heart matters

Bangulzai SG

heart matters

The World Heart Federation says heart disease is the world's leading cause of death. It's responsible for one in every three deaths, and 80 per cent of these deaths occur in low-and middle-income countries.

Despite these discouraging figures, with medical science making rapid and continued progress with new diagnostic and treatment methods, it is heartening to know that heart disease is preventable and treatable.
Recognising the health risks early is important as preventive measures can be taken. The presence of risk factors increase your likelihood for heart disease. Some of these factors, such as age, cannot be changed while others may be modified.
By understanding and managing these factors, you can lower your risk for heart disease. The factors you cannot change are age, gender, ethnicity and family history.

THE RISK FACTORS YOU CAN MODIFY
High blood cholesterol
Low-density lipoproteins (LDL) or "bad "cholesterol increase the build-up of plaque in the arteries, while high density lipoproteins (HDL) or "good" cholesterol removes cholesterol from the cells before they are deposited as plaque in the arteries. This build-up causes the arteries to harden, such that they become narrowed and blood flow to the heart is reduced or blocked.
Modify: Keep your total cholesterol level as low as possible - do check your cholesterol levels regularly. The desirable level depends on your pre-existing risk for coronary heart disease.

High Blood Pressure
High blood pressure (hypertension) is one of the major risk factors for coronary heart disease and cerebrovascular disease, such as stroke. Left untreated, hypertension can also cause heart failure or lead to rupture of blood vessels in the brain. You may not experience any symptoms but in the long-term, it can lead to the damage of various body organs, including the heart, kidney and blood vessels.
Modify: Check your blood pressure at least once a year. Marginally elevated blood pressure may normalise when you lose weight, exercise more and reduce salt intake. If these measures are not successful, drug treatment may be needed. Once medicine has started, you must continue with the treatment, complemented by a healthy lifestyle.

Diabetes Mellitus and Abnormal Blood Glucose (Sugar) Levels
Diabetes mellitus is a chronic illness, and people with it are two to four times more likely to develop coronary artery disease and stroke. lt is often associated with other cardiovascular risk factors, like high blood pressure and obesity.
Modify: Maintain control over the amount of glucose in your blood. While maintaining a healthy weight, a balanced diet and regular exercise can prevent the onset of the disease.

Menopause
Natural oestrogen may help protect women against heart disease, but as oestrogen declines (as in menopause), it may contribute to a higher risk of heart disease and stroke. After menopause as well, women tend to have higher LDL cholesterol levels, increasing the risk of developing coronary heart disease.
Modify: Management of these risk factors becomes more important. However, hormone replacement for women who have undergone natural menopause does not prevent heart disease, and is not indicated for prevention of heart disease.

Obesity and excessive weight
People who have excess body fat, especially around the waist, are more prone to developing heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart. It also raises blood pressure and LDL and lowers HDL.
Modify: Weight loss leads to a decrease in blood pressure, blood glucose and blood cholesterol levels.

Lack of physical activity
Those who are inactive put themselves at risk of heart disease.
Modify: If you want to be active, start at a slow pace to avoid muscle injury. People with known coronary artery disease or those above 40 years old who have been inactive should seek medical advice first.

Smoking
Smokers have two to three times the risk of non-smokers for heart disease. Smoking leads to stroke, heart attack, high blood pressure, blood vessel disease, cancer and lung disease.
The carbon monoxide in the smoke lowers the amount of oxygen carried in the blood to the rest of the person's body; the cancer-causing substances are deposited in his airways and lungs.
Modify: Don't start.or if you are already a smoker, stop.

Stress
Blood pressure goes up momentarily when you get angry, excited, scared or are under physical or emotional stress. This makes the heart pump faster and harder, causing palpitation, insomnia, headache and digestive problems.
Modify: Learn to manage your stress. If you are constantly stressed over long periods of time, you may be at a higher risk of developing high blood pressure and even heart disease.

are you in the high-risk group for heart disease?
AGE: Age increases a person's susceptibility to heart disease.
GENDER: Men are three to five times more likely to have coronary heart disease than women. However, the risk for women increases after menopause. By about five to 10 years following it, their risk increases to the same rate as men.
ETHNICITY: Compared with Chinese, South Asians (Indians, Sri Lankans, Pakistanis etc) are three times, and Malays are two times more likely to suffer from coronary heart disease.
OBESITY: People who have excess body fat, especially located around the waist, are more prone to developing heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart. It also raises blood pressure and "bad" cholesterol, and lowers "good" cholesterol. It is also associated with the development of Diabetes Mellitus.
FAMILY HISTORY: You can be at a higher risk of having heart disease if your immediate family members (parents, siblings) have a history of premature heart disease. If there is a family history of heart disease, control your other risk factors too.

