Dietary Salt Restriction May Be Detrimental to One’s Health (and a rebuttal in the journal Lancet)

For years the conventional medical wisdom has been to reduce salt intake for improved cardiovascular health and reduced hypertension risks.

Now it seems that limiting dietary salt may not only not work as advocated, but also be detrimental to one’s health.

From the 3 May  News@JAMA site (Journal of the American Medical Association)

May 3, 2011
Author Insights: Questioning the Benefits of Salt Restriction
Filed under: Cardiovascular Disease/Myocardial Infarction,Diet,Hypertension,Stroke — Mike Mitka @ 4:09 pm

Research by Jan A. Staessen, MD, PhD, of the University of Leuven in Belgium and colleagues, raises questions regarding whether population-wide sodium restriction will actually lower cardiovascular risks. (Image: University of Leuven)

Research by Jan A. Staessen, MD, PhD, of the University of Leuven in Belgium and colleagues, raises questions regarding whether population-wide sodium restriction will actually lower cardiovascular risks. (Image: University of Leuven)
National policies that advise restricting sodium (salt) intake to reduce the risk of hypertension might not provide the anticipated cardiovascular benefits and may even be detrimental to health, report researchers in an article in today’s JAMA.
In the study, the researchers categorized the 3681 study participants according to sodium intake, using a procedure that measures sodium in the urine over a 24-hour period, considered the gold standard for such assessment. At a median of nearly 8 years later, participants in the group with the lowest sodium intake at the beginning of the trial were significantly more likely than the other 2 groups to die of cardiovascular disease.

The researchers also found that these 3 groups had the same risk of developing hypertension, regardless of initial sodium intake. They did find in a subgroup of 1499 study participants who had sodium intake measured at the beginning and at the end of the study that an increase in sodium intake was associated with an increase in systolic (but not diastolic) blood pressure. However, this relationship did not result in a higher risk of complications from hypertension or cardiovascular disease, such as heart attack or stroke.

Jan A. Staessen, MD, PhD, professor of medicine at the University of Leuven in Belgium and one of the study’s authors, discusses his team’s findings:

news@JAMA: Are you surprised by your results?

Dr Staessen: Not so much. We started this research more than 25 years ago, and in all our studies, it was almost impossible to find an association between blood pressure and 24-hour sodium excretion. We were a bit surprised to see an inverse relationship between sodium intake and cardiovascular death.

news@JAMA: Why would lowering sodium intake possibly increase cardiovascular risk?

Dr Staessen: Ours is an epidemiological study so we cannot be sure of the underlying mechanism. But if you decrease sodium intake a lot, you activate some of the systems that conserve sodium and they are known to have a negative influence on cardiovascular outcomes. This may be an underlying mechanism.

news@JAMA: Where does your study fit into the discussion of mandating sodium restriction in foods to improve health, as advocated by some public health officials and government agencies?

Dr Staessen: One should be very careful when one wants to implement [sodium restriction], as it is based on short-term studies mainly in hypertensive populations. Whether one can extrapolate these short-term results over the long term remains to be seen, especially as our study and 2 previous studies have shown an inverse association between sodium intake and mortality.

news@JAMA: What is needed to provide a clearer picture of the benefits and risks of controlling sodium consumption?

Dr Staessen: What one needs is a long-term interventional study to look at cardiovascular complications. Reducing blood pressure is not what one is in this for. You want to show that it actually changes cardiovascular outcomes.

Related articles

• The Science Is Settled (maxredline.typepad.com)

• Less Salt, Less Strokes, Says New Research (Science Daily, August 11, 2011)

• To Salt Or Not To Salt, That Is The Question (Medical News Today, June 2011)
• Eat Less Salt – and Die? (psychologytoday.com)
• Is the war on salt justified? (macleans.ca)
• Heart Benefits From Cutting Back on Salt? (webmd.com)

        “A new eight year long European study concludes that salt consumption is not dangerous and may in fact be beneficial. This is certainly contrary to advice from American Medical Association, American Heart Association and the Center for Disease Control and Prevention, which says higher sodium consumption can increase the risk of heart disease. It’s not unusual to see differing opinions, but what are we ordinary folks to make of the controversy? The study followed 3,681 middle-aged Europeans who did not have high blood pressure or heart disease at the start of the study…”

