Wood Street Clinic Blog

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Newly discovered molecule could treat heart failure

In heart failure, the heart is unable to pump blood effectively throughout the body. One key factor in the development of this condition is calcium dysregulation. A newly discovered molecule that may be able to address this issue could become the next therapeutic target for this heart condition.
heart concept illustration
Will a newly discovered molecule become the next therapeutic target for heart failure?

The heart can contract, relax, and pump blood through the veins effectively, partly due to a process called "calcium cycling." This process allows calcium to circulate in and out of cells.

This cycle is sometimes impaired by a person's age, which can also affect the rate or potency with which the heart muscle pumps out blood.

Calcium dysregulation may therefore lead to the development of heart failure.

So far, researchers have focused on developing therapies targeting a molecule known as SERCA, whose role is to transport calcium ions, ensuring the relaxation of the heart muscle.

In heart failure, SERCA does not function properly, which has led some scientists to look into the possibilities of developing a gene therapy that would increase SERCA expression.

Now, however, specialists from the University of Texas Southwestern in Dallas, and from Loyola University Chicago in Illinois, have discovered a micropeptide, which they named "dwarf open reading frame" (DWORF). The scientists believe that DWORF could pave the way to better treatments for heart failure.

"Our lab recently discovered a micropeptide called [DWORF], which binds directly to SERCA and enhances its activity," explains the lead author of this new study, Catherine Makarewich.

"In this study, we explored the therapeutic potential of high levels of DWORF, as a way to increase SERCA activity and improve heart contractility in heart failure."

Catherine Makarewich

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DWORF's impact on heart function

Makarewich and team first found that DWORF displaces a molecule called phospholamban (PLN), which inhibits SERCA activity.

This suggested that scientists might be able to use DWORF to help boost SERCA activity, thus allowing the heart to regain its ability to contract and relax effectively.

In the current study, whose findings appear in the journal eLife, the researchers worked with mice that they genetically engineered to express higher levels of DWORF, higher levels of PLN, or higher levels of both DWORF and PLN in the heart.

By comparing genetically engineered rodents with normal ones, the scientists noticed that the mice with higher DWORF levels had better calcium cycling than regular mice.

At the same time, the mice engineered to express higher PLN levels had poorer calcium cycling compared with the controls. Finally, in the mice with high levels of both molecules, DWORF prevented the impact of PLN.

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'An attractive candidate' for new therapies

In order to consolidate these findings, the researchers also assessed the effects of DWORF in a mouse model of dilated cardiomyopathy, in which the heart becomes enlarged and unable to pump blood efficiently.

Regular mice with dilated cardiomyopathy had poor function of the left heart ventricle, the part of the heart that pumps oxygenated blood towards the body.

Mice with dilated cardiomyopathy that were also engineered to have higher levels of DWORF, however, showed better function of the left heart ventricle.

Conversely, rodents with the same heart problem but with no DWORF at all displayed even poorer left ventricle function than the controls.

Makarewich and team also noted that mice with high DWORF levels did not show some of the usual physiological signs of cardiomyopathy, such as enlarged heart chambers, thinning of the chamber walls, and a higher volume of heart muscle cells.

Also, the mice with high DWORF levels did not develop a buildup of scar tissue in the heart, which is another characteristic of cardiomyopathy.

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"Previous attempts to restore SERCA to protect against heart failure have been unsuccessful because they have focused on increasing levels of SERCA itself," notes the study's senior author, Eric Olson.

Based on the current findings, however, he thinks the team may have identified a more viable therapeutic target in DWORF.

"We believe that increasing levels of DWORF instead may be more feasible and that the small size of the DWORF molecule could make it an attractive candidate for a gene therapy drug for heart failure," Olson adds.

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Why are my feet swollen?

A person might experience swollen feet for a number of reasons. Some causes, such as minor injury, are apparent and easy to treat. Others, however, may be signs of a serious underlying health condition that needs prompt medical attention.

Here, we take a look at some of the reasons why a person's feet may appear swollen, when they should talk to a doctor, and what the treatment might involve.

1. Edema Swollen foot
Edema refers to swelling that results from trapped fluid.

Edema is the medical term for swelling that occurs when fluid becomes trapped in the body's tissues. It usually affects the legs and feet but can also occur in other parts of the body, such as the face or abdomen.

Other signs of edema include:

shiny, stretched skin over the affected area skin that stays dimpled after pressing it discomfort and reduced mobility coughing or difficulty breathing, if it affects the lungs

Treatment

Edema may go away by itself, or there may be an underlying cause that needs medical treatment.

Home remedies include wearing support stockings, reducing salt intake, and lying down while raising the legs above the chest.

If the swelling does not improve, a person should talk to their doctor to check for any underlying causes.

2. Foot or ankle injury Trauma to the foot or ankle can cause swelling in this area of the body. For example, a sprained ankle, which occurs when the ligaments become overstretched, could cause the foot to swell. Treatment To treat a foot or ankle injury, a person should elevate the foot when possible and try not to bear weight on the affected leg. Using an ice pack or compression bandage can help reduce swelling, and over-the-counter pain relievers can help ease discomfort. If the swelling and pain do not go away, a person might need to see their doctor to rule out more severe damage. 3. Pregnancy A common symptom of late pregnancy is for the feet and ankles to swell. This swelling is due to fluid retention and increased pressure on the veins. Home remedies To treat swollen feet during pregnancy, women can elevate their feet where possible, wear comfortable and supportive footwear, and avoid standing for extended periods. Staying cool, avoiding salt, and increasing water intake can help reduce fluid retention. Wearing supportive clothing, such as tights or compression stockings, should also reduce discomfort and help the swelling decrease. 4. Preeclampsia If swelling during pregnancy comes on suddenly and is severe, it could be a sign of preeclampsia. This is a condition that can occur during pregnancy or immediately after the birth. Symptoms include protein in the urine, rapid excessive fluid retention, and high blood pressure. This is a severe condition that usually occurs in the latter half of pregnancy and can progress to eclampsia, which is even more dangerous and constitutes a medical emergency. Signs of preeclampsia include: severe swelling headaches dizziness nausea and vomiting vision changes less frequent urination Treatment If a pregnant woman experiences any of these symptoms, she should speak with her doctor or midwife straight away. 5. Lifestyle factors Some lifestyle factors can also lead to swollen feet. These factors include: having a sedentary lifestyle being overweight wearing ill-fitting shoes Home remedies Exercising regularly and maintaining a healthy weight can reduce the risk of swollen feet. Other ways to alleviate swollen feet include: drinking plenty of water wearing compression socks or stockings soaking the feet in cool water raising the feet above the heart regularly staying active losing weight if overweight eating a healthful diet and being mindful of salt intake massaging the feet eating more potassium-rich foods, as these can help reduce water retention Thank you for supporting Medical News Today 6. A side effect of medication Steroids can cause swelling.
Steroids can cause swelling in the feet. Taking certain medications can result in the feet swelling, especially if they cause water retention. Medications that may cause the feet to swell include: Anyone who thinks that their medication is causing their feet to swell should speak with a doctor, who may be able to alter the dosage or prescribe a different type of medication. 7. Alcohol Alcohol can cause the body to retain excess water, causing the feet to swell. If the swelling continues for more than 2 days, a person should make an appointment with their doctor. Recurrent swelling of the feet after drinking alcohol may be a sign of an underlying issue with the heart, liver, or kidneys. Home remedies Elevating the feet above the heart, drinking plenty of water, and reducing salt intake may all help minimize swelling. Soaking the feet in cold water can also relieve symptoms. 8. Hot weather During hot weather, the feet can swell because their veins expand to cool the body. This process can cause fluid to leak into the surrounding tissue. Fluid can also collect in the ankles and feet. Home remedies Drinking plenty of water and wearing well-fitting, comfortable shoes that allow some ventilation can help prevent the feet from swelling in warm weather. 9. Infection An infection can cause swelling in the feet and ankles. People with diabetes have an increased risk of infection affecting their feet, so they should remain vigilant for any changes to this part of the body, such as blisters and sores appearing. Treatment A doctor will typically prescribe antibiotics to treat infections. 10. Venous insufficiency Venous insufficiency occurs when a person's blood cannot flow around the body properly. This is due to damaged valves causing blood to leak down the vessels and fluid retention in the lower legs, particularly around the feet and ankles. Signs of venous insufficiency include: achy legs skin changes, such as flaking new varicose veins appearing skin ulcers infection Treatment A person experiencing any signs of venous insufficiency should make an appointment with their doctor as soon as possible. To treat venous insufficiency, a doctor may recommend making some lifestyle changes, such as taking up exercise to help keep the blood pumping around the body efficiently. Compression stockings and medication to prevent blood clots can also help. In some cases, a doctor may suggest surgery to try to repair the damaged valves. 11. Blood clot Blood clots occur when the blood fails to flow around the body correctly, causing platelets to stick together. If blood clots develop in the leg veins, they may prevent the blood from moving back to the heart. This can cause the ankles and feet to swell. Deep vein thrombosis (DVT) occurs when blood clots form deep in the legs. DVT is a serious condition that can cause a blockage in the major leg veins. In some cases, the clots may break loose and move to the heart or lungs. Signs of DVT include: swelling in one leg pain or discomfort in the leg low-grade fever color changes in the leg Treatment If a person notices any signs of DVT, they should seek urgent medical attention. A doctor may prescribe blood-thinning medication to treat blood clots. People can help prevent blood clots by wearing tights, compression stockings, or clothing that is loose-fitting around the ankles. Other prevention methods include keeping active and reducing salt intake. It is also best to avoid standing or sitting still, especially with crossed legs, for extended periods. Thank you for supporting Medical News Today 12. Lymphedema Lymphedema causing swelling in the feet
Treatments for lymphedema focus on draining excess fluid. The lymphatic system helps the body get rid of unwanted substances, such as bacteria and toxins. Lymphedema occurs when lymphatic fluid gathers in the tissues as a result of problems with the lymph vessels. If the lymph vessels are damaged or absent, lymphatic fluid can build up and lead to infection, slow wound healing, and even deformity. People who undergo radiation therapy or lymph node removal have a higher risk of lymphedema. Anyone who has undergone cancer treatment and experiences swelling should contact their doctor immediately. As well as swelling of the feet, signs of lymphedema include: recurrent infections impaired motion aching a feeling of tightness or heaviness thickening of the skin Treatment Treatment options for lymphedema include exercises and targeted massage, which can both help drain the excess fluid. Wearing bandages or compression garments may also be beneficial. 13. Heart disease Swelling of the feet could be a sign of heart disease or heart failure. If the heart is damaged, it cannot pump blood to the heart efficiently. Right-sided heart failure can cause the body to retain salt and water, resulting in swollen feet. As well as swelling of the legs, ankles, and feet, symptoms of heart failure include: shortness of breath, particularly when exercising or lying down rapid heartbeat weakness fatigue coughing or wheezing white or pink, blood-tinged phlegm abdominal swelling rapid weight gain from fluid retention loss of appetite nausea or vomiting difficulty concentrating or confusion Treatment If a person experiences any of the above symptoms, they should seek immediate medical attention. Treatment options for heart failure include medications, medical devices to help support the heart, and surgery. 14. Kidney disease People with poorly functioning kidneys may not be able to flush out fluid, which can build up in the body. Kidney disease may not present any symptoms until it is severe and the kidneys are beginning to fail. Signs and symptoms of kidney failure include: less frequent urination shortness of breath drowsiness or fatigue pain or pressure in the chest seizures nausea confusion coma Treatment Treatment options for kidney disease include medication, a low-protein diet, and supplements of vitamin D and calcium. The treatment options for kidney failure include dialysis or a kidney transplant. 15. Liver disease Liver disease can inhibit the production of albumin. Albumin is a protein that helps stop the blood leaking from blood vessels. A lack of albumin means that the blood may leak, causing fluid to pool in the legs and feet, which can result in swelling. Symptoms of liver disease include: jaundice, in which the skin and eyes turn yellow dark urine bruising easily loss of appetite skin itching lack of energy nausea or vomiting tender, swollen abdomen pale, bloody, or tar-colored stools Treatment To treat liver disease, a doctor may prescribe medication. They may also suggest making lifestyle changes, such as losing weight or reducing alcohol intake. In more severe cases of liver disease, surgery may be necessary. When to see a doctor Many cases of swollen feet tend to resolve without medical care, although home remedies and lifestyle changes can help reduce the swelling. If the swelling does not go away or it occurs repeatedly, it is essential to make an appointment with a doctor to determine whether there is an underlying cause. If swollen feet occur alongside shortness of breath, chest pain, or pressure in the chest, call the emergency services immediately.
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Just how harmful is it to have 1 drink per day?

