Tag Archives: Hypertension

Three research pieces with a lot of heart

Posted by on September 10, 2013 Comments Off on Three research pieces with a lot of heart

Often the most heartening news comes from health research. The past couple of weeks have revealed three worthy of note. All three involve prevention measures, two before a heart attack, and one after.

First, the US Centers for Disease Control and Prevention estimate that 200,000 deaths from heart attacks can be avoided annually. The preventable deaths are concentrated in three areas.

The first area is age, where preventable deaths are concentrated in the 45-64 age cohort.
Preventable deaths by age

The second area is race, where African-American men are at the highest risk of preventable death, 143 out of 100,000.

Preventable deaths by race

Finally, the deaths are concentrated geographically in the South-Central Region.
Preventable deaths by region

Second, a study from Britain and India, published in the Journal of the American Medical Association (JAMA) found that a single pill or “polypill” with fixed doses of aspirin, anti-hypertensive, and cholesterol-lowering drugs was statistically more effective than offering separate prescriptions. While physicians point out that this approach limits flexibility, greater variation of dosage combinations in polypills is a promising approach.

Polypill study

Third, a study in JAMA Internal Medicine found that even after a heart attack, better diet, as measured with Alternative Healthy Eating Index (AHEI 2010), resulted in lowered mortality.

The good news is that either before, or failing that, after a heart attack, the good practices of medication adherence and reduction of risk factors such as poor diet, can improve our survival as individuals. Furthermore, we can move the needle in a better direction by focusing our educational and interventional efforts on those under 65, African-American, residing in the South-Central United States.

The things we already know–but don’t often do

Posted by on July 15, 2013 Comments Off on The things we already know–but don’t often do

There is the old Middle Eastern story of the one who journeyed East in search of wisdom. He came upon a stone where he read, “Turn me over.”
He picked up the stone and read on the underside: Why do you seek new knowledge when you do not use that which you already have?

A recently reported Swedish study that followed 71,000 individuals over a 13-year period found that consuming less than five daily servings of fruits and vegetables was associated with higher mortality and shorter survival periods. Those eating one serving of fruit daily lived 19 months longer on average, while those eating 3 servings of vegetables lived 32 months longer.

Now by itself, this is not very surprising. We know that heavy meat consumption is linked to colorectal cancer, particularly in combination with genetic mutations, as described in a recent issue of Smithsonian Magazine. So, the possibility that a different diet would be protective, even by contrast, makes some sense.

Fornaciari subsequently analyzed bone collagen of King Ferrante and other Aragonese nobles, revealing a diet extremely reliant on red meat; this finding may correlate with Ferrante’s cancer. Red meat is widely recognized as an agent that increases risk for mutation of the K-ras gene and subsequent colorectal cancer. (As an example of Ferrante’s carnivorous preferences, a wedding banquet held at his court in 1487 featured, among 15 courses, beef and veal heads covered in their skins, roast ram in a sour cherry broth, roast piglet in vinegar broth and a range of salami, hams, livers, giblets and offal.)

In a similar vein, one out of three Americans suffers from hypertension (high blood pressure), a major risk factor for serious cardiovascular events such as stroke and heart attack. A recent study in JAMA showed that 18 months after the beginning of a study in which the experimental group did home blood pressure monitoring along with pharmacist case management, 71.8 percent had controlled blood pressure compared to the control group with usual care at 57.1 percent.

It would be easier if we had pills that would lower our body weight or a vaccination against high blood pressure. We don’t. But we have knowledge that we are not using: walk more, eat less processed foods and more whole grains, vegetables, and fruits, monitor blood pressure and pulse regularly. No, it is not magic–just the best that we can do.

Bad News for Boomers: Our Parents Were Healthier

Posted by on March 14, 2013 Comments Off on Bad News for Boomers: Our Parents Were Healthier

As Americans we believe in progress, in a better tomorrow, sometimes with a bump in the road or a hiccough, but always a better tomorrow.

The data are in (March 4,2013 edition of JAMA Internal Medicine), and it ain’t happening for boomers. Blood pressure, cholesterol, diabetes, and obesity–all greater than the previous generation.