• High Potassium-To-Sodium Ratio May Reduce Risk Of Cardiovascular Disease (Medical News Today, 6 May 2011)
• False Assumption That Salt is “Bad” For Us Is Creating Iodine Deficiency (Health and Well-Being Blog)
• High salt diet ‘lowers heart disease risk’ (news.bioscholar.com)
• ‘Salt intake drop could increase chances of heart disease’ (dailymail.co.uk)
• Cochrane Salt/Blood-Pressure Message Blasted in the Lancet “July 28, 2011 (London, United Kingdom) — Two preventive-medicine experts in the UK are crying foul over a recent and controversial meta-analysis that concluded cutting salt consumption would have no clear health benefits [1]. In a Comment published in the July 30, 2011 issue of theLancet, Dr Feng J He (Queen Mary University, London, UK) and Dr Graham A MacGregor(Wolfson Institute of Preventive Medicine, Barts, London, UK) say that the meta-analysis published simultaneously by Taylor and colleagues in the Cochrane Review [2] and the American Journal ofHypertension [3] and press release that accompanied it “reflect poorly on the reputation of the Cochrane Library and the authors.””…….
• Eat Less Salt – and Die? (psychologytoday.com)
• Is the war on salt justified? (macleans.ca)
• Heart Benefits From Cutting Back on Salt? (webmd.com)

May is National Stroke Awareness Month

The US Centers for Disease Control and Prevention has useful stroke information at May is National Stroke Awareness Month
The Web page includes information about symptoms and healthy lifestyles.
Links are given to related podcasts and publications.

Excerpts

Stroke is the third leading cause of death in the United States. It is also a leading cause of serious long-term disability. While most strokes occur in people aged 65 years or older, strokes can occur at any age.

Knowing the symptoms of stroke and calling 9-1-1 immediately if someone appears to be having a stroke are crucial steps in getting prompt emergency medical care for a stroke.  New treatments are available that can reduce the damage caused by a stroke for some victims, but these treatments need to be given soon after the symptoms start.

Know Your Signs and Symptoms

The American Stroke Association notes these five major signs of stroke:

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, or loss of balance and coordination.
• Sudden, severe headache with no known cause.

If you think someone is having a stroke, you should call 9–1–1 or emergency medical services immediately.  Receiving immediate treatment is critical in lowering the risk of disability and even death.

Quick Facts

• Stroke is the third leading cause of death in the United States. In 2006, 137,119 people died from stroke in the United States.
• Stroke is a leading cause of serious long-term disability.
• About 795,000 strokes occur in the United States each year. About 610,000 of these are first or new strokes. About 185,000 occur in people who have already had a stroke before.
• Nearly three-quarters of all strokes occur in people aged 65 years or older. The risk of having a stroke doubles each decade after the age of 55.
• Strokes can—and do—occur at ANY age. Nearly 25% of strokes occur in people younger than age 65.
• Stroke death rates are higher for African Americans than for whites, even at younger ages.
• According to the American Heart Association, stroke will cost almost $73.7 billion in both direct and indirect costs in 2010.
• It has been noted for several decades that the southeastern United States has the highest stroke mortality rates in the country. It is not completely clear what factors might contribute to the higher incidence of and mortality from stroke in this region.
• People with a family history of stroke have a higher risk.

Additional Resources

• US National Stroke Association includes links to Warning Signs of Stroke (Use FAST to remember the warning signs), What is Stroke (basic information, myths, types of stroke, treatment),  Prevention information, and Ways to Stay Informed (newsletters, Facebook, Twitter, etc).
  It also includes a Stroke Awareness Center with useful information for those interested in educating and raising awareness (and the rest of us!)
• American Stroke Association (Beta Version by the American Heart Assocation/American Stroke Association) with links to news stories, warning signs, and (hospital) stroke centers, Online Stroke Magazine, and more.
• Stroke: MedlinePlus with links to overviews, news items, diagnosis/symptoms, treatments, related issues, specific conditions, organizations, videos, and much more.
• Know Stroke can help you learn the signs of stroke and the importance of getting to the hospital quickly. Fast medical action is key to successful recovery from stroke. Stroke strikes fast, and you should too.

