Category Archives: Heart and Vascular Health
“Hypertension affects nearly one in three adults and kills more people around the world than anything else. It is both too common and too often poorly controlled.”
So said Tom Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), during a panel discussion at the annual meeting of the American Society of Hypertension (ASH) this past weekend. The panel was convened by ASH, the American Heart Association and the CDC to launch a project supporting improved control of hypertension worldwide. According to the panel an estimated 970 million people have hypertension worldwide, and the disease is responsible for more than nine million deaths, as hypertension can lead to heart disease and stroke.
Data from the groups finds that rates of hypertension have increased in both developed and developing nations, due in part to an aging population and lifestyles that include high salt diets and low physical activity.
For the developing world, the CDC; the Pan American Health Organization; and other regional and global stakeholders are identifying both cost effective medicines and inexpensive delivery strategies for the drugs to help patients afford and receive them.
In the United States, the Affordable Care Act is expected to increase the number of people on hypertension medications, but despite the availability of coverage for hypertension diagnosis and treatment there remains concern over disparities. A study of more than 16,000 members of the Hispanic community published in the American Journal of Hypertension earlier this year found that while the prevalence of hypertension among Hispanics is nearly equal to that of non-Hispanic whites, diagnosis of the disease is much lower, as is general awareness of its symptoms and treatment options.
"Given the relative ease of identifying hypertension and the availability of low-cost medications, enabling better access to diagnostic and treatment services should be prioritized to reduce the burden of cardiovascular disease on Hispanic populations,” said Paul Sorlie, MD, the lead author of the study and an epidemiologist with the National Heart, Lung and Blood Institute. “This study gives us the information needed to support the development of policies that can improve this access and, subsequently, the overall health of countless US citizens.”
- A new infographic from the Measure Up/Pressure Down initiative of the American Medical Group Association provides some key patient information about hypertension, including normal and dangerous ranges of blood pressure—numbers patients should be familiar with.
- A map from the Institute for Health Metrics and Evaluation at the University of Washington shows hypertension levels for 2001 to 2009 by race and gender.
May is stroke awareness month and a new infographic from the American Stroke Association wants everyone to know minutes count when a stroke hits. The campaign uses research published by the Association this year in the campaign infographic to let people know that for each minute shaved off stroke response in a hospital, patients get back days of healthy living.
The infographic includes the FAST warning signs and symptoms for stroke:
- Face drooping
- Arm weakness
- Speech difficulty
- Time to call 911
>>Bonus Content: The American Stroke Association has a site full of patient education resources on stroke awareness and prevention, including a very effective PSA on body language to help teach the FAST warning signs of stroke. The association also previously created another infographic on the FAST warning signs.
Living Near Foreclosed Property is Linked to Higher Blood Pressure
Living near foreclosed property may increase the risk of higher blood pressure, according to new research published in the American Heart Association journal Circulation. Researchers reviewed data from 1,740 participants (mostly white, 53 percent women) in 1987-2008 in the Framingham (Massachusetts) Offspring Cohort, which is part of the Framingham Heart Study. The researchers distinguished between real-estate-owned foreclosures, which are owned by lenders and typically sit vacant, and foreclosures purchased by third-party buyers, which are generally put into housing use. The researchers found each additional foreclosed property within 100 meters (328 feet) of participants’ homes was associated with an average increase of 1.71 mm Hg in systolic blood pressure. The association only applied to properties that were real-estate owned and there was no effect from foreclosed properties more than 100 meters from participants’ homes.
“The increases in blood pressure observed could be due in part to unhealthy stress from residents’ perception that their own properties are less valuable, their streets less attractive or safe and their neighborhoods less stable,” said Mariana Arcaya, Sc.D., M.C.P., study lead author and a research fellow at the Harvard Center for Population and Development Studies in Cambridge, Mass. “Safety could also be a concern that affects their ability to exercise in these neighborhoods.”
Research on different populations in urban and rural settings is needed, says Arcaya. The study was funded by the Robert Wood Johnson Foundation, the Harvard School of Public Health and the National Institutes of Health and the Robert Wood Johnson Foundation funded the study. Read more on prevention.
