[News release] Researchers identify mechanisms linking early adversity, disease later in life

Researchers identify mechanisms linking early adversity, disease later in life.

From the 20 May 2015 University of Georgia news release

May 20th, 2015 Author: Cal Powell  |  706-542-3536  |  More about Cal
Contact: Kandauda Wickrama  |  706-542-4926  | More about Kandauda

Athens, Ga. – Early socioeconomic adversity, such as poverty, low education and disadvantaged community, has both direct and indirect long-term effects on young adults’ cardio-metabolic disease risk, according to researchers within the University of Georgia College of Family and Consumer Sciences.

K.A.S. Wickrama, the Athletic Association Endowed Professor in human development and family science, and his research team explored a “resource focused model” examining the positive psychosocial resources—self-esteem, personality and educational attainment—linking adolescents’ early life experiences to young adults’ health outcomes as measured by nine bio-markers including blood pressure, blood glucose level and body mass index.

The research showed that in addition to early adversity’s direct impact on cardio-metabolic health, it also negatively influenced the development of these psychosocial resources, which, in turn, proved detrimental to disease risk, including diseases such as diabetes, heart disease or stroke.

The study included data from more than 12,000 young adults currently aged 25-34 who participated in the National Longitudinal Study of Adolescent to Adult Health over a 13-year period. Wickrama has published extensively from this data set.

“Youth in a poor family or poor community likely feel less valuable, have lower self-worth and lower self-esteem than youth in families with more socioeconomic capital,” Wickrama said. “Also, early socioeconomic adversity manifests itself directly in the form of impaired cognitive development and educational attainment.”

This connection between psychosocial resources and disease risk is likely due to multiple factors, researchers said, including neurological pathways and poor health behaviors.

Researchers also found gender differences relative to the association between psychosocial resources and cardio-metabolic risk.

The association was statistically significant for women but not for men, they noted. For men, researchers said, early adversity impairs development of psychosocial resources, but those impaired resources do not seem to lead to cardio-metabolic risk for young adults as it does for women.

The paper, “Early socioeconomic adversity, youth positive development and young adults’ cardio-metabolic disease risk,” appeared in the March issue of Health Psychology and is one of three recent papers on the subject produced by Wickrama’s research team.

Co-authors include Catherine Walker O’Neal, a postdoctoral research associate, and Tae Kyoung Lee, a doctoral candidate, both in the human development and family science department within the college.

Another paper, “Stressful life experiences in adolescence and cardio-metabolic risk factors in young adulthood,” was published online in February by the Journal of Adolescent Health.

Using a stress-focused model, the paper links early adversity to poor physical health outcomes based on stressful events that can lead to a rush into adulthood, such as teenage pregnancy or dropping out of high school.

“There is a physical effect on your body from being in these stressful environments,” O’Neal said. “This is a long-term effect that you really can’t easily overcome.”

Researchers refer to this phenomenon as a person’s allostatic load, or weathering.

“Think of a rock continually exposed to the elements day after day,” O’Neal said. “It gets weathered and worn down, and you can’t restore the rock to its original state. In the same way, recovering from the physical effects of these stressors is incredibly difficult.”

A third paper, “Stress and resource pathways connecting early socioeconomic adversity to young adults’ physical health risk,” was published in the Journal of Youth Adolescence late last year.

This paper shows that both the resource and stress pathways connecting early socioeconomic adversity to cardio-metabolic health operate independently.

Researchers suggested through these studies that vulnerable groups of children can be identified early for prevention and intervention efforts.

“I think our findings definitely could be very applicable to intervention and prevention work,” O’Neal said. “I think we show multiple intervening points and areas where you could step in and stop the cycle.”

An abstract of the Health Psychology paper is available at http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/hea0000208.

 

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[press release] One in three people would risk shorter life rather than take daily pill to avoid heart disease

Study does not address why, which I would really like to know!
My cholesterol is high, but I do not take a statin, against the advice of the doctor. Still not convinced they work after reading several evidence based biomedical journal articles. But I admit I am not consistent. Am exercising and watching what I eat.

From the 3 February 2015 American Heart Association press release

Study Highlights

• In a survey, one in three adults say they would risk living a shorter life rather than taking a daily pill to prevent cardiovascular disease.
• About one in five say they were willing to pay $1,000 or more to avoid taking a daily pill for the rest of their lives.
• Most respondents weren’t willing to trade any weeks of life to avoid daily medication.

Embargoed until 3 p.m. CT/4 p.m. ET Tuesday, Feb. 3, 2015

DALLAS, Feb. 3, 2015 — One in three people say they would risk living a shorter life instead of taking a daily pill to prevent cardiovascular disease, according to new research inCirculation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Researchers at the University of California San Francisco (UCSF) and the University of North Carolina at Chapel Hill surveyed 1,000 people (average age 50) via the Internet hypothetically asking how much time they were willing to forfeit at the end of their lives to avoid taking daily medication. They were also asked the amount of money they would pay and the hypothetical risk of death they were willing to accept to avoid taking medications to prevent cardiovascular disease.