Many enjoy a glass of wine or beer during dinner, believing that this little alcohol couldn't possibly affect them. A new study is, however, warning that even one small drink per day can influence our health.
glass of wine
It is not safe to have even one glass of wine with your meal, finds a new study.

In August, we covered a large-scale review that drew an unequivocal conclusion: it's not, in fact, safe to drink any amount of alcohol.

Senior author Dr. Emmanuela Gakidou referred to the idea that one or two drinks are safe for health as "a myth."

She said that her and her colleagues' research found that any level of drinking is tied to an increased risk of early death, cancer, and cardiovascular events.

Now, researchers from Washington University School of Medicine in St. Louis, MO, have discovered even more about just how harmful it can be to have even as little as one drink per day.

The new study focused on the impact of alcohol on light drinkers specifically, so its findings — now published in the journal Alcoholism: Clinical & Experimental Research — are relevant to a large segment of the population.

"It used to seem like having one or two drinks per day was no big deal, and there even have been some studies suggesting it can improve health," says first author Dr. Sarah M. Hartz.

"But now we know that even the lightest daily drinkers have an increased mortality risk," she cautions.

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Even light drinking heightens death risk

The authors of the recent study analyzed data collected from 434,321 participants, aged 18–85. Of these, 340,668 (aged 18–85) were recruited via the National Health Interview Survey, and 93,653 (aged 40–60) provided health information as outpatients at Veterans Health Administration sites.

Dr. Hartz and team found that people who had one or two drinks four or more times weekly had a 20 percent higher risk of premature death, compared with those who drank only three times per week or less often. This increased death risk, the study authors add, remains consistent across all age groups.

"A 20 percent increase in risk of death is a much bigger deal in older people who already are at higher risk," notes Dr. Hartz.

"Relatively few people die in their 20s, so a 20 percent increase in mortality is small but still significant," she adds.

"As people age, their risk of death from any cause also increases, so a 20 percent risk increase at age 75 translates into many more deaths than it does at age 25."

Dr. Sarah M. Hartz

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The risks outweigh any potential benefits

One study published earlier this year suggested that people who drink just a little — one drink each day, at most — appear to have lower cardiovascular risk than both people who drink more and people who shun alcohol entirely.

Dr. Hartz and team's research, however, reveals that the health hazards that even people who drink lightly face outweigh any potential benefits.

When the scientists assessed the risk for heart disease and cancer, they saw that, on the whole, though drinking a little did help protect the heart in some cases, daily consumption — even when light — increased a person's risk of cancer.

"Consuming one or two drinks about four days per week seemed to protect against cardiovascular disease, but drinking every day eliminated those benefits," explains Dr. Hartz.

"With regard to cancer risk, any drinking at all was detrimental," she warns.

However, Dr. Hartz also believes that in the future, health practitioners may want to develop more highly personalized guidelines for their patients.

Therefore, healthcare providers might advise people at risk of developing heart problems to drink on occasion. Conversely, they may encourage those who are at risk of cancer to give up drinking entirely.

"If you tailor medical recommendations to an individual person," explains Dr. Hartz, "there may be situations under which you would think that occasional drinking potentially could be helpful."

"But overall," she reports, "I do think people should no longer consider a glass of wine a day to somehow be healthy."

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Could we use gene mutations to treat diabetes and heart disease?

Genes that control one aspect of our health can also influence others. Now, a recent study has revealed such a link between mutations of three genes that control cholesterol and a lower risk of certain cardiovascular conditions and type 2 diabetes.
dna structure with red patch
Scientists find a link between gene mutations, cholesterol, heart health, and diabetes.

Researchers at the Stanford University School of Medicine as well as the Veteran Affairs Palo Alto Health Care System, both in California, have led an investigation that linked genetic information on 300,000 veterans to their electronic health records.

It focused on three gene variants, or mutations, that change the way their associated genes behave.

Studies of gene mutations usually uncover how they damage health or give rise to disease, but in this study, the gene variants are all linked to positive effects.

Veterans who carried any one of these three gene variants not only had better levels of blood cholesterol, but also — depending on the gene — a lower risk of developing type 2 diabetes, coronary heart disease, or abdominal aortic aneurysm.

The investigators suggest that their findings — which now feature in the journal Nature Genetics — offer valuable information for developing drugs to treat the conditions associated with the three genes.

The genes are: ANGPTL4 for type 2 diabetes, PCSK9 for abdominal aortic aneurysm, and PDE3B for coronary heart disease.

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The 'power of numbers'

For a genetic study such as the recent one to give significant results, it must draw on the "power of numbers."

The Million Veteran Program (MVP), which was set up in 2011, offers such an opportunity. Its aim is to explore the relationship between genetic variation and health in military veterans in the United States.

The MVP gave the researchers access to genetic information on 297,626 — including 57,332 black and 24,743 Hispanic — veterans for whom there were also electronic health records containing measures of their cholesterol.

By bringing the MVP data together with "data from the Global Lipids Genetics Consortium," the team was able to identify 188 genetic markers of cholesterol that were already known about and 118 that were not.

Then, by applying an approach called a phenome-wide association study, the team picked out the cholesterol-associated gene variants that were also associated with other health factors or conditions in the MVP data.

The result was that variants in ANGPTL4, PCSK9, and PDE3B appeared not only to favor beneficial cholesterol levels but were also linked to a lower risk of developing type 2 diabetes, abdominal aortic aneurysm, and coronary heart disease, respectively.

These associations were previously unknown; the PCSK9 variant was already known to lower risk of heart disease, but this was the first study to tie it to a lower risk of abdominal aortic aneurysm.

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'Good case' for new drugs

The researchers believe that their results "make a good case" for developing drugs that "mimic the effects" of the gene variants.

They acknowledge that there already exists a drug called cilostazol, which mimics the effect of the PDE3B mutation on cholesterol, for treating vascular conditions. However, they advise against using it to treat heart disease on the basis of the recent genetic study alone.

"The genetics," explains senior study author Dr. Themistocles L. Assimes, an assistant professor of medicine in Stanford University's Division of Cardiovascular Medicine, "help suggest that this drug can decrease the risk of heart disease by lowering triglycerides, but it's not proof."

He urges people to wait until the approved drugs have been thoroughly tested for other desired effects in large randomized clinical trials before using them for those purposes.

"We've been misled before by drugs that had effects on cholesterol, but they turned out to be cosmetic," he adds.

"Better cholesterol profiles can look great, but if the drug doesn't affect the outcome you're aiming for [...] then it's useless."

Dr. Themistocles L. Assimes

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Why sudden cardiac arrests no longer peak in the morning

New research, published in the journal Heart Rhythm, discovers that due to recent cultural shifts in our work schedules and daily stressors, sudden cardiac arrests no longer tend to occur in the mornings.
person holding their chest
Sudden cardiac arrest can occur any time of the day, says a new study.

Until now, the consensus has been that a range of cardiovascular events, such as angina, heart attacks, and stroke, tend to happen mostly in the early hours of the morning.

A possible explanation for this phenomenon is that in the morning, the sudden pressures of daily activities put a strain on people's cardiovascular system.

Just waking up, in fact, releases the activity of certain hormones, such as cortisol, that raise blood pressure, heart rate, and glucose levels, as well as narrow blood vessels and prompt our hearts to pump harder.

However, given the new pressures of modern life — such as instant communication, the prevalence of smartphones, apps, and the online medium in general — the timing of our daily stressors may have changed.

So, do these changes have a bearing on certain cardiovascular events and the time of day in which they occur? New research suggests so.

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Zooming in on sudden cardiac arrests

Scientists from the Cedars-Sinai Medical Center in Los Angeles, CA — led by Dr. Sumeet Chugh, a professor of medicine — set out to investigate when the peak times for sudden cardiac arrests during the day are.

As Dr. Chugh and team explain, contrary to popular belief, sudden cardiac arrest is quite different to a heart attack. Unlike in a heart attack, during sudden cardiac arrest, the heart stops beating suddenly. Death occurs if medical assistance is not given within minutes.