TIPS ON PREVENTING HEART DISEASE

Eat a healthy diet
Avoid foods high in cholesterol and saturated fats such as animal fats, whole milk products, eggs, red meat such as beef and lamb and coconut milk. Instead, choose lean meat, fish and low-fat dairy products and increase your intake of fruit and vegetables.

Exercise regularly
Exercise at least three times a week to prevent heart and blood vessel disease. Although there are many kinds of physical activities, brisk walking is one of the best. Check with your doctor to see what's suitable for you.

Stop smoking
Heart disease is found to be more common in smokers than in non-smokers. Smoking is a big contributor to heart disease risk and in addition high-risk group also causes heart disease to occur earlier, approximately seven years on average. To reduce your risk of getting heart disease, stop smoking.

Watch your weight
Maintaining a healthy body weight reduces the risks of heart disease. To give you a good idea of whether you are keeping a healthy weight, your Body Mass Index [BMI = weight (kg) / Height (m) x Height (m)] should not be more than 23. The waist to hip ratio is another useful indicator.

Take it easy
To manage stress, engage in regular exercises. Adopt a balanced approach to work and family life. In addition, relax whenever possible to ease the tension whenever feelings of stress arise since stress may aggravate heart disease.

are you in the high-risk group for stroke?
It's not surprising to learn that those who smoke are likely candidates for stroke. Also at risk are those who are obese and, disturbingly, those who are on oral contraceptives, as new studies show. Of course, the combination of these factors increases your chances even more.
     The most vulnerable age group for women, mainly due to oral contraceptives as well, is between 35 to 44 years of age.
     But does that mean that if you're slim, healthy and below 35, do not smoke and are not on the Pill, you will not get a stroke?
     The reality is that just about anyone can get a stroke. Rupture of aneurysm (weakening in the wall of blood vessels) resulting in brain haemorrhage (bleeding in the brain) may occur at any age.There is cause for alarm if you experience the sudden onset of one or more of these symptoms:
• unilateral (one-sided) weakness,
• difficulty with speech
• severe headache (especially if it's different from any you've had) and
• loss of vision. If you do suffer a stroke, which is not likely for most of us, the truth is that life continues, albeit at a new baseline, as stroke is a leading cause of disability and handicap in adults.
     To lessen your chances of a stroke, practise good lifestyle habits, say doctors. Many patients fear disability and value quality of life, yet they often fail to heed the doctor's simple advice; such as to stop smoking, to watch what they eat, and to exercise regularly.

Bangulzai SG

a good heart

Heart attacks are not confined to the old. Even young men can get a serious heart attack leading to sudden death.
Eighty per cent of all sudden cardiac death is related to coronary heart disease which, in most cases, can be prevented.

without warning
What causes young men to die suddenly?
The most common cause is sudden cardiac death (SCD), of which 80 per cent is related to coronary artery disease, or CAD (see box on right), with or without an acute myocardial infarction (heart attack).Unfortunately over half of sudden cardiac death victims have no prior symptoms. Some patients have chest pain, breathlessness or sweatiness and when these occur in a patient who has a heart problem risk, they should always seek treatment immediately.

An SCD attack is not the same as a heart attack. SCD is caused by an abnormal heart rhythm due to abnormal ‘electrical circuitry’ of the heart. A heart attack is caused by blockage or occlusion of the arteries supplying blood to the heart, causing a portion of the heart muscle to be damaged. This may or may not lead to an SCD attack. It is estimated that 1,000 Singaporeans die from SCD every year, about half of whom are below 60 years old.

if you are around...
1. Call the ambulance immediately. Early treatment increases his survival rate.
2. Perform chest compression CPR. This will improve his chances of survival.

cardiac artery disease
CAD is a common type of heart disease whereby fatty deposits accummulate in the coronary artery and impede the blood flow. Reduced blood flow to your heart can cause chest pain (angina). A sudden, complete blockage can lead to a heart attack.
The problem is that many people who have this form of heart disease are not aware they have it. CAD develops slowly and silently over decades. It can go virtually unnoticed until it produces a heart attack.
You can prevent or slow down CAD by taking steps to improve the health of your heart and blood vessels. Drugs and surgical techniques can open up narrowed coronary arteries, but the best long-term solution is to make lifestyle choices.

are you in the high-risk group?

