A treadmill stress test can predict heart attacks or other serious heart disease even in men without symptoms, U.S. researchers reported.
The findings, published in the journal Circulation, suggest that exercise tests may be able to help predict which men who already appear to have a moderate to high risk of heart disease really need to take care.
One of the two studies showed exercise tests may be used to judge who would receive an implanted pacemaker-like device called a defibrillator, researchers said.
In one study two measurements -- a change in electrocardiogram or ECG tracing called ST-segment depression and an inability to reach target heart rate -- more than doubled the 10-year risk of coronary events such as heart attacks.
Men who did well on the stress test had a lower-than-expected rate of heart attack and serious heart disease in the 10 years following.
"Our results suggest that exercise testing may be of benefit in asymptomatic men with intermediate to high risk," said Dr. Gary Balady, a professor of medicine at Boston University School of Medicine.
His team tested women, too, but so few women developed heart attacks or serious heart disease that they could not decide if the test was a good predictor for women.
The 1,431 men and 1,612 women were taking part in a bigger study called the Framingham Heart Study. They were 45 years old at the start on average and had been followed for more than 18 years.
The volunteers got a battery of tests when they began the study that included the stress test. In the 10 years following 224 men, or 15.7 percent, had chest pain, a heart attack or died from coronary heart disease.
Overall, there was a 9.6 percent risk of heart attack, chest pain or other serious heart disease for the 3,000 people in the study over 10 years.
The men who had the highest predicted risk anyway, based on cholesterol levels, high blood pressure, family history and other factors, were the most likely to have serious heart disease if they also did poorly on the stress tests, the researchers found.
They said such patients should get aggressive care, including drugs to lower blood pressure and cholesterol.
A second study in Circulation, done at Columbia University Medical Center, found that an exercise test looking for a certain heartbeat pattern, called a Microvolt T-Wave Alternanscan or MTWA, also shows who may benefit from an implantable defibrillator device.
"It's an exercise test with a smart computer," said Dr. Thomas Bigger, who led the study.
Every year 300,000 to 400,000 people in the United States die suddenly when the heart's rhythm is suddenly disrupted.
But there is controversy over how to decide who needs defibrillators implanted to prevent this, and debate over whether Medicare and other insurers should use certain tests to qualify patients for payment.
Medicare only pays if patients have an abnormal QRS test, but the Columbia team say the MTWA test is more accurate.
They tested 177 patients and followed them for an average of 20 months.
Three percent of patients identified as high-risk by the MTWA died during that time, compared with 12 percent identified as low-risk by the QRS test.
The researchers noted that the test could also show who would not be helped by a defibrillator, potentially saving money and trouble.
Showing posts with label heart diseases. Show all posts
Showing posts with label heart diseases. Show all posts
Thursday, December 3, 2009
Thursday, November 19, 2009
Cluster Headache Linked to Heart Defect
New research suggests that cluster headache, a severe type of headache that usually begins around one eye, often occurs together with a heart defect called patent foramen ovale (PFO), in which blood can pass through a small hole from the right to the left side of the heart without going through the lungs first.
In the fetus, the hole (foramen ovale) is open, since blood does not need pass through the lungs to pick up oxygen while the baby is in the womb. After birth, the hole normally closes, but quite often this closure is incomplete. Since it is a small defect, people are often unaware that they have an open (patent) foramen ovale.
As reported in the medical journal Neurology, Dr. Cinzia Finocchi and colleagues, from the University of Genoa in Italy, used ultrasound to look for PFO in 40 people with cluster headache and 40 similar subjects without such headaches.
There was evidence of PFO in 17 patients with cluster headache compared with just 7 headache-free subjects. Having a cluster headache more than tripled the odds of having a PFO.
So, why do the two conditions often occur together? The reason is unclear, but it may relate to lower oxygen levels in the blood. With PFO, blood that bypasses lungs carries less oxygen than normal, and previous reports have suggested that poorly oxygenated blood may help induce cluster headaches.
Further studies are needed to better understand the association between cluster headache and PFO, the investigators conclude.
In the fetus, the hole (foramen ovale) is open, since blood does not need pass through the lungs to pick up oxygen while the baby is in the womb. After birth, the hole normally closes, but quite often this closure is incomplete. Since it is a small defect, people are often unaware that they have an open (patent) foramen ovale.
As reported in the medical journal Neurology, Dr. Cinzia Finocchi and colleagues, from the University of Genoa in Italy, used ultrasound to look for PFO in 40 people with cluster headache and 40 similar subjects without such headaches.
There was evidence of PFO in 17 patients with cluster headache compared with just 7 headache-free subjects. Having a cluster headache more than tripled the odds of having a PFO.
