Heart disease more likely for adults with dysfunctional childhoods

Trauma, neglect, family dysfunction in childhood leads to health issues in 50s, 60s

April 28, 2020

Science Daily/Northwestern University

Children who experience trauma, abuse, neglect and family dysfunction are at increased risk of having heart disease in their 50s and 60s, according to a new Northwestern Medicine study.

Results from the study showed people exposed to the highest levels of childhood family environment adversity were more than 50 percent more likely to have a cardiovascular disease event such as a heart attack or stroke over a 30-year follow-up.

The longitudinal study of more than 3,600 participants is among the first to describe the trajectory of cardiovascular disease and death based on family environment ratings from young adulthood into older middle age.

The findings were published today, April 28, in the Journal of the American Heart Association.

Children who experience this type of adversity are predisposed to higher rates of lifelong stress, smoking, anxiety, depression and sedentary lifestyle that persist into adulthood. These can lead to increased body mass index (BMI), diabetes, increased blood pressure, vascular dysfunction and inflammation.

"This population of adults is much more likely to partake in risky behaviors -- for example, using food as a coping mechanism, which can lead to problems with weight and obesity," said first author Jacob Pierce, a fourth-year medical student at Northwestern University Feinberg School of Medicine. "They also have higher rates of smoking, which has a direct link to cardiovascular disease."

Adults who were exposed to these risk factors as children may benefit from counseling on the link between coping with stress and controlling smoking and obesity, but more research is needed, Pierce said.

"Early childhood experiences have a lasting effect on adult mental and physical well-being, and a large number of American kids continue to suffer abuse and dysfunction that will leave a toll of health and social functioning issues throughout their lives," said senior author Joseph Feinglass, research professor of medicine and of preventive medicine at Feinberg. "Social and economic support for young children in the United States, which is low by the standards of other developed countries, has the biggest 'bang for the buck' of any social program."

The study used the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a prospective cohort that has followed participants from recruitment in 1985-1986 through 2018, to determine how childhood psychosocial environment relates to cardiovascular disease incidence and mortality in middle age.

To get a broad idea of what a study participant's family environment was like during their childhood, participants answered survey questions that asked questions such as, "How often did a parent or other adult in the household make you feel that you were loved, supported, and cared for?" or "How often did a parent or other adult in the household swear at you, insult you, put you down or act in a way that made you feel threatened?"

The most predictive of cardiovascular disease later in life was "Did your family know what you were up to as a kid?" Pierce said.

While the study didn't specifically address attentiveness of parents, the findings indicate parents' involvement in their children's lives could impact their health later in life.

https://www.sciencedaily.com/releases/2020/04/200428165751.htm

Analysis predicts purified fish oil could prevent thousands of cardiovascular events

March 25, 2020

Science Daily/University of California - Irvine

Researchers from the University of California, Irvine have conducted a statistical analysis that predicts more than 70,000 heart attacks, strokes and other adverse cardiovascular events could be prevented each year in the U.S. through the use of a highly purified fish oil therapy.

Led by Nathan D. Wong, PhD, professor and director of the Heart Disease Prevention Program in the Division of Cardiology at the UCI School of Medicine, the abstract of the statistical analysis was accepted by the American College of Cardiology and is slated to be presented at the upcoming ACC.20/World Congress of Cardiology virtual conference taking place March 28-30. The analysis utilizes data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES), and inclusion criteria from a multinational clinical trial led by investigators from Harvard University called REDUCE-IT, which was published in the New England Journal of Medicine in January of 2019.

The REDUCE-IT trial showed patients with known cardiovascular disease or diabetes and multiple risk factors who have elevated triglyceride levels and are at increased risk for ischemic events benefitted substantially from icosapent ethyl, a highly purified fish oil therapy, which lowered cardiovascular events, including heart attacks and strokes, by 25 percent. Positive results were not found in other trials, possibly due to mixtures with other omega-3 fatty acids such as DHA, or inadequate dosages according to Wong.

"Our analysis extends the findings of the REDUCE-IT trial by estimating its potential impact on the U.S. population," said Wong. "By using inclusion criteria and cardiovascular disease event rates from the REDUCE-IT trial and applying it to data on US adults from NHANES, we were able to estimate the beneficial impact icosapent ethyl could have on preventing initial and total cardiovascular events in eligible U.S. adults with cardiovascular disease or diabetes and multiple risk factors."

Wong's analysis is the first to project the findings of REDUCE-IT to the overall U.S. population.

"When you consider that for every 21 patients treated with icosapent ethyl you can spare a cardiovascular event, you begin to see the implications of our results," said Wong.