Age: Age increases a person’s susceptibility to heart disease.

Gender: Men are three to five times more likely to have coronary heart disease than women. However, the risk for women increases after menopause. By about five to 10 years following menopause, the risk for coronary heart disease for women increases to the same rate as men.

Ethnicity: Compared with Chinese, South Asians (Indians, Sri Lankans, Pakistanis etc) are three times, and Malays are two times more likely to suffer from coronary heart disease.

Obesity: People who have excess body fat – especially located around the waist – are more prone to developing heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart. It also raises blood pressure, blood cholesterol and triglyceride levels, and lowers HDL, ("good" cholesterol levels). It is also associated with the development of Diabetes Mellitus.

Family history: You can be at higher risk of having heart disease if your immediate family members (parents, children, brothers and sisters) have a history of premature heart disease. Certain risk factors tend to run in some families. If there is a history of heart disease in the family, you should try very hard to control your other risk factors too.

preventing SCD
Although SCD by definition occurs unexpectedly, there are ways to prevent it through some simple and effective steps. If you are young or have not developed signs and symptoms of CAD, you should: stress raises the risk of developing high blood pressure, palpitation, insomnia and may contribute to heart attack.

1. Watch your weight, eat a healthy diet. Keep your cholesterol level low. Excess cholesterol may be deposited in the arteries, causing them to harden and narrow – blood flow to the heart is reduced or blocked.

2. Exercise regularly.

3. Stop smoking. The nicotine in smoke speeds up heart rate and disturbs the flow of blood and air in the lungs. Carbon monoxide in smoke decreases oxygen carried in the blood to the body, including heart and brain. The tar and cancer-causing substances are deposited in the airways and lungs.

4. Relax. Blood pressure goes up momentarily when you get angry, excited, or are under stress. Constant

5. Go for regular health checkups.
Those above 40 years old are advised to go for regular heart health screenings. Early treatment improves the chances of preventing or delaying complications. You can also discover your health and fitness levels.

6. Control cardiovascular risk factors
such as hypertension, Diabetes Mellitus and Abnormal Blood Sugar levels.
___________________________________

"In general all adults should know their family history of heart disease or sudden death. They should know their cholesterol level and know if they have diabetes or hypertension. If these are detected and treated early, coronary artery disease can be reduced."
- Dr Lee Chung Yin, Senior Consultant Cardiologist, National Heart Centre

___________________________________

"If you have any high-risk factor, get your doctor’s advice on how to improve those risk factors, change your lifestyle and dietary habits, and embark on a safe exercise programme."

– Dr Teo Wee Siong, Senior Consultant Cardiologist, National Heart Centre

Bangulzai SG

Welcome to better heart health

Heart problems are not something that we just grow old into. It is preventable. Yet, heart diseases and stroke are now causing one in every three deaths in Singapore. Tripling since 1957, their incidence is now affecting an even younger generation. So, does this apply to you? 58% of us have at least one risk factor. Choose to control it. This site tells you how and why. Welcome to better heart health.

Heart Health Tip of the Month

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Heart Alert

How much or little exercise is enough? We walk to the train station, we walk to lunch, we walk when we are shopping - now if you could walk at a moderately intense pace for 10 minutes at 3 times a day, 5 days a week, you are onto a good start...

Your lifestyle

Physical Activities

Can it really be true that six out of ten Singaporeans adults are physically inactive? Isn't a shopping expedition to Orchard Road enough exercise for a week? And do you get enough physical activity if you are not desk-bound?

The values of physical activity is so great that you cannot afford to ignore it - it reduces your heart risks, improves cholesterol levels, lowers blood pressure, controls your weight, keeps your bones and muscles strong, and reduces stress. And if that weren't enough, daily exercise can help you to sleep better, to think more clearly, boost your self-image and counter anxiety. Every calorie that you burn off during the activity also helps you to keep your weight down, while increasing your metabolism, causing you to "burn" more of the food you eat instead of storing it as fat. It also helps to prevent stroke, type 2 diabetes, osteoporosis and arthritis.