A heart attack, on the other hand, occurs when blood flow to the heart is partially blocked, which does not usually cause the heart to stop beating.

As the study authors mention, around half of all cardiovascular deaths in the United States result from sudden cardiac arrest, and up to 350,000 cases occur each year, making the condition a significant concern for public health.

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'Stress is likely a major factor'

Dr. Chugh and his team studied data available from the Oregon Sudden Unexpected Death Study, which began in 2002.

For the analysis, the investigators looked at the data collected from emergency medical reports in 2004–2014. During this time, 1,535 adults had sudden cardiac arrests and died as a result.

Of these people, note the authors, only 13.9 percent died between 12 a.m. and 6 a.m. Contrary to older research and an ensuing widespread belief, the study found no evidence of a higher prevalence of sudden cardiac arrests on Mondays.

"While there are likely several reasons to explain why more cardiac arrests happen outside of previously identified peak times, stress is likely a major factor," explains Dr. Chugh.

"Because sudden cardiac arrest is usually fatal, we have to prevent it before it strikes," he adds.

"We now live in a fast-paced, 'always on' era that causes increased psychosocial stress and possibly, an increase in the likelihood of sudden cardiac arrest."

Dr. Sumeet Chugh

Dr. Chugh also shares some directions for future research, explaining, "Our next steps are to conclusively determine the underlying reasons behind this shift, then identify public health implications as a result."

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Some chiropractic treatments can harm eyesight

Chiropractic care realigns the bones in the spine and other body parts to treat issues such as headaches and back pains. Some chiropractic adjustments, however, can produce side effects, and according to a new case report, these include vision problems.
chiropractor treating patient
Chiropractic techniques can harm vision, a new case study illustrates.

A case report — now featuring in the American Journal of Ophthalmology Case Reports — has analyzed the situation of a 59-year-old woman who experienced patchy vision after receiving chiropractic intervention.

She noted that she had a "tadpole-shaped" spot in her vision soon after having undergone high-velocity cervical spine manipulation, which she sought in order to relieve a problem with headaches.

The following day, the woman's eyesight got even worse.

Dr. Yannis Paulus, a retina specialist at the University of Michigan Kellogg Eye Center in Ann Arbor, analyzed the woman's case with Dr. Nicolas Belil, her optometrist, who referred her to the Kellogg Eye Center.

Drs. Paulus and Belil explain that, although the chance of something like this happening is low, at times, particularly forceful movements performed in high-velocity manipulation can damage the blood vessels in the retina.

The retina is the layer of tissue that sits at the back of the eye, which contains the type of cells that convert light into neural signals that will later be sent to the brain for "decoding."

If there is bleeding inside the retina, it can result in a measure of vision loss. In the case discussed in the recent study, the woman regained her normal vision within approximately 2 months without requiring any treatment.

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Specialists found that chiropractic treatment can bring serious risks for cardiovascular health; it may damage important blood vessels. One of the most notable risks is cervical artery dissection, which can lead to stroke.

In 2014, the American Heart Association (AHA) issued a warning statement, calling for practitioners to be aware that cervical artery dissection could occur and to clearly inform their patients of the risks involved.

Forceful manipulation of the bones in the neck, Dr. Paulus points out, can cause artery walls to tear, leading to some bleeding. If a blood clot forms at the site and it later happens to become dislodged, it may end up blocking a blood vessel in the brain and causing a stroke.

This may also lead to problems with eyesight, such as double vision or the occlusion of the central retinal artery, which is the main blood vessel that carries oxygen to the nerve cells found in the retina.

Now, the case study that Drs. Paulus and Belil analyzed suggests that the motion of high-velocity neck manipulation can actually cause more direct damage to the eye.

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For instance, such motions can lead to preretinal hemorrhage, which is bleeding in the vitreous humor. This is the transparent tissue that fills the eye between the lens at the front and the retina at the back.

The high-velocity technique might also result in what is known as "posterior vitreous detachment," which takes place when the vitreous humor is dislodged from the retina.

Although posterior vitreous detachment requires no special treatment and the vision problems it causes tend to improve on their own within 3 months, the event can sometimes cause serious complications. In those cases, laser treatment or surgery must be done to repair the tear.

For this reason, Dr. Paulus urges people who seek chiropractic care to alert their doctors of their choices.

He also urges chiropractors to remember that some of their patients may need them "to modify techniques" in order to avoid events such as the one reported in the case study.

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Does 'bad' cholesterol deserve its bad name?

"Misleading statistics, exclusion of unsuccessful trials, and [...] ignoring numerous contradictory observations" are at the root of a half-century-long assumption that may be entirely wrong, says new research.
heart shape with foods in it
Heart health may not have much to do with cholesterol levels.

In the case of good vs. bad cholesterol, things are less clear-cut than we'd like them to be.

An increasing number of studies suggest that high-density lipoprotein (HDL) cholesterol, or the "good" kind, may not be so good after all.

A recent study found an unsettling association between HDL cholesterol and mortality in men.

Another one found that HDL cholesterol levels correlated with a higher risk of heart disease among women.

Now, new research has shone a critical light on "bad," or low-density lipoprotein (LDL), cholesterol.

Researchers led by Dr. Uffe Ravnskov, Ph.D. — a former medical practitioner and independent researcher based in Lund, Sweden — set out to analyze the findings of three large reviews that maintain that LDL cholesterol gives rise to atherosclerosis and cardiovascular disease (CVD) and that statins prevent CVD.

The results were published in the journal Expert Review of Clinical Pharmacology.

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Why high LDL cholesterol is not the culprit

Dr. Ravnskov and his team started with philosopher Karl Popper's criterion for the falsifiability of scientific claims, according to which a scientific theory can never be proven true, but it can be shown to be false. So, they set out to see if the bad cholesterol hypothesis could be falsified.

The hypothesis that high LDL cholesterol is the main cause of heart disease is invalid, explain the researchers, "because people with low levels become just as atherosclerotic as people with high levels and their risk of suffering from CVD is the same or higher."

"The usual argument in support of the lipid hypothesis," they continue, "is that numerous studies of young and middle-aged people have shown that high [total cholesterol] or LDL [cholesterol] predict future CVD."

"This is correct, but association is not the same as causation," write the scientists. Not only are the studies unable to prove causality, but the statistical methods are also flawed, they say.

The authors go on to point to a range of other potential causes of CVD that the reviews analyzed did not account for, such as mental stress, inflammation, and infections.

Dr. Ravnskov and colleagues conclude:

"Our search for falsifications of the cholesterol hypothesis confirms that it is unable to satisfy any of the Bradford Hill criteria for causality, and that the conclusions of the [...] three reviews are based on misleading statistics, exclusion of unsuccessful trials, and by ignoring numerous contradictory observations."

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People should make an informed decision

Study co-author Prof. David Diamond, of the University of Southern Florida in Tampa, comments on the findings, saying, "There have been decades of research designed to deceive the public and physicians into believing that LDL causes heart disease, when in fact, it doesn't."

"The research that has targeted LDL is terribly flawed," he goes on to explain. "Not only is there a lack of evidence of causal link between LDL and heart disease, the statistical approach statin advocates have used to demonstrate benefits has been deceptive."

The researchers aim "to share this information with people, so they can make an informed decision when they're considering taking cholesterol lowering medication."

In the paper, the authors disclose that Dr. Ravnskov — along with a few other co-authors — have previously published books that criticize the idea that LDL cholesterol causes heart disease.

Dr. Ravnskov is the director of The International Network of Cholesterol Skeptics, and in 2007, he was awarded the Leo-Huss-Walin Prize for Independent Thinking.

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Yo-yoing weight linked to higher cardiovascular risk

Recent research cautions that fluctuating weight, blood pressure, cholesterol, and blood sugar are associated with an increased risk of cardiovascular events and death.
concept photo of scales and yoyo
Weight fluctuation is a top risk factor for cardiovascular events, says new research.

Scientists at the Catholic University of Korea in Seoul, South Korea — with other institutions — have now assessed the associations between fluctuations in some certain types of health measurement and cardiovascular health outcomes.

The health measurements include body weight, systolic blood pressure (blood pressure during heartbeats), cholesterol, and blood sugar.

Essentially, the investigators wanted to see whether or not high variability of these health measurements would be good predictors of heart problems and negative cardiovascular events, such as stroke.

Their findings now appear in the journal Circulation.

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Increased risk of early death

In the recent study, the investigators analyzed health data collected from 6,748,773 people with no history of diabetes, high blood pressure, high cholesterol, or heart attacks at the beginning of the study. This information was provided by the Korean National Health Insurance system.

All those involved with this study underwent at least three different health checkups in 2005–2012. Some of the information recorded during these examinations included body weight, systolic blood pressure, cholesterol, and fasting blood sugar.

For the first time, the authors concluded that high fluctuations in the measurements of these factors was associated with a negative impact on cardiovascular health.

Also, they go on, if a person has high variability of more than one of these, their cardiovascular risk may be further heightened.

Compared with people with stable measurements across an average period of 5.5 years, those who scored the highest variability on all risk factors had a 127 percent higher risk of all-cause death, were 43 percent more likely to experience a heart attack, and had a 41 percent higher risk of stroke.

Such fluctuations in the measurements under analysis can be the result of either negative changes or positive changes, the researchers note.

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All fluctuations appear to heighten risk

For this reason, they also decided to separately assess the effect of the changes on people whose measurements had either improved or worsened by over 5 percent. The team found that, in both cases, high variability was linked to a heightened risk of all-cause death.

"Healthcare providers should pay attention to the variability in measurements of a patient's blood pressure, cholesterol, and glucose levels as well as body weight," urges senior study author Dr. Seung-Hwan Lee.

"Trying to stabilize these measurements may be an important step in helping them improve their health," he adds.

Nevertheless, the researchers emphasize that their study was of an observational nature, meaning that they cannot readily conclude that there is a causal relationship between the fluctuations and the risk of death and cardiovascular events.

Furthermore, they admit that they did not look into the causes behind the fluctuating body weight, cholesterol, blood sugar, or blood pressure.

Also, as Dr. Lee points out, "It is not certain whether these results from Korea would apply to the United States."

"However, several previous studies on variability were performed in other populations, suggesting that it is likely to be a common phenomenon."