Icosapent ethyl is a purified stable eicosapentaenoic acid (EPA) which was recently approved by the Federal Drug Administration (FDA) in conjunction with maximally tolerated statin therapy to reduce the risk of cardiovascular events in certain adults with elevated triglyceride levels. The only drug of its kind to show such an effect, icosapent ethyl, is currently marketed under the name Vascepa® by Amarin Pharma. The EPA therapy has also gained the support of several major societies, which have incorporated it in various guidelines, scientific statements and advisories, including the American Diabetes Association, American Heart Association, National Lipid Association, and the European Society of Cardiology/European Atherosclerosis Society.

https://www.sciencedaily.com/releases/2020/03/200325131536.htm

Drinks with added sugars linked to lipid imbalance, which increases CVD risk

February 26, 2020

Science Daily/American Heart Association

Drinking 12 ounces of sugary drinks more than once per day is linked to lower levels of high-density lipoprotein cholesterol (HDL-C), ("good" cholesterol), and higher levels of triglycerides, in middle aged and older adults, both of which have been shown to increase risk of cardiovascular disease. These results are from a new observational study published today in the Journal of the American Heart Association, the open access journal of the American Heart Association.

In previous studies, added sugars have been shown to increase cardiovascular disease risk. Beverages such as sodas, sports drinks and fruit-flavored drinks are the largest source of added sugars for Americans.

"For some time, we have known sugary drinks can have a negative effect on Americans' health status, yet the assumption for many is that they only contribute to weight gain," said Eduardo Sanchez, M.D., M.P.H., chief medical officer for prevention and chief of the Center for Health Metrics and Evaluation at the American Heart Association. "This research reinforces our understanding of the potential negative impact sugary drinks have on blood cholesterol, which increases heart disease risk. It is yet one more reason for all of us to cut back on sodas and other sugar-sweetened beverages."

Researchers hypothesized that dyslipidemia could be one pathway by which sugary drinks may increase cardiovascular disease risk. An estimated 40% to 50% of U.S. adults are affected by dyslipidemia, an unhealthy imbalance of cholesterol and triglyceride levels in the blood, which increases the risk of cardiovascular disease.

To determine the association between sugary drinks on triglyceride and cholesterol levels, researchers studied observational medical data of up to 5,924 participants from the Offspring and Generation 3 cohorts of the Framingham Heart Study, who were followed for an average of 12.5 years between 1991 and 2014. The Offspring cohort of the Framingham Heart Study includes the children of original participants in the Framingham Heart Study, and the Generation 3 cohort includes grandchildren of the original participants in the Framingham Heart Study.

For this study, the beverages were defined as: 12 ounces of sugary drinks, such as sodas, fruit-flavored drinks, sports drinks, presweetened coffees and teas; 12 ounces of low-calorie sweetened beverages, including naturally and artificially sweetened "diet" sodas or other flavored drinks; or 8 ounces of 100% fruit juices, including orange, apple, grapefruit and other juices derived from whole fruits with no added sugars. Study participants were classified into five groups according to how often they drank the different beverage types ranging from low intake (<1 serving per month) to high intake (>1 serving per day).

Researchers analyzed how the different drink types and their consumption levels correlated with changes in cholesterol and triglyceride levels over approximately four-year periods. They found that:

• Drinking sugar-sweetened beverages (more than 12 ounces per day) was associated with a 53% higher incidence of high triglycerides and a 98% higher incidence of low HDL cholesterol (the "good" cholesterol) compared to those who drank less than one serving per month;

• Drinking low-calorie sweetened beverages did not appear to be associated with increased dyslipidemia risk among the people who regularly drank low-calorie sweetened beverages; and

• Regularly drinking up to 12 ounces of 100% fruit juice per day was not associated with adverse changes in cholesterol or dyslipidemia, though further research is needed to warrant this finding.

"Reducing the number of or eliminating sugary drink consumption may be one strategy that could help people keep their triglyceride and HDL cholesterol at healthier levels," said lead study author Nicola McKeown, Ph.D., a nutrition epidemiologist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston. "And, while our study didn't find negative consequences on blood lipids from drinking low-calorie sweetened drinks, there may be health consequences of consuming these beverages on other risk factors. Water remains the preferred and healthiest beverage."

While previous cross-sectional studies have had similar findings, this study reaffirms those findings with prospective data. One potential limitation of the study is that participants self-reported their dietary intake.

The American Heart Association recommends people eliminate sugary drink consumption to improve heart health and to reduce the risk of cardiovascular disease.

The National Institutes of Health, the American Heart Association and the U.S. Department of Agriculture's Agricultural Research Service supported the study.

https://www.sciencedaily.com/releases/2020/02/200226072110.htm

Caregiver stress: The crucial, often unrecognized byproduct of chronic disease

September 11, 2019

Science Daily/Elsevier

There is growing evidence that caregivers of patients with cardiovascular disease (CVD) are vulnerable to developing their own poor cardiovascular health. Investigators report in the Canadian Journal of Cardiology, published by Elsevier, on a proof-of-concept couples-based intervention in a cardiac rehabilitation setting. This intervention has shown potential for reducing caregiver distress, and future studies are evaluating its impact on both caregivers' and patients' cardiovascular health.