Myth: I move around, I carry goods, and shop - that should be enough?
Truth: You should participate in moderate-intensity physical activity five 5 times a week for 30 minutes per day

The good news is that shopping does count, even a 10-minute walk around your block will help, but to achieve a healthy effect, you need to walk faster, without stopping for a breather, for up to 30 minutes a day on at least five days a week. Doing rigourous sports such as playing squash once a week is not enough. Even if you take healthy meals or go on a diet, you still need to exercise. Your heart will become a stronger, more efficient muscular pump if you sustain moderate activity for 20 minutes or longer. Most people find it hard to be consistent in exercising for better health, so it is best to make a schedule to stick to. Look for moderate physical activities that increase the rate and depth of your breathing but not so much that it makes you pant. You can break the activities down into three 10-minute sessions per day, but the key is to take such activity regularly, at least five days a week.

Myth: No pain, no gain
Truth: Anything more than a mild burning sensation in your muscles may be a sign that you are injuring yourself

Painful exercises do not make you any healthier overnight and can cause serious, lasting harm. Regular physical activities help you achieve better health, but sudden exertion may shock your body and injure it. Build up your exercise slowly, especially if you haven't been active for a while. This will allow your muscles to warm up. Gradually increase the duration, intensity and frequency of your exercise. Choose regular activities, monitor laps, repetitions, time or distance and track your progress by keeping an exercise log. Build up your endurance gradually.

Myth: I am a heart patient, I cannot exercise!
Truth: An active lifestyle can help you achieve a healthy heart

Even though you have heart trouble, adopting an active lifestyle that includes regular exercise is important. In fact, it is one way to ensure a healthy, enjoyable future. Starting an exercise program may seem like a big effort, but it really is something that you can take step by step. Before getting started, your doctor may advise you to have an exercise stress test, which shows how your body responds to exercise. You may also have other special cardiac (heart) tests. Based on their results, your doctor can plan an exercise program that will be safe and effective for you.

Five steps to Increased Physical Activity

1: Take It One Step at a Time

You may have been active before your heart trouble. Or, perhaps this is the first time you've started a regular exercise program. Either way, ease into your routine instead of jumping into it headlong. In time, you will be doing enough physical activity to improve your heart health.

2: Make It a Daily Habit

You will reap the greatest rewards if you exercise at least for half an hour a day. This takes about the same amount of time as watching TV show or going to the market. You do not have to complete your whole exercise program at once. You can also reach your goal by exercising for 10 minutes, three times a day, on five days a week. To achieve that, you can build physical activities into your day to day activities. Some examples are taking the stairs instead of the elevator or escalator, parking at the far end of the parking lot, walking to the mall or the grocery store, getting up and walking to a co-worker's office rather than sending an e-mail or calling on the phone, taking "powerwalk" in the mall during lunch time, walking the dog, or riding an exercise bike while you watch TV.

3: Step Up Your Activity Level

Besides doing your exercise program, try being more active throughout the day. This will help you reach your goal faster. Start by moving more during your daily routines. When doing errands, walk as much as you can. Take on more household tasks. For fun, chat with a friend while on a walk, rather than on the phone. Visit a local park or go out dancing instead of watching TV.

4: Picking Your Best Options

The kind of physical activities you do is up to you, so choose something that you enjoy. Swimming, walking, and riding a bike can all help to improve your heart function. Some prefer group fitness classes while others may like to follow an exercise video or even take up ballroom dancing. While there are many aerobic activities to choose from, walking is one of the best. It requires no special skills, costs nothing, is easy on the body and nearly anyone can do it. What matters is that your activity should work for you. . For a change of pace, mix and match different activities from day to day.

5: Walk More

Walking works for most people. All it takes is a pair of sturdy, well-fitting walking shoes. Be sure to start with small excursions, like walking 10 minutes a day. Then build up to at least half an hour a day. You can begin by using the walking program below, or ask your doctor for advice.

Week

Minutes Walking

Walks per week

3-4

4-5

5-6

6-7

Source: Fitness and Heart Disease: Improving Your Heart Health with Exercise by The StayWell Company

Bangulzai SG

Waist size found to be predictor of heart failure in both men and women

Wednesday, April 8, 2009

Adding to the growing evidence that a person's waist size is an important indicator of heart health, a study led by investigators at Beth Israel Deaconess Medical Center (BIDMC) has found that larger waist circumference is associated with increased risk of heart failure in middle-aged and older populations of men and women.

The findings, published online in the April 7 Rapid Access Report of the journal Circulation: Heart Failure, showed that increased waist size was a predictor of heart failure even when measurements of body mass index (BMI) fell within the normal range.

"Currently, 66 percent of adults in the United States are overweight or obese," explains Emily Levitan, ScD, the study's first author and a Research Fellow in the Cardiovascular Epidemiology Research Unit at BIDMC. "Knowing that the prevalence of heart failure increased between 1989 and 1999, we wanted to better understand if and how this increase in obesity was contributing to these rising figures."