Underage College Men Downplay Danger of Driving after Using Marijuana
Underage male college students who report using marijuana in the month before they were surveyed had a high prevalence of driving under the influence of marijuana and of riding with a marijuana-using driver, at a rate more than double that of driving or riding after alcohol use, according to a recent study by researchers from the University of Massachusetts Amherst School of Public Health and Health Sciences and University of Washington pediatrics department. The researchers also found that among marijuana-using students, 44 percent of males and 9 percent of females drove after using the drug, and 51 percent of males and 35 percent of females rode as a passenger with a marijuana-using driver. The researchers say the study results reflect the widespread belief that driving after using marijuana is safe and that strategies to dispute that belief are needed to help change social norms and encourage using a designated driver not only after alcohol use, but after a driver has used any risky substance. The study was published in JAMA Pediatrics. Read more on substance abuse.
Moderate Exercise Reduces Premature Death Risk in Older Men
Older men with hypertension can lower their risk of premature death with even moderate levels of exercise, according to a new study in Hypertension. The researchers say the needed level of fitness can be achieved by a brisk twenty to forty minute walk on most days. The researchers reviewed the fitness levels of 2,153 men, aged 70 years and older with high blood pressure by a standard treadmill exercise test, using a standard measure of fitness called metabolic equivalents (METs.) An MET is equal to the amount of oxygen the body uses per kilogram of body weight per minute. The peak MET level of a sedentary 50-year-old is about five to six METs; for a moderately fit individual it’s about seven to nine METS; and for a highly fit person it’s 10 to 12 METs. (Marathon runners, cyclists and other long distance athletes often have MET levels of 20 or higher.)
After an average follow-up of nine years, researchers found that the risk of death was 11 percent lower for every one-MET increase in exercise capacity:
- Those in the low-fit category (4.1 to 6 peak METs) had an 18 percent lower risk of death.
- Moderately-fit men (6.1 to 8 peak METs) had a 36 percent lower risk of death.
- High-fit men with peak METs of more than 8 reduced the risk of death by 48 percent.
Read more on heart health.
Starting at Age 30, Inactivity Accounts for Greatest Risk of Heart Disease for Women
A new study in the British Journal of Sports Medicine finds that from the age of 30 onward, physical inactivity exerts a greater impact on a woman's lifetime risk of developing heart disease than other risk factors, including being overweight, smoking and having high blood pressure. The research was based on a longitudinal study of more than 30,000 Australian women ages 22-64 over almost twenty years. Read more on heart health.
Domestic Violence Victims More Likely to Take Up Smoking
A new study in 29 low and middle-income countries by researchers at the Mailman School of Public Health at Columbia University links intimate partner violence (IPV) with smoking. The researchers examined the association between IPV and smoking among 231,892 women ages 15-29 data collected from health surveys. Reports of IPV ranged from 9 to 63 percent, and using a meta-analysis that accounted for other factors including age, education, and household wealth, the researchers found a 58 percent increased risk for smoking among the women who experienced IPV. The study points to a specific need for investments to help IPV victims avoid tobacco, according to the researchers, who suggest that information about the consequences of smoking, motivation to quit smoking and smoking-cessation treatments could be incorporated into IPV treatment by health care providers who routinely interact with IPV victims. Read more on violence.
Many Veterans Face Food Insecurity
A new study by researchers at the University of Minnesota School of Public Health has found that 27 percent of veterans of the wars in Iraq and Afghanistan are facing food insecurity—nearly double the rate of the general population. The findings came from a university-supported sturdy of veterans’ behavioral health begun in 2001. Researchers found that people who report being food insecure tend to get less sleep, report using cigarettes, tend to be unemployed, ten not be married or partnered and have lower incomes. Veterans would be helped by increasing awareness of the issue so that they are connected to assistance both for food and for employment opportunities. Read more on poverty.
CDC: Parasitic Diseases a Significant U.S. Public Health Issue
Although the perception is that parasitic diseases only occur in poor and developing countries, people in the United States are also at risk for the diseases, which can cause serious illnesses, including seizures, blindness, pregnancy complications, heart failure and even death, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC has designated five neglected parasitic infections (NPIs) as U.S. public health priorities: Chagas disease, cysticercosis, toxocariasis, toxoplasmosis and trichomoniasis. While they can be treated when identified, there remains difficulty in correctly diagnosing the diseases, according to the CDC.
The estimates of the burden of NPIs include:
- More than 300,000 people living in the United States are infected with Trypanosoma cruzi, the parasite that causes Chagas disease, and more than 300 infected babies are born every year.
