To reap heart benefits of a plant-based diet, avoid junk food

Plant-based diet found to reduce cardiovascular risk, but only if foods are healthful

March 18, 2020

Science Daily/American College of Cardiology

Plant-based diets are becoming more popular in many areas of the world, but the health benefits of this dietary pattern may depend largely on the specific foods consumed. A new study being presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC) suggests that people following a plant-based diet who frequently consumed less-healthful foods like sweets, refined grains and juice showed no heart health benefit compared with those who did not eat a plant-based diet.

"Based on these results, it seems that simply following a plant-based or vegetarian diet is not enough to reduce cardiovascular disease risk," said Demosthenes Panagiotakos, PhD, professor of biostatistics, research methods and epidemiology at Harokopio University of Athens, Greece and the study's lead author. "It is also important to focus on specific, healthful plant-based food groups to see a benefit in terms of reducing cardiovascular disease."

Researchers tracked eating behavior and the development of heart disease among more than 2,000 Greek adults over a 10-year period, beginning in 2002. Participants were asked to complete a detailed food frequency survey at the time of enrollment, after five years and after 10 years.

At the end of the study period, researchers analyzed the relationship between diet and the development of cardiovascular disease using a dietary index that divided participants into three groups based on the number of animal-based foods (which included meats as well as animal-derived products such as eggs and dairy) they consumed per day. Overall, men eating fewer animal-based foods were 25% less likely to develop heart disease compared to men eating more animal-based foods. The same overall trend was seen in women, but the relationship was less strong, with an overall risk reduction of about 11% among women eating the fewest animal-based foods.

Even though the difference in cardiovascular disease risk was significant between these groups, the overall difference in consumption of animal-based foods was relatively small. Those following a more plant-based diet consumed, on average, three animal-based foods daily while those following a less plant-based diet consumed five.

"These findings highlight that even a small reduction in the daily consumption of animal-based products -- principally the less healthy foods, such as processed meat products -- accompanied by an increase in healthy plant-based foods may contribute to better cardiovascular health," Panagiotakos said.

Focusing in on participants who followed a more plant-based diet, researchers then categorized each participant's diet as either healthful (reflecting increased consumption of fruits, vegetables, whole grains, nuts, legumes, oils and tea or coffee) or unhealthful (reflecting increased consumption of juices,

sweetened beverages, refined grains, potatoes and sweets). Only participants following a healthful plant-based diet had a significant reduction in cardiovascular risk compared to those who ate more animal-based products.

Differences in eating patterns -- and associated cardiovascular risk reduction -- were also observed between women and men. In general, men ate about three times per day while women tended to snack more, eating four to five times daily. At the same time, women showed a more dramatic increase in heart disease risk when eating an unhealthful plant-based diet and a more dramatic reduction in risk when eating a healthful plant-based diet compared to men who fell into the same two categories. This suggests that snacking on healthful foods can be beneficial while snacking on unhealthful foods can bring higher risks, Panagiotakos said.

The study was limited by its reliance on questionnaires to track participants' diets. However, the findings bolster evidence for the heart health benefits of a plant-based diet and could help inform future dietary guidance for prevention of cardiovascular disease.

"In the future, I believe it will be useful if cardiovascular disease prevention guidelines offer clearer and specific nutrition suggestions, in terms of the types of foods that are recommended and the portions that should be consumed," Panagiotakos said.

https://www.sciencedaily.com/releases/2020/03/200318104449.htm

Depression associated with greater risk of cardiovascular disease

The global study tracked 145,862 middle-aged participants from 21 countries

June 16, 2020

Science Daily/Simon Fraser University

A new study co-led by Simon Fraser University health sciences professor Scott Lear provides further evidence of the link between depressive symptoms and an increased risk of heart disease and early death.

The global study tracked 145,862 middle-aged participants from 21 countries and found a 20 per cent increase in cardiovascular events and death in people with four or more depressive symptoms. The risks were twice as high in urban areas -- where the majority of the global population will be living by 2050 -- and more than double in men.

Depression and mental health issues are highly prevalent in Canada. One in five Canadians will experience a mental health problem during their lifetime and eight per cent will experience a major depressive event.

Lear says the results are timely as experts anticipate an increase in the number of people dealing with mental health issues as a result of the COVID-19 pandemic.

The data suggests that depressive symptoms should be considered as important as traditional risk factors such as smoking, high blood pressure and high cholesterol when preventing heart disease and early death.