A life-threatening condition that develops when the heart can no longer pump enough blood to meet the body's needs, heart failure (also known as congestive heart failure) is usually caused by existing cardiac conditions, including high blood pressure and coronary artery disease. Heart failure is the leading cause of hospitalization among patients 65 and older, and is characterized by such symptoms as fatigue and weakness, difficulty walking, rapid or irregular heartbeat, and persistent cough or wheezing.

The researchers examined two Swedish population-based studies, the Swedish Mammography Cohort (made up of 36,873 women aged 48 to 83) and the Cohort of Swedish Men (43,487 men aged 45 to 79) who responded to questionnaires asking for information about their height, weight and waist circumference. Over a seven-year period between January 1998 and December 2004 the researchers reported 382 first-time heart-failure events among the women (including 357 hospital admissions and 25 deaths) and 718 first-time heart-failure events among men (accounting for 679 hospital admissions and 39 deaths.)

Their analysis found that based on the answers provided by the study participants, 34 percent of the women were overweight and 11 percent were obese, while 46 percent of the men were overweight and 10 percent were obese.

"By any measure – BMI, waist circumference, waist to hip ratio or waist to height ratio –our findings showed that excess body weight was associated with higher rates of heart failure," explains Levitan.

Further breakdown of the numbers showed that among the women with a BMI of 25 (within the normal range), a 10-centimeter higher waist measurement was associated with a 15 percent higher heart failure rate; women with a BMI of 30 had an 18 percent increased heart failure rate. In men with a BMI of 25, a 10-centimeter higher waist circumference was associated with a 16 percent higher heart failure rate; the rate increased to 18 percent when men's BMI increased to 30.

Furthermore, adds Levitan, among the men, each one-unit increase in BMI was associated with a four percent higher heart failure rate, no matter what the man's waist size. In women, she adds, BMI was only associated with increased heart failure rates among the subjects with the largest waists. Finally, the authors found that the association between BMI and heart-failure events declined with age, suggesting that the younger the person, the greater the impact of weight to heart health.

"This study reinforces the importance of maintaining a healthy weight," says Levitan. "Previous research has looked at various types of heart disease and related health issues, and no matter the particulars of the study, they've all been pretty consistent in determining that excess body weight increases a person's risk of heart disease."

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Beth Israel Deaconess Medical Center

Thanks to Beth Israel Deaconess Medical Center for this article.

Bangulzai SG

Exercise improves quality of life for heart failure patients

Human Heart

Wednesday, April 8, 2009

Heart failure patients who regularly exercise fare better and feel better about their lives than do similar patients who do not work out on a regular basis, say researchers at Duke University Medical Center.

The findings, reported in the April 8 issue of the Journal of the American Medical Association, go a long way toward addressing concerns about the value of exercise for the nation's five million patients with heart failure. They also raise important policy questions for the country's Medicare program and other insurers.

"Past studies have sent mixed signals about the merit of exercise for patients with heart failure. The HF-ACTION study (A Controlled Trial Investigating Outcomes Exercise Training) shows that exercise is not only safe for patients, but also helps to improve the quality of their lives, overall," says Kathryn Flynn, Ph.D., a health services researcher at the Duke Clinical Research Institute (DCRI) and lead author of the study.

HF-ACTION is the largest clinical trial to date examining the value of exercise in the treatment of heart failure. Investigators enrolled 2331 patients with moderate to severe heart failure at 82 sites throughout the U.S., Canada and France from 2003 to 2008.

Funded by a $37 million grant from the National Heart, Blood, and Lung Institute, researchers randomized participants to receive either standard care or standard care plus an exercise program. The exercise regimen consisted of three months of supervised aerobic training on a bicycle or treadmill, followed by instruction for continued home-based training. Researchers set the exercise goal at five, 40-minute workouts, or 200 minutes of exercise per week. Participants reached about 60 percent of that goal at one year.

Participants had significant heart failure upon entering the study, measured by diminished left ventricular ejection fraction (mean, 25 percent). Ninety-five per cent of the patients were taking medications for heart failure, such as ACE-inhibitors or beta-blockers, and 40 percent were using mechanical devices to boost their hearts' ability to pump or to treat arrhythmias. The average age of the patients was 59; 28 percent were women.