- There are at least 1,000 hospitalizations for symptomatic cysticercosis per year in the United States.
- At least 14 percent of the U.S. population has been exposed to Toxocara, the parasite that causes toxocariasis, and each year at least 70 people—most of them children—are blinded by resulting eye disease.
- More than 60 million people in the United States are chronically infected with Toxoplasma gondii, the parasite that causes toxoplasmosis; new infections in pregnant women can lead to birth defects and infections in those with compromised immune systems can be fatal.
- Trichomoniasis can cause pregnancy problems and increase the risk of other sexually transmitted infections including HIV. The Trichomonas parasite is extremely common, affecting 3.7 million people in the United States, although it is easily treatable.
Read more on global health.
Study: Many People Who Believe They Are Sensitive to Gluten Do Not Get Tested for Celiac Disease
Despite the increasing number of gluten-free products on grocery store shelves, many people who believe they are sensitive to gluten do not undergo tests to rule out celiac disease, according to a new study in the journal Nutrition in Clinical Practice. The autoimmune disorder damages the lining of the intestines, resulting in digestive symptoms and potential complications, and left untreated can lead to significant health problems. “There is a great deal of hype and misinformation surrounding gluten and wheat allergies and sensitivities. The group of so-called ‘non-celiac gluten sensitivity’ remains undefined and largely ambiguous because of the minimal scientific evidence,” said study author Jessica R. Biesiekierski, according to Reuters. “This non-celiac gluten sensitivity entity has become a quandary, as patients are powerfully influenced by alternative practitioners, Internet websites and mass media who all proclaim the benefits of avoiding gluten- and wheat-containing foods.” Read more on nutrition.
Study: ECGs Should Be Added to Health Screenings for High School Athletes
Electrocardiograms should be added to the health screening programs for high school athletes, according to a new study presented at the Heart Rhythm Society's annual meeting in San Francisco. The test would increase the odds of detecting medical conditions that could lead to sudden cardiac arrest and death. Researcher used data on approximately 5,000 athletes, ages 13-19, who underwent standard American Heart Association screening and also received an electrocardiogram, finding that while 23 were found to have significant heart abnormalities that required further evaluation, seven would not have been detected without an electrocardiogram. Read more on heart health.
The Cuyahoga County, Ohio Place Matters team's focus is on ensuring health implications and equity considerations are at the forefront as policy makers and others make decisions that substantially impact the county’s residents and the neighborhoods in which they live.
Key Team Objectives:
- A broader definition of health. Health is not simply the absence of disease—health begins where people live, work, learn, age and play. Health includes the social conditions one lives in, such as the jobs we do, the money we're paid, the schools we attend and the neighborhoods we live in, as well as our genes, our behaviors and our medical care.
- Inform, influence and engage policy makers and community members to develop policies—using an overarching health equity lens—that have long-term impacts, create conditions for optimal health and reduce inequities.
- Utilize "place-based" interventions to engage and empower residents in under-resourced communities to revitalize their communities.
East Cleveland is one of the most densely settled communities in Cuyahoga County. The city has a poverty rate of 32 percent, while its heart disease mortality rates (355/100,000) are higher than in the county (10 percent higher) and the nation (32 percent higher).
Team objectives include building effective partnerships; striving for equal opportunity for all; equity; recognition that neighborhood condition is the context in which health and wellbeing begins; health in all policies; mobilizing the community for action; and measuring indicators of social determinants of health.
Sebelius to Step Down as Head of HHS
Kathleen Sebelius is resigning as secretary of the U.S. Department of Health and Human Services (HHS). The formal announcement is expected to come at 11 a.m. this morning, with President Obama to name Office of Management and Budget Director Sylvia Mathews Burwell as the replacement for the former Kansas governor. Sebelius assumed the HHS position in April 2009. Read more on the HHS.
FDA Expands Approved Use of Certain Pacemakers, Defibrillators
The U.S. Food and Drug Administration (FDA) has expanded the approved application of certain pacemakers and defibrillators, allowing them to also be used for patients with atrioventricular (AV) block and less severe heart failure. Previously the devices—which provide electrical impulses to the heart through implanted leads in the ventricles—were approved only for people with more severe heart failure as evaluated by their physician using specific criteria. The expansion covers two cardiac resynchronization pacemakers (CRT-P) and eight cardiac resynchronization defibrillators produced by Medtronic. Approximately 5.1 million people in the United States have heart failure. Read more on heart health.