So, why do the two conditions often occur together? The reason is unclear, but it may relate to lower oxygen levels in the blood. With PFO, blood that bypasses lungs carries less oxygen than normal, and previous reports have suggested that poorly oxygenated blood may help induce cluster headaches.
Further studies are needed to better understand the association between cluster headache and PFO, the investigators conclude.
Tuesday, November 17, 2009
Stress Tests Can Predict Heart Ills in Healthy Men
A treadmill stress test can predict heart attacks or other serious heart disease even in men without symptoms, U.S. researchers reported.
The findings, published in the journal Circulation, suggest that exercise tests may be able to help predict which men who already appear to have a moderate to high risk of heart disease really need to take care.
One of the two studies showed exercise tests may be used to judge who would receive an implanted pacemaker-like device called a defibrillator, researchers said.
In one study two measurements -- a change in electrocardiogram or ECG tracing called ST-segment depression and an inability to reach target heart rate -- more than doubled the 10-year risk of coronary events such as heart attacks.
Men who did well on the stress test had a lower-than-expected rate of heart attack and serious heart disease in the 10 years following.
"Our results suggest that exercise testing may be of benefit in asymptomatic men with intermediate to high risk," said Dr. Gary Balady, a professor of medicine at Boston University School of Medicine.
His team tested women, too, but so few women developed heart attacks or serious heart disease that they could not decide if the test was a good predictor for women.
The 1,431 men and 1,612 women were taking part in a bigger study called the Framingham Heart Study. They were 45 years old at the start on average and had been followed for more than 18 years.
The volunteers got a battery of tests when they began the study that included the stress test. In the 10 years following 224 men, or 15.7 percent, had chest pain, a heart attack or died from coronary heart disease.
Overall, there was a 9.6 percent risk of heart attack, chest pain or other serious heart disease for the 3,000 people in the study over 10 years.
The men who had the highest predicted risk anyway, based on cholesterol levels, high blood pressure, family history and other factors, were the most likely to have serious heart disease if they also did poorly on the stress tests, the researchers found.
They said such patients should get aggressive care, including drugs to lower blood pressure and cholesterol.
A second study in Circulation, done at Columbia University Medical Center, found that an exercise test looking for a certain heartbeat pattern, called a Microvolt T-Wave Alternanscan or MTWA, also shows who may benefit from an implantable defibrillator device.
"It's an exercise test with a smart computer," said Dr. Thomas Bigger, who led the study.
Every year 300,000 to 400,000 people in the United States die suddenly when the heart's rhythm is suddenly disrupted.
But there is controversy over how to decide who needs defibrillators implanted to prevent this, and debate over whether Medicare and other insurers should use certain tests to qualify patients for payment.
Medicare only pays if patients have an abnormal QRS test, but the Columbia team say the MTWA test is more accurate.
They tested 177 patients and followed them for an average of 20 months.
Three percent of patients identified as high-risk by the MTWA died during that time, compared with 12 percent identified as low-risk by the QRS test.
The researchers noted that the test could also show who would not be helped by a defibrillator, potentially saving money and trouble.
The findings, published in the journal Circulation, suggest that exercise tests may be able to help predict which men who already appear to have a moderate to high risk of heart disease really need to take care.
One of the two studies showed exercise tests may be used to judge who would receive an implanted pacemaker-like device called a defibrillator, researchers said.
In one study two measurements -- a change in electrocardiogram or ECG tracing called ST-segment depression and an inability to reach target heart rate -- more than doubled the 10-year risk of coronary events such as heart attacks.
Men who did well on the stress test had a lower-than-expected rate of heart attack and serious heart disease in the 10 years following.
"Our results suggest that exercise testing may be of benefit in asymptomatic men with intermediate to high risk," said Dr. Gary Balady, a professor of medicine at Boston University School of Medicine.
His team tested women, too, but so few women developed heart attacks or serious heart disease that they could not decide if the test was a good predictor for women.
The 1,431 men and 1,612 women were taking part in a bigger study called the Framingham Heart Study. They were 45 years old at the start on average and had been followed for more than 18 years.
The volunteers got a battery of tests when they began the study that included the stress test. In the 10 years following 224 men, or 15.7 percent, had chest pain, a heart attack or died from coronary heart disease.
Overall, there was a 9.6 percent risk of heart attack, chest pain or other serious heart disease for the 3,000 people in the study over 10 years.
The men who had the highest predicted risk anyway, based on cholesterol levels, high blood pressure, family history and other factors, were the most likely to have serious heart disease if they also did poorly on the stress tests, the researchers found.
They said such patients should get aggressive care, including drugs to lower blood pressure and cholesterol.