Upon enrollment, patients filled out the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 23-item measure shown to be responsive to underlying clinical changes in patients with heart failure. The KCCQ generated an overall measure of quality of life and subscale measures reflecting the patients' physical limitations, symptoms, quality of life and social restrictions. Participants completed the questionnaire at three-month intervals for the first 12 months, and annually thereafter. The average time of follow-up was two and one-half years. There were no significant differences between the two patient groups at baseline. The average overall KCCQ score among patients in both groups was 66.

At three months, patients in both groups showed improvement, with patients in the usual care group registering an average three-point gain on the KCCQ score and those in the exercise group showing an average five-point gain (p < .001 for difference between the groups). Previous reports had defined a five-point gain as clinically significant.

Researchers also looked at how individual patients responded to exercise training and found that a higher percentage of those in the exercise group experienced clinical meaningful improvement. At three months, 54 percent of those in the exercise group saw a five-point gain in overall KCCQ score, while only 28 percent of those in the usual care group met that goal. (p < .001).

Exercise group members consistently outscored those in the usual care group on all subscale measures on the KCCQ, as well. "And the best news is that while the gains were modest, they were sustained over time," says Flynn.

During the study period, the incidence of adverse effects was similar between the two groups. There were 41 heart attacks among patients in the exercise arm and 45 heart attacks among those receiving usual care. Arrhythmias occurred in about 14 percent of the patients in each group.

Researchers say the findings are important because they demonstrate that a relatively low-cost and readily available intervention can significantly improve the quality of life for heart failure patients, a finding that may be important for the country's Medicare program, which currently does not pay for exercise therapy for patients with heart failure.

"We found that a majority of those who exercised reported a five-point improvement in the KCCQ scale. That means that they experienced significant improvement in many aspects of their day-to-day activities, such as working, walking, being able to dress, bathe, and getting out to visit family and friends," says Ileana Piña, MD, a professor of medicine at Case Western Reserve University and chair of the HF-ACTION Steering Committee. Piña, who is a Quality Scholar at the Cleveland VA, says clinicians should consider using the KCCQ inventory on a regular basis. "It is a quick and easy method to find out valuable information about patients' health status. It only takes about eight minutes to fill out, which is a small burden for patients."

"This study has important implications for the five million Americans who have heart failure," noted Elizabeth G. Nabel, MD, NHLBI director. "As the number of people affected by heart failure is expected to rise with the aging U.S. population, it is promising to know that regular aerobic activity can not only help patients extend their lives, but exercise can also positively impact their everyday activities and outlook."

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Duke University Medical Center

Thanks to Duke University Medical Center for this article.

Bangulzai SG

Music reduces stress in heart disease patients

Wednesday, April 15, 2009

Listening to music may benefit patients who suffer severe stress and anxiety associated with having and undergoing treatment for coronary heart disease. A Cochrane Systematic Review found that listening to music could decrease blood pressure, heart rate, and levels of anxiety in heart patients.

Living with heart disease is extremely stressful. The uncertainties and anxieties surrounding diagnosis and the various medical procedures involved in treatment can significantly worsen the condition. For example, stress can increase blood pressure, leading to increased risk of complications. Music listening may help to alleviate stress and therefore reduce this risk.

"Our findings suggest music listening may be beneficial for heart disease patients," says Joke Bradt, who works at the Arts and Quality of Life Research Center at Temple University in Philadelphia. "But the trials we looked at were generally small and varied in terms of styles of music used and length of music sessions. More research on the specifics of music listening is certainly warranted."

The researchers reviewed data from 23 studies, which together included 1,461 patients. Two studies focused on patients treated by trained music therapists, but most did not, using instead interventions where patients listened to pre-recorded music on CDs offered by healthcare professionals.

Listening to music provided some relief for coronary heart disease patients suffering from anxiety, by reducing heart rate and blood pressure. There was also some indication that music listening improved mood, although no improvement was seen for patients suffering from depression due to the disease.

"We all know that music can impact on our emotions, our physiological responses, as well as our outlook on life, and this early research shows that it is well worth finding out more about how it could help heart disease patients. In particular, it would be interesting to learn more about the potential benefits of music offered by trained music therapists, which may be differ substantially from those associated with pre-recorded music," says Bradt.

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Wiley-Blackwell

Thanks to Wiley-Blackwell for this article.

HiAy3Captain SG

good health=enjoy life

Bangulzai SG

good health=enjoy life

cool

Bangulzai SG

Healing heart attack victims, one cell at a time

By using the amount of carbon 14 in the atmosphere from above-ground nuclear testing in the 1950s and 1960, researchers have determined that cells in the human heart develop into adulthood.