The survey showed:

• More than 8 percent of participants were willing to trade as much as two years of life to avoid taking daily medication for cardiovascular disease; while roughly 21 percent would trade between one week and a year of their lives.
• About 70 percent said they wouldn’t trade any weeks of their lives to avoid taking a CVD pill daily
• About 13 percent of participants said they would accept minimal risk of death to avoid taking a pill daily; 9 percent said they’d risk a 10 percent chance; and about 62 percent weren’t willing to gamble any risk of immediate death.
• About 21 percent said they would pay $1,000 or more to avoid taking a pill each day for the rest of their lives, but 43 percent said they wouldn’t pay any amount.

 

[Press release] Gut Bacteria Byproduct Linked to Chronic Kidney Disease for the First Time

From the 29 January 2015 Cleveland Clinic press release

TMAO Found To Be A Contributing Factor To Development Of Chronic Kidney Disease And Associated Mortality Risk

Thursday, January 29th

Cleveland Clinic researchers have, for the first time, linked trimethylamine N-oxide (TMAO) – a gut metabolite formed during the digestion of egg-, red meat- or dairy-derived nutrients choline and carnitine – to chronic kidney disease.

TMAO has been linked to heart disease already, with blood levels shown to be a powerful tool for predicting future heart attacks, stroke and death. TMAO forms in the gut during digestion of choline and carnitine, nutrients that are abundant in animal products such as red meat and liver. Choline is also abundant in egg yolk and high-fat dairy products.

The research team was led by Stanley Hazen, MD, PhD, Chair of the Department of Cellular & Molecular Medicine for the Lerner Research Institute and section head of Preventive Cardiology & Rehabilitation in the Miller Family Heart and Vascular Institute at Cleveland Clinic, and W.H. Wilson Tang, MD, Department of Cardiovascular Medicine in the Miller Family Heart and Vascular Institute and Lerner Research Institute. The research will be published online on January 29th and in the January 30th print edition of Circulation Research .

According to the Centers for Disease Control and Prevention, more that 20 million Americans are estimated to have chronic kidney disease, many of whom are undiagnosed. It is caused by a gradual loss of kidney function over time. As the disease worsens, waste products can accumulate in the blood and can be fatal without interventions. It has long been known that patients with chronic kidney disease are at an increased risk for cardiovascular disease, but the exact mechanisms linking the two diseases are not known. This newly discovered TMAO link offers further insight into the relationship between cardiovascular disease and chronic kidney disease.

…

 

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[Press release] That’s using your head: Brain regulates fat metabolism, potentially stopping disease

[Press release] That’s using your head: Brain regulates fat metabolism, potentially stopping disease

Jessica Yue

 

From the University of Alberta press release By Cait Wills on January 26, 2015

Recent research into brain control of liver lipid production could cause break in obesity and diabetes treatment

Ways of keeping the heart healthy has widened, with the discovery that the brain can help fight off hardening of the arteries.

Atherosclerosis—hardening and narrowing of the arteries—can be caused by fat build up that causes plaque deposits, and is one of the main causes of cardiovascular disease. Jessica Yue, a newly recruited researcher in the Department of Physiology in the Faculty of Medicine & Dentistry, has shown a link between how the brain can regulate fat metabolism, potentially stopping the development of this disease risk factor in obesity and diabetes.

Her findings, published this month in Nature Communications, the online version of the high-impact Nature publication, outlines how the brain can use the presence of fatty acids, which are building blocks of fat molecules, to trigger the liver to reduce its own lipid production.

“We know that when there is dyslipidemia, or an abnormal amount of fat in the bloodstream, it’s dangerous for health—largely because this can lead to obesity, obesity-related disorders such as Type 2 diabetes, and atherosclerosis,” says Yue, and that “if you can find ways to lower fats in the bloodstream, it helps to lower these chances of diabetes and cardiovascular disease as a result of this atherosclerosis.”

Yue trained at the Toronto General Research Institute under Tony Lam, where she was a recipient of fellowships from the Canadian Institutes of Health Research (CIHR) and the Canadian Diabetes Association. With her associates in Toronto and with Peter Light, professor of pharmacology in the Faculty of Medicine & Dentistry, she looked at how the infusion of oleic acid, a naturally occurring monounsaturated fatty acid, in the brain “triggers” a signal from the hypothalamus to the liver to lower its fat secretion, which Yue says is a “triglyceride-rich, very-low-density lipoprotein. Light is the co-author of Yue’s paper in Nature Communications and is the director of the Alberta Diabetes Institute (ADI), where Yue is applying for membership.

“This fat complex is the kind of lipoprotein that is dangerous when its levels in the blood are elevated because it promotes atherosclerosis,” she says.

The catch, though, is that this “trigger” doesn’t work in obesity, a setting in which blood lipid levels are usually high. “In a model of diet-induced obesity, which then leads to insulin resistance and pre-diabetes, oleic acid no longer provides the fat-lowering trigger to the liver.” Yue’s findings, though, demonstrate how this faulty signal can be bypassed, unveiling potentially other ways to trigger this same function in obese patients.

This study could potentially impact how obesity and diabetes are treated, says Yue, which is the focus of her future research.

The next steps, she says, will be to look at how the brain can sense other compounds to regulate not only liver secretion of fats, but also liver glucose production, a significant contributing factor to diabetes. As a member of the Group on Molecular and Cell Biology of Lipids and with the strength of the ADI, she feels enthusiastic and inspired by her new research environment at the University of Alberta.

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[News] Scientists say tweets predict heart disease and community health — Tech News and Analysis

                                                                        Psychological Science / UPenn

 

Scientists say tweets predict heart disease and community health — Tech News and Analysis.