Boomer_Parent_Comparison_JAMAinternalmed_20130304
Source: The Status of Baby Boomers’ Health in the United States The Healthiest Generation?
Dana E. King, MD, MS; Eric Matheson, MD, MS; Svetlana Chirina, MPH; Anoop Shankar, MD, PhD, MPH; Jordan Broman-Fulks
JAMA Intern Med. 2013;173(5):385-386

Although longevity has risen during the twenty-year gap between the two groups, every other indicator of health, except smoking, has become less favorable. And the pattern is clear.

At the top of the following chart are general measures of health. Then, we can see that lifestyle factors have declined leading to the trends in the last section: declining indicators of cardiovascular health.

We can’t choose to be healthy or not: what we can do is make healthy choices by changing the lifestyle factors.

We are choosing illness at great expense to ourselves, both financially and in quality of life, while continuing to endure longer and sicker lives instead of enjoying healthier lives.

Boomer_Parent_Extract_Comparison

Salt: Connecting the Dots

Posted by on March 11, 2013 Comments Off on Salt: Connecting the Dots

Some number of millenia ago our evolutionary forebears crawled out of the sea, carrying its salt flowing through their veins to ours. In the right amount, salt is not only good for us but essential to life.

That is not the same, however, as dumping salt on our food before tasting it or eating processed dinners, from the supermarket or from the nearest fast food franchise.

Most of us have long known that salt increases hypertension among salt-sensitive individuals.

Two sets of studies have come out, one widely publicized, the other well below the radar, that add concerns about excess salt consumption.

Researchers publishing in a recent issue of Nature have linked salt consumption to auto-immune disorders such as multiple sclerosis, psoriasis, ankylosing spondylitis, and rheumatoid arthritis. Unless you have a $200 annual subscription to Nature, you may wish to google “salt autoimmune” to read descriptions of the studies. Or, you may wish to simply click on these links to Medical News Today or The Huffington Post.

So, what are the dots to be connected? That’s where the second study comes in, the one with little publicity.

A presentation at the 2013 American Academy of Dermatology annual meeting in March found that individuals with psoriasis were more likely to have metabolic syndrome. They found that 30 percent of the psoriasis children had metabolic syndrome symptoms compared to the non-psoriasis group. There were not significant differences in Body-Mass Index (BMI), c-reactive protein, or endothelial cells

A 2012 study in South India found a higher incidence of metabolic syndrome among those with psoriasis. In this case:

Patients were diagnosed with MetS for having three or more South Asian Modified National Cholesterol Education Program Adult Treatment Panel III criteria: abdominal obesity (waist circumference ≥90 cm for men, ≥80 cm for women); blood pressure, >130/85 mm Hg; fasting blood glucose, ≥100 mg/dL; hypertriglyceridemia, >150 mg/dL; or low HDL (<40 mg/dL for men, <50 mg/dL for women).

Sugar and spice, and salt is not very nice Part II

Posted by on February 21, 2013 Comments Off on Sugar and spice, and salt is not very nice Part II

Last time we looked at the danger of dietary sodium, likely to shorten the lives of a million Americans. If knowledge is power, then here is some power for you:

Let’s start simple, with the major sources of dietary sodium from the CDC.
CDC Sources of Sodium

Unless we make our own bread (a fun thing to do with a bread maker, not as much fun by hand), we have little control over the amount of salt in bread. We can look for low-sodium alternatives or we can wait for government action. By the way, the government has been regulating bread for a long time, in Europe before the founding of this country and since the 17th century by colonies/states such as Massachusetts. Since 1941 the US government has been mandating nutritional additives to bread, including folic acid, iron, and other nutrients. Regulating sodium content is not even a stretch.

Take a look at this graphic from the CDC–sodium can be reduced by half in nearly identical sandwiches with a bit of care in choosing ingredients:

Low Sodium Sandwich

Reducing sodium in our diets is one of those simple things we can do to improve our health. Doing the easy thing is sometimes better than the difficult. 2 Kings 5:13

Here is some further reading on dietary sodium:

UCSF Low Sodium Guidelines
CDC Sodium Tip Sheet
Medline Plus: Dietary Sodium