But as humans age, the percentage of new heart cells decreases markedly. By age 25, renewal of heart cells gradually decrease from 1 percent turning over annually to .45 percent by the age of 75. About 50 percent of the heart cells a human is born with will regenerate during a lifetime.

Myocardial damage often results in chronic heart failure because of the loss and insufficient regeneration of heart cells. But this new finding may mean that patients, who have suffered myocardial damage as a result of a heart attack, may have some good news.

Lawrence Livermore National Laboratory scientist Bruce Buchholz with colleagues from the Karolinska Institute, Université Claude Bernard Lyon, Lund University and Lund University Hospital, found that cells in a human heart can develop into adulthood and the age of heart cells is, on average, six years younger than the individual.

Using the Laboratory's Center for Accelerator Mass Spectrometry, Buchholz measured the amount of carbon 14 in DNA to establish the age of caridiomyocytes (cardiac muscle cells) in humans.

Carbon 14 atmospheric concentration levels remained relatively stable until the Cold War, when above-ground nuclear bomb tests caused a sharp increase, or peak, which decreased slowly after the end of above-ground testing in 1963. This spike in carbon 14 in the atmosphere serves as a chronometer of the past 55 years.

Because DNA is stable after a cell has gone through its last cell division, the concentration of carbon 14 in DNA serves as a date mark for when a cell was born and can be used to date cells in humans.

The team determined the ages of heart cells by determining the time at which the sample's carbon 14 concentration corresponded to the atmospheric concentration. Buchholz found that people born around or after the nuclear bomb tests corresponded to atmospheric concentrations several years after the subjects' birth, indicating substantial postnatal DNA syntheses.

"By analyzing individuals born at different times before 1955, it is possible to establish the age up to which DNA synthesis occurs, or whether it continues beyond that age," Buchholz said.

In the study, carbon 14 concentrations were elevated in subjects compared to those people born up to 22 years before the beginning of nuclear bomb tests.

"DNA of myocardial cells is synthesized many years after birth, indicating that cells in the human heart do, in fact, renew into adulthood," Buchholz said. "At the age of 50, 55 percent of the heart's cells remain from the time around birth and 45 percent have been generated later."

Cardiac muscles have a striated appearance and their contraction in the heart propels blood from the atria and ventricles to the blood vessels of the circulatory system.

The limited recovery in humans after a heart injury, such as a heart attack, demonstrates failing regeneration of heart cells. But the team concluded that the renewal of heart cells, as indicated by the mixing of carbon 14 in the DNA, suggest that the development of pharmacological strategies to stimulate this process may be a rational alternative or complement to cell transplantation strategies for heart cell replacement.

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DOE/Lawrence Livermore National Laboratory. Thanks to DOE/Lawrence Livermore National Laboratory for this article.

Bangulzai SG

Greens, greens, they're good for your heart: study

Diets worldwide that are rich in fried and salty foods increase heart attack risk, while eating lots of fruit, leafy greens and other vegetables reduces that risk, a study published Monday showed..

The study, called INTERHEART, looked at 16,000 heart attack patients and controls between 1999 and 2003 in countries on every continent, marking a shift from previous studies which have focussed on the developed world..

The patients and controls filled in a "dietary risk score" questionnaire based on 19 food groups, which contained healthy and unhealthy items and were tweaked to include dietary preferences of each country taking part in the study..

The researchers found that people who eat a diet high in fried foods, salty snacks, eggs and meat -- the "Western Diet" -- had a 35 percent greater risk of having a heart attack than people who consumed little or no fried foods or meat, regardless of where they live..

People who ate a "Prudent Diet" -- high in leafy green vegetables, other raw and cooked vegetables, and fruits -- had a 30 percent lower risk of heart attack than those who ate little or no fruit and veg, the study showed..

The third dietary pattern, called the "Oriental Diet" because it contained foods such as tofu and soy sauce which are typically consumed in Asian societies, was found to have little impact on heart attack risk..

Although some items in the Oriental diet might have protective properties such as vitamins and anti-oxidants, others such as soy sauce have a high salt content which would negate the benefits, the study said..

The study was groundbreaking in its scope and because previous research had focussed mainly on developed countries, according to Salim Yusuf, a senior author of the study..

"We had focussed research on the West because heart disease was mainly predominant in western countries 25-30 years ago," Yusuf, who is a professor of medicine at McMaster University in Canada, told AFP..