A second study in Circulation, done at Columbia University Medical Center, found that an exercise test looking for a certain heartbeat pattern, called a Microvolt T-Wave Alternanscan or MTWA, also shows who may benefit from an implantable defibrillator device.
"It's an exercise test with a smart computer," said Dr. Thomas Bigger, who led the study.
Every year 300,000 to 400,000 people in the United States die suddenly when the heart's rhythm is suddenly disrupted.
But there is controversy over how to decide who needs defibrillators implanted to prevent this, and debate over whether Medicare and other insurers should use certain tests to qualify patients for payment.
Medicare only pays if patients have an abnormal QRS test, but the Columbia team say the MTWA test is more accurate.
They tested 177 patients and followed them for an average of 20 months.
Three percent of patients identified as high-risk by the MTWA died during that time, compared with 12 percent identified as low-risk by the QRS test.
The researchers noted that the test could also show who would not be helped by a defibrillator, potentially saving money and trouble.
Migraine sufferers more at risk of heart attack
Middle-aged men who suffer from migraine are more at risk of heart attacks, says a new study.
Migraine is a painful neurological condition, of which the most common symptom is an intense and disabling episodic headache.
Men with migraines were more likely to have high blood pressure or elevated cholesterol levels, compared to men who didn't have migraines, a study done on 20,084 men revealed.
Tobias Kurth, assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School, and other researchers had earlier shown that older women with migraines - especially those accompanied by neurological visual disturbances known as aura - had a higher risk of heart attacks and cardiovascular disease, reported the online edition of health magazine WebMD.
In the current study, the researchers did not have information on whether the men had auras. According to Kurth, the findings in women could be applied to men as well.
An aura occurs before the onset of a migraine. Aura symptoms can include, but are not limited to, light flashes, blind spots, blurred vision, and the formation of dazzling zigzag lines during the migraine. Aura can also include changes in sensation and smell.
"Until we understand more about the association between migraines and heart disease, patients with migraines should think about how to mitigate other known heart disease risk factors such as high blood pressure, diabetes, high cholesterol levels, smoking and obesity," the scientist said.
Migraine is a painful neurological condition, of which the most common symptom is an intense and disabling episodic headache.
Men with migraines were more likely to have high blood pressure or elevated cholesterol levels, compared to men who didn't have migraines, a study done on 20,084 men revealed.
Tobias Kurth, assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School, and other researchers had earlier shown that older women with migraines - especially those accompanied by neurological visual disturbances known as aura - had a higher risk of heart attacks and cardiovascular disease, reported the online edition of health magazine WebMD.
In the current study, the researchers did not have information on whether the men had auras. According to Kurth, the findings in women could be applied to men as well.
An aura occurs before the onset of a migraine. Aura symptoms can include, but are not limited to, light flashes, blind spots, blurred vision, and the formation of dazzling zigzag lines during the migraine. Aura can also include changes in sensation and smell.
"Until we understand more about the association between migraines and heart disease, patients with migraines should think about how to mitigate other known heart disease risk factors such as high blood pressure, diabetes, high cholesterol levels, smoking and obesity," the scientist said.
Monday, November 16, 2009
Exercise lowers stroke risk
Climbing stairs daily helps to lower the risk of suffering a stroke, according to the German Stroke Foundation. It noted that getting too little exercise and being overweight were among the risk factors for a stroke.
Regular exercise and a balanced diet could prevent half of the strokes in Germany, the foundation said, pointing out that cardiovascular events such as stroke were the third-most frequent cause of early retirement in the country.
The foundation said getting more exercise was simply a matter of making small changes in one's daily routine, for example by riding a bicycle to work instead of driving a car or taking public
transportation. In inclement weather, office workers who choose to drive rather than ride to work could park further away from the office and walk the rest of the way.
Many workers make the mistake of not leaving the office during lunch, the foundation noted. It cited a survey by the Berlin-based polling institute Forsa showing that a quarter of all workers in Germany work right through their break even though it presents a good opportunity to stretch their legs for at least 10 minutes.
Generally speaking, adults should exercise at least 30 minutes daily to keep healthy, the foundation said. It suggested that people monitor their exercise regimen with an "exercise book"
in which they jot down all of their physical activities, such as jogging or cycling.
According to the foundation, working up a sweat or exercising for 30 minutes at a time is not necessary since every physical activity lasting longer than 10 minutes is beneficial.
Regular exercise and a balanced diet could prevent half of the strokes in Germany, the foundation said, pointing out that cardiovascular events such as stroke were the third-most frequent cause of early retirement in the country.
The foundation said getting more exercise was simply a matter of making small changes in one's daily routine, for example by riding a bicycle to work instead of driving a car or taking public
transportation. In inclement weather, office workers who choose to drive rather than ride to work could park further away from the office and walk the rest of the way.