Excerpt from the 22 January 2015 article

University of Pennsylvania researchers have found that the words people use on Twitter can help predict the rate of heart disease deaths in the counties where they live. Places where people tweet happier language about happier topics show lower rates of heart disease death when compared with Centers for Disease Control statistics, while places with angry language about negative topics show higher rates.

The findings of this study, which was published in the journal Psychological Science, cut across fields such as medicine, psychology, public health and possibly even civil planning. It’s yet another affirmation that Twitter, despite any inherent demographic biases, is a good source of relatively unfiltered data about people’s thoughts and feelings,well beyond the scale and depth of traditional polls or surveys. In this case, the researchers used approximately 148 million geo-tagged tweets from 2009 and 2010 from more than 1,300 counties that contain 88 percent of the U.S. population.

(How to take full advantage of this glut of data, especially for business and governments, is something we’ll cover at our Structure Data conference with Twitter’s Seth McGuire and Dataminr’s Ted Bailey.)

What’s more, at the county level, the Penn study’s findings about language sentiment turn out to be more predictive of heart disease than any other individual factor — including income, smoking and hypertension. A predictive model combining language with those other factors was the most accurate of all.

That’s a result similar to recent research comparing Google Flu Trends with CDC data. Although it’s worth noting that Flu Trends is an ongoing project that has already been collecting data for years, and that the search queries it’s collecting are much more directly related to influenza than the Penn study’s tweets are to heart disease.

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Oranges versus orange juice: Which one might be better for your health? — ScienceDaily

Oranges versus orange juice: Which one might be better for your health?

From the ACS News Service Weekly PressPac: January 21, 2015

“In Vitro Bioaccessibility of Carotenoids, Flavonoids, and Vitamin C from Differently Processed Oranges and Orange Juices [Citrus sinensis (L.) Osbeck]”
Journal of Agricultural and Food Chemistry


Embed from Getty Images


Many health advocates advise people to eat an orange and drink water rather than opt for a serving of sugary juice. But in ACS’ Journal of Agricultural and Food Chemistry, scientists report that the picture is not clear-cut. Although juice is indeed high in sugar, the scientists found that certain nutrients in orange juice might be easier for the body to absorb than when a person consumes them from unprocessed fruit.

Ralf Schweiggert, Julian Aschoff and colleagues note that oranges are packed with nutrients such as carotenoids and flavonoids that, among other benefits, can potentially help lower a person’s risk for certain cancers and cardiovascular disease. But many people prefer to drink a glass of orange juice rather than eat the fruit. Sugar content aside, are they getting the same nutritional benefits? Schweiggert’s team set out to answer that question.

The researchers found that the production of pasteurized orange juice slightly lowered the levels of carotenoids and vitamin C. But at the same time, it significantly improved the carotenoid and vitamin C bioaccessibility — or how much the body can absorb and use. And contrary to conventional wisdom, although juicing oranges dramatically cut flavonoid levels, the remaining ones were much more bioaccessible than those in orange segments.

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[Press release] Healthy gut microbiota can prevent metabolic syndrome, researchers say

Healthy gut microbiota can prevent metabolic syndrome, researchers say.

From the press release

Posted On November 25, 2014

ATLANTA—Promoting healthy gut microbiota, the bacteria that live in the intestine, can help treat or prevent metabolic syndrome, a combination of risk factors that increases the risk of heart disease, diabetes and stroke, according to researchers at Georgia State University and Cornell University.

Their findings are published in the journal Gastroenterology.

The study, a follow-up to the research team’s previous paper in Science, uses an improved technical approach, making the results more significant.

The research team includes Dr. Andrew Gewirtz, a professor in the Institute for Biomedical Sciences at Georgia State; Dr. Benoit Chassaing, a post-doctoral student at Georgia State; and Dr. Ruth Ley of the departments of Microbiology and Molecular Biology at Cornell.

“These results suggest that developing a means to promote a more healthy microbiota can treat or prevent metabolic disease,” Gewirtz said. “They confirm the concept that altered microbiota can promote low-grade inflammation and metabolic syndrome and advance the underlying mechanism. We showed that the altered bacterial population is more aggressive in infiltrating the host and producing substances, namely flagellin and lipopolysaccharide, that further promote inflammation.”

Metabolic syndrome is a serious health condition that affects 34 percent of American adults, according to the American Heart Association. A person is diagnosed with metabolic syndrome when he or she has three of these risk factors: a large waistline, high triglyceride (type of fat found in the blood) level, low HDL cholesterol level, high blood pressure and high fasting blood sugar. A person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes, according to the National Institutes of Health.

Because metabolic syndrome is becoming more common, scientists are exploring possible causes. In their previous study in Science, Gewirtz, Ley and other researchers showed altered gut microbiota play a role in promoting metabolic syndrome.

Gut microbiota perform key functions in health and when it becomes deregulated it can promote chronic inflammatory diseases such as Crohn’s disease and ulcerative colitis. In addition, altered gut microbiota promote inflammation that leads to metabolic syndrome.

“We’ve filled in a lot of the details about how it works,” Gewirtz said. “It’s the loss of TLR5 on the epithelium, the cells that line the surface of the intestine and their ability to quickly respond to bacteria. That ability goes away and results in a more aggressive bacterial population that gets closer in and produces substances that drive inflammation.”