Dr. Seung-Hwan Lee

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Some cancer therapies may avert cardiovascular disease

Existing cancer drugs could be repurposed as treatments for vascular inflammation, according to new research from the University of California San Diego School of Medicine.
Researcher in lab coat holding bottle of pills and tablet
Several drugs approved by the FDA for cancer treatment may also treat vascular inflammation.

Publishing their findings in Cell Reports, the authors describe new insights into the way G-protein-coupled receptors (GPCRs) work within cells to influence inflammation using cellular "waste disposal systems."

Vascular inflammation (inflammation of the blood vessels) is a significant contributing factor in the early phases of atherosclerosis, a disease whereby plaque builds up inside the arteries and which can lead to heart attack, stroke, or even death.

Cardiovascular disease is the leading cause of death worldwide, so identifying any potential targets for therapies addressing cardiovascular disease or its causes — such as vascular inflammation — is a priority.

GPCR functions 'not fully understood'

GPCRs are embedded in the membranes of all cells, where they mediate cells' responses to their external environments. GPCRs change shape when a nutrient or other molecule binds to them.

Part of this shape change involves a G-protein inside the cell docking to the GPCR on the internal side of the membrane, which initiates a series of molecular changes.

Scientists know that GPCRs are important in maintaining many biological functions such as smell, sight, taste, allergic responses, blood pressure, and heart rate.

They also know that when GPCRs malfunction, they can contribute to a range of diseases. However, many of the basic functions of GPCRs are still not fully understood.

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How GPCRs influence inflammation

The research team from this latest study investigated how a process called ubiquitination affects GPCR functions in the cells that line blood vessels.

Ubiquitination is when proteins are tagged by enzymes with molecules called ubiquitin, acting as a kind of flag to let the cell know that this protein can be disposed of.

However, the team discovered that in these cells, the GPCR activates the E3 ligase enzyme that initiates ubiquitination, which in turn activates an inflammation-promoting protein called p38. This is a markedly different mechanism to the usual process of ubiquitination.

"We were surprised to discover that GPCRs and inflammation are influenced by ubiquitination — a process that was previously thought to only mark proteins for destruction," explains senior author JoAnn Trejo. "Instead, we've unveiled new insights into both GPCR function and ubiquitination."

According to Trejo, this is the first time that E3 ligases have been identified as playing a role in vascular inflammation, making it a viable target in developing treatments for this condition.

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The good news is that several drugs that are currently used as cancer treatments have already been approved by the Food and Drug Administration (FDA); such drugs inhibit these E3 ubiquitin ligases, and researchers are currently studying more in clinical trials. So, it may be possible to also use these drugs to treat vascular inflammation.

However, Trejo warns that "the field is really in its infancy," and that "the number of E3-targeting drugs approved or in clinical trials is remarkably small." This is further complicated by the sheer number of different E3 ligases in the body, thought to be between 600 and 700, and which are associated with a variety of biological functions.

Although vascular inflammation is a known contributor to atherosclerosis, Medical News Today recently reported on a study that found inflammation may actually help to keep heart attack and stroke at bay in more advanced cases of the condition.

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What to know about ectopic heartbeats

Ectopic heartbeats are extra heartbeats that occur just before a regular beat. Ectopic beats are normal and usually not a cause for concern, though they can make people feel anxious.

Ectopic beats are common. People may feel like their heart is skipping a beat or is producing an extra beat.

In this article, we look at the causes, symptoms, and treatments for ectopic heartbeats.

What is an ectopic heartbeat? woman with hands on heart
Ectopic heartbeats are premature or extra heartbeats.

An ectopic heartbeat is when the heart either skips a beat or adds an extra beat. They are also called premature heartbeats.

Ectopic heartbeats are usually not a cause for concern, and they may occur for no known reason. Despite the skipped or added beat, the heart otherwise functions normally.

People may be worried if they feel their heartbeat skipping. But it is not a sign of a serious problem. Anxiety often causes ectopic beats, and they will usually go away by themselves.

There are two types of ectopic heartbeat:

Premature atrial contractions (PAC), which originate in the upper chambers, or atria. Premature ventricular contractions (PVC), which originate in the lower chambers, or ventricles.

Ectopic heartbeats are common in adults. They are less common in children and typically occur due to an underlying heart condition.

When a child experiences an ectopic heartbeat, it is often a PAC. It is usually harmless.

The chances of having a PVC increase as people get older. A heart attack or family history of PVC may increase the risk of someone developing PVCs as they age.

Causes of ectopic heartbeats Ectopic heartbeats have several potential causes or risk factors that can increase the chance of their occurrence. Possible causes of ectopic heartbeats include: caffeinated drinks and foods containing caffeine smoking anxiety or stress recreational drug use drinking alcohol exercise decreased potassium levels certain prescription medications some allergy and cold medications asthma medications Also, several potential underlying conditions may cause or be risk factors for ectopic heartbeats, including: a family history of ectopic heartbeats previous history of a heart attack heart disease Thank you for supporting Medical News Today Symptoms Ectopic heartbeats can occur with no symptoms. In other instances, people may realize that their heart skipped or had an extra beat by feeling it in their chest. Some people may experience more extreme symptoms that are similar to the symptoms of more serious heart conditions. Typical symptoms of ectopic heartbeats may include: an extra awareness of the heart beating a feeling of faintness or dizziness a sensation of the heart stopping for a moment a racing heartbeat a fluttering sensation in the chest Diagnosis man having a heart ultrasound
A heart ultrasound can help a doctor make a diagnosis. Some people may not have any symptoms. A person may never know they have had an ectopic heartbeat. If someone does experience symptoms, and they occur regularly, they should speak to their doctor. Doctors can diagnose ectopic heartbeats by discussing the symptoms a person is experiencing. They will likely hold a stethoscope to the person's chest to listen for an irregular beat. A doctor may also order other tests to help determine the cause of the ectopic heartbeat. These tests may help them rule out more dangerous causes. Diagnostic tests used may include: a Holter monitor, a heartbeat device that a person wears for 24 hours electrocardiogram (ECG), which measures the heart's rhythm and electrical signals echocardiogram, or heart ultrasound coronary angiography, or heart X-ray MRI or CT scans exercise testing Treatments In most cases, doctors do not treat an ectopic heartbeat. Typically, it will go away with no intervention. However, if symptoms do not go away on their own, a doctor is likely to want to explore the underlying condition. Once determined, they will treat the cause, which will help stop further ectopic heartbeats from occurring. In other cases, people can help prevent further ectopic heartbeats through lifestyle changes. Often, this will involve finding what triggers them. Once someone identifies the triggers, they can reduce or eliminate their contact with them. Triggers can include stress, smoking, or alcohol. Other changes a person can try include, reducing caffeine and exercising regularly. Thank you for supporting Medical News Today Complications Typically, a person will have no further complications from ectopic heartbeats. However, in some uncommon cases, they may develop: Ventricular tachycardia, which is an irregular and rapid heartbeat. Arrhythmias, which involves issues with the heart's rhythm. People who have had a previous heart attack are at a greater, though low, risk of cardiac arrest and death. Ectopic beats and pregnancy pregnant woman laying down with her stomach exposed
During pregnancy, it is normal to experience ectopic beats and arrhythmias. Ectopic beats and arrhythmias are normal during pregnancy. According to research published in Cardiology and Therapy, during pregnancy, people experience many physiological changes that increase the demand placed on their cardiovascular system. These changes lead to an increase in heat rate and may cause people to notice extra beats. It is also quite common for the fetus to experience extra beats. In most case, extra beats or even faster-than-normal beats are not a cause of undue concern for doctors. Typically, a doctor will discover the ectopic beats in a fetus and decide if any treatment is needed. Other types of irregular heartbeat Ectopic heartbeats are just one type of irregular heartbeats a person may experience in their lifetime. Irregular heartbeats can also involve the heart beating too fast, too slow, or in a different rhythm than usual. An example of an irregular heartbeat is atrial fibrillation (AF). When AF occurs, the upper chambers of the heart are contracting at odd intervals, which causes the irregular beat to occur. AF is not common in children. Other irregular heartbeats that people can have include: supraventricular tachycardia, where the electrical signals come from the wrong area atrial flutter, where the upper chamber of the heart fires too quickly ventricular tachycardia, where there are abnormal electrical signals in the lower chambers of the heart Thank you for supporting Medical News Today Outlook A person may never realize that they have experienced an ectopic heartbeat. In other cases, they may feel as though their heart is skipping or having an extra beat. Normally, ectopic heartbeats are not a cause for concern. If ectopic beats do not clear naturally or are recurring frequently, a person should speak to their doctor. Typical treatment involves avoiding triggers, such as smoking or drinking alcohol, and treating the underlying cause of the ectopic beats if necessary.
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Your height may predict your risk of varicose veins

A genetic study of nearly half a million people concludes that height is "not just a correlated factor, but an underlying mechanism leading to varicose veins."
woman massaging her legs
Women are at a higher risk of varicose veins, but new research suggests that height is also a factor.

Varicose veins — also known as spider veins — are "swollen, twisted veins" that can usually be seen right beneath the skin on a person's legs.

According to the most recent estimates, the condition affects approximately 33 million people in the United States.

The condition is generally considered quite harmless, but previous studies have found a strong association with serious cardiovascular problems, such as blood clotting and deep vein thrombosis.

Also, varicose veins may be moderately painful and aesthetically unpleasant to some people. Now, a large-scale genetic study published in Circulation suggests that a person's height may determine their risk of developing varicose veins.

The new research was jointly supervised by Dr. Nicholas Leeper, an associate professor of surgery and cardiovascular medicine at Stanford University School of Medicine in California and Dr. Erik Ingelsson, a professor of cardiovascular medicine at Stanford University.

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Dr. Leeper and his colleagues applied machine learning and statistical methods to examine the genetic data of 493,519 people who were registered in the UK Biobank database.

Furthermore, the researchers conducted a genome-wide association study in 337,536 of these individuals, 9,577 of whom developed varicose veins.

The study confirmed previously known risk factors for varicose vein disease, such as age, sex, weight, and lifestyle habits including smoking and being sedentary.

However, the study also identified some new risk factors. "We confirmed that having had deep vein thrombosis in the past puts you at increased risk in the future," Dr. Leeper explains.

"Recent research suggests that the converse appears to be true as well. Having varicose veins puts you at risk of these blood clots."