The study results, published this month in JAMA Psychiatry, lend credibility to existing World Health Organization (WHO) policies to integrate treatment and prevention of mental disorders into primary care.

The study concludes that a greater awareness of the physical health risks associated with depression is needed.

Researchers suggest that a comprehensive approach to tackling non-communicable diseases and mental disorders -- to achieve health-related UN Sustainable Development Goals -- needs to be a global priority.

https://www.sciencedaily.com/releases/2020/06/200616100817.htm

Study links frequent red meat consumption to high levels of chemical associated with heart disease

Findings reveal tripling of blood levels of TMAO from red meat diet, but dietary effects can be reversed

December 11, 2018

Science Daily/NIH/National Heart, Lung and Blood Institute

Researchers have identified another reason to limit red meat consumption: high levels of a gut-generated chemical called trimethylamine N-oxide (TMAO), that also is linked to heart disease. Scientists found that people who eat a diet rich in red meat have triple the TMAO levels of those who eat a diet rich in either white meat or mostly plant-based proteins, but discontinuation of red meat eventually lowers those TMAO levels.

TMAO is a dietary byproduct that is formed by gut bacteria during digestion and is derived in part from nutrients that are abundant in red meat. While high saturated fat levels in red meat have long been known to contribute to heart disease -- the leading cause of death in the United States -- a growing number of studies have identified TMAO as another culprit. Until now, researchers knew little about how typical dietary patterns influence TMAO production or elimination.

The findings suggest that measuring and targeting TMAO levels -- something doctors can do with a simple blood test -- may be a promising new strategy for individualizing diets and helping to prevent heart disease. The study was funded largely by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. It will be published Dec. 10 in the European Heart Journal, a publication of the European Society of Cardiology.

"These findings reinforce current dietary recommendations that encourage all ages to follow a heart-healthy eating plan that limits red meat," said Charlotte Pratt, Ph.D., the NHLBI project officer for the study and a nutrition researcher and Deputy Chief of the Clinical Applications & Prevention Branch, Division of Cardiovascular Sciences, NHLBI. "This means eating a variety of foods, including more vegetables, fruits, whole grains, low-fat dairy foods, and plant-based protein sources such as beans and peas."

"This study shows for the first time what a dramatic effect changing your diet has on levels of TMAO, which is increasingly linked to heart disease," said Stanley L. Hazen, M.D., Ph.D., senior author of the study and section head of Preventive Cardiology & Rehabilitation at the Cleveland Clinic. "It suggests that you can lower your heart disease risk by lowering TMAO."

Hazen estimated that as many as a quarter of middle-aged Americans have naturally elevated TMAO levels, which are made worse by chronic red meat consumption. However, every person's TMAO profile appears to be different, so tracking this chemical marker, Hazen suggested, could be an important step in using personalized medicine to fight heart disease.

For the study, researchers enrolled 113 healthy men and women in a clinical trial to examine the effects of dietary protein -- in the form of red meat, white meat, or non-meat sources -- on TMAO production. All subjects were placed on each diet for a month in random order. When on the red meat diet, the participants consumed roughly the equivalent of about 8 ounces of steak daily, or two quarter-pound beef patties. After one month, researchers found that, on average, blood levels of TMAO in these participants tripled, compared to when they were on the diets high in either white meat or non-meat protein sources.

While all diets contained equal amounts of calories, half of the participants were also placed on high-fat versions of the three diets, and the researchers observed similar results. Thus, the effects of the protein source on TMAO levels were independent of dietary fat intake.

Importantly, the researchers discovered that the TMAO increases were reversible. When the subjects discontinued their red meat diet and moved to either a white meat or non-meat diet for another month, their TMAO levels decreased significantly.

The exact mechanisms by which TMAO affects heart disease is complex. Prior research has shown TMAO enhances cholesterol deposits into cells of the artery wall. Studies by the researchers also suggest that the chemical interacts with platelets -- blood cells that are responsible for normal clotting responses -- in a way that increases the risk for clot-related events such as heart attack and stroke.

TMAO measurement is currently available as a quick, simple blood test first developed by Hazen's laboratory. In recent published studies, he and his colleagues reported development of a new class of drugs that are capable of lowering TMAO levels in the blood and reducing atherosclerosis and clotting risks in animal models, but those drugs are still experimental and not yet available to the public.

https://www.sciencedaily.com/releases/2018/12/181211084948.htm

Sitting is bad for your brain -- not just your metabolism or heart

Thinning in brain regions important for memory linked to sedentary habits

April 12, 2018

Science Daily/University of California - Los Angeles

Studies show that too much sitting, like smoking, increases the risk of heart disease, diabetes and premature death. Researchers found sedentary behavior is linked to thinning in regions of the brain that are critical to memory formation.