Many workers make the mistake of not leaving the office during lunch, the foundation noted. It cited a survey by the Berlin-based polling institute Forsa showing that a quarter of all workers in Germany work right through their break even though it presents a good opportunity to stretch their legs for at least 10 minutes.
Generally speaking, adults should exercise at least 30 minutes daily to keep healthy, the foundation said. It suggested that people monitor their exercise regimen with an "exercise book"
in which they jot down all of their physical activities, such as jogging or cycling.
According to the foundation, working up a sweat or exercising for 30 minutes at a time is not necessary since every physical activity lasting longer than 10 minutes is beneficial.
Keep heart attack victim cool for better survival chance
Rapid cooling of the body after a cardiac arrest seems to improve chances of survival without damaging the victim's brain, a new study has found.
"We now have a method that is safe and can be started within minutes of cardiac arrest to minimise damage during this very critical period," said study leader Maaret Castren, professor of emergency medicine at the Karolinska Institute, Stockholm.
For years, people hospitalised after cardiac arrest have been cooled to reduce damage to the brain and other tissues when blood circulation normalises after being temporarily halted.
In the Prince (Pre-Resuscitation Intra-Nasal Cooling Effectiveness) investigation, Castren and colleagues at 14 other centres across Europe used a new tool, RhinoChill, that cools the brain during ongoing cardiopulmonary resuscitation (CPR).
Researchers randomised 200 adults going into witnessed cardiac arrest to receive either standard resuscitation or resuscitation with cooling started as soon as possible during the arrest, with ongoing CPR.
All patients who survived until hospitalisation were further cooled according to standard criteria.
Eighteen patients were excluded from the analysis because a ?do-not-resuscitate' order was found or there was a non-cardiac reason for their cardiac arrest.
In the 182 patients reported, 83 (average age 66 years, 71 percent male) were randomised to receive nasal cooling (although two were not cooled because of user or device problems) and 99 (average age 64.8, 78 percent male) received standard care.
RhinoChill is a non-invasive device that introduces coolant through nasal prongs. The system is battery-powered and requires no refrigeration, making it suitable for emergency medical technicians to use while a person is receiving CPR.
In the total group, 46.7 percent of those cooled survived until hospital discharge, compared with 31 percent of those receiving standard care.
And 36.7 percent of those cooled were in good neurological condition on hospital discharge, compared with 21.4 percent of those receiving standard care, said a Karolinska Institute release.
In a time analysis, patients who received a combination of early CPR started within six minutes of collapse and cooling had the best outcomes.
These findings were presented at the American Heart Association's Scientific Sessions 2009.
"We now have a method that is safe and can be started within minutes of cardiac arrest to minimise damage during this very critical period," said study leader Maaret Castren, professor of emergency medicine at the Karolinska Institute, Stockholm.
For years, people hospitalised after cardiac arrest have been cooled to reduce damage to the brain and other tissues when blood circulation normalises after being temporarily halted.
In the Prince (Pre-Resuscitation Intra-Nasal Cooling Effectiveness) investigation, Castren and colleagues at 14 other centres across Europe used a new tool, RhinoChill, that cools the brain during ongoing cardiopulmonary resuscitation (CPR).
Researchers randomised 200 adults going into witnessed cardiac arrest to receive either standard resuscitation or resuscitation with cooling started as soon as possible during the arrest, with ongoing CPR.
All patients who survived until hospitalisation were further cooled according to standard criteria.
Eighteen patients were excluded from the analysis because a ?do-not-resuscitate' order was found or there was a non-cardiac reason for their cardiac arrest.
In the 182 patients reported, 83 (average age 66 years, 71 percent male) were randomised to receive nasal cooling (although two were not cooled because of user or device problems) and 99 (average age 64.8, 78 percent male) received standard care.
RhinoChill is a non-invasive device that introduces coolant through nasal prongs. The system is battery-powered and requires no refrigeration, making it suitable for emergency medical technicians to use while a person is receiving CPR.
In the total group, 46.7 percent of those cooled survived until hospital discharge, compared with 31 percent of those receiving standard care.
And 36.7 percent of those cooled were in good neurological condition on hospital discharge, compared with 21.4 percent of those receiving standard care, said a Karolinska Institute release.
In a time analysis, patients who received a combination of early CPR started within six minutes of collapse and cooling had the best outcomes.
These findings were presented at the American Heart Association's Scientific Sessions 2009.
Sunday, November 15, 2009
Heart Disease Still Number-One Killer
Cardiovascular disease remains the leading cause of death in the world, according to a report released by the American Heart Association (AHA).