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Of all the new risk factors identified, the scientists deemed height as the most surprising. "[G]reater height remained independently associated with varicose veins," the study authors report.

"We were very surprised to find that height came up from our machine-learning analyses," says co-first study author Alyssa Flores, a Stanford University medical student.

"Our results strongly suggest height is a cause, not just a correlated factor, but an underlying mechanism leading to varicose veins," says Dr. Ingelsson.

He adds, "By conducting the largest genetic study ever performed for varicose vein disease, we now have a much better understanding of the biology that is altered in people at risk for the disease."

"Genes that predict a person's height may be at the root of this link between height and varicose veins and may provide clues for treating the condition."

Dr. Nicholas Leeper

The recent study also identified 30 genes that are not just tied to varicose veins, but also to deep vein thrombosis.

"[Varicose vein disease]," says Flores, "is incredibly prevalent but shockingly little is known about the biology. There are no medical therapies that can prevent it or reverse it once it's there."

"We're hoping," she adds, "that with this new information, we can create new therapies, as our study highlights several genes that may represent new translational targets."

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Why a regular bedtime may benefit your heart and metabolism

New research — which is now published in the journal Scientific Reports — examines and highlights the importance of regular bedtimes for optimal heart and metabolic health.
clock on bedside table
Going to bed at the same time each night may keep both your heart and metabolism healthy.

The cardiometabolic health risks linked to sleep deprivation are numerous.

These health risks include weight gain, insulin resistance, type 2 diabetes, high blood pressure, and heart disease.

Going to bed and waking up at the same time every day, however, is also vital for health.

A study from last year reported that "social jet lag" — that is, the difference in sleep and waking times between the weekend and the weekdays — can also raise the risk of heart disease.

Previous studies have also suggested that obesity and diabetes may be on the cards for those who hit the snooze button on weekends.

Now, new research from the Duke University Medical Center in Durham, NC, adds to the mounting evidence suggesting that regular bedtimes are key to a person's heart health and the good functioning of their metabolism.

Jessica Lunsford-Avery, Ph.D. — an assistant professor in psychiatry and behavioral sciences from the Duke University Medical Center — led the new study.

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Lunsford-Avery and team examined the sleeping patterns of almost 2,000 adults aged 54–93, who had no history of sleep disorders.

The volunteers all wore sleep tracking devices that picked up on the slightest variations in bedtime patterns. The adults wore the devices for 7 days and kept a sleep diary.

The researchers examined the link between bedtime patterns and markers of cardiometabolic risk, and they calculated a 10-year projected risk of heart disease, obesity, hypertension, and type 2 diabetes markers, such as high blood sugar and hemoglobin A1.

Overall, volunteers with irregular bedtimes had a higher body mass index (BMI), higher levels of blood sugar, higher blood pressure, and higher levels of hemoglobin A1C, and they were more likely to have a heart attack or stroke in the following decade than individuals with regular sleeping patterns.

Also, the volunteers who went to bed and woke up at varying times had a higher risk of depression and stress than their more disciplined counterparts.

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"[S]leep irregularity may represent a target for early identification and prevention of cardiometabolic disease," conclude the authors. However, they also point out that their study is observational and cannot say anything about causality.

"From our study," reports Lunsford-Avery, "we can't conclude that sleep irregularity results in health risks, or whether health conditions affect sleep. Perhaps all of these things are impacting each other."

"Perhaps there's something about obesity that disrupts sleep regularity," she states. "Or, as some research suggests, perhaps poor sleep interferes with the body's metabolism which can lead to weight gain, and it's a vicious cycle."

"With more research," says Lunsford-Avery, "we hope to understand what's going on biologically, and perhaps then we could say what's coming first or which is the chicken and which is the egg."

Either way, the new findings help establish who is at risk of developing serious cardiometabolic conditions.

"Heart disease and diabetes are extremely common in the United States, are extremely costly and also are leading causes of death in this country. To the extent we can predict individuals at risk for these diseases, we may be able to prevent or delay their onset."

Jessica Lunsford-Avery, Ph.D.

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The Mediterranean diet reduces stroke risk, too

In the largest study of its type, scientists conclude that adhering to the Mediterranean diet might reduce the risk of stroke. The benefits are particularly pronounced for women over 40.
Mediterranean diet
Is reducing stroke risk another benefit of the Mediterranean diet?

When it comes to alleged health benefits, the Mediterranean diet fares incredibly well.

Increasing one's intake of fresh fish, nuts, fruits, cereals, and potatoes while reducing dairy and meat seems to be a veritable panacea.

In recent years, the diet has grown in popularity, and a body of research has now developed to support many of the varied health claims.

Potential health benefits include extending lifespan, minimizing diabetes risk, reducing body mass index (BMI), and slowing cognitive decline.

Studying the impact of dietary choices on a population is notoriously challenging, but the amount of evidence supporting the benefits of the Mediterranean diet is close to overwhelming.

Recently, the Universities of East Anglia, Aberdeen, and Cambridge — all in the United Kingdom — joined forces to discover whether everyone's favorite diet might also reduce the risk of stroke. Earlier this week, their findings were published in the journal Stroke.

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Mediterranean diet and stroke risk

In all, the study used information from 23,232 white people, aged 40–77, over a 17-year period. The data were taken from the European Prospective Investigation into Cancer study, a project initially set up to investigate "the connection between diet, lifestyle factors, and cancer."

To gauge the participants' diets, the scientists asked them to use 7-day diaries; everything that they consumed was noted down for a 1-week period. This method is more reliable than the often-used food-frequency questionnaires, which ask participants how frequently they tend to eat certain items.

The authors say that this is the first time that 7-day diaries have been used on such a large group of people.

Next, they assessed how closely each participant followed the Mediterranean diet and sorted them into four groups depending on how cloesly they adhered to it.

The team concluded that a Mediterranean-style diet reduced the risk of stroke by 17 percent.

When they split the data into men and women, the effect was much more pronounced in women; those who followed the diet most closely had a 22 percent reduction in stroke risk. However, among men, there was only a 6 percent reduction, which was not statistically significant.

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"It is unclear why we found differences between women and men, but it could be that components of the diet may influence men differently than women."

Lead study author Ailsa A. Welch, Ph.D.

Benefits for those at risk

There are other potential variables that might help explain the sex differences in stroke risk. Welch explains, "We are also aware that different subtypes of stroke may differ between genders. Our study was too small to test for this, but both possibilities deserve further study in the future."

When looking at people already at risk of cardiovascular disease, the data revealed that, across all four groups of Mediterranean diet scores, there was a 13 percent reduction in stroke risk.

This effect was, again, predominant among women, who saw a 20 percent reduction in risk.

"Our findings provide clinicians and the public with information regarding the potential benefit of eating a Mediterranean-style diet for stroke prevention, regardless of cardiovascular risk."

Study co-author Prof. Phyo Myint

The health benefits of the Mediterranean diet appear to know no bounds. However, it is important to note that this is an observational study, and, therefore, cannot prove cause and effect. More studies will be sure to follow.

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Inflammation keeps heart attack and stroke at bay

Scientists have discovered that, as far as arteries are concerned, inflammation can be both good and bad. In its well-known bad role, it can aid atherosclerosis, the plaque-forming process that clogs up arteries and raises the risk of heart attacks and strokes.
plaque in artery
Inflammation affects the plaque-forming process in the arteries.

New research, however, has also revealed that during the advanced stages of atherosclerosis, inflammation helps to keep the plaques stable, which reduces the risk of heart attacks and strokes.

The study was done at the University of Virginia (UVA) at Charlottesville and now features in the journal Nature Medicine.

These findings have important implications for drugs that treat advanced atherosclerosis by reducing inflammation.

The investigators draw attention to the "high-profile drug" canakinumab, which is undergoing trials for the treatment of advanced atherosclerosis.

Based on their results, they suggest that, should it receive federal approval, the drug should only be given to "a select group of patients."

"What our data suggest," says senior study author Gary K. Owens, a professor of cardiovascular research at UVA, "is that you need to be extremely cautious in starting to give this drug more broadly to lower-risk patients."

"If you give it to the wrong person, it could do the opposite of what you intended," he warns.

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Atherosclerosis and plaques

The Centers for Disease Control and Prevention (CDC) estimate that each year in the United States, around 795,000 people have a stroke and 790,000 have a heart attack.

Most strokes and heart attacks are the result of the complex process of atherosclerosis.

The process builds up plaques in the inside walls of arteries, or blood vessels that supply the heart and other organs and tissues with oxygen and nutrients. The plaques are made of calcium, fats, cholesterol, and other bloodborne substances.

As atherosclerosis progresses, these plaques harden and cause the affected arteries to narrow and impede blood flow.

This increases the risk of heart attack if the artery nurtures heart muscle, or stroke if it is one that feeds the brain.

The traditional view is that the body deposits potentially harmful substances in the plaques and after this they do not change much and enter a dormant state. The "fibrous caps" that seal the plaques are thought to be inert, serving like patches on tires.

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Plaque caps are constantly changing

By working with cell cultures and mice, however, Prof. Owens and his colleagues revealed that the caps are far from inert and can change rapidly and dramatically over time; they are constantly "remodeling."

They noticed that treatment with a drug that blocked an inflammation promoter weakened the cap structure, causing the plaque to rupture more readily.

The scientists suggest that reducing inflammation at the wrong time sends a signal that the job of sealing the plaque is done.

"This study," reports first author Ricky Baylis, who is a student in Prof. Owens's laboratory, "seems to indicate that the fibrous cap, as a structure, is actually much more plastic than previously thought."

Though at first this might appear to be a problem, Baylis says that it may actually present "a much greater opportunity to strengthen the caps to prevent heart attacks and strokes."

Prof. Owens reckons that studies similar to theirs should lead to better design of drugs that target the "bad parts of inflammation" while preserving and even promoting the "good parts" so as to "increase the stability of atherosclerotic lesions."

"[W]e believe our data suggest that if you suppress inflammatory response without first removing or reducing the cause of the inflammation [...] that this could become dangerous and have unintended consequences."

Prof. Gary K. Owens

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High-fiber foods for a healthful diet

When a person includes high-fiber foods in their diet, it has many benefits, such as keeping the gut healthy, boosting heart health, and promoting weight loss.