UCLA researchers recruited 35 people ages 45 to 75 and asked about their physical activity levels and the average number of hours per day they spent sitting over the previous week. Each person had a high-resolution MRI scan, which provides a detailed look at the medial temporal lobe, or MTL, a brain region involved in the formation of new memories.

The researchers found that sedentary behavior is a significant predictor of thinning of the MTL and that physical activity, even at high levels, is insufficient to offset the harmful effects of sitting for extended periods.

This study does not prove that too much sitting causes thinner brain structures, but instead that more hours spent sitting are associated with thinner regions, researchers said. In addition, the researchers focused on the hours spent sitting, but did not ask participants if they took breaks during this time.

The researchers next hope to follow a group of people for a longer duration to determine if sitting causes the thinning and what role gender, race, and weight might play in brain health related to sitting.

MTL thinning can be a precursor to cognitive decline and dementia in middle-aged and older adults. Reducing sedentary behavior may be a possible target for interventions designed to improve brain health in people at risk for Alzheimer's disease, researchers said.

https://www.sciencedaily.com/releases/2018/04/180412141014.htm

Known risk factors largely explain links between loneliness and first time heart disease/stroke

But social isolation still associated with death among those with preexisting cardiovascular disease

March 26, 2018

Science Daily/BMJ

Conventional risk factors largely explain the links observed between loneliness/social isolation and first time heart disease/stroke, a new study finds. But having few social contacts still remains an independent risk factor for death among those with pre-existing cardiovascular disease.

Recent research has increasingly highlighted links between loneliness and social isolation and cardiovascular disease and death. But most of these studies have not considered a wide range of other potentially influential factors, say the authors.

In a bid to clarify what role these other factors might have, they drew on data from nearly 480,000 people aged between 40 and 69, who were all part of the UK Biobank study between 2007 and 2010.

Participants provided detailed information on their ethnic background, educational attainment, household income, lifestyle (smoking, drinking, exercise) and depressive symptoms.

They were also asked a series of questions to gauge their levels of social isolation and loneliness. Height, weight, and grip strength were measured, and blood samples taken.

Their health was then tracked for an average of 7 years.

Nearly one in 10 (9%) respondents were deemed to be socially isolated, 6 percent lonely, and 1 percent both.

Those who were socially isolated and/or lonely were more likely to have other underlying long term conditions and to be smokers, while those who were lonely reported more depressive symptoms.

During the 7 year monitoring period, 12,478 people died. And 5731 people had a first time heart attack while 3471 had a first time stroke.

Social isolation was associated with a 43 percent higher risk of first time heart attack, when age, sex, and ethnicity were factored in.

But when behavioural, psychological, health, and socioeconomic factors were added into the mix, these factors accounted for most (84%) of the increased risk, and the initial association was no longer significant.

Similarly, social isolation was initially associated with a 39 percent heightened risk of a first time stroke, but the other conventional risk factors accounted for 83 percent of this risk.

Similar results were observed for loneliness and risk of first time heart attack or stroke.

But this was not the case for those with pre-existing cardiovascular disease among whom social isolation was initially associated with a 50 percent heightened risk of death. Although this halved when all the other known factors were considered, it was still 25 percent higher.

Similarly, social isolation was associated with a 32 percent heightened risk of death even after all the other conventional factors had been accounted for.

This is an observational study so no firm conclusions can be drawn about cause and effect, but the findings echo those of other research in the field, say the study authors.

And the size and representative nature of the study prompt the authors to conclude that their findings "indicate that social isolation, similarly to other risk factors such as depression, can be regarded as a risk factor for poor prognosis of individuals with cardiovascular disease."

This is important, they emphasise, as around a quarter of all strokes are recurrent, and targeting treatment of conventional risk factors among the lonely and isolated might help stave off further heart attacks and strokes, they suggest.

https://www.sciencedaily.com/releases/2018/03/180326213304.htm

Obesity, Depression Found to Be Root Causes of Daytime Sleepiness

June 13, 2012

Science Daily/American Academy of Sleep Medicine

Three new studies conclude that obesity and depression are the main culprits making Americans excessively sleepy while awake. Researchers examined a random population sample of 1,741 adults and determined that obesity and emotional stress are the main causes of an "epidemic" of sleepiness and fatigue plaguing the country. Insufficient sleep and obstructive sleep apnea also play a role; both have been linked to high blood pressure, heart disease, stroke, depression, diabetes, obesity and accidents.