"But heart disease is now increasingly striking people in developing countries. Eighty percent of heart disease today is in low- to middle-income countries" partly because more people around the world are eating western diets, he said..

"This study indicates that the same relationships that are observed in western countries exist in different regions of the world," said Yusuf, who is also head of the Population Health Research Institute at Hamilton Health Sciences in Ontario..

Patients who had been admitted to coronary care units in 262 centers around the world, and at least one control subject per patient, took part in the study..

The INTERHEART results were published Monday in Circulation, the journal of the American Heart Association..

The main countries in the study were Argentina, Brazil, Chile and Colombia in South America; Canada and the United States in North America; Sweden in western Europe; Croatia, Poland and Russia for eastern Europe; and Dubai, Egypt, Iran, Kuwait and Qatar for the Middle East..

In sub-Saharan Africa, the main countries were Cameroon, Kenya, Mozambique, South Africa and Zimbabwe; while nearly all the South Asian countries -- India, Pakistan, Bangladesh, Nepal and Sri Lanka -- took part, as did Southeast Asian countries including the Philippines and Singapore, Yusuf told AFP. — AFP

Bangulzai SG

Benefit of grapes may be more than skin deep

Thursday, April 23, 2009

Can a grape-enriched diet prevent the downhill sequence of heart failure after years of high blood pressure?

A University of Michigan Cardiovascular Center study suggests grapes may prevent heart health risks beyond the simple blood pressure-lowering impact that can come from a diet rich in fruits and vegetables. The benefits may be the result of the phytochemicals – naturally occurring antioxidants – turning on a protective process in the genes that reduces damage to the heart muscle.

The study, performed in laboratory rats, was presented at the 2009 Experimental Biology convention in New Orleans.

The researchers studied the effect of regular table grapes (a blend of green, red, and black grapes) that were mixed into the rat diet in a powdered form, as part of either a high- or low-salt diet. Comparisons were made between rats consuming the grape powder and rats that received a mild dose of a common blood pressure drug. All the rats were from a research breed that develops high blood pressure when fed a salty diet.

After 18 weeks, the rats that received the grape-enriched diet powder had lower blood pressure, better heart function, and fewer signs of heart muscle damage than the rats that ate the same salty diet but didn't receive grapes.

Rats that received the blood pressure medicine, hydrazine, along with a salty diet also had lower blood pressure, but their hearts were not protected from damage as they were in the grape-fed group.

"There are the small changes that diet can bring, but the effect of grape intake on genes can have a greater impact on disease down the road," said E. Mitchell Seymour, M.S., who led the research as part of his doctoral work in nutrition science at Michigan State University. He manages the U-M Cardioprotection Research Laboratory, which is headed by U-M cardiac surgeon Steven Bolling, M.D.

Heart cells, like other cells in the body, make an antioxidant protein called glutathione, which is one of our first defenders against damaging oxidative stress. High blood pressure causes oxidative stress in the heart and lowers the amount of protective glutathione. However, intake of grapes actually turned on glutathione-regulating genes in the heart and significantly elevated glutathione levels.

This may explain why the hearts of grape-fed animals functioned better and had less damage.

Although the current study was supported in part by the California Table Grape Commission, which also supplied the grape powder, the authors note that the commission played no role in the study's design, conduct, analysis or the preparation of the journal article for publication. Seymour also receives funding from the National Heart, Lung and Blood Institute, part of the National Institutes of Health, through a National Research Service Award.

Bolling said the latest results take research on the health benefits of grapes "a step further" by examining the mechanisms impacted by antioxidant-rich grapes.

The rats in the study were from a strain called Dahl rats, which have been specially bred to all be susceptible to salt-induced hypertension. The animals are similar to

Americans who have elevated blood pressure related to diet, and who develop heart failure over time because of prolonged hypertension.

Each group of 12 rats was fed the same weight of food each day with powdered grapes making up 3 percent of the diet (by weight) for rats that received grapes as part of either a low-salt or high-salt diet. The rats that received hydrazine were fed it through their water supply in a dose that has been previously shown to be effective in reducing blood pressure.

Such naturally occurring chemicals have already been shown in other research, including previous U-M studies, to reduce other potentially harmful molecular and cellular activity in the body.

In all, the researchers say, the study further demonstrates that a grape-enriched diet can have broad effects on the development of hypertension and the risk factors that go with it. Whether the effect can be replicated in humans, they say, remains to be seen.

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University of Michigan Health System

Thanks to University of Michigan Health System for this article.