Nearly half of Canadians have been in caregiving roles to family and friends, with similar figures in the United States and Europe. A caregiver is broadly defined as someone who provides informal or unpaid work to a family member or friend with a chronic condition or disability. Caregivers provide crucial, rarely remunerated support to sick family members or friends. About 40 per cent of caregivers, of whom more than half are women, report high psychological, emotional, physical, social, and financial stresses imposed by the caregiving role. These factors can contribute to a higher risk of CVD among caregivers themselves. However, despite an appreciation of these issues, few approaches have been effective in reducing caregiver stress. This need is expected to increase because pressures on "cardiac" caregivers are projected to rise in the next decade as the population ages, length of hospital stays decline, and CVD and associated risk factors continue to increase.

"It is abundantly clear that caregivers need to be better supported!" said lead investigator Heather Tulloch, PhD, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute (UOHI), and University of Ottawa, Ottawa, ON, Canada. First author, Karen Bouchard, PhD, postdoctoral fellow in behavioral medicine at UOHI added, "Caregivers are critical for patients' cardiovascular health management and are an invaluable healthcare resource, contributing enormously to the Canadian healthcare system. Individuals who care for their partners may experience additional cardiovascular risk -- a risk that should be recognized and to which we should respond."

In this narrative review, investigators look at evidence from the fields of health psychology and relationship science and highlight the direct (e.g., physiological) and indirect (e.g., behavioral, emotional) factors that link caregiver distress with caregivers' own cardiovascular risk. For example, caregivers are more likely to continue to smoke and less likely to be physically active than individuals who provide no or low levels of care; their diets tend to be high in saturated fat intake leading to greater body mass indexes; they spend less time engaging in self-care activities and report poor preventive health behaviors; they experience less or disordered sleep; and demonstrate poor adherence to medication. Spousal caregivers have higher levels of depressive symptoms, physical and financial burden, relationship strain, and lower levels of positive psychological wellbeing compared to adult children caregivers, for example.

The researchers report that the risk of hypertension and metabolic syndrome may be directly related to high-intensity caregiving, defined as providing more than 14 hours of caregiving per week over two consecutive years. They also report findings that estimate the economic contribution of caregivers' unpaid labor to be $26 billion annually in Canada, which is projected to increase to $128 billion by 2035 (likely translating to over a trillion dollars each in the USA and Europe).

The investigators contend that the cardiovascular health of both patient and caregiver could be improved by enhancing the quality of the patient-caregiver relationship. They describe a proof of concept testing of Healing Hearts Together, a relationship-enhancement and educational program for patients and partners. Based on attachment theory, which states that close emotional bonds are essential when faced with a threat such as a cardiac event, the program guides couples through conversations in which they review information on heart health and attachment; share their unique experiences with heart disease with partners and peers; and learn to clearly communicate their need for connection and reassurance. This connection enhances couple satisfaction and problem solving. Participants reported improvements in relationship quality, mental health, and select quality of life measures. A controlled evaluation of the impact of the program on cardiovascular risk factors is underway.

"The aim of Healing Hearts Together is to increase emotional accessibility and responsiveness in couples facing CVD," explained Dr. Tulloch. "Taken together, couples-based interventions in a cardiac rehabilitation setting may be a timely and appropriate approach to reduce caregiver distress and enhance caregivers' comprehensive health outcomes. There is an emerging opportunity to care for those who care for their partners and enhance the health of both. It is important that healthcare professionals recognize the burden of caregiving and act sensitively and strategically to address these challenges."

"Detrimental effects of the caregiving experience are greater among middle-aged caregivers, those known as the 'sandwich generation,' because they balance paid work commitments and interpersonal relationships with care delivery tasks for parents, children, and/or partners," commented Monica Parry, NP-Adult, MEd, MSc, PhD, University of Toronto, Toronto, ON, Canada, in an accompanying editorial. She points out that men and women deal differently with caregiving and, as the landscape of heart disease in women is changing, so must our approach and understanding of the caregiving experiences of men. For example, male caregivers may struggle with the societal views of caring; feel invisible at times; and may be unsure how to assimilate the caring role, masculinity, and accessing help for themselves. "We are facing an epidemic of caregiver burden. Caregivers cannot remain under-researched, under-diagnosed, under-treated and/or under-supported," she concluded.

https://www.sciencedaily.com/releases/2019/09/190911091400.htm

High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases

January 10, 2019

Science Daily/The Lancet

Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fiber a day, according to a series of systematic reviews and meta-analyses.

People who eat higher levels of dietary fibre and whole grains have lower rates of non-communicable diseases compared with people who eat lesser amounts, while links for low glycaemic load and low glycaemic index diets are less clear. Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fibre a day, according to a series of systematic reviews and meta-analyses published in The Lancet.

The results suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Per 1,000 participants, the impact translates into 13 fewer deaths and six fewer cases of coronary heart disease.