The AHA estimates that 61,800,000 Americans have cardiovascular disease, which can include high blood pressure, coronary heart disease (heart attack and chest pain), stroke, birth defects of the heart and blood vessels, and congestive heart failure.
Cardiovascular disease kills more people than the next seven causes combined--including cancer--the AHA report states.
``The most surprising finding is that heart disease and stroke numbers are not going down,'' says Dr. David Faxon, president of the AHA. ``For many years, they did, but now we are seeing a leveling off, and in fact, we are seeing an increase in some groups such as African-American women.''
According to Faxon, reasons for the leveling off in numbers include the aging of the population and the ``growing problem'' of diabetes and obesity, both of which greatly increase heart disease risk.
In 1999, the most recent year for which data is available, cardiovascular disease deaths totaled nearly 1 million--equivalent to 1 death every 33 seconds--and accounted for 40% of all deaths that year.
The new report also states that caring for people with cardiovascular disease costs billions of dollars and will get more expensive. Cardiovascular disease-related costs for 2001 were estimated at $298.2 billion and are expected to rise to $329.2 billion in 2002.
``The majority of the cost is for inpatient hospitalization so anything that prevent the disease and complications and the need for rehospitalization can reduce cost,'' Faxon said.
He pointed out that medication and lifestyle changes can have powerful benefits for people with heart disease. ``For instance, taking a beta-blocker, an ACE inhibitor or statin after a heart attack dramatically reduces the chance of another heart attack or death,'' he said.
According to Faxon, lifestyle changes have the greatest effect on preventing death and disease associated with cardiovascular disease. ``While we have made modest effects on smoking and cholesterol awareness, we are losing ground in high blood pressure awareness,'' he added.
``Both men and women need to stop smoking, eat right, exercise and know their blood pressure and cholesterol and keep them at target levels,'' he advised.
The AHA estimates that 61,800,000 Americans have cardiovascular disease, which can include high blood pressure, coronary heart disease (heart attack and chest pain), stroke, birth defects of the heart and blood vessels, and congestive heart failure.
Cardiovascular disease kills more people than the next seven causes combined--including cancer--the AHA report states.
``The most surprising finding is that heart disease and stroke numbers are not going down,'' says Dr. David Faxon, president of the AHA. ``For many years, they did, but now we are seeing a leveling off, and in fact, we are seeing an increase in some groups such as African-American women.''
According to Faxon, reasons for the leveling off in numbers include the aging of the population and the ``growing problem'' of diabetes and obesity, both of which greatly increase heart disease risk.
In 1999, the most recent year for which data is available, cardiovascular disease deaths totaled nearly 1 million--equivalent to 1 death every 33 seconds--and accounted for 40% of all deaths that year.
The new report also states that caring for people with cardiovascular disease costs billions of dollars and will get more expensive. Cardiovascular disease-related costs for 2001 were estimated at $298.2 billion and are expected to rise to $329.2 billion in 2002.
``The majority of the cost is for inpatient hospitalization so anything that prevent the disease and complications and the need for rehospitalization can reduce cost,'' Faxon said.
He pointed out that medication and lifestyle changes can have powerful benefits for people with heart disease. ``For instance, taking a beta-blocker, an ACE inhibitor or statin after a heart attack dramatically reduces the chance of another heart attack or death,'' he said.
According to Faxon, lifestyle changes have the greatest effect on preventing death and disease associated with cardiovascular disease. ``While we have made modest effects on smoking and cholesterol awareness, we are losing ground in high blood pressure awareness,'' he added.
``Both men and women need to stop smoking, eat right, exercise and know their blood pressure and cholesterol and keep them at target levels,'' he advised.
New device may help heal a failing heart
A new artificial pump along with the intake of certain drugs could enable a failing heart to rest and repair itself, say scientists in Britain.
The temporary pumps, known as Left Ventricular Assist Devices (LVADs), are currently used in patients with severe heart failure while they await transplantation, reported the online edition of BBC News.
The LVAD takes on the work of one of the heart's four chambers, the left ventricle, which pumps oxygen-rich blood from the heart around the body.
Experts from Imperial College London and the Royal Brompton and Harefield NHS Trust administered the combination therapy to 15 severely ill patients and found that 11 of them recovered.
Eight of these patients were alive, free of heart failure and did not need a transplant for more than four years.
Magdi Yacoub, from the Heart Science Centre at the Royal Brompton and Harefield NHS Trust, said: "We are impressed by the dramatic, sustained improvement in the condition of these severely ill patients. The improvement observed was far greater than what has been reported to date for any other therapy.
"The study also highlights the fact that 'end stage' heart failure can be reversed and that the heart has the capacity to regenerate itself."