Normally, the bacteria are in the mucous layer at a certain distance away from epithelial cells. The researchers showed altered gut microbiota is more aggressive in infiltrating the host and gets very close to the epithelium. This altered population produces flagellin and lipopolysaccharide, which further promote inflammation.

The research team improved the study by comparing mice that were siblings and littermates, making all conditions in the study the same. The mice only differed by whether they were missing a specific gene, TLR5. Previously, the researchers studied mice that were from two different strains and lived in separate environments. In this study, they found the absence of TLR5 on the intestinal surface leads to alterations in bacteria that drive inflammation, leading to metabolic syndrome.

This study was funded by the National Institutes of Health and the Crohn’s and Colitis Foundation of America.

[Press release]Herbs and spices enhance heart health as well as flavor

Herbs and spices enhance heart health as well as flavor.

English: cinnamon bark Cinnamomum verum. Français : Canelle Cinnamomum verum. Ελληνικά: Κανέλα, μπαχαρικό (Photo credit: Wikipedia)

Excerpt

Spices and herbs are rich in antioxidants, which may help improve triglyceride concentrations and other blood lipids, according to Penn State nutritionists.

Triglyceride levels rise after eating a high-fat meal — which can lead to an increased risk of heart disease. If a high-antioxidant spice blend is incorporated into the meal, triglyceride levels may be reduced by as much as 30 percent when compared to eating an identical meal without the spice blend. The spiced meal included garlic powder, rosemary, oregano, cinnamon, cloves, paprika, turmeric, ginger and black pepper.

Sheila G. West, professor of biobehavioral health and nutritional sciences, and Ann C. Skulas-Ray, research associate in nutritional sciences, reviewed a variety of research papers that focused on the effects that spices and herbs have on cardiovascular disease risk. They published their findings in a supplement to the current issue of the journal Nutrition Today, based on papers presented at the McCormick Science Institute Summit held in May 2014.

“The metabolic effects of spices and herbs and their efficacy and safety relative to traditional drug therapy represent an exciting area for future research given the public health significance of cardiovascular disease,” the researchers wrote.

West and Skulas-Ray looked at three categories of studies — spice blends, cinnamon and garlic.

“We live in a world where people consume too many calories every day,” said West. “Adding high-antioxidant spices might be a way to reduce calories without sacrificing taste.”

West and Skulas-Ray reviewed several cinnamon studies that looked at the effect of the spice on both diabetics and non-diabetics. Cinnamon was shown to help diabetics by significantly reducing cholesterol and other blood lipids in the study participants. However, cinnamon did not appear to have any effect on non-diabetics.

The garlic studies reviewed were inconclusive, but this is likely because the trials had a wide range of garlic doses, from nine milligrams of garlic oil to 10 grams of raw garlic. The reviewers noted that across the studies there was an eight percent decrease in total cholesterol with garlic consumption, which was associated with a 38 percent decrease in risk of heart problems in 50-year-old adults.

[Reblog] Seven Nation Army (update on the link between heart disease and food)

Excerpts from the 11 May 2014 item at The Paleo Pocket

Investigative author Nina Teicholz, author of The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, has been investigating dietary fat and disease for nearly a decade. She has traced the history of the academic dietary establishment’s idea that you should reduce fat in your food – the idea that has lead to a replacement of fat with carbohydrates, turning us from fat burners to sugar burners. Her story has been published in many places, among them theWall Street Journal, where it quickly went to the top of the Popular Now list:

The Questionable Link Between Saturated Fat and Heart Disease

1961 was the year of the first recommendation from the nutrition committee on the American Heart Association that people should eat less fat, in particular saturated fat, in order to reduce heart disease. This came from a Dr. Ancel Keyes, who built his career on this theory. He was a highly persuasive man who obtained a seat on the committee. America was struggling with rising heart disease at the time and people wanted answers.

Where was his proof? He had done a “Seven Countries” study that was considered the most thorough study on the link between heart disease and food. For this study he picked countries that were likely to support his theory, such as Yugoslavia, Finland and Italy. He ignored France, Switzerland, West Germany and Sweden, countries with high-fat diets and low rates of heart disease.

…

And so today people suffer from the effects of replacing fat with carbohydrates turning to blood sugar. Nina Teicholz:

One consequence is that in cutting back on fats, we are now eating a lot more carbohydrates—at least 25% more since the early 1970s. Consumption of saturated fat, meanwhile, has dropped by 11%, according to the best available government data. Translation: Instead of meat, eggs and cheese, we’re eating more pasta, grains, fruit and starchy vegetables such as potatoes. Even seemingly healthy low-fat foods, such as yogurt, are stealth carb-delivery systems, since removing the fat often requires the addition of fillers to make up for lost texture—and these are usually carbohydrate-based.

The problem is that carbohydrates break down into glucose, which causes the body to release insulin—a hormone that is fantastically efficient at storing fat. Meanwhile, fructose, the main sugar in fruit, causes the liver to generate triglycerides and other lipids in the blood that are altogether bad news. Excessive carbohydrates lead not only to obesity but also, over time, to Type 2 diabetes and, very likely, heart disease.