According to the most up-to-date Dietary Guidelines for Americans, the adequate intake (AI) of fiber for adult men is 33.6 grams (g) per day, and 28 g for adult women.

But most people in America do not meet this goal. The average fiber intake in the United States is 17 g, and only 5 percent of people meet the adequate daily intake.

People need to get both soluble and insoluble fiber from their diet. Eating a varied high-fiber diet means getting plenty of fruits, vegetables, legumes, and whole grains.

In this article, we provide a list of 38 healthful, high-fiber foods — explaining how much fiber each one has — to help people boost their daily fiber intake.

High-fiber legumes Navy beans which are a high-fiber food
Navy beans contain 10.5 g of fiber per 100 g and are also high in protein.

Legumes are fiber-rich plant-based foods that include beans, lentils, and peas.

Beans are a good source of fermentable fibers. This fiber moves into the large intestine and helps to feed the diverse colony of healthy bacteria in the gut.

Researchers have found connections between a healthy gut microbiome and lower rates of obesity and type 2 diabetes.

The following are some of the best legumes for fiber:

1. Navy beans

Navy beans are one of the richest sources of fiber. They are also high in protein. Add navy beans to salads, curries, or stews for an extra fiber and protein boost.

Fiber content: Navy beans contain 10.5 g per 100 g (31.3 percent of AI).

2. Pinto Beans

Pinto beans are a popular U.S. staple. People can eat pinto beans whole, mashed or as refried beans. Along with their high-fiber content, pinto beans are a great source of calcium and iron.

Fiber content: Pinto beans contain 9 g of fiber per 100 g (26.8 percent of AI).

3. Black beans

Black beans contain good amounts of iron and magnesium. They are also a great source of plant-based protein.

If people who follow a vegan diet combine black beans with rice, they will be getting all nine essential amino acids.

Fiber content: Black beans contain 8.7 g of fiber per 100 g (25.9 percent of AI).

4. Split peas

Split peas are a great source of iron and magnesium. They go well in casseroles, curries, and dahl.

Fiber content: Split peas contain 8.3 g of fiber per 100 g (24.7 percent of AI).

5. Lentils

There are many types of lentils, including red lentils and French lentils. They make a great addition to couscous, quinoa dishes, or dahl.

Fiber content: Lentils contain 7.9 g of fiber per 100 g (23.5 percent of AI).

6. Mung beans

Mung beans are a versatile source of potassium, magnesium, and vitamin B-6.

When dried and ground, people can use mung bean flour to make pancakes.

Fiber content: Mung beans contain 7.6 g of fiber per 100 g (22.6 percent of AI).

7. Adzuki beans

Adzuki beans are used in Japanese cuisine to make red bean paste, which is a traditional sweet. People can also boil these fragrant, nutty beans and eat them plain.

Fiber content: Adzuki beans contain 7.3 g of fiber per 100 g (21.7 percent of AI).

8. Lima Beans

Not only are lima beans a great source of fiber, but they are also high in plant protein.

Fiber content: Lima beans contain 7 g of fiber per 100 g (20.8 percent of AI).

9. Chickpeas

Chickpeas, or garbanzo beans, are a popular source of plant-based protein and fiber. They are also full of iron, vitamin B-6, and magnesium.

Use this legume as a base for hummus and falafel.

Fiber content: Chickpeas contain 6.4 g of fiber per 100 g (19 percent of AI).

10. Kidney Beans

Kidney beans are a rich source of iron. Kidney beans are a great addition to chili, casseroles, and salads.

Fiber content: Kidney beans contain 6.4 g of fiber per 100 g (19 percent of AI).

11. Soybeans

Soybeans are used to make a variety of products, such as tofu, tempeh, and miso. People often use soybean products as dietary replacements for meat and dairy.

Fresh soybeans can also be eaten raw or added to salads as edamame.

Fiber content: Soybeans contain 6 g of fiber per 100 g (17.9 percent of AI).

12. Baked beans

Baked beans are rich in fiber and protein. They are available from most grocery stores. Try to buy brands with reduced sugar and salt to get more health benefits.

Fiber content: Plain baked beans from a can contain 4.1 g of fiber per 100 g (12.2 percent of AI).

13. Green peas

Green peas are available canned or fresh. Green peas are a great source of fiber, protein, vitamin C, and vitamin A.

Fiber content: Green peas contain 4.1–5.5 g of fiber per 100 g (12–16 percent of AI).

High-fiber vegetables Among the many health benefits of vegetables, they are a great source of dietary fiber. Vegetables with a high-fiber content include: 14. Artichoke Artichokes in a basket which are a high fiber food
Artichokes are high in fiber as well as vitamins C and K. Artichokes are packed with vitamins C and K, plus calcium, and folate. Grill, bake, or steam whole artichokes and use in dishes or as a side. People often prepare just the artichoke heart above the outside leaves. Fiber content: One medium artichoke contains 6.9 g of fiber (20.5 percent of AI). 15. Potato As a staple vegetable, potatoes are a good source of B vitamins plus vitamin C and magnesium. Fiber content: One large potato, baked in its skin, contains 6.3 g of fiber (18.8 percent of AI). 16. Sweet potato Sweet potatoes are one of the starchy vegetables. They are high in vitamin A. Fiber content: One large sweet potato, baked in its skin, contains 5.9 g of fiber (17.6 percent of AI). 17. Parsnips Parsnips are a good source of vitamins C and K, as well as B vitamins, calcium, and zinc. Fiber content: One boiled parsnip contains 5.8 g of fiber (17.3 percent of AI). 18. Winter squash Winter squash vegetables are a bountiful source of vitamins A and C. Fiber content: One cup of winter squash contains 5.7 g of fiber (17 percent of AI). 19. Broccoli Broccoli is a cruciferous vegetable that is high in vitamins C and A. Cruciferous vegetables also have lots of antioxidant polyphenols. Fiber content: One cup of cooked broccoli florets contains 5.1 g of fiber (15.2 percent of AI). 20. Pumpkin Pumpkin is a popular vegetable and source of vitamins A and K and calcium. People use it in sweet and savory dishes. Fiber content: A standard portion of canned pumpkin contains 3.6 g of fiber (10.7 percent of AI). Thank you for supporting Medical News Today High-fiber fruit People can boost their daily fiber intake by including healthful fruits as a snack between meals. Some fruits contain more fiber than others. 21. Avocado Avocado is full of healthful monounsaturated fats that are beneficial to heart health. They are popular in salads and for making dips. Fiber content: One peeled avocado contains 9.2 g of fiber (27.4 percent of AI). 22. Pear Pears are full of fiber, as well as vitamins C and A, folate and calcium. Keep a few pears in the fruit bowl, or serve them with dessert. Fiber content: One medium pear contains 5.5 g of fiber (16.4 percent of AI). 23. Apple Apples are a good source of vitamins C and A and folate. Make sure to eat the skin as well as the apple flesh, as the skin contains much of the fruit's fiber. Fiber content: One large apple contains 5.4 g of fiber (16.1 percent of AI). 24. Raspberries Raspberries are a great source of antioxidants. These ruby-red berries also contain vitamins C and K. Fiber content: Half a cup of raspberries contains 4 g of fiber (11.9 percent of AI). 25. Blackberries Similarly to raspberries, blackberries are full of healthful antioxidants and are a great source of vitamins C and K. Fiber content: Half a cup of blackberries contains 3.8 g of fiber (11.3 percent of AI). 26. Prunes Prunes, or dried plums, can help promote digestive health. Although high in fiber, prunes can also be high in sugar, so eat these in moderation. Fiber content: Five prunes contain 3.4 g of fiber (10.1 percent of AI). 27. Orange Oranges are surprisingly a good source of fiber. Oranges are full of vitamin C, which is essential for health. Fiber content: One orange contains 3.4 g of fiber (10.1 percent of AI). 28. Banana Bananas are a great source of nutrients, including potassium, magnesium, and vitamin C. They can be included in baking or eaten on their own as a snack. Fiber content: One medium banana contains 3.1 g of fiber (9.2 percent of AI). 29. Guava Not only is this tropical fruit a source of fiber, but it also has a very high amount of vitamin C and contains vitamin A. Try guava in smoothies or juices. The rinds are edible, which means they can make a great fruit snack when on the go. Fiber content: One guava fruit contains 3 g of fiber (8.9 percent of AI). High-fiber nuts and seeds Nuts and seeds provide numerous health benefits. They contain healthful fats, high concentrations of protein, and they often have essential omega-3 fatty acids. High-fiber nuts and seeds include: 30. Buckwheat Buckwheat on a wooden spoon
People can use buckwheat to make soba noodles. Despite its name, buckwheat is a seed and not a grain. Buckwheat groats are grain-like seeds from a plant that is more closely related to rhubarb than wheat. It is rich in magnesium and zinc. Buckwheat does not contain gluten. People traditionally use buckwheat in Japan for making soba noodles. It has also gained popularity in other countries. People can add the groats to breakfast cereal or smoothies. Buckwheat flour is an excellent gluten-free alternative to plain flour for baking and cooking. Fiber content: Half a cup of buckwheat groats contains 8.4 g of fiber (25 percent of AI). 31. Chia seeds People originally cultivated chia seeds in Central America. Not only are these edible seeds high in fiber, but they also contain high levels of omega-3s, protein, antioxidants, calcium, and iron. People may get more health benefits from ground chia seeds. Buy them ground up or blitz the seeds into a fine powder, using a food processor or mortar and pestle. Fiber content: Each tablespoon of chia seeds contains 4.1g of fiber (12.2 percent of AI). 32. Quinoa Quinoa is another pseudocereal and is also an edible seed. This seed is high in antioxidants, magnesium, folate, and copper, as well as vitamins B-1, B-2, and B-6. Quinoa is useful for people who are sensitive to gluten. Quinoa flour is excellent for baking, and people often include the flakes in breakfast cereals. Fiber content: Half a cup of quinoa contains 2.6 g of fiber (7.7 percent of AI). 33. Pumpkin seeds Pumpkin seeds are a brilliant source of healthful monounsaturated and polyunsaturated fats, as well as magnesium, and zinc. Fiber content: A quarter cup of pumpkin seeds contains 1.9 g of fiber (5.7 percent of AI). 34. Almonds Almonds are high in vitamin E, which acts as an antioxidant, as well as calcium and healthful, monounsaturated and polyunsaturated fatty acids. Fiber content: Ten almonds contain 1.5 g of fiber (4.5 percent of AI). 35. Popcorn Popcorn is a healthful, whole food snack. It is a source of zinc, folate, and vitamin A. Avoid popcorn brands high in sugar and salt. Fiber content: One cup of popcorn contains 1.2 g of fiber (3.6 percent of AI). Whole grains Whole grains help to keep the heart healthy and make people feel fuller after meals. High-fiber whole grains include: 36. Freekeh People make freekeh from roasted green wheat. They use it as a side to meat or mixed into salads to add substance and a nutty flavor. Fiber content: Freekeh contains 13.3 g of fiber per 100 g (39.6 percent of AI). 37. Bulgur wheat Bulgur wheat is the whole-wheat grain popular in Middle Eastern cuisine. Processing bulgur wheat involves cracking the wheat germ open and parboiling it. Bulgur wheat is a traditional ingredient in tabbouleh and pilafs. Use it as an alternative to rice in warm salads. Bear in mind that it is not gluten-free. Fiber content: Bulgur wheat contains 4.5 g of fiber per 100 g (13.4 percent of AI). 38. Pearled barley Pearled barley is great as a side to meats, or in salads or stews. Fiber content: Pearled barley contains 3.8 g of fiber per 100 g (11.3 percent of AI). Thank you for supporting Medical News Today Tips to increase fiber in the diet The following tips can help people increase the amount of fiber they get in their diet each day: avoid peeling vegetables, as the skins contain plenty of fiber, including cellulose swap white bread for wholemeal bread swap white rice for brown rice try using steel-cut or rolled oats instead of instant oats aim for at least 2 ½ cups of vegetables and 2 cups of fruit each day choose starchy vegetables use psyllium husk or other fiber supplements when unable to meet the adequate intake through diet Summary Fiber is an essential part of a healthful diet, though most people in the U.S. do not meet the recommended daily fiber intake. A high-fiber diet helps to prevent constipation, maintain heart health, and feed the good bacteria in the gut. It can also help with weight loss. People can increase the amount of fiber they get from their diet by choosing high-fiber foods and following certain dietary tips, such as not peeling off edible skins on fruit and vegetables. Foods that are naturally rich in fiber have many other health benefits, too. Eating a wide variety of whole foods will help people meet their daily needs for fiber and other key nutrients.
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Stroke severity reduced in those who walk regularly