In addition, a meta-analysis of clinical trials suggested that increasing fibre intakes was associated with lower bodyweight and cholesterol, compared with lower intakes.

The study was commissioned by the World Health Organization to inform the development of new recommendations for optimal daily fibre intake and to determine which types of carbohydrate provide the best protection against non-communicable diseases (NCDs) and weight gain.

Most people worldwide consume less than 20 g of dietary fibre per day. In 2015, the UK Scientific Advisory Committee on Nutrition recommended an increase in dietary fibre intake to 30 g per day, but only 9% of UK adults manage to reach this target. In the US, fibre intake among adults averages 15 g a day. Rich sources of dietary fibre include whole grains, pulses, vegetables and fruit.

"Previous reviews and meta-analyses have usually examined a single indicator of carbohydrate quality and a limited number of diseases so it has not been possible to establish which foods to recommend for protecting against a range of conditions," says corresponding author Professor Jim Mann, the University of Otago, New Zealand.

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

The researchers included 185 observational studies containing data that relate to 135 million person years and 58 clinical trials involving 4,635 adult participants. They focused on premature deaths from and incidence of coronary heart disease, cardiovascular disease and stroke, as well as incidence of type 2 diabetes, colorectal cancer and cancers associated with obesity: breast, endometrial, esophageal and prostate cancer. The authors only included studies with healthy participants, so the findings cannot be applied to people with existing chronic diseases.

For every 8g increase of dietary fibre eaten per day, total deaths and incidence of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 5-27%. Protection against stroke, and breast cancer also increased. Consuming 25g to 29g each day was adequate but the data suggest that higher intakes of dietary fibre could provide even greater protection.

For every 15g increase of whole grains eaten per day, total deaths and incidence of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 2-19%. Higher intakes of whole grains were associated with a 13-33% reduction in NCD risk -- translating into 26 fewer deaths per 1,000 people from all-cause mortality and seven fewer cases of coronary heart disease per 1,000 people. The meta-analysis of clinical trials involving whole grains showed a reduction in bodyweight. Whole grains are high in dietary fibre, which could explain their beneficial effects.

The study also found that diets with a low glycaemic index and low glycaemic load provided limited support for protection against type 2 diabetes and stroke only. Foods with a low glycaemic index or low glycaemic load may also contain added sugars, saturated fats, and sodium. This may account for the links to health being less clear.

"The health benefits of fibre are supported by over 100 years of research into its chemistry, physical properties, physiology and effects on metabolism. Fibre-rich whole foods that require chewing and retain much of their structure in the gut increase satiety and help weight control and can favourably influence lipid and glucose levels. The breakdown of fibre in the large bowel by the resident bacteria has additional wide-ranging effects including protection from colorectal cancer." says Professor Jim Mann.

While their study did not show any risks associated with dietary fibre, the authors note that high intakes might have ill-effects for people with low iron or mineral levels, for whom high levels of whole grains can further reduce iron levels. They also note that the study mainly relates to naturally-occurring fibre rich foods rather than synthetic and extracted fibre, such as powders, that can be added to foods.

Commenting on the implications and limitations of the study, Professor Gary Frost, Imperial College London, UK, says, "[The authors] report findings from both prospective cohort studies and randomised controlled trials in tandem. This method enables us to understand how altering the quality of carbohydrate intake in randomised controlled trials affects non-communicable disease risk factors and how these changes in diet quality align with disease incidence in prospective cohort studies. This alignment is seen beautifully for dietary fibre intake, in which observational studies reveal a reduction in all-cause and cardiovascular mortality, which is associated with a reduction in bodyweight, total cholesterol, LDL cholesterol, and systolic blood pressure reported in randomised controlled trials... There are some important considerations that arise from this Article. First, total carbohydrate intake was not considered in the systematic review and meta-analysis... Second, although the absence of association between glycaemic index and load with non-communicable disease and risk factors is consistent with another recent systematic review, caution is needed when interpreting these data, as the number of studies is small and findings are heterogeneous. Third, the absence of quantifiable and objective biomarkers for assessing carbohydrate intake means dietary research relies on self-reported intake, which is prone to error and misreporting. Improving the accuracy of dietary assessment is a priority area for nutrition research. The analyses presented by Reynolds and colleagues provides compelling evidence that dietary fibre and whole grain are major determinants of numerous health outcomes and should form part of public health policy."

https://www.sciencedaily.com/releases/2019/01/190110184737.htm

Even light drinking increases risk of death

At any age, daily drinkers 20 percent more likely to die prematurely than less frequent drinkers

October 3, 2018

Science Daily/Washington University School of Medicine

Analyzing data from more than 400,000 people, researchers have found that consuming one to two drinks four or more times per week -- an amount deemed healthy by current guidelines -- increases the risk of premature death by 20 percent.