The real surprise is that, according to the best science to date, people put themselves at higher risk for these conditions no matter what kind of carbohydrates they eat. Yes, even unrefined carbs. Too much whole-grain oatmeal for breakfast and whole-grain pasta for dinner, with fruit snacks in between, add up to a less healthy diet than one of eggs and bacon, followed by fish. The reality is that fat doesn’t make you fat or diabetic. Scientific investigations going back to the 1950s suggest that actually, carbs do.

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[News article] Edible flowers may inhibit chronic diseases — ScienceDaily

 

Salad with candied walnuts, persimmon slice, cheese (feta?), dried cranberries and pansies. (Photo credit: Wikipedia)

Edible flowers may inhibit chronic diseases — ScienceDaily.

From the April news article

Common edible flowers in China are rich in phenolics and have excellent antioxidant capacity, research has shown. Edible flowers, which have been used in the culinary arts in China for centuries, are receiving renewed interest. Flowers can be used as an essential ingredient in a recipe, provide seasoning to a dish, or simply be used as a garnish. Some of these flowers contain phenolics that have been correlated with anti-inflammatory activity and a reduced risk of cardiovascular disease and certain cancers.

[News article] Marijuana use may increase heart complications in young, middle-aged adults — ScienceDaily

 

English: Close up shot of some high quality marijuana. (Photo credit: Wikipedia)

Marijuana use may increase heart complications in young, middle-aged adults — ScienceDaily.ews

From the April report

Marijuana use may result in heart-related complications in young and middle-aged adults. Nearly 2 percent of the health complications from marijuana use reported were cardiovascular related. A quarter of these complications resulted in death, according to a study. Surveillance of marijuana-related reports of cardiovascular disorders should continue and more research needs to look at how marijuana use might trigger cardiovascular events, researchers say.

Sugar, not fat, is real heart disease killer: We got it wrong on diet advice, claims expert

 

Read more: http://www.dailymail.co.uk/health/article-2574269/Sugar-not-fat-real-heart-disease-killer-We-got-wrong-diet-advice-claims-expert.html#ixzz2vvZtwFZC
Follow us: @MailOnline on Twitter | DailyMail on Facebook

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[Press release] Majority of Americans have their heart health facts wrong

From the 6 February 2014 ScienceDaily article

Summary:

Despite the fact that heart disease is the leading cause of death for both men and women in the U.S., about three-quarters (74 percent) of Americans do not fear dying from it, according to a recent survey.

Despite the fact that heart disease is the leading cause of death for both men and women in the U.S., about three-quarters (74 percent) of Americans do not fear dying from it, according to a recent survey from Cleveland Clinic.

Conducted as part of its “Love Your Heart” consumer education campaign in celebration of Heart Month, the survey found that Americans are largely misinformed about heart disease prevention and symptoms, and almost a third (32 percent) of them are not taking any proactive steps to prevent it. Even among those Americans with a family history of the disease (39 percent), who are at a significantly higher risk, 26 percent do not take any preventative steps to protect their heart health, according to the survey.

Perhaps even more concerning is that the majority (70 percent) of Americans are unaware of all the symptoms of heart disease, even though two out of three (64 percent) have or know someone who has the disease. Only 30 percent of Americans correctly identified unusual fatigue, sleep disturbances and jaw pain as all being signs of heart disease — just a few of the symptoms that can manifest.

Related Slide show at the Cleveland Clinic Web site
http://my.clevelandclinic.org/default.aspx

“Heart disease is the No. 1 killer of men and women in this country, so it’s disappointing to see that so many Americans are unaware of the severity of not taking action to prevent heart disease, or how exactly to do so,” said Steven Nissen, M.D., Chairman of Cardiovascular Medicine at Cleveland Clinic. “This is a disease that can largely be prevented and managed, but you have to be educated about how to do so and then incorporate prevention into your lifestyle.”

…

Many Americans believe the myth that fish oil can prevent heart disease.

…

Vitamins are viewed — mistakenly — as a key to heart disease prevention.

…

There is a lack of awareness about secret sodium sources.

…

Americans believe there is a heart disease gene.

 …

There is no single way to prevent heart disease, given that every person is different,” Dr. Nissen added.
“Yet there are five things everyone should learn when it comes to their heart health because they can make an enormous difference and greatly improve your risk:

eat right,
exercise regularly,
know your cholesterol,blood pressure, and body mass index numbers,
do not use tobacco,
and know your family history.
Taking these steps can help lead to a healthier heart and a longer, more vibrant life.”

Read the entire article here

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Preventing disease is a problem for the health industry

By ROB LAMBERTS, MD | PHYSICIAN | OCTOBER 3, 2013, at KevinMD.com

……

People come to me for answers, and my profession pitches doctors as the ones with answers.  We fix problems.

This, of course, is not true — a fact that I have come to see as a core problem in the practice of medicine in America, and a reality that (as everything seems to do) comes largely from the way we pay for medicine.  We are paid to fix problems.  How do we fix problems?  With procedures.

The best evidence for this are the things at the heart of health care: codes.   There are three types of codes that dominate the financial and clinical lives of anyone in health care:

• ICD codes: codes for medical problems
• CPT codes: codes for medical procedures
• E/M codes: codes used by doctors who don’t do procedures so they can get paid for office visits

What this encourages from the medical profession is predictable: lots of problems treated by lots of procedures.  This is good for doctors who do procedures, especially ones that are cutting-edge (like robotic surgery) or ones that seem particularly dramatic and/or heroic (open heart surgery, heart stents).  These are the things the headline consuming public is most hungry for.  Just like it grabs more headlines to catch a terrorist plot just before it has its horrible effect than to prevent it early in the process, it’s a lot sexier to do a procedure to treat heart disease than to simply prevent the disease in the first place.  Which is the better outcome?  Preventing heart disease.  Which is paid more?  Not even close.