Wake up, America, and lose some weight -- it's keeping you tired and prone to accidents. Three studies being presented June 13 at sleep 2012 conclude that obesity and depression are the two main culprits making us excessively sleepy while awake.

Researchers at Penn State examined a random population sample of 1,741 adults and determined that obesity and emotional stress are the main causes of the current "epidemic" of sleepiness and fatigue plaguing the country. Insufficient sleep and obstructive sleep apnea also play a role; both have been linked to high blood pressure, heart disease, stroke, depression, diabetes, obesity and accidents.

"The 'epidemic' of sleepiness parallels an 'epidemic' of obesity and psychosocial stress," said Alexandros Vgontzas, MD, the principal investigator for the three studies. "Weight loss, depression and sleep disorders should be our priorities in terms of preventing the medical complications and public safety hazards associated with this excessive sleepiness."

In the Penn State cohort study, 222 adults reporting excessive daytime sleepiness (EDS) were followed up 7½ years later. For those whose EDS persisted, weight gain was the strongest predicting factor. "In fact, our results showed that in individuals who lost weight, excessive sleepiness improved," Vgontzas said.

Adults from that same cohort who developed EDS within the 7½-year span also were studied. The results show for the first time that depression and obesity are the strongest risk factors for new-onset excessive sleepiness. The third study, of a group of 103 research volunteers, determined once again that depression and obesity were the best predictors for EDS.

"The primary finding connecting our three studies are that depression and obesity are the main risk factors for both new-onset and persistent excessive sleepiness," Vgontzas said.

In the Penn State cohort study, the rate of new-onset excessive sleepiness was 8 percent, and the rate of persistent daytime sleepiness was 38 percent. Like insufficient sleep and obstructive sleep apnea, EDS also is associated with significant health risks and on-the-job accidents.

http://www.sciencedaily.com/releases/2012/06/120613091037.htm

Death rate for depressed heart patients double than for non-depressed heart patients

July 28, 2017

Science Daily/Intermountain Medical Center

People who are diagnosed with coronary artery disease and then develop depression face a risk of death that's twice as high as heart patients without depression, according to a major new study.

The increased risk of death from any cause holds true whether the depression immediately follows the heart disease diagnosis or occurs even years later, according to Heidi May, PhD, a cardiovascular epidemiologist at Intermountain Medical Center Heart Institute and the study's lead author.

She said the findings point out the importance of screening for and treating depression even years after someone is diagnosed with heart disease.

The research, one of a number of studies to explore the connection between heart disease and development of depression by researchers at Intermountain Medical Center Heart Institute, will be published on July 28 in the European Heart Journal -- Quality of Care & Clinical Outcomes.

Researchers found that post-coronary artery disease depression was the single biggest predictor of death, and remained so even after researchers controlled for the other factors.

"No matter how long or how short it was, patients were found to have twice the risk of dying compared to those who didn't have a follow-up diagnosis of depression," Dr. May said. "Depression was the strongest risk factor for dying, compared to any other risk factors we evaluated. That included age, heart failure, diabetes, high blood pressure, kidney failure, or having a heart attack or stroke."

That association didn't change for patients who were previously diagnosed with depression before their heart disease diagnosis or for patients whose angiograms were performed for various reasons, which included stable angina, unstable angina, or heart attack.

Dr. May and the Intermountain Medical Center Heart Institute research team studied 24,138 patients who underwent angiographies, which determined they had coronary artery disease. To detect subsequent depression, the researchers looked at standardized diagnostic codes called International Classification of Diseases codes, or ICD codes.

Patients with depression were also placed into subcategories based on how long after their heart disease diagnosis the depression was identified.

Dr. May said most studies have looked at depression at a single point in time, such as within 30 days of a heart event or at the time of heart disease diagnosis. Just a handful of studies have looked over the course of a year, let alone years, such as this study, which followed patients for an average of 10 years after their coronary artery disease diagnosis to see if they were ever diagnosed with depression.

In all, 15 percent, or 2,646 patients, were diagnosed with depression at some point during follow-up. Of those, 27 percent were diagnosed within a year of their heart event, 24 percent between one and three years after, nearly 15 percent between three and five years after, and nearly 37 percent at least five years after a baseline heart disease event.