Related Articles

• Young adults’ beliefs about their health clash with risky behaviors (eurekalert.org)
• How Do Strokes Affect Women? (everydayhealth.com)
• Stroke Risk and African-Americans (everydayhealth.com)
• Know Your High Blood Pressure and Stroke Risk (everydayhealth.com)
• Stroke Risk Factors: What You Should Know (everydayhealth.com)

Blood pressure: 100 million Americans may be unnecessarily labeled abnormal

Blood pressure: 100 million Americans may be unnecessarily labeled abnormal

From a March 9 2011 Science Daily news item

ScienceDaily (Mar. 9, 2011) — As many as 100 million Americans may currently be misclassified as having abnormal blood pressure, according to Dr. Brent Taylor from the Veterans Affairs Health Care System in Minneapolis and the University of Minnesota and his colleagues. Their findings show that these people are not actually more likely to die prematurely than those with ‘normal’ blood pressure, i.e. below 120/80. Taylor and colleagues’ article in the Journal of General Internal Medicine, published by Springer, also shows that in those under 50, diastolic blood pressure* is the more important predictor of mortality, whereas in those over 50, systolic blood pressure* is the stronger predictor. The authors argue it is time to consider a new definition of ‘normal’ blood pressure.

Related Articles

• Redefining normal blood pressure (eurekalert.org)
• High blood pressure: Thousands ‘wrongly treated for high blood pressure’ as fear of GPs cause heart rates to soar (dailymail.co.uk)
• Ambulatory monitoring reveals many patients have ‘white coat’ hypertension (eurekalert.org)
• High Blood Pressure in Doc’s Office Not Always Hypertension
  Round-the-clock monitoring can distinguish ‘white coat’ syndrome from real thing, study finds
• Research: Losing weight lowers blood pressure (abclocal.go.com)

High Blood Pressure and Cholesterol (CDC Vital Signs Feature Issue)

The US Centers for Disease Control and Prevention (CDC) Vital Signs offers recent data and calls to action for important public health issues.

CDC launched a new program called CDC Vital Signs, which includes an MMWR Early Release, a fact sheet and website, a media release, and a series of announcements via social media tools.

Vital Signs will be released the first Tuesday of every month. Issues include colorectal and breast cancer screening, obesity, alcohol and tobacco use, access to health care, HIV testing, seat belt use, cardiovascular disease, teen pregnancy and infant mortality, healthcare-associated infections, asthma, and foodborne disease.

The feature issue High Blood Pressure and Cholesterol includes and overview, latest findings, outline of what can be done, and links to related social media (as Facebook and Twitter)

Related news items

• CDC Reports Sharp Increase in Strokes Among Those Under 35 Years of Age
  
• U.S. health system not helping heart disease: CDC

CDC Reports Most Americans with High Blood Pressure and High Cholesterol are Not Being Treated Effectively

Image via Wikipedia

CDC Reports Most Americans with High Blood Pressure and High Cholesterol are Not Being Treated Effectively
http://www.cdc.gov/media/releases/2011/p0201_vitalsigns.html?s_cid=2011_p0201_vitalsigns
Two out of three U.S. adults with high cholesterol and half of U.S. adults with high blood pressure are not being treated effectively, according to the Centers for Disease Control and Prevention (CDC).

Among the findings in the Vital Signs Report:

• By the Numbers – High Blood Pressure
  • 1 in 3 Adults has high blood pressure
  • 1 in 3 Adults with high blood pressure does not get treatment
  • 1 in 2 Adults with high blood pressure does not have it under control
• By the Numbers – High Cholesterol
  • 1 in 3 Adults has high cholesterol
  • 1 in 2 Adults with high cholesterol does not get treatment
  • 2 in 3 Adults with high cholesterol do not have it under control

Related Articles

• Is Your Medication Raising Your Cholesterol? (everydayhealth.com)
• Study Suggests That ‘Bad’ Cholesterol Is Not As Bad As People Think (6 May 2011, Medical News Today)

  “The so-called “badcholesterol” – low-density lipoprotein, commonly called LDL – may not be so bad after all, shows a Texas A&M University study that casts new light on the cholesterol debate, particularly among adults who exercise. ”

  “Riechman and colleagues examined 52 adults from ages to 60 to 69 who were in generally good health but not physically active, and none of them were participating in a training program. The study showed that after fairly vigorous workouts, participants who had gained the most muscle mass also had the highest levels of LDL (bad) cholesterol, “a very unexpected result and one that surprised us.

  “It shows that you do need a certain amount of LDL to gain more muscle mass. There’s no doubt you need both – the LDL and the HDL – and the truth is, it (cholesterol) is all good. You simply can’t remove all the ‘bad’ cholesterol from your body without serious problems occurring. ”

  “”Our tissues need cholesterol, and LDL delivers it,” he notes. “HDL, the good cholesterol, cleans up after the repair is done. And the more LDL you have in your blood, the better you are able to build muscle during resistance training.”