Drinking a daily glass of wine for health reasons may not be so healthy after all, suggests a new study from Washington University School of Medicine in St. Louis.

Analyzing data from more than 400,000 people ages 18 to 85, the researchers found that consuming one to two drinks four or more times per week -- an amount deemed healthy by current guidelines -- increases the risk of premature death by 20 percent, compared with drinking three times a week or less. The increased risk of death was consistent across age groups.

The study is published online Oct. 3 in the journal Alcoholism: Clinical & Experimental Research.

"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," said first author Sarah M. Hartz, MD, PhD, an assistant professor of psychiatry. "But now we know that even the lightest daily drinkers have an increased mortality risk."

Although some earlier studies have linked light drinking to improvements in cardiovascular health, Hartz said the new study shows that those potential gains are outweighed by other risks. Her team evaluated heart disease risk and cancer risk and found that although in some cases, drinking alcohol may reduce risk of heart-related problems, daily drinking increased cancer risk and, as a result, mortality risk.

"Consuming one or two drinks about four days per week seemed to protect against cardiovascular disease, but drinking every day eliminated those benefits," she said. "With regard to cancer risk, any drinking at all was detrimental."

The new study comes on the heels of research published in The Lancet, which reviewed data from more than 700 studies around the world and concluded that the safest level of drinking is none. But that study looked at all types of drinking -- from light alcohol consumption to binge drinking. The Washington University team analysis focused on light drinkers: those who consumed only one or two drinks a day.

The Washington University study focused on two large groups of people in the United States: 340,668 participants, ages 18-85, in the National Health Interview Survey, and another 93,653 individuals, ages 40-60 who were treated as outpatients at Veterans Administration clinics.

"A 20 percent increase in risk of death is a much bigger deal in older people who already are at higher risk," Hartz explained. "Relatively few people die in their 20s, so a 20 percent increase in mortality is small but still significant. 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."

She predicted that as medicine becomes more personalized, some doctors may recommend that people with family histories of heart problems have a drink from time to time, but in families with a history of cancer, physicians may recommend abstinence.

"If you tailor medical recommendations to an individual person, there may be situations under which you would think that occasional drinking potentially could be helpful," she said. "But overall, I do think people should no longer consider a glass of wine a day to somehow be healthy."

https://www.sciencedaily.com/releases/2018/10/181003102732.htm

Study found people would rather pop a pill or sip tea than exercise to treat high blood pressure

April 8, 2018

Science Daily/American Heart Association

Survey respondents were more likely to choose a daily cup of tea or a pill over exercise to 'treat' high blood pressure in an imaginary scenario, but many didn't think the interventions were worth the benefits. When the perceived gain of treating hypertension was higher -- one or five extra years of life versus one extra month, for example -- survey respondents were more likely to say they would.

Researchers wanted to find out how people weigh the benefits of high blood pressure treatment options against its inconvenience. They asked survey respondents to imagine that they had high blood pressure and then asked about their willingness to adopt any of four "treatments" to gain an extra month, year or five years of life. In this survey, the "treatments" proposed were: a daily cup of tea, exercise, pills or monthly or semi-annual injections.

Results showed that taking a pill or drinking a daily up of tea were the preferred treatments, though some were unwilling to adopt any intervention even if it meant gaining an additional year or five years of life. For each treatment, participants were more likely to say they would adopt it if the benefit were greater:

·     79 percent of respondents said they would be willing to take a pill for an extra month of life, 90 percent would for an extra year of life and 96 percent would for an extra five years of life;

·     78 percent said they would drink a daily cup of tea for one extra month of life, 91 percent would for one extra year of life and 96 percent would drink it for an extra five years of life;

·     63 percent would be willing to exercise for an extra month of life, 84 percent would for an extra year of life and 93 percent would exercise if it meant an extra five years of life;

·     A shot was the least preferred of the options -- 68 percent would take a shot every six months if it would give them an extra month of life, 85 percent would do it for an extra year of life and 93 percent would be willing if it gave them another five years, but only about half (51 percent) would take a monthly shot for an extra month of life, 74 percent would for an extra year and 88 percent would opt for an injection every month if it gave them five extra years of life.

In addition, at least 20 percent of respondents wanted to achieve gains in life expectancy beyond what any of the individual interventions could provide.

"Our findings demonstrate that people naturally assign different weights to the pluses and minuses of interventions to improve cardiovascular health," said Erica Spatz, M.D., M.H.S., the study lead author and an assistant professor of cardiovascular medicine in the Center for Outcomes Research and Evaluation at Yale School of Medicine in New Haven, CT. "I believe we need to tap into this framework when we are talking with patients about options to manage their blood pressure. We are good about discussing side effects, but rarely do we find out if other inconveniences or burdens may be impacting a person's willingness to take a lifelong medication or to exercise regularly."