Study: Doctor’s ‘Bedside Manner’ Has Real Effect on Patient Health
The doctor-patient relationship can have a real and significant impact on patient health, with doctors with better “beside manner” also having patients who fare better in efforts to lose weight, lower their blood pressure or manage pain, according to a new study in the journal PLOS One. Researchers reviewed 13 clinical trials, finding that improved patient outcomes were linked directly to doctors who had undergone training to hone their people skills. "I think that intuitively, people think that if you have an open, caring relationship with your provider, that's beneficial," said Helen Riess, the senior researcher on the new study, according to HealthDay. Read more on access to health care.
Study: ‘White Coat Effect’ on Blood Pressure is Real
The “White Coat Effect” is real, according to a new study in the British Journal of General Practice. The effect, wherein a person’s blood pressure is higher when taken by a doctor than when taken by a nurse, has long been assumed, but this is the first study to confirm it. The study analyzed the results of more than 1,000 people who had their blood pressure taken by both a physician and a nurse, finding the results of the physician-administered tests were noticeably higher. "Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome,” said Christopher Clark, MD, of the University of Exeter Medical School, in a release. “The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects.” Clark also noted that researchers should also take these findings into account when performing studies on topics such as hypertension. Read more on heart health.
Black, Latina Breast Cancer Patients More Likely to Struggle with Health Care-Related Debt
Black and Latina breast cancer patients are far more likely than their white counterparts to have medical debt as a result of treatment or to skip treatments due to costs, according to a new study in the Journal of Clinical Oncology. In a survey of 1,502 patients, researchers determined that 9 percent of whites, 15 percent of blacks, 17 percent of English-speaking Latinas and 10 percent of Spanish-speaking Latinas reported medical-related debt four years post diagnosis. The study said the findings should “motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.” Read more on health disparities.
Lawsuit Challenges New York City’s Ban on E-Cigarettes
A “smoker’s rights” group called New York City Citizens Lobbying Against Smoker Harassment has filed a legal challenge to the city’s ban on electronic cigarettes—or e-cigarettes—in restaurants, parks and certain other public places. The group contends that since e-cigarettes do not contain tobacco or produce smoke, they should not be subject to New York City’s Smoke-Free Air Act. The city council expanding regulations to include e-cigarettes last year and the U.S. Food and Drug Administration has announced its intention to propose government regulations over their use. In the lawsuit, the group wrote that "E-Cig regulation is, even in the Council's words, at best, tangentially related to the subject of smoking, in much the same way that toy water guns are at best tangentially related to authentic firearms.” However, city council spokeswoman Robin Levine said by email to Reuters that "Our legislation ensures the goals of the Smoke-Free Air Act are not undermined and protects the public against these unregulated substances.” Read more on tobacco.
Overweight Teens Should Start Healthy Eating by Cutting Down on Salt
Overweight or obese teenagers who eat lots of salty foods shows signs of faster cell aging, according to research presented at the American Heart Association’s Epidemiology & Prevention/Nutrition, Physical Activity & Metabolism Scientific Sessions 2014. Previous research found that protective ends on chromosomes (telomeres) naturally shorten with age, but the process is accelerated by smoking, lack of physical activity and high body fat. This study is the first to examine the impact of sodium intake on telomere length.
In the study, 766 people ages 14-18 were divided into the lowest or highest half of reported sodium intake. Low-intake teens consumed an average 2,388 mg/day, compared with 4,142 mg/day in the high-intake group. Both groups consumed far more than the 1,500 mg/day maximum (about 2/3 teaspoon of salt) recommended by the American Heart Association. After adjusting for several factors that influence telomere length, researchers found that in overweight/obese teens, telomeres were significantly shorter with high-sodium intake. In normal weight teens, telomeres were not significantly different with high-sodium intake.
“Even in these relatively healthy young people, we can already see the effect of high sodium intake, suggesting that high sodium intake and obesity may act synergistically to accelerate cellular aging,” said Haidong Zhu, MD, PhD, lead author of the study and assistant professor of pediatrics at Medical College of Georgia, Georgia Regents University in Augusta, Ga. “Lowering sodium intake may be an easier first step than losing weight for overweight young people who want to lower their risk of heart disease. The majority of sodium in the diet comes from processed foods, so parents can help by cooking fresh meals more often and by offering fresh fruit rather than potato chips for a snack.” Read more on heart health.