The problem with problems

A more subtle (and perhaps more significant) effect of this mindset is the way in which everything is labeled as “problems” or “diseases.”  A recent ruling of the AMA that obesity is a “disease” stirred up quite a bit of controversy. The AMA ruling does nothing to change the nature of obesity, and clearly is more a discussion of semantics, politics, and funding, than it is a true medical question.  In reality, I used to not be able to bill the ICD-9 code for obesity and get paid, but now I guess I could (if I did that kind of thing any more).  I suspect this opens the door for more procedures to be paid for by insurers, as the response to any problem is always a procedure in our system.

There is pressure now to respond to each “problem” with a procedure, or at least a thing to eliminate it as a problem.  Examples:

• Sinus infections are routinely treated with antibiotics despite no evidence that it actually helps.  Having marketed our profession as problem-fixers, we are met with patients expecting a fix to their problem.  They are disappointed (and even angry) when we don’t “do something” for a “problem” that will resolve on its own, even if the intervention probably causes more harm than benefit.  Problem: sinusitis.  Procedure: antibiotic.  Check.
• Cholesterol treatment is another example of this.  High cholesterol, be it LDL, total, or triglyceride is seen as a “problem,” even in people who are not at risk for heart disease.  I’ve seen many low-risk patients come to my practice on cholesterol medication that does little more than improve their numbers.  The evidence shows that certain high-risk people benefit from being on certain medications which lower the cholesterol.  For folks outside of those high-risk groups, the medications simply make numbers look better (at best) and potentially harm them (at worst).  Problem: High cholesterol.  Procedure: cholesterol drug.  Check.
• Depression and anxiety are normal emotions.  Life is painful and unsure.  There only are two ways to avoid these emotions: die or get stoned.  My personal experience (some fairly recent) is that the times of life most marked by anxiety and depression are accompanied by significant personal growth.  Before everyone gets mad at me for saying these aren’t diseases, I must add that there are cases of both of these emotions that are terribly destructive and potentially fatal if not treated.  But we physicians have lowered the price of admission to treatment, including people going through hard times as those who have clinical depression.  Responding to TV ads about “that pill that will make me happy,” we are met with patients expecting us to “fix their problem” — a problem that is not really a problem; it’s life.  Problem: anxious and depressed people.  Procedure: medication.  Check.

A better way

I think there’s a better way to look at things.  I’ve said this before, but I am coming to grasp just how radical this approach is and just how much it undermines our health care system.  There is something far more important than problems:

Risk.

When someone comes to my office with chest pain, my thoughts do not go to the question: “what is going on?”  A more important problem comes first: “is this a dangerous situation?”  I want to know if the person is ready to die from a heart attack or other serious problem.  This is true in nearly every decision I make as a doctor when faced with a condition.  Could that cough be latent lung cancer?  Could that headache be a brain tumor?  Could the depressed man kill himself?

Risk reduction also rules how I approach disease.  I treat cholesterol and hypertension, not because they themselves are problems, but because they can lead to heart disease, stroke, and other problems.  High cholesterol is not, in my opinion, a “disease” for most people; it is a risk factor.  I treat diabetes mainly to prevent the complications.  Do I care if a 90-year-old has an A1c of 8?  No way.  It doesn’t increase their risk enough to matter.

This does not mean we approach “prevention” like the system presently does: throwing procedures at it.  The health care system doesn’t reward having healthy patients, it rewards doing procedures reported to prevent problems.  Yet the system is not addressing the true goal of prevention: risk reduction. We are “rewarded” by ordering tests, whether or not they reduce risk.  PSA testing is a perfect example of this, as are many other misguided attempts to treat prevention as another problem to  fix with a procedure.

The problem with this, of course, is that it far more to the financial benefit of doctors (and drug companies) for us to address every problem and show we are giving “good care” by checking off the box next to each problem.  In the bigger picture, risk reduction makes the jobs of future cardiovascular surgeons (and drug companies) much less secure.  It attacks the revenue stream of most doctors and hospitals (and drug companies) right where it counts: you can’t make nearly as much money off of healthy people as you can people with “problems.”

This is why, I believe, any system that profits more from people with “problems” than those without is destined to collapse.  Our system is opposed to the goal of every person I see: to stay healthy and stay on as few drugs, have as few procedures, and avoid as many doctors (and drug companies) as possible.

What would happen if we prevented disease?  What would happen if people didn’t have medical problems?  For society it would be great.  For the health care industry it would be a huge problem.

Rob Lamberts is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).

Read the entire article here

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[Reblog] All work and no play… Could too much sitting at work be affecting your health?

From the 11 October 2013 post at Cardiac Exercise Research Group  – The K.G. Jebsen Center for Exercise in Medicine’s blog about exercise and cardiac health

There remains little doubt that lack of exercise and a sedentary lifestyle represent key health problems in today’s modern society. A quick search on the World Health Organisation’s (WHO) website and you’ll find that physical inactivity ranks 4^th in the global leading risk factors for mortality, with many countries around the world demonstrating a trend for women to be less active than men. While health organisations around the world are making a concerted effort to encourage the general public to incorporate exercise into their leisure and free time, this may not be the only period of our day that is dominated by sedentary behavior. Work forms one of the largest segments of sedentary time for employed individuals, and current trends have shifted parts of the working population into less active, ‘sitting’ jobs.