From March to June 2017, 1,284 U.S. adults recruited through Amazon MTurk and 100 patients attending an outpatient health clinic completed the survey. Most survey respondents were under 45 years old, and half were female. Roughly three-quarters of respondents were non-Hispanic white, 10 percent were African American, 7 percent were Hispanic or Latino, and 8 percent were Asian. Most had high blood pressure.

A study limitation is that most respondents were relatively young. Since cardiovascular disease is more common among older people, they may have different responses than younger people. Another limitation is that survey respondents were not told the true life-extending ability of each intervention.

High blood pressure is a leading risk factor for heart and blood vessel, or cardiovascular, disease. Yet, it is often called the silent killer because it causes no symptoms. To prevent high blood pressure, the American Heart Association recommends getting regular physical activity, in addition to other lifestyle changes. These changes include eating a healthy diet, limiting alcohol, managing stress, maintaining a healthy weight, and quitting smoking. It is also important to work with a healthcare provider and to properly take medications, if prescribed, to reduce blood pressure.

https://www.sciencedaily.com/releases/2018/04/180408190404.htm

PTSD, traumatic experiences may raise heart attack, stroke risk in women

June 29, 2015

Science Daily/American Heart Association

Women with severe PTSD or traumatic events may have a 60 percent higher lifetime risk of cardiovascular disease. The study is the first to examine trauma exposure, PTSD, and onset of cardiovascular disease exclusively in women. Researchers suggest physicians ask women about traumatic events and PTSD symptoms and then monitor them for cardiovascular issues.

In the first major study of PTSD and onset of cardiovascular disease (both heart attacks and strokes) exclusively in women, researchers examined about 50,000 participants in the Nurses' Health Study II over 20 years.

PTSD occurs in some people after traumatic events (such as a natural disaster, unwanted sexual contact or physical assault). Patients may experience flashbacks of the trauma, insomnia, fatigue, trouble remembering or concentrating, and emotional numbing. Other symptoms include nightmares, irritability or being startled easily. PTSD is twice as common in women as in men.

In the study:

Women with four or more PTSD symptoms had 60 percent higher rates of cardiovascular disease compared to women who weren't exposed to traumatic events.

Women with no PTSD symptoms but who reported traumatic events had 45 percent higher rates of cardiovascular disease. Almost half of the association between elevated PTSD symptoms and cardiovascular disease was accounted for by unhealthy behaviors like smoking, obesity, lack of exercise and medical factors such as high blood pressure. "PTSD is generally considered a psychological problem, but the take-home message from our findings is that it also has a profound impact on physical health, especially cardiovascular risk," said Jennifer Sumner, Ph.D., lead author and an Epidemiology Merit Fellow at Columbia University's Mailman School of Public Health in New York City and a Visiting Scientist at the Harvard T.H. Chan School of Public Health in Boston. "This is not exclusively a mental problem -- it's a potentially deadly problem of the body as well."

Most studies of cardiovascular disease risk in PTSD patients have been conducted in men who have served in the military or among disaster survivors.

The current study, conducted by a team of researchers at Columbia and Harvard-Chan, is unique in that it examined women from the community who were exposed to a variety of traumatic events.

Our results provide further evidence that PTSD increases the risk of chronic disease," said. Karestan C. Koenen, the study's senior author and Professor of Epidemiology at Columbia University Mailman School of Public Health and Harvard T. H. Chan School of Public Health. "The medical system needs to stop treating the mind and the body as if they are separate. Patients need access to integrated mental and physical healthcare."

Researchers used a questionnaire to evaluate different types of traumatic experiences and PTSD symptoms. They also considered cardiovascular disease risk factors such as obesity, lack of exercise, diabetes, cigarette smoking, high blood pressure, and other contributors to cardiovascular health such as excessive alcohol use, and hormone replacement use.

PTSD emerged as a risk factor for cardiovascular disease in a sample of women under the age of 65. Physicians should be aware of this link and screen for cardiovascular disease risk, as well as monitor related health conditions and behaviors, including encouraging changes in lifestyle factors that may increase this risk, Sumner said.

More than half of the people in the United States who suffer from PTSD don't get treatment, especially minorities. Women need to get mental healthcare to treat symptoms as well as be monitored for signs of cardiovascular problems, she said.

http://www.sciencedaily.com/releases/2015/06/150629175956.htm

Reassessing the benefits of plant-based eating

August 29, 2017

Science Daily/European Society of Cardiology

A large dietary study from 18 countries, across seven geographic regions has found that even relatively moderate intake of fruit, vegetables and legumes such as beans and lentils may lower a person's risk of cardiovascular disease (CVD) and death.

Analysis of the Prospective Urban Rural Epidemiology (PURE) study was presented at ESC Congress today1 and published in the Lancet.

"To our knowledge, this is the first study to report on the associations of fruit, vegetable and legume intake with CVD risk in countries at varying economic levels and from different regions," said study investigator Dr Andrew Mente, PhD, from the Population Health Research Institute, McMaster University, Hamilton, Canada.