Many patients are often unable to get a new heart due to a shortage of donor organs. The new therapy, however, has the potential to ease the pressure on the waiting list while also offering patients a better alternative to a donor heart - their own healthy heart.
The British Heart Foundation (BHF), which supported the research, stressed that the technique was only suitable for certain patients.
"It could help some who develop severe heart failure as a result of a disease that weakens their heart muscle, but not those with the more common coronary heart disease, which damages the heart as a result of a lack of blood supply," explained Peter Weissberg, medical director of the BHF.
He added: "The study raises several important questions which will need answering in future clinical studies - we need to know exactly what part of this treatment regimen is responsible for the recovery of heart function, and which patients can benefit from it."
The temporary pumps, known as Left Ventricular Assist Devices (LVADs), are currently used in patients with severe heart failure while they await transplantation, reported the online edition of BBC News.
The LVAD takes on the work of one of the heart's four chambers, the left ventricle, which pumps oxygen-rich blood from the heart around the body.
Experts from Imperial College London and the Royal Brompton and Harefield NHS Trust administered the combination therapy to 15 severely ill patients and found that 11 of them recovered.
Eight of these patients were alive, free of heart failure and did not need a transplant for more than four years.
Magdi Yacoub, from the Heart Science Centre at the Royal Brompton and Harefield NHS Trust, said: "We are impressed by the dramatic, sustained improvement in the condition of these severely ill patients. The improvement observed was far greater than what has been reported to date for any other therapy.
"The study also highlights the fact that 'end stage' heart failure can be reversed and that the heart has the capacity to regenerate itself."
Many patients are often unable to get a new heart due to a shortage of donor organs. The new therapy, however, has the potential to ease the pressure on the waiting list while also offering patients a better alternative to a donor heart - their own healthy heart.
The British Heart Foundation (BHF), which supported the research, stressed that the technique was only suitable for certain patients.
"It could help some who develop severe heart failure as a result of a disease that weakens their heart muscle, but not those with the more common coronary heart disease, which damages the heart as a result of a lack of blood supply," explained Peter Weissberg, medical director of the BHF.
He added: "The study raises several important questions which will need answering in future clinical studies - we need to know exactly what part of this treatment regimen is responsible for the recovery of heart function, and which patients can benefit from it."
Fatigue Often Precedes Heart Attacks in Women
Most women who have a heart attack have experienced telltale symptoms, such as extreme fatigue and sleep disturbance, during the weeks leading up to the attack, investigators report.
Chest pain, however, is not usually one of these symptoms.
According to their report the American Heart Association's journal Circulation, Dr. Jean C. McSweeney and her colleagues believe that doctors sometimes don't recognize that a woman is having a heart attack because the symptoms don't match those of men, who more commonly experience severe chest pain.
To further investigate, McSweeney, with the University of Arkansas for Medical Sciences, Little Rock, and colleagues telephoned 515 women who had had a heart attack within the previous 4 to 6 months. The women were asked what symptoms they experienced before and during the heart attack.
Ninety-five percent of the subjects reported unusual symptoms during the weeks leading up to the heart attack.
"These are symptoms that change in intensity or frequency, or they're a brand new appearance, starting in the period prior to their heart attack," McSweeney told.
The most frequently reported were unusual fatigue (71 percent) and sleep disturbance (48 percent). Shortness of breath, indigestion and anxiety were also common. Less than a third reported chest discomfort, and when they did it was most often described as pressure, aching or tightness.
"A lot of women ignore these symptoms, thinking it's just because they're 'getting older,"' McSweeney commented. "But even when they do go to a physician, their physicians may overlook these symptoms."
These warning signs can be overwhelming, she said, and shouldn't be shrugged off. Some of the subjects said they had been so tired they couldn't finish making a bed without having to rest. Others said they had trouble climbing stairs.
"Women need to explain to their doctor how these symptoms are impacting their daily life. They should specifically say what they can't do, so that physicians can judge how severe this fatigue is."
When the heart attack occurred, the acute symptoms most commonly reported were shortness of breath, weakness, unusual fatigue, cold sweat and dizziness. If they had chest discomfort, they rarely described is as "pain."
Most women also had conventional risk factors, such as a history of cardiovascular disease, diabetes and high blood pressure.
"I'm trying to get women and physicians to look not only at these symptoms but also at their cardiovascular risk factors, such as hypertension or a strong family history of heart disease," to decide what diagnostic tests should be performed, McSweeney concluded.
Chest pain, however, is not usually one of these symptoms.
According to their report the American Heart Association's journal Circulation, Dr. Jean C. McSweeney and her colleagues believe that doctors sometimes don't recognize that a woman is having a heart attack because the symptoms don't match those of men, who more commonly experience severe chest pain.