But what does this mean for our long-term health? One study, published last month in PLoS ONE, aimed to answer this question by assessing the impact of occupational sitting on the risk of cancer, cardiovascular disease, and all-cause mortality from a large number of British men and women. Stamatakis and colleagues gathered data from identical health surveys conducted in England and Scotland between 1994 and 2004. Subjects (5380 women, 5788 men) were classified based on whether the majority of time in their job was spent walking, standing or sitting. Subjects were further categorized on levels of physical activity during free time, alcohol intake, smoking, socioeconomic status, and whether they had cardiovascular disease or cancer at the time of the survey. The mortality rate (number of deaths) was then monitored over a 13 year follow-up period.

The major findings reported by this study were that standing/walking occupations carried a lower risk of mortality from either all-causes or cancer, in women but not men. When the researchers further compared groups based on free-time physical activity levels, they found that in both men and women, high levels of free-time physical activity coupled with a standing/walking occupation was associated with a lower risk of cancer and all-cause mortality versus low free-time activity coupled with sitting occupation. At first glance, it could be easy to take the results at face value, but there are limitations to the study design which the authors themselves highlight: Much of the data is self-reported, which may introduce bias, especially when it comes to levels of physical activity during free-time. In addition, there was no information available on how long individuals had been in their current jobs, nor was there any data for people switching jobs during the 13 year follow-up, which may have eventually placed them into a different category. The findings are also surprising given that a similar study published earlier in the year, found that even moderate free-time exercise was enough to reduce the risk of both cardiovascular and all-cause mortality, regardless of levels of physical activity in work.

The issue still seems unresolved, and it has also been discussed here on the blog earlier. Current exercise recommendations from the Norwegian Directorate of Health suggest daily physical activity levels should be at least 30 min, a total 3.5 hours per week, which has been shown in a number of studies to confer significant benefits to health and an overall decrease in mortality rates. However, a busy lifestyle, coupled with raising a family may make this target difficult to reach during our leisure time, making activity levels at work a significant factor in overall health. Everything is better than nothing, and maintaining a physically active lifestyle outside of work hours will contribute significantly to achieve the health benefits of exercise. However, if you’re still worried and have been sat at your desk for the last few hours, when you reach the end of this sentence, why not stand up and take a walk?

Allen Kelly, post doc at CERG.

 

 

Read the entire article here

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Health Insurance: Those Who Are Covered, Recover

 

From the 7 August 2012 article at Science News Daily

Underinsured CVD patients die sooner than patients with private insurance, irrespective of race…

Insurance status is a better predictor of survival after a serious cardiac event than race, and may help explain racial disparities in health outcomes for cardiovascular disease. A new study by Derek Ng, from the Johns Hopkins Bloomberg School of Public Health in the US, and his team shows that race is not linked to an increased risk of death but being underinsured is a strong predictor of death among those admitted into hospital with a serious cardiac event. Their work appears online in the Journal of General Internal Medicine, published by Springer…

…

g and colleagues looked at whether the risk of early death was associated with insurance status or race. They took into account the potential effects of neighborhood socioeconomic status and disease severity. They analyzed data from a sample of patients admitted to one of three Maryland hospitals for three specific cardiovascular events: 4,908 with acute myocardial infarction (or heart attack); 6,758 with coronary atherosclerosis (or furring up of the arteries); and 1,293 with stroke.

They found that underinsured patients died sooner than patients with private insurance, whereas the survival rates were comparable between whites and blacks. More specifically, underinsured patients had a 31 percent higher risk of early death after a heart attack and a 50 percent higher risk after atherosclerosis. This survival effect was independent of race, neighborhood socioeconomic status and disease severity.

The authors conclude: “Among those admitted to the hospital with an acute cardiovascular event, there was an increased risk of mortality among subjects who were underinsured compared to those who had private insurance. Given the recent changes in health insurance and healthcare reform, these results underscore the need to closely investigate the factors relating to health insurance that may explain these disparities. Indeed, targeting these factors may relieve the burden of mortality disproportionally affecting those who are underinsured.”

Related articles

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Mindfulness Meditation Reduces Loneliness in Older Adults, Study Shows

Mindfulness (Photo credit: Cathdew)

From the 24 July 2012 article at Science News Daily

For older adults, loneliness is a major risk factor for health problems — such as cardiovascular disease and Alzheimer’s — and death. Attempts to diminish loneliness with social networking programs like creating community centers to encourage new relationships have not been effective.

However, a new study led by Carnegie Mellon University’s J. David Creswell offers the first evidence that mindfulness meditation reduces loneliness in older adults. Published in Brain, Behavior & Immunity, the researchers also found that mindfulness meditation — a 2,500-year-old practice dating back to Buddha that focuses on creating an attentive awareness of the present moment — lowered inflammation levels, which is thought to promote the development and progression of many diseases. These findings provide valuable insights into how mindfulness meditation training can be used as a novel approach for reducing loneliness and the risk of disease in older adults.