"Previous research, and many dietary guidelines in North America and Europe recommended daily intake of these foods ranging from 400 to 800 grams per day, but this is unaffordable for many people in low to middle-income countries," he explained.

"Our findings indicate that optimal health benefits can be achieved with a more modest level of consumption, an approach that is likely to be much more affordable."

Using country-specific food frequency questionnaires, PURE documented diet in 135,335 individuals, aged 35 to 70 years, from countries in North America and Europe, South America, the Middle East, South Asia, China, South East Asia and Africa.

For this analysis, investigators assessed associations between fruit, vegetable, and legume consumption at baseline and risk of CVD and mortality after a median of 7.4 years of follow-up.

Looking at the total of 5,796 deaths, 1,649 CV deaths, and 4,784 major CVD events, and adjusting for demographic, lifestyle, health, and dietary factors, the study showed greater fruit, vegetable, and legume intake was associated with lower total mortality, and non-CV mortality.

Of particular importance, an intake of 3 to 4 servings per day (equivalent to 375-500 grams per day) was just as beneficial on total mortality as higher amounts (hazard ratio [HR] of 0·78; 95% CI 0·69 to 0·88).

Looking at the dietary components separately showed that the benefits were attributable to fruit and legumes, with vegetable intake not significantly associated with improved outcomes.

Specifically, compared to fewer than three servings of fruit per week, more than 3 per day was associated with an 18% reduced risk in non-CV mortality (HR: 0·82: 95% CI 0·70 to 0·97; P-trend=0·0008), and 19% reduction in total mortality (HR: 0·81; 95% CI 0·72 to 0·93; P-trend<0·0001).

Regarding legumes, higher consumption was associated with significant reduction in both non-CV mortality and total mortality risk.

As compared with less than one serving of legumes per month, more than one serving per day was associated with an 18% reduction in non-CV mortality (95% CI 0·70 to 0·97; P-trend=0·0019) and a 26% reduction in total mortality (95% CI 0·64 to 0·86; P-trend=0·0013).

Finally, comparing vegetable preparation, the study showed a trend towards lower risk of cardiovascular disease and death with raw versus cooked vegetable intake "but raw vegetables are rarely eaten in South Asia, Africa and Southeast Asia," said Dr. Mente.

"Since, dietary guidelines do not differentiate between the benefits of raw versus cooked vegetables -- our results indicate that recommendations should emphasize raw vegetable intake over cooked."

In conclusion he said that findings from the study "are robust, globally applicable and provide evidence to inform nutrition policies. Many people in the world don't consume an optimal amount of fruit, vegetables and legumes. The PURE data add to the substantial evidence from many studies and extend them globally."

https://www.sciencedaily.com/releases/2017/08/170829091009.htm

PTSD, traumatic experiences may raise heart attack, stroke risk in women

June 29, 2015

Science Daily/American Heart Association

Women with severe PTSD or traumatic events may have a 60 percent higher lifetime risk of cardiovascular disease. The study is the first to examine trauma exposure, PTSD, and onset of cardiovascular disease exclusively in women. Researchers suggest physicians ask women about traumatic events and PTSD symptoms and then monitor them for cardiovascular issues.

In the first major study of PTSD and onset of cardiovascular disease (both heart attacks and strokes) exclusively in women, researchers examined about 50,000 participants in the Nurses' Health Study II over 20 years.

PTSD occurs in some people after traumatic events (such as a natural disaster, unwanted sexual contact or physical assault). Patients may experience flashbacks of the trauma, insomnia, fatigue, trouble remembering or concentrating, and emotional numbing. Other symptoms include nightmares, irritability or being startled easily. PTSD is twice as common in women as in men.

In the study:

Women with four or more PTSD symptoms had 60 percent higher rates of cardiovascular disease compared to women who weren't exposed to traumatic events.

Women with no PTSD symptoms but who reported traumatic events had 45 percent higher rates of cardiovascular disease. Almost half of the association between elevated PTSD symptoms and cardiovascular disease was accounted for by unhealthy behaviors like smoking, obesity, lack of exercise and medical factors such as high blood pressure. "PTSD is generally considered a psychological problem, but the take-home message from our findings is that it also has a profound impact on physical health, especially cardiovascular risk," said Jennifer Sumner, Ph.D., lead author and an Epidemiology Merit Fellow at Columbia University's Mailman School of Public Health in New York City and a Visiting Scientist at the Harvard T.H. Chan School of Public Health in Boston. "This is not exclusively a mental problem -- it's a potentially deadly problem of the body as well."

Most studies of cardiovascular disease risk in PTSD patients have been conducted in men who have served in the military or among disaster survivors.

The current study, conducted by a team of researchers at Columbia and Harvard-Chan, is unique in that it examined women from the community who were exposed to a variety of traumatic events.