To further investigate, McSweeney, with the University of Arkansas for Medical Sciences, Little Rock, and colleagues telephoned 515 women who had had a heart attack within the previous 4 to 6 months. The women were asked what symptoms they experienced before and during the heart attack.
Ninety-five percent of the subjects reported unusual symptoms during the weeks leading up to the heart attack.
"These are symptoms that change in intensity or frequency, or they're a brand new appearance, starting in the period prior to their heart attack," McSweeney told.
The most frequently reported were unusual fatigue (71 percent) and sleep disturbance (48 percent). Shortness of breath, indigestion and anxiety were also common. Less than a third reported chest discomfort, and when they did it was most often described as pressure, aching or tightness.
"A lot of women ignore these symptoms, thinking it's just because they're 'getting older,"' McSweeney commented. "But even when they do go to a physician, their physicians may overlook these symptoms."
These warning signs can be overwhelming, she said, and shouldn't be shrugged off. Some of the subjects said they had been so tired they couldn't finish making a bed without having to rest. Others said they had trouble climbing stairs.
"Women need to explain to their doctor how these symptoms are impacting their daily life. They should specifically say what they can't do, so that physicians can judge how severe this fatigue is."
When the heart attack occurred, the acute symptoms most commonly reported were shortness of breath, weakness, unusual fatigue, cold sweat and dizziness. If they had chest discomfort, they rarely described is as "pain."
Most women also had conventional risk factors, such as a history of cardiovascular disease, diabetes and high blood pressure.
"I'm trying to get women and physicians to look not only at these symptoms but also at their cardiovascular risk factors, such as hypertension or a strong family history of heart disease," to decide what diagnostic tests should be performed, McSweeney concluded.
Coffee Tied to Inflammation, Perhaps Heart Disease
Consuming moderate-to-high amounts of coffee is associated with increased levels of several inflammatory markers, a finding that could help explain previous reports linking the beverage to heart disease.
Ongoing, low-level inflammation is thought to be an underlying factor in the development of heart disease.
The latest findings, which appear in the American Journal of Clinical Nutrition, are based on a study of about 3000 subjects with no history of cardiovascular disease. A food-frequency questionnaire was used to assess coffee intake, and blood samples were tested for levels of various compounds that are known to promote, or are a marker of, inflammation.
Compared with subjects who did not drink coffee, those who consumed more than about 1 cup of the beverage per day had significantly higher levels of all the inflammatory markers tested, Dr. Demosthenes B. Panagiotakos, from Harokopio University in Athens, and colleagues report.
The results held true even after factoring in age, gender, smoking, body weight, physical activity, and other potential confounders, the researchers point out.
Although the findings provide a mechanism by which coffee intake could promote heart disease, the authors note that not all previous studies have identified an association between the two. Hence, further studies are needed to confirm the present findings.
Ongoing, low-level inflammation is thought to be an underlying factor in the development of heart disease.
The latest findings, which appear in the American Journal of Clinical Nutrition, are based on a study of about 3000 subjects with no history of cardiovascular disease. A food-frequency questionnaire was used to assess coffee intake, and blood samples were tested for levels of various compounds that are known to promote, or are a marker of, inflammation.
Compared with subjects who did not drink coffee, those who consumed more than about 1 cup of the beverage per day had significantly higher levels of all the inflammatory markers tested, Dr. Demosthenes B. Panagiotakos, from Harokopio University in Athens, and colleagues report.
The results held true even after factoring in age, gender, smoking, body weight, physical activity, and other potential confounders, the researchers point out.
Although the findings provide a mechanism by which coffee intake could promote heart disease, the authors note that not all previous studies have identified an association between the two. Hence, further studies are needed to confirm the present findings.
Early Diabetes Leads to Early Heart Disease
The ever-increasing waistlines of young adults in the U.S. have led to more and more cases of type 2 diabetes in young people -- and these young people are having far too many heart attacks and strokes, new research suggests.
In the study, young adults -- younger than 45 -- with type 2 diabetes were many times more likely to have a heart attack than their peers who did not have diabetes. The increased risk was most pronounced in women.
It's no secret that diabetes promotes the development of heart disease, but the increased risk associated with diabetes was much greater in younger adults than in older people, researchers report in the November issue of the journal Diabetes Care.
"Our study showed that young adults, especially women, with type 2 diabetes have a much higher risk of heart disease at an age when heart disease essentially does not exist unless you have type 2 diabetes," says study author Dr. Teresa A. Hillier of Kaiser Permanente Northwest/Hawaii in Portland, Oregon.
Hillier noted that it is well known that both obesity and type 2 diabetes are rapidly increasing in both children and young adults. "I believe that obesity may well be altering the usual course of type 2 diabetes to make it more aggressive in these younger adults," she said.
