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Heart Disease: Overview, Causes, Risk Factors, Treatment, Prevention

Coronary artery disease tests prompt patients toward healthier habits
UCLA researchers have found that undergoing a computer tomographic angiography was a better motivator to get people with suspected coronary artery disease to adopt healthier lifestyle practices than an exercise electrocardiography and stress test. A higher percentage of people who underwent the CTA test adopted healthier practices, including taking preventive medication, eating better and losing weight, while those who underwent the other tests did so at a lower rate. Little is known about how CTA or an exercise electrocardiography and stress test might prompt someone who gets checked for coronary artery disease to adopt a healthier lifestyle. To examine the factors influencing why people choose to adopt preventive medical therapy and healthier lifestyle practices, the researchers randomly assigned 10,003 people, who were symptomatic for coronary artery disease, to undergo a CTA or exercise electrocardiography and stress tests. They also assessed the association of preventive changes with major cardiovascular events. The study participants had a mean age of 61 and 53 percent of them were women. There were no differences among the study participants in medications or lifestyle at the start of the study.

Improved lifestyle led to decreased cholesterol and less cardiac death
Cholesterol levels - the most common risk factor for heart attacks - have decreased in northern Sweden over the last 20 years. Since medical drugs only account for a third of the decrease, the reduced risk of cardiovascular disease is greatly thanks to a change in lifestyle. This according to a study published in the European Heart Journal. Researchers at Umeå University and Sunderby Hospital in Luleå, both in northern Sweden, have found a general decrease in cholesterol levels, which was more pronounced in older people, women without university education and in people with high risk of cardiovascular disease. “The most important reason for the decreased cholesterol in the population of Norrbotten and Västerbotten counties in northern Sweden is most likely a change in lifestyle, such as a reduced intake of fat, together with an increased intake of fibre from fruit, vegetables and grains,” according to Mats Eliasson, professor at the Department of Public Health and Clinical Medicine as well as doctor at Sunderby Hospital in Luleå