Our results provide further evidence that PTSD increases the risk of chronic disease," said. Karestan C. Koenen, the study's senior author and Professor of Epidemiology at Columbia University Mailman School of Public Health and Harvard T. H. Chan School of Public Health. "The medical system needs to stop treating the mind and the body as if they are separate. Patients need access to integrated mental and physical healthcare."

Researchers used a questionnaire to evaluate different types of traumatic experiences and PTSD symptoms. They also considered cardiovascular disease risk factors such as obesity, lack of exercise, diabetes, cigarette smoking, high blood pressure, and other contributors to cardiovascular health such as excessive alcohol use, and hormone replacement use.

PTSD emerged as a risk factor for cardiovascular disease in a sample of women under the age of 65. Physicians should be aware of this link and screen for cardiovascular disease risk, as well as monitor related health conditions and behaviors, including encouraging changes in lifestyle factors that may increase this risk, Sumner said.

More than half of the people in the United States who suffer from PTSD don't get treatment, especially minorities. Women need to get mental healthcare to treat symptoms as well as be monitored for signs of cardiovascular problems, she said.

http://www.sciencedaily.com/releases/2015/06/150629175956.htm

Poor Sleep in Adolescents May Increase Risk of Heart Disease

October 1, 2012

Science Daily/Canadian Medical Association Journal

Adolescents who sleep poorly may be at risk of cardiovascular disease in later life, according to a study in CMAJ (Canadian Medical Association Journal).

"We found an association between sleep disturbance and cardiovascular risk in adolescents, as determined by high cholesterol levels, increased BMI [body mass index] and hypertension," writes lead author Dr. Indra Narang, respirologist and director of sleep medicine at The Hospital for Sick Children (SickKids), Toronto, Ontario, with coauthors. "These findings are important, given that sleep disturbance is highly prevalent in adolescence and that cardiovascular disease risk factors track from childhood into adulthood."

Approximately 20% of adolescents have significant sleep problems, such as sleep disturbances or sleep deprivation. Sleep disturbances include frequent waking up during the night, early wakening, inability to fall asleep within 30 minutes, restlessness and bad dreams.

Students who consumed more fried foods, soft drinks, sweets and caffeinated drinks exercised less and had more screen time had higher sleep disturbance scores. A higher sleep disturbance score was associated with a higher cholesterol level, higher BMI, larger waist size, higher blood pressure and increased risk of hypertension. Shorter sleep duration was also associated with higher BMI and waist size but not increased cholesterol levels or blood pressure.

"In addition to these health risks, previous studies have shown that poor sleep also negatively impacts school performance. Parents should monitor caffeine intake, bedtimes and bedrooms overloaded with media," says Dr. Brian McCrindle, senior author and cardiologist at SickKids.

http://www.sciencedaily.com/releases/2012/10/121001124753.htm

Inflammation in those with PTSD linked to changes in microRNA

- April 24, 2014

Science Daily/University of South Carolina

With a new generation of military veterans returning home from Iraq and Afghanistan, post-traumatic stress disorder (PTSD) has become a prominent concern in American medical institutions and the culture at-large. Estimates indicate that as many as 35 percent of personnel deployed to Iraq and Afghanistan suffer from PTSD. New research is shedding light on how PTSD is linked to other diseases in fundamental and surprising ways.

The rise in PTSD has implications beyond the impact of the psychiatric disorder and its immediate consequences, which include elevated suicide risk and inability to lead a normal life, that result in approximately $3 billion in lost productivity every year. Over time, these PTSD patients will continue to experience increased risks of a myriad of medical conditions like cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, musculoskeletal disorders and others, all of which share chronic inflammation as a common underlying cause.

Dr. Mitzi Nagarkatti sums up the significance of this study as follows: "We are very excited about these results. Thus far, no one had looked at the role of microRNA in the blood of PTSD patients. Thus, our finding that the alterations in these small molecules are connected to higher inflammation seen in these patients is very interesting and helps establish the connection between war trauma and microRNA changes."

In addition to the alterations in microRNA expression, the study also found that PTSD patients had higher levels of inflammation caused by certain types of immune cells called T cells. These T cells produced higher levels of inflammatory mediators called cytokines, specifically interferon-gamma and interleukin-17. This finding was especially interesting because one of the inflammation-associated microRNAs, miR-125a, which specifically targets increased production of interferon-gamma, was found to have decreased expression in the PTSD patients studied. Overall, these results suggested that trauma may cause alterations in the expression of microRNA which promote inflammation in PTSD patients.

Commenting on this, Dr. Prakash Nagarkatti said, "These studies form the foundation to further analyze the role of microRNA in PTSD. Trauma experienced during war may trigger changes in microRNA which may in turn cause various clinical disorders seen in PTSD patients. Our long-term goal is to identify whether PTSD patients express a unique signature profile of microRNA which can be used towards early detection, prevention and treatment of PTSD."

http://www.sciencedaily.com/releases/2014/04/140424102843.htm