  Riechman says the study could be helpful in looking at a condition called sarcopenia, which is muscle loss due to aging. Previous studies show muscle is usually lost at a rate of 5 percent per decade after the age of 40, a huge concern since muscle mass is the major determinant of physical strength. After the age of 60, the prevalence of moderate to severe sarcopenia is found in about 65 percent of all men and about 30 percent of all women, and it accounts for more than $18 billion of health care costs in the United States.

  “The bottom line is that LDL – the bad cholesterol – serves as a reminder that something is wrong and we need to find out what it is,” Riechman says.

  “It gives us warning signs. Is smoking the problem, is it diet, is it lack of exercise that a person’s cholesterol is too high? It plays a very useful role, does the job it was intended to do, and we need to back off by always calling it ‘bad’ cholesterol because it is not totally bad.”

• Diagnosing High Cholesterol (everydayhealth.com)
• Benefits of a Vegetarian Diet for High Cholesterol (everydayhealth.com)

Solar-powered device affordable, reliable tool to measure blood pressure

From a November 8, 2010 American Heart Association news release

DALLAS, Nov. 8, 2010 — A new solar-powered device to measure blood pressure may help slow the worldwide increase in cardiovascular disease by providing affordable and reliable blood pressure testing in low income countries, according to research published in Hypertension: Journal of the American Heart Association.***

 

The solar powered device — 94 percent in agreement with the standard blood pressure testing method for systolic blood pressure — is in field testing in Uganda and Zambia, Africa.

 

“The incidence of hypertension is rising dramatically in these countries,” said Eoin O’Brien, M.D., lead author of the study and professor in Conway Institute of Biomolecular and Biomedical Research at the University College Dublin in Belfield, Dublin, Ireland. “Hypertension leads to stroke and heart attack as the major cause of death around the world. It is greater than malnutrition, cancer and AIDS.”

 

Many low-income countries have a short supply of trained medical personnel, he said. “We have been able to provide an accurate, robust and inexpensive device to diagnose high blood pressure. It’s a start. If we can’t measure blood pressure, we certainly can’t begin to treat hypertension.”

 

Study Highlights:***

 

• A new solar powered, automated blood pressure monitoring device was equally accurate as the standard device that measures systolic blood pressure.
• The device was favored by health professionals and patients when tested in Africa.
• The new device eliminates the need for batteries, which are expensive and scarce in low economic settings.

 

*** Click here for tips on how to obtain this article for free or at low cost

Barbers: Cut, Shave, Lower Your Blood Pressure

[Editor Flahiff comment : this press release  reminds me of an article I read about 20 years ago. Beauticians were trained to refer clients to social service/health agencies when hearing their clients talk about issues touching on abuse and other safety and health issues]

 

From an October 25 Reuters Health press release

By Alison McCook

EW YORK (Reuters Health) – Black men with hypertension appear to benefit from regular blood pressure checks and advice from a somewhat unlikely source – their barbers.

A new study finds that training barbers to check their patrons’ blood pressure, offer advice and anecdotes, and even help refer the clients to a doctor if they don’t have one, appears to help men get their blood pressure under control.

Nationwide, barbershops are increasingly becoming a source of health information and a locus for health outreach, according to the authors led by Dr. Ronald G. Victor, associate director of Cedars-Sinai Heart Institute in California, and this study shows it is a type of intervention that can work.

“It’s a proof-of-concept study,” Victor told Reuters Health.

Millions of African-American men have high blood pressure, and most do not have it under control – putting them at risk of serious illness and death. Barbershops are community gathering spots for black men, some of whom have been clients for years, visiting once every three to four weeks. As a result, some researchers have asked: Why not work health information into the cut and shave?

In the current study, published in the Archives of Internal Medicine, Victor and his team asked patrons of 17 black-owned barbershops in Dallas County, Texas, to be screened for hypertension. They found that 45 percent of the shops’ clientele had hypertension, but only 38 percent of the men had brought their blood pressure down to a safe level….

[Editor Flahiff’s note: This article is only available online through paid subscription. Check with a local medical, academic, or public library for availability. The library may charge a fee for access or for a copy. It would be wise to call ahead and ask a reference librarian for details]