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Sleeplessness Bad for the Heart

heart 3Men who slept badly were twice as likely to suffer a heart attack and up to four times as likely to have a stroke compared with those who slept well, according to a Russian study presented at EuroHeartCare.

“Sleep disorders are very closely related to the presence of cardiovascular diseases. However, until now there has not been a population based cohort study examining the impact of sleep disorders on the development of a heart attack or stroke,” lead investigator Valery Gafarov, MD, PhD, professor of cardiology at the Russian Academy of Medical Sciences in Novosibirsk, said in a press release.

The study included 657 men ages 25 to 64 with no history of cardiovascular disease or diabetes. They were enrolled in 1994 as part of the World Health Organization’s MONICA (multinational monitoring of trends and determinants in cardiovascular disease) project.sleep

Sleep quality was assessed at baseline with the MONICA-psychosocial interview sleep disturbances scale. Incidence of new cases of myocardial infarction (MI) and stroke were determined at 5 years, 10 years, and 14 years of follow-up. The investigators used Cox proportional regression models to estimate hazard ratios.

Compared with men who rated their sleep as “good,” those who rated it “poor” or “very bad” had more than twice the risk of experiencing MI at 5 years.

This increased risk for MI was also seen at 10 years and at 14 years of follow-up.heart 2

Nearly two-thirds (63%) of the men experiencing their first MI described their sleep as “poor” or “very bad.”

Compared with men who rated their sleep as “good,” those who rated it “poor” or “very bad” had nearly quadruple the risk of stroke at 5 years.

Source: Medpage Today


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Myocardial Infarction Survivors Face Higher Cancer Risk

Heart attackThe risk of developing cancer is significantly higher in survivors of an acute MI compared to the general population, according to a large Danish national registry study.

“Greater focus on long-term cancer risk is warranted in MI survivors. This could potentially have implications on future patient care for MI patients, outpatient follow-up strategies, and distribution of health care resources,” Morten Winther Malmborg said at the annual meeting of the American College of Cardiology.heart attack 3

He presented a nationwide cohort study including 3,005,734 Danish adults with no baseline history of MI or cancer who were followed for up to 17 years in the comprehensive Danish National Patient Registry. During the study period, 125,926 of these individuals had a nonfatal MI.

The subsequent incidence of cancer in the MI survivors was 167 cases per 10,000 person-years compared with 95 per 10,000 person-years in the control group, reported Mr. Malmborg, a fourth-year medical student at the University of Copenhagen.

Source: Family Practice News


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Focus More Heart Care on the Young, Study Says

Living decades with high cholesterol greatly increases the risk for heart disease, according to a recent study that bolsters a push by some doctors for regular cholesterol testing and perhaps early drug treatment of people in their 30s and 40s.

About 37% of young adults have never had their cholesterol checked, according to the Centers for Disease Control and Prevention. And when elevated cholesterol levels are found, doctors typically won’t prescribe a drug until patients are in their 50s or 60s. By then, significant damage from years of cholesterol buildup has been done, the new research indicates.cholesterol 2

“If we wait until people are in their 50s and 60s to be thinking about high arterycholesterol, it is probably too late,” said Ann Marie Navar-Boggan, a cardiology fellow at Duke Clinical Research Institute in Durham, N.C., and lead author of the study, which was published in the journal Circulation in January. The risk of developing heart disease increases by 39% for every 10 years a person lives with high cholesterol, the research found.

Heart disease can be prevented through healthier eating, more exercise and weight loss, though many patients find it difficult to make the necessary lifestyle changes. Although statins have been proved to lower cholesterol and reduce the risk of heart attack, the safety and effectiveness of taking the drugs for several decades hasn’t been closely studied. In short-term studies, some people experience side effects to statins including muscle pains.

Source: WSJ

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Cardiovascular Disease Kills 51% Of Women In Europe And Breast Cancer Kills 3%

Cardiology 2Cardiovascular disease (CVD) is the top killer in women and is largely preventable. The call for women to reduce their risk comes from the European Society of Cardiology (ESC) today on International Women’s Day.

Dr. Susanna Price, ESC spokesperson and consultant cardiologist at the Royal Brompton Hospital in London, UK, said:

“CVD is still largely considered a man’s problem with breast cancer commonly perceived as the greater issue for women. However, CVD is the top killer of women in Europe, resulting in 51% of deaths compared to 3% caused by breast cancer.” (1)

She added: “Women’s risk of heart disease tends to be underestimated by both the public and the medical Cardiology 1profession because of the perception that estrogen protects them. In reality this just delays the onset of CVD by 10 years. (2) The result is that women’s risk factors are left untreated, leaving them more vulnerable to heart attack, heart failure and sudden cardiac death when the protection fades after menopause.”

