regime, the biomarkers became less favorable again.

Then, once the healthful diets were restarted, the metabolic markers once again improved.

The key message is that only a few weeks of healthful eating can make measurable improvements to markers of cardiovascular health, but at the same time, it does not take long before they return to their unhealthy state once a person terminates their healthful diet.

"These findings should encourage people to try again if they fail at their first attempt to adopt a healthy eating pattern," Prof. Campbell says. "It seems that your body isn't going to become resistant to the health-promoting effects of this diet pattern just because you tried it and weren't successful the first time."

More research will be needed to explore whether yo-yo dieting has an impact on long-term health.

Some studies have shown that losing and gaining weight again in a cycle, or weight cycling, could cause stress to the cardiovascular system. However, the evidence is certainly not overwhelming, and some scientists question whether weight cycling has any adverse effects at all.

Overall, the results are bittersweet; they show that just a few weeks of dietary change can produce measurable improvements in health markers. On the flip side, after just a few weeks following the abandonment of a new diet, those benefits are lost.

However, if a person restarts their healthful eating plan, the benefits can be won back in the same short amount of time. As such, Prof. Campbell's message is one of stubborn persistence:

"The best option is to keep the healthy pattern going, but if you slip up, try again."

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Can exercise lower blood pressure as effectively as drugs?

Millions of people live with high blood pressure, which can place them at risk of developing cardiovascular diseases. For this condition, doctors typically prescribe blood-lowering drugs, but could exercise help just as well?
people jogging
A new study suggests that exercise can be just as effective as drugs when it comes to keeping blood pressure under control.

According to the Centers for Disease Control and Prevention (CDC), approximately 75 million adults in the United States have to manage high blood pressure, where it exceeds the threshold of 140 millimeters of mercury (mm Hg).

The condition can increase their risk of developing heart disease or experiencing a stroke, both of which are leading causes of death in the U.S.

Moreover, high blood pressure drives an expense of around $48.6 billion per year nationally, including the cost of medication, accessed health care, and absence from work.

People with high blood pressure typically follow an antihypertensive or blood pressure-lowering treatment, which includes special medication. At the same time, specialists sometimes advise that people make lifestyle changes to help them manage their blood pressure.

One such change is to take regular, structured exercise that can be of several types:

endurance exercises, such as walking, jogging, or swimming high-intensity interval training, involving short bursts of intensive exercise dynamic resistance, including strength training isometric resistance, such as the plank exercise a combination of endurance and resistance exercises

However, no studies have yet compared the effectiveness of physical activity in lowering blood pressure with that of antihypertensive medication.

A new study in the British Journal of Sports Medicine — a BMJ publication — aims to address this gap in the literature.

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Findings indicate similar effects

Since there are no studies that directly compare the effects of blood pressure medication with those of structured exercise, the study analyzed the data of various research projects that focused on one or other of these approaches.

The researchers — from institutions across Europe and the U.S., including the London School of Economics and Political Science in the United Kingdom, and the Stanford University School of Medicine in California — explain that structured exercise helps lower systolic blood pressure, which measures the blood pressure in the blood vessels as the heart beats.

In the current study, they looked at the data from 194 clinical trials that focused on antihypertensive drugs and their impact on systolic blood pressure, and another 197 clinical trials, looking at the effect of structured exercise on blood pressure measurements. In total, these trials collected information from 39,742 participants.

Dr. Huseyin Naci — from the Department of Health Policy at the London School of Economics and Political Science — and colleagues conducted several sets of analyses on the data from the trials.

First, they compared the effects of all types of antihypertensive drugs with those of all kinds of exercise. Then, they looked at specific drug types versus specific types of exercise. Finally, they compared the impact of different exercise intensities with those of different drug dosages.

In the first instance, the investigators conducted these analyses by using data from healthy participants with normal blood pressure. Then, they repeated them with data from individuals with high blood pressure only.

They found that antihypertensive drugs were more effective in lowering blood pressure than structured exercise in the case of the general population. However, when they looked specifically at people with high blood pressure, they saw that exercise was as effective as most blood-lowering medication.

Moreover, the study authors concluded that there is "compelling evidence that combining endurance and dynamic resistance training was effective in reducing [systolic blood pressure]."

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More exercise is beneficial

Still, the research team cautions that they based their analyses on many small-scale trials, and others should replicate their results with more extensive studies.

Dr. Naci and colleagues also strongly advise against giving up on antihypertensive medication and replacing it with exercise.

"We don't think, on the basis of our study, that patients should stop taking their antihypertensive medications," the researcher says in a podcast in which he speaks about the current research.

"But," Dr. Naci adds, "we hope that our findings will inform evidence-based discussions between clinicians and their patients."

The lead researcher notes that many people in the U.S. and throughout Europe lead sedentary lives and that they would benefit from taking more exercise.

At the same time, however, he emphasizes that doctors should make sure their patients can adhere to prescribed exercise regimens.

"It's one thing to recommend that physicians start prescribing exercise to their patients, but we also need to be cognizant of the resource implications and ensure that the patients that have been referred to exercise interventions can adhere to them and so really derive benefit."

Dr. Huseyin Naci

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