“We always tell people to quit smoking for health reasons, but rarely do we think about loneliness in the same way,” said Creswell, assistant professor of psychology within CMU’s Dietrich College of Humanities and Social Sciences. “We know that loneliness is a major risk factor for health problems and mortality in older adults. This research suggests that mindfulness meditation training is a promising intervention for improving the health of older adults.”…

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  As previously reported, practicing a certain form of chanting yogic meditation for just 12 minutes daily for eight weeks led to a reduction in the biological mechanisms responsible for an increase in the immune system’s inflammation response. Inflammation, if constantly activated, can contribute to a multitude of chronic health problems.

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No Proof Found That Gum Disease Causes Heart Disease or Stroke

(I will continue to floss, tho, for the sake of my gums.  However it is a relief to know there is one less thing to think about when it comes to heart health)

From the 18th April 2012 article at Science Daily article

Despite popular belief, gum disease hasn’t been proven to cause atherosclerotic heart disease or stroke, and treating gum disease hasn’t been proven to prevent heart disease or stroke, according to a new scientific statement published in Circulation, an American Heart Association journal.

Keeping teeth and gums healthy is important for your overall health. However, an American Heart Association expert committee — made up of cardiologists, dentists and infectious diseases specialists — found no conclusive scientific evidence that gum disease, also known as periodontal disease, causes or increases the rates of cardiovascular diseases. Current data don’t indicate whether regular brushing and flossing or treatment of gum disease can cut the incidence of atherosclerosis, the narrowing of the arteries that can cause heart attacks and strokes.

Observational studies have noted associations between gum disease and cardiovascular disease, but the 500 journal articles and studies reviewed by the committee didn’t confirm a causative link.

“There’s a lot of confusion out there,” said Peter Lockhart, D.D.S., co-chair of the statement writing group and professor and chair of oral medicine at the Carolinas Medical Center in Charlotte, N.C. “The message sent out by some in healthcare professions that heart attack and stroke are directly linked to gum disease, can distort the facts, alarm patients and perhaps shift the focus on prevention away from well known risk factors for these diseases.”

Gum disease and cardiovascular disease both produce markers of inflammation such as C-reactive protein, and share other common risk factors as well, including cigarette smoking, age and diabetes mellitus . These common factors may help explain why diseases of the blood vessels and mouth occur in tandem. Although several studies appeared to show a stronger relationship between these diseases, in those studies researchers didn’t account for the risk factors common to both diseases….

…

“We already know that some people are less proactive about their cardiovascular health than others. Individuals who do not pay attention to the very powerful and well proven risk factors, like smoking, diabetes or high blood pressure, may not pay close attention to their oral health either” Lockhart said.  [Janice’s emphasis]

Statements that imply a cause and effect relationship between periodontal disease and cardiovascular disease, or claim that dental treatment may prevent heart attack or stroke are “unwarranted,” at this time, the statement authors said.

The American Dental Association Council on Scientific Affairs agrees with the conclusions of this report. The statement has been endorsed by the World Heart Federation.

 

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Optimism May Help Protect the Heart

myocardial infarction - Myokardinfarkt - scheme (Photo credit: Wikipedia)

From the 18th April 2012 article at Medical News Today

Harvard researchers suggest optimism, happiness and other positive emotions may help protect heart health and lower the risk of heart attacks, strokes and other cardiovascular events. It also appears that these psychological well-being factors slow the progress of cardiovascular disease.

The findings are the result of the first and largest systematic review of its kind, and are reported in the 16 April online issue of Psychological Bulletin, by lead author Julia Boehm, a research fellow, and senior author Laura Kubzansky, an associate professor, in the department of society, human development, and health, at the Harvard School of Public Health (HSPH) in Boston, Massachusetts….

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Soda’s Evil Twin – The Dangers of Fruit Drinks (Infographic) [With Added Item on Environmental Degradation by Soda Manufacturer Processes]

From Jen Rs Web page  (Twitter: jenicarhee)

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• [Environmenal effects of soda drink manufacturing overseas]

From the January 2012 newsletter item by the Mt. St. Agnes Theological Center for Women
Green Notes

Bad news for soft drink lovers…You might believe that your daily cola fix only poses a threat to your diet but, depending on your brand of choice, you could be terribly wrong.  As major soft drink manufactures move their bottling plants over seas and into the developing world, many are engaging in irresponsible behaviors that harm the local environment and communities dependent on it.

Coca-Cola stands out as the worst offender, particularly in India.  In the last decade, tens of thousands of farmers and their families have lost their livelihoods as Coca-Cola’s activities have dried out their wells and poisoned any alternate local water sources.  The company has peddled potentially toxic product containing elevated levels of dangerous pesticides in drinks sold in India. The dangerous pesticides include DDT, Lindane, and Malathion.  PepsiCo’s activities in India have been only marginally better.  India’s parliament has banned Coca-Cola and PepsiCo products from all of its cafeterias and, as of 2007, ten thousand of its schools and colleges have followed suit.

In support of India’s efforts to force responsible practices from the Coca-Cola and PepsiCo corporations, our Center will no longer purchase or serve soft drinks from these companies.  We hope you will do the same.  For more information regarding the on-going protest movement against Coca-Cola and PepsiCo, check outwww.cokejustice.org  andwww.indiaresource.org/news/2010/1044.html, or refer to Paul Hawken’s book, Blessed Unrest, which our Center will be discussing this April.

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