Despite these misconceptions, the facts are that:

-CVD is the main cause of death in women in all countries of Europe (3)

-CVD causes 51% of deaths in women and 42% of deaths in men in Europe (1)

-CVD kills 51% of women in Europe and breast cancer causes 3% of deaths (1)

-The risks of smoking are higher in women because women metabolize nicotine faster, especially those taking oral contraceptives (2)

-Type 2 diabetes doubles CVD risk in men but more than triples the risk in women (4)

-Women are more likely to be severely disabled after a stroke than men (5).

Source: European Society of Cardiology


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Smoking and Mortality

smoking 4Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking.

We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort.Smoking 2

During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure, intestinal ischemia, hypertensive heart disease, infections, various respiratory smoking 3diseases, breast cancer, and prostate cancer. Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased.

A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated.

Source: The New England Journal of Medicine


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Cardiovascular Screening May Be Worthwhile For Middle-Aged Athletes

Heart 2Cardiovascular screenings are a cost-effective way to identify middle-aged athletes who may risk heart attacks or strokes by participating in high-intensity sports, a new study suggests.

“I would suggest that all middle-aged athletes should be screened at least once, particularly men over 40 and women over 50,” said the study’s lead author, Dr. Andrea Menafoglio, a cardiologist at Ospedale San Giovanni in Bellinzona, Switzerland.

While the benefits of regular exercise are well known, vigorous physical exertion can be life-threatening for older athletes who may not realize that they have an underlying heart condition. Guidelines in Europe and the U.S. urge cardiovascular risk evaluations for middle-aged athletes, but researchers say the recommendations aren’t universally followed because widespread implementation hasn’t proved effective or affordable.

To see if widespread screening could detect hidden symptoms and risks for heart disease at a reasonable price, MenafoglioHeart 3 and colleagues at three hospitals in Switzerland evaluated 785 athletes between the ages of 35 and 65.

Each of the athletes reported spending at least two hours a week participating in high-intensity sports such as running, cycling, triathlon, football, swimming, tennis, climbing, or cross-country skiing.

The initial evaluation included a personal and family history, a physical heart 5exam, and a resting electrocardiogram, or ECG. For each participant, the researchers also estimated the risk of death from cardiovascular disease within the next 10 years based on gender, age, cholesterol level, blood pressure, and smoking habits.

Overall, the cost of screening averaged $199 per athlete (about 160 euros), because most athletes didn’t need any testing beyond the initial evaluation.

About one in seven athletes needed additional screening. Extra tests found some cases of previously unimagined diabetes, hypertension, high cholesterol, and mild heart valve disease.

Overall, the screenings caught previously undetected cardiovascular abnormalities in about 3 percent of participants and aheart 4 high cardiovascular risk profile in about 4 percent.

Just three athletes had abnormalities that made it too dangerous for them to continue their exercise routines.

Source: Reuters Health

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Kidney Stones May Raise Heart, Stroke Risk

In an analysis of cohort studies, a history of kidney stones was associated with an increased risk for coronary heart disease (CHD) and stroke. The data suggest that the risk may be higher in women than men.

The studies included close to 50,000 patients with kidney stones and 3.56 million controls. Results found kidney stone history to be associated with a 19% greater risk for CHD and a 40% greater risk for stroke. Additionally, women showed a statistically significant increased risk for myocardial infarction, while men did not.

The researchers noted that a lack of studies separately evaluating for effect modification by sex, along with other limitations, could explain the risk difference among men and women. Though, they added that several recent studies have shown a gender difference in kidney stone-related CHD and stroke risk.

One was reported in JAMA in July 2013. kidney stones

The prospective study included 45,748 men and 196,357 women in the U.S. without a history of CHD at baseline, including 19,678 who reported a history of kidney stones. Two cohorts of women and one of men were followed for up to 24 years.

The study found that women with a history of kidney stones had about an 18% increased risk for CHD and a 48% increased risk compared with women who had never had a kidney stone.

An even larger study from Alberta, Canada, reported in March of this year, showed similar differences in risk by gender.

The study included close to 3.2 million people registered in Alberta’s universal healthcare system between 1997 and 2009 who were followed for a median of 11 years.

The study showed that people who had at least one kidney stone had a 40% higher risk for heart attack, a 63% higher risk for blockage of blood flow to the heart and other organs, and a 26% higher risk for stroke. The magnitude of increased risk appeared more pronounced for women than men.

Both studies were included in the newly-published meta-analysis.

Gary C. Curhan, MD, who was a co-author on both, said the new data make a strong case for a real gender difference in cardiovascular disease risk associated with kidney stone history.

Curhan is a professor of medicine at Harvard Medical School and a renal disease specialist at Brigham and Women’s Hospital, Boston.

“The risk certainly seems to be higher in women than men, but I would not say the risk is zero in men.” “These two studies give us more confidence that this association is real. The next step is to try and answer the question ‘Why is there a difference?'”

Source: medpage Today