This study reinforces previous research investigating the link between depression, heart disease, and increased risks of death. It's already been shown that people with coronary artery disease don't live as long as their peers who don't have heart disease. And while life expectancy has increased with better therapies, surgeries, and more aggressive treatment of identified risk factors, depression has come under increasing scrutiny as a risk factor that could make a difference, if properly treated.

"We've completed several depression-related studies and been looking at this connection for many years," said Dr. May. "The data just keeps building on itself, showing that if you have heart disease and depression and it's not appropriately treated in a timely fashion, it's not a good thing for your long-term well-being."

Research has shown that the relationship is bi-directional: Depression may result in worse outcomes for people with heart disease, while the presence of heart disease may increase the likelihood that someone will develop depression.

Those with depression were significantly younger and more often female, diabetic, previously diagnosed with depression, and less likely to have presented with a heart attack compared to those who didn't have depression.

The study didn't explain the reason for the elevated risk of death, although Dr. May said one possibility is that depression impacts how closely patients follow their treatment plans.

"We know people with depression tend to be less compliant with medication on average and probably in general aren't following healthier diets or exercise regimens," she said. "They tend to do a poorer job of doing things that are prescribed than people without depression. That certainly doesn't mean you're depressed so you're going to be less compliant, but in general, they tend to follow those behaviors."

She also noted that physiological changes occur within the body when patients are diagnosed with depression, which might help explain the link.

The researchers emphasize the importance of continual screening of depression for all heart disease patients. "Patients who have depression need to be treated for it to improve not only their long-term risks but their quality of life," Dr. May said.

"I hope the takeaway is this: it doesn't matter how long it's been since the patient was diagnosed with coronary artery disease. Continued screening for depression needs to occur, said Dr. May. "After one year, it doesn't mean they're out of the woods. It should be ongoing, just like we keep measuring things like LDL cholesterol."

https://www.sciencedaily.com/releases/2017/07/170728092552.htm

Abused girls may have higher risk of heart disease, stroke as adults

November 30, 2011

Science Daily/American Heart Association

Sexually and physically abused girls may have higher risks for heart attacks, heart disease and strokes as adults, according to new research.

In the study, compared to women who weren't molested or raped as children or teens, women who reported:

Repeated episodes of forced sex in childhood or adolescence had a 62 percent higher risk of cardiovascular disease as adults.

Severe physical abuse in childhood or adolescence was associated with a 45 percent increased risk of cardiovascular events.

Mild to moderate physical or sexual abuse was not associated with increased risk.

"The single biggest factor explaining the link between severe child abuse and adult cardiovascular disease was the tendency of abused girls to have gained more weight throughout adolescence and into adulthood,' said Janet Rich-Edwards, Sc.D., M.P.H., lead author of the study and associate professor in the Department of Medicine at Brigham and Women's Hospital in Boston, Mass.

"Women who experience abuse need to take special care of their physical and emotional well-being to reduce their risk of chronic disease," Rich-Edwards said. "Primary care health professionals need to consider childhood abuse histories of women as they transition into adulthood but to help the health professionals prevent cardiovascular disease among women with a history of abuse, we need to learn more about specific psychological, lifestyle, and medical interventions to improve the health of abuse survivors."

http://www.sciencedaily.com/releases/2011/11/111113141258.htm

Childhood depression may increase risk of heart disease by teen years

January 30, 2014

Science Daily/University of South Florida (USF Health)

Children with depression are more likely to be obese, smoke and be inactive, and can show the effects of heart disease as early as their teen years, according to a newly published.

The research, by Rottenberg and his colleagues at Washington University and the University of Pittsburgh, suggests that depression may increase the risk of heart problems later in life. The researchers also observed higher rates of heart disease in the parents of adolescents that had been depressed as children. The research is published online in Psychosomatic Medicineand will be included in the medical journal's February 2014 issue.

"Given that the parents in this sample were relatively young, we were quite surprised to find that the parents of the affected adolescents were reporting a history of heart attacks and other serious events," Rottenberg explained.

Cardiologists and mental health professionals have long known a link exists between depression and heart disease. Depressed adults are more likely to suffer a heart attack, and if they do have a heart attack, it's more likely to be fatal.

However it was unclear when the association between clinical depression and cardiac risk develops, or how early in life the association can be detected. These findings suggest improved prevention and treatment of childhood depression could reduce adult cardiovascular disease.