Hillier and a colleague, Kathryn L. Pedula, based their findings on a study of nearly 8,000 people who were newly diagnosed with type 2 diabetes. Participants were enrollees in the Kaiser Permanente Northwest health maintenance organization.
The researchers divided participants into two groups based on whether they had been diagnosed before or after turning 45, and compared them with "control" groups of people matched for age who did not have diabetes.
Diabetes increased the risk of heart attack and stroke in both age groups, but the increased risk was much larger in younger people.
People who had been diagnosed before age 45 were 14 times more likely to have a heart attack and 30 times more likely to have a stroke than their non-diabetic peers. In contrast, older people with diabetes were four times more likely than their peers to have a heart attack and three times more likely to have a stroke.
In younger adults, women were most likely to have a heart attack, according to the report.
In addition, there were several signs that diabetes was more severe in younger adults. People who developed diabetes before age 45 were more likely to need insulin, and they were also more likely to develop a diabetes complication called microalbuminuria -- a sign of kidney impairment -- which also increases the risk of heart disease.
"As individuals, communities and as a nation, we have got to do more to become healthier in our eating habits, exercise and body weight," Hillier said.
The good news is that modest weight loss and physical activity can drastically reduce the risk of developing type 2 diabetes. One study, she pointed out, found that people at high risk of developing type 2 diabetes were able to cut their risk in half by losing 7 percent of their weight and walking 30 minutes a day half an hour a week.
Type 2, or non-insulin dependent diabetes, is closely linked to obesity. This type of diabetes usually develops in adulthood, although as the nation's young people become heavier and heavier, more and more younger people are developing the disease.
In people with type 2 diabetes, blood sugar levels rise as the body becomes resistant to insulin, the hormone that processes sugar in the body. While type 2 diabetes used to be primarily a problem of middle and old age, new cases of the illness among people 30 to 39 have risen 70 percent in the last decade.
In the study, young adults -- younger than 45 -- with type 2 diabetes were many times more likely to have a heart attack than their peers who did not have diabetes. The increased risk was most pronounced in women.
It's no secret that diabetes promotes the development of heart disease, but the increased risk associated with diabetes was much greater in younger adults than in older people, researchers report in the November issue of the journal Diabetes Care.
"Our study showed that young adults, especially women, with type 2 diabetes have a much higher risk of heart disease at an age when heart disease essentially does not exist unless you have type 2 diabetes," says study author Dr. Teresa A. Hillier of Kaiser Permanente Northwest/Hawaii in Portland, Oregon.
Hillier noted that it is well known that both obesity and type 2 diabetes are rapidly increasing in both children and young adults. "I believe that obesity may well be altering the usual course of type 2 diabetes to make it more aggressive in these younger adults," she said.
Hillier and a colleague, Kathryn L. Pedula, based their findings on a study of nearly 8,000 people who were newly diagnosed with type 2 diabetes. Participants were enrollees in the Kaiser Permanente Northwest health maintenance organization.
The researchers divided participants into two groups based on whether they had been diagnosed before or after turning 45, and compared them with "control" groups of people matched for age who did not have diabetes.
Diabetes increased the risk of heart attack and stroke in both age groups, but the increased risk was much larger in younger people.
People who had been diagnosed before age 45 were 14 times more likely to have a heart attack and 30 times more likely to have a stroke than their non-diabetic peers. In contrast, older people with diabetes were four times more likely than their peers to have a heart attack and three times more likely to have a stroke.
In younger adults, women were most likely to have a heart attack, according to the report.
In addition, there were several signs that diabetes was more severe in younger adults. People who developed diabetes before age 45 were more likely to need insulin, and they were also more likely to develop a diabetes complication called microalbuminuria -- a sign of kidney impairment -- which also increases the risk of heart disease.
"As individuals, communities and as a nation, we have got to do more to become healthier in our eating habits, exercise and body weight," Hillier said.
The good news is that modest weight loss and physical activity can drastically reduce the risk of developing type 2 diabetes. One study, she pointed out, found that people at high risk of developing type 2 diabetes were able to cut their risk in half by losing 7 percent of their weight and walking 30 minutes a day half an hour a week.
Type 2, or non-insulin dependent diabetes, is closely linked to obesity. This type of diabetes usually develops in adulthood, although as the nation's young people become heavier and heavier, more and more younger people are developing the disease.
In people with type 2 diabetes, blood sugar levels rise as the body becomes resistant to insulin, the hormone that processes sugar in the body. While type 2 diabetes used to be primarily a problem of middle and old age, new cases of the illness among people 30 to 39 have risen 70 percent in the last decade.