New research supports the idea that light to moderate physical activity, such as walking and swimming, could reduce the severity of strokes.
mature couple walking
Activities such as walking and swimming can reduce stroke severity.

A study of nearly 1,000 individuals who had had a stroke found that those who had been doing 4 hours per week of light or 2–3 hours each week of moderate activity had less severe strokes than those who had not been exercising.

The researchers defined light activity as walking at normal pace and moderate activity as brisk walking, swimming, and running.

"While exercise benefits health in many ways," says study author Katharina S. Sunnerhagen, of the University of Gothenburg in Sweden, "our research suggests that even simply getting in a small amount of physical activity each week may have a big impact later by possibly reducing the severity of a stroke."

She and her colleagues emphasize, however, that due to the nature of their study, their findings do not prove that physical activity actually reduces stroke severity — only that there is a significant link to it.

Commenting on the study, Nicole Spartano and Julie Bernhardt, both of Boston University School of Medicine in Massachusetts, say that while the underlying mechanisms are not fully understood, exercise likely helps maintain the brain's complex system of blood vessels.

A recent report on the study and an editorial article by Spartano and Bernhardt both feature in the journal Neurology.

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A major cause of disability

Stroke is a major cause of significant disability in adults. In the United States, where approximately 795,000 people have a stroke every year, it is the fifth main cause of death.

There are two main kinds of stroke: ischemic, which occurs when a blood clot or constriction in an artery stops blood flow in part of the brain; and hemorrhagic, which happens when a blood vessel ruptures, causing a bleed in the brain.

Both types of stroke stop oxygen and nutrients from reaching brain cells, which eventually — starved of this sustenance — will die.

The amount of disability that can follow a stroke depends on its location and the number of cells killed. It can, for example, result in difficulty walking, talking, and thinking.

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Data came from registries and self-reports

The study data came from 925 people — aged 73 years, on average — in Sweden who had had a stroke. Sunnerhagen and colleagues identified them from stroke registries that gave information about the severity of the stroke.

Symptoms such as facial, arm, and eye movement, as well as language ability and consciousness level, determined the level of severity. Based on this, 80 percent of the cohort were classed as having had a "mild" stroke.

The individuals had also answered questions following their stroke about the extent to which they engaged in leisure time physical activity in the period before the stroke. Where necessary, the team confirmed the answers by checking with relatives.

Walking for at least 4 hours each week was classed as light activity, while more intensive exercise, such as swimming, running, and brisk walking for 2–3 hours per week, was classed as moderate activity.

In this context, 52 percent of study participants were inactive in the period leading up to their stroke.

Studies that rely on self-reported physical activity levels often cite this as a possible weakness or limitation of the research. In this case, the researchers are especially cautious about their findings because stroke can affect memory and the questions were put to the individuals after they'd had a stroke.

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Exercise, younger age tied to milder strokes

The analysis revealed that those whose physical activity levels were light to moderate in the period leading up to their stroke had double the chance of having a mild stroke compared with those who were inactive.

Of the 59 people whose physical activity levels in the period before their stroke were moderate, 53 (89 percent) had a mild stroke. Of the 384 people whose physical activity level was light, 330 (85 percent) had a mild stroke. Of the 481 who were inactive, 354 (73 percent) had a mild stroke.

When the researchers considered the effect of younger age on stroke severity, however, they saw that physical activity accounted for only 6.8 percent of the differences between the active and inactive groups.

The team suggests that further research should now be done to clarify the extent to which exercise might reduce stroke severity.

Sunnerhagen also advises that "physical inactivity should be monitored as a possible risk factor for severe stroke."

Spartano notes that animal studies have revealed that physical activity helps safeguard the brain's complex network of blood vessels by boosting the ability for several arteries to supply the same regions of the brain.

"There is a growing body of evidence that physical activity may have a protective effect on the brain and our research adds to that evidence.'

Katharina S. Sunnerhagen

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Can a heart treatment lower depression and anxiety?

Many people who have atrial fibrillation experience symptoms of mood disorders, such as anxiety and depression. Do particular treatments for this condition help resolve such symptoms? A new study suggests they might.
woman in distress
A-fib is tied to psychological distress, but one treatment for this heart condition can also improve the psychological symptoms.

Atrial fibrillation (A-fib) is a common condition characterized by an irregular heart rhythm.

According to the Centers for Disease Control and Prevention (CDC), about 2.7–6.1 million people in the United States have A-fib.

Studies show that about a third of people with this heart condition also have symptoms of depression and anxiety.

Starting from this evidence, researchers from Australia decided to look into how various treatments for A-fib might influence a person's levels of psychological distress.

The results of the study — the senior author of which is Jonathan Kalman, of the Royal Melbourne Hospital — were published earlier this week in the Journal of the American Heart Association.

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Which treatment improves mental health?

The researchers worked with a cohort of 78 participants who had received some form of treatment for A-fib. The team monitored the participants' levels of depression and anxiety and evaluated and took into consideration their personality traits.

Of the total number of participants, 20 had received ablations, a type of procedure through which the heart tissue that produces the irregular heartbeat is removed or destroyed.

The remaining 58 participants chose to take drugs to regulate heart rate and prevent the formation of blood clots.

At the beginning of the study, 35 percent of the participants said that they lived with symptoms of severe anxiety and psychological distress. A further 20 percent reported suicidal ideation.

After a year from the beginning of the study, those who opted for an ablation tended to report lower levels of depression and anxiety compared with those who took drugs as therapy.

More of the people who had received ablations also reported no longer having suicidal thoughts. Specifically, the number of individuals with suicidal ideation fell from six to one among those participants.

Kalman believes that the new findings "[demonstrate] that effective treatment of atrial fibrillation markedly reduces psychological distress."

"This psychological impact," he adds, "is not well appreciated by many heart specialists and is important to take into consideration" — particularly when deciding on the most appropriate treatment for A-fib.

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Psychological distress and chronic conditions

The participants' personality types appeared to have a bearing on whether or not they experienced psychological distress and suicidal ideation.

Individuals who displayed a type D personality were more at risk of anxiety and depression. This personality type is characterized by a predisposition to stress, anger, and pessimism, which has also been tied to poorer outcomes when experiencing a heart condition.

Thirty-five of the total number of participants had type D personalities. Dr. Dimpi Patel, a researcher specializing in the mind-heart link — who is based at the New Hanover Regional Medical Center in Wilmington, NC — explains that the association between heart conditions and psychological distress is important, albeit understudied.

"Patients need to be aware," notes Dr. Patel, "that physical ailments can and do have psychological manifestations, and both must be acknowledged and managed to ensure a good quality of life and perhaps even prevent worse outcomes."

While the new research offers fresh evidence that heart and mind health are closely interlinked, Dr. Patel explains that this association is likely to occur in many more conditions than just A-fib.

"It is important to note that psychological distress, depression, anxiety and, at times, suicidal ideation are not exclusive to atrial fibrillation, but to many chronic diseases such as diabetes, chronic obstructive pulmonary disease, and congestive heart failure."

Dr. Dimpi Patel

"Physicians have an obligation," she adds, "to broaden their approach in managing any chronic illness to include emphasis on the psychological well-being of their patient. To me, it is simply practicing good and compassionate medicine."

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Daily aspirin does not make for a longer, 'disability-free' life

A large clinical trial of thousands of healthy older people with no history of heart problems or stroke finds that taking a low dose of aspirin per day did not help them live a longer life free of disability or dementia.
older lady taking a pill
Taking daily aspirin does not contribute to a longer, disability-free life.

The researchers, however, point out that further analysis needs to be done to determine the risk of dying from specific causes — including heart disease and cancer.

Called Aspirin in Reducing Events in the Elderly (ASPREE), the double-blind, randomized, and placebo-controlled international trial is still going, and the new findings are the early results.

Three papers now published in the New England Journal of Medicine present and discuss these early findings: the first focuses on cardiovascular events and bleeding, the second addresses disability-free survival, and the third concerns death from all causes.

Need to assess benefits, risks in older people

The main reason for the research was that the benefits and risks of older people taking a low dose of daily aspirin had not been weighed up.