Heart disease is the leading cause of death for men and women- accounting for one in every four deaths in the United States every year, according to the Centers for Disease Control and Prevention.

During the study, Rottenberg and his colleagues followed up on Hungarian children who had participated in a 2004 study of the genetics of depression. The researchers compared heart disease risk factors -- such as smoking, obesity, physical activity level, and parental history -- across three categories of adolescents.

The investigators surveyed more than 200 children with a history of clinical depression, as well as about 200 of their siblings who have never suffered from depression. They also gathered information from more than 150 unrelated children of the same age and gender with no history of depression.

Rottenberg plans to conduct additional research in order to understand why depression early in life may put people at increased risk for cardiovascular disease. Further studies planned with the Hungarian group will also examine whether any early warning signs of heart disease are present as these adolescents move into young adulthood.

http://www.sciencedaily.com/releases/2014/01/140130164454.htm

Childhood stress impacts adult health

Persistent distress, distress in childhood associated with higher risk of heart disease, diabetes

September 28, 2015

Science Daily/American College of Cardiology

A 45-year study of nearly 7,000 people born in a single week in Great Britain in 1958 found psychological distress in childhood -- even when conditions improved in adulthood -- was associated with higher risk for heart disease and diabetes later in life.

The study, published today in the Journal of the American College of Cardiology, looked at information related to stress and mental health collected about participants in the 1958 British Birth Cohort Study at ages 7, 11, 16, 23, 33 and 42. Researchers also collected data for nine biological indicators at age 45 using information from blood samples and blood pressure measures to create a score indicating risk for heart disease and diabetes, known as the cardiometabolic risk score, for each.

The study found that people with persistent distress throughout their lives had the highest cardiometabolic risk score relative to participants who reported low levels of distress throughout childhood and adulthood. Using the same comparison group, participants with high levels of distress occurring primarily in childhood, and those with high levels of distress occurring primarily in adulthood also exhibited higher cardiometabolic risk. The estimated risk for cardiometabolic disease for people with persistent distress through to middle adulthood was higher than risk commonly observed for people who are overweight in childhood.

After adjusting for a range of factors that might affect these associations, including medication use, socioeconomic status, and health behaviors, the researchers found the risk for people who experienced high distress levels primarily in adulthood was not different compared with those with low levels of distress over their life course. But participants who experienced high distress primarily in childhood and those with persistent distress continued to have significantly higher risk scores even after considering those other factors.

"This study supports growing evidence that psychological distress contributes to excess risk of cardiovascular and metabolic disease and that effects may be initiated relatively early in life," said lead author Ashley Winning, ScD, MPH, of Department of Social and Behavioral Sciences at Harvard's T.H. Chan School of Public Health.

"While effects of distress in early childhood on higher cardiometabolic risk in adulthood appeared to be somewhat mitigated if distress levels were lower by adulthood, they were not eradicated," the authors said. "This highlights the potentially lasting impact of childhood distress on adult physical health."

"It is also increasingly apparent that adversity in a child's social environment increases the likelihood of developing high levels of distress. Thus, early prevention and intervention strategies focused not only on the child but also on his or her social circumstances may be an effective way to reduce the long-lasting harmful effects of distress," Winning said.

In the accompanying editorial in the Journal, E. Alison Holman, PhD, FNP, of the Program of Nursing Science at University of California, Irvine, said the study indicates it may not be helpful for clinicians to focus on "managing" known cardiovascular disease risk factors like smoking, obesity, elevated cholesterol and lack of exercise without addressing underlying risk factors that affect patients.

"When considering our patients in this broader social context, telling them to lose weight, stop smoking, eat a better diet without addressing the underlying stress or distress that may be fueling unhealthy behaviors (and lab values) may be counter-productive," Holman said. "Indeed, by 'advising' or 'directing' our patients to change their behaviors, we undermine their trust in us and may exacerbate their distress, especially if they feel stuck or unable to make the recommended changes."

Holman suggests patient-centered motivational interviewing and more compassionate approaches to patient communication.

JACC Editor-in-Chief Valentin Fuster, MD, PhD, said, "If stress contributes to cardiovascular disease in adults, as this study finds, it is easy to extrapolate the impact that stress may cause in earlier years of life when psychological and biological stages are at such a heightened state for young people."

http://www.sciencedaily.com/releases/2015/09/150928144037.htm