DOT Awards Grants to Improve Transportation for American Indian and Alaska Native Tribes
The U.S. Department of Transportation is awarding $5 million to 42 American Indian and Alaska Native tribes in 19 states for projects to improve transit service, in addition to $25 million in funds announced recently to help improve public transit service on rural tribal lands and better connect tribal members and other residents with jobs, education, and other opportunities.
“We fully recognize that residents on tribal lands and in surrounding communities often face significant transportation challenges, as many cannot afford to own a vehicle, or fill the tank, and yet must travel long distances to reach basic services,” said Federal Transit Administration head Therese McMillan. “We want to ensure that everyone who needs a ride to earn a paycheck, attend school, see the doctor, or buy groceries has that opportunity.” Read more on transportation.
Health Providers Should Prescribe Sleep for People with Metabolic Disorders
A new study in The Lancet Diabetes & Endocrinology finds that insufficient or disturbed sleep is associated with metabolic disorders such as type 2 diabetes and obesity, and addressing poor quality sleep should be a target for the prevention—and even treatment—of the disorders. According to the study authors, addressing some types of sleep disturbance—such as sleep apnea—may have a directly beneficial effect on patients' metabolic health, but a far more common problem is people simply not getting enough sleep, particularly due to the increased use of devices such as tablets and online games. The authors say that early studies are starting to provide evidence that there is a direct causal link between loss of sleep and the body's ability to metabolize glucose, control food intake, and maintain its energy balance. Read more on obesity.
Some Will Be Able to Enroll After March 31 Affordable Care Act Deadline
Some people will be able to enroll for coverage under the Affordable Care Act after the official enrollment deadline of March 31, according to new guidelines expected to be issued by the Obama administration. The new guidelines would allow people had previously tried to enroll by were prevented by systems problems such as technical difficulties, according to Reuters. "Open enrollment ends March 31. We are preparing for a surge in enrollment, and if consumers are in line on the 31st and can't finish, we won't shut the door on them. To be clear, if you don't have health insurance and do not start to sign up by the deadline, you can't get coverage again until next year," said U.S. Department of Health and Human Services spokeswoman Joanne Peters in a statement. Read more on the Affordable Care Act.
Study: Alcohol-Related Vehicle Crashes Greatly Underreported
Alcohol is a far greater factor in U.S. motor vehicle deaths than has been reported, according to a new study in the Journal of Studies on Alcohol and Drugs. Using Fatality Analysis Reporting System (FARS) data from the U.S. National Highway Traffic Safety Administration, researchers determined that in the decade from 1999 to 2009 while only a little more than 3 percent of the death certificates for traffic deaths included alcohol as a contributing cause, about 21 percent of the deaths were legally drunk. Approximately 450,000 Americans were killed in traffic crashes during the period. The time that it takes coroners to take and process blood alcohol tests could be a reason for the underreported figures. Ralph Hingson, Sc.D., of the U.S. National Institute on Alcohol Abuse and Alcoholism, said the vast discrepancy demonstrates the need for more reliable data. "We need to have a handle on what's contributing to the leading cause of death among young people," he said in a release. "You want to know how big the problem is, and if we can track it. Is it going up, or going down? And what policy measures are working?" Read more on alcohol.
NIH Identifies Genetic Markers Tied to Stroke, Cardiovascular Disease
Researchers and the National Institutes of Health have identified a genetic variant linked to increased risk for stroke, as well as a metabolic pathway tied to several common diseases, which taken together could improve how doctors identify and treat major diseases. “Our findings have the potential to identify new targets in the prevention and treatment of stroke, cardiovascular disease and many other common diseases,” said Stephen R. Williams, PhD, a postdoctoral fellow at the University of Virginia Cardiovascular Research Center and the University of Virginia Center for Public Health Genomics, Charlottesville. The genetic markers were found through the analysis of nearly 5,000 genomes. The results were published in the journal PLoS Genetics. About 600,000 Americans die of heart disease each year—one in every four deaths—and stroke is the fourth-leading cause of death in the United States. Read more on heart health.