Previous studies had demonstrated that "low-dose aspirin therapy" can reduce the risk of "vascular events" such as heart attack and stroke, but these had largely addressed middle-aged people.

Also, they had mainly focused on cardiovascular outcomes, whereas the "most desirable" impact of preventive medicine on older people should be to help them live longer "free of functional disability."

"Clinical guidelines," says Richard J. Hodes, who is director of the National Institute on Aging (NIA), "note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease."

"The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions," he adds.

The NIA is one of the National Institutes of Health (NIH) and one of the collaborators in the trial.

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Study design

ASPREE started in 2010 and recruited 16,703 older people aged 70 and older in Australia and 2,411 in the United States. The average follow-up for the recent findings was 4.7 years. The final completion date is January 2019.

The admission age was 65 and older only for African-American and Hispanic recruits in the U.S. because these groups have a higher risk of developing cardiovascular disease and dementia.

Anybody with a physical disability, dementia, or one or more conditions that required them to take aspirin was excluded from the study.

Of the 19,114 people recruited to the trial, 9,525 were randomly assigned to take 100 milligrams of aspirin per day and 9,589 to take placebo.

Key preliminary findings

Overall, the findings have so far revealed that the daily low-dose aspirin had no effect on dementia- and disability-free survival compared with placebo.

Of the individuals who took aspirin, 90.3 percent were alive and free of dementia and "persistent physical disability" at the end of the follow-up period. This compared with 90.5 percent who took placebo. Incidence of dementia was the same in both groups, and rates of disability were largely similar.

Rates of nonfatal heart attacks, coronary heart disease, and nonfatal and fatal ischemic stroke were also largely similar in the aspirin and placebo groups.

It is well-known that taking aspirin regularly can raise the risk of significant bleeding. The recent results reveal a significantly higher risk of this happening — in the stomach and intestines as well as the brain — in the aspirin group.

Half of the deaths during the follow-up occurred in people with cancer. This is not unexpected in a study of older adults.

What was surprising was that there appears to have been a higher risk of cancer-related death in the aspirin group, given that studies have suggested that aspirin can reduce it.

The team is now carrying out an analysis of all the cancer-associated data of the trial and urging others to treat this particular finding "with caution" until that analysis is complete.

A further 19 percent of deaths were due to stroke and heart disease and 5 percent to major bleeding.

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Further work to be done

"Continuing follow-up of the ASPREE participants is crucial," states Evan Hadley, the director of the Division of Geriatrics and Clinical Gerontology at the NIA, "particularly since longer-term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date."

The team has already begun to put in place plans to monitor the individuals in the longer-term, and to continue the data analysis.

In the meantime, says Hadley, older people should seek advice from their physicians about the use of aspirin as a preventive measure.

He explains that the point of the trial was not to study people who are taking aspirin because they are known to be at higher risk of cardiovascular events and so cannot comment on this group.

Also, the findings do not apply to those under the age of 65. In addition, the results are not robust enough to indicate whether healthy older people who are already taking aspirin as a preventive measure should carry on or stop. Only a further study can answer that question.

"These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned."

Evan Hadley

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High blood pressure breakthrough: Over 500 genes uncovered

The "largest genetic association study of blood pressure traits" to date has studied over 1 million people and found 535 new genetic loci linked with the condition. This finding may help predict the risk of high blood pressure and identify better treatments.
illustration of dna strand inside blood sample tube
DNA plays a much larger role in the development of high blood pressure than previously believed.

The American Heart Association (AHA) suggest that more than 100 million people in the United States now have high blood pressure.

That number equates to almost half of all adults who reside in the country.

Worldwide, the condition is the leading cause of cardiovascular death.

In the U.S., the number of deaths resulting from high blood pressure increased by 38 percent in 2005–2015. High blood pressure can cause many serious conditions, such as heart attack, stroke, heart failure, kidney failure, and the loss of vision, among several others.

Risk factors for high blood pressure are also numerous and can be divided into modifiable and non-modifiable ones.

A lack of physical activity, smoking, an unhealthful diet, excessive alcohol intake, stress, and being overweight are some factors that heighten risk but that can be changed or modified.

However, race, sex, genes, and age can also influence risk, and such factors cannot be changed. That being said, just being aware of them can help a person make lifestyle changes that could offset the risk.

New research delves deeper into the genetic risk factors. A team led by scientists at Queen Mary University of London and Imperial College London — both in the United Kingdom — reviewed the genetic data of over 1 million people and found more than 500 new genetic regions that could be responsible for high blood pressure.

Researcher Prof. Mark Caulfield, from Queen Mary University of London, is a co-corresponding author of the paper. The team's findings have recently been published in the journal Nature Genetics.

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Uncovering 535 new genetic locations

Prof. Caulfield and his colleagues analyzed genetic and blood pressure data from the UK Biobank database and the International Consortium of Blood Pressure Genome Wide Association Studies.

In total, they studied the DNA of over 1 million European participants and cross-referenced it with data on their systolic, diastolic, and pulse blood pressure.

Overall, the researchers identified 535 new genetic loci associated with high blood pressure. This accounts for almost a third (27 percent) of "the estimated heritability for blood pressure," explain the study authors.

More specifically, the study revealed that people who were in the highest genetic risk group had a blood pressure that was 13 millimeters of mercury higher, on average, than those in the lowest genetic risk group.

Also, people in this group were 3.34 times more likely to develop hypertension and 1.52 times more likely to have more serious cardiovascular problems.

Finally, the study points to some potential new drug targets and ways in which existing drugs could serve to treat hypertension.

Because one of the newly discovered genetic locations, for instance, is targeted by a drug for type 2 diabetes, the drug could be used to treat patients with hypertension who did not respond to other treatments.

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'Preventing thousands of heart attacks'

Prof. Caulfield comments on the significance of the new findings, saying, "This is the most major advance in blood pressure genetics to date."

"We now know that there are over 1,000 genetic signals which influence our blood pressure," he adds. This provides us with many new insights into how our bodies regulate blood pressure and has revealed several new opportunities for future drug development.

"With this information, we could calculate a person's genetic risk score for high blood pressure in later life," Prof. Caulfield says. "Taking a precision medicine approach, doctors could target early lifestyle interventions to those with a high genetic risk, such as losing weight, reducing alcohol consumption, and increasing exercise."

Co-lead researcher Prof. Paul Elliott, at Imperial College London, echoes the same sentiments, claiming, "Identifying these kinds of genetic signals will increasingly help us to split patients into groups based on their risk of disease."

"By identifying those patients who have the greatest underlying risk, we may be able to help them to change lifestyle factors which make them more likely to develop disease, as well as enabling doctors to provide them with targeted treatments earlier, reducing the burden of disease on the health service, and increasing people's quality of life."

Prof. Jeremy Pearson — an associate medical director at the British Heart Foundation, a nonprofit organization that co-funded the research — also chimes in.

According to him, "Knowing which genes cause high blood pressure may help us to spot the people who are at risk, before the damage is done.

"Those at risk can be treated — either with medication or lifestyle changes — potentially preventing thousands of heart attacks and strokes every year."

Prof. Jeremy Pearson

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Three daily servings of dairy may keep your heart healthy

A large observational study recently published in the journal The Lancet examines the link between the consumption of whole-fat dairy and cardiovascular health.
dairy products
Dairy products may benefit cardiovascular health, says new research.

The United States Department of Agriculture and American Heart Association (AHA) both recommend that adults do not exceed three servings of low-fat dairy per day.

The high content of saturated fat found in dairy products, they warn, may raise the levels of "bad" cholesterol, which poses a threat to cardiovascular health.

However, new research is challenging these guidelines.

For instance, a recent study has suggested that the fatty acids found in whole-fat dairy may have a protective role against heart disease and stroke.

Now, a large-scale observational study has reviewed the dietary habits of over 130,000 people in 21 countries across five continents and found that whole-fat dairy correlates with a lower risk of mortality and cardiovascular disease.

Dr. Mahshid Dehghan — from McMaster University in Ontario, Canada — is the lead author of the new research.

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Whole-fat dairy lowers mortality risk

Dr. Dehghan and colleagues used food questionnaires to collect self-reported data on the eating habits of 136,384 people over a follow-up period of 9.1 years. The people surveyed were aged between 35 and 70, and the dairy products they consumed were milk, yogurt, and cheese.

For the purposes of the study, a portion of dairy comprised either a glass of milk of 244 grams, a cup of yogurt of 244 grams, a 15-gram slice of cheese, or a 5-gram teaspoon of butter.

Based on these intakes, the team divided the volunteers into four groups: those who consumed no dairy, those whose intake did not exceed one serving per day, those who consumed one to two servings daily, and the "high-intake" group, who consumed over two daily servings — or 3.2 servings, on average — every day.

The study revealed that people in the high-intake group were less likely to die from any cause, less likely to die of cardiovascular disease, and less likely to have a stroke or develop major heart disease.

Also, within the group that regularly consumed full-fat dairy only, the researchers found that the more whole-fat dairy was consumed, the lower the risk of mortality and cardiovascular issues.

"Our findings support that consumption of dairy products might be beneficial for mortality and cardiovascular disease, especially in low-income and middle-income countries where dairy consumption is much lower than in North America or Europe."

Dr. Mahshid Dehghan

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Should dietary guidelines be changed?

Although this is an observational study that cannot confirm causality, the results suggest that some saturated fats in whole-fat dairy could benefit cardiovascular health, as do some vitamins and calcium. Does this mean that the current dietary guidelines should be changed?

Previous research that found similar results suggested that the guidelines do need revising. However, a linked commentary written by Jimmy Chun Yu Louie, at the University of Hong Kong, and Anna M. Rangan, from the University of Sydney in Australia, explains why that may not be such a good idea yet.

"The results from the [...] study seem to suggest that dairy intake, especially whole-fat dairy, might be beneficial for preventing deaths and major cardiovascular diseases," they write.

"However, as the authors themselves concluded, the results only suggest the 'consumption of dairy products should not be discouraged and perhaps even be encouraged in low-income and middle-income countries.'"

"[The study] is not the ultimate seal of approval for recommending whole-fat dairy over its low-fat or skimmed counterparts," they add. "Readers should be cautious, and treat this study only as yet another piece of the evidence (albeit a large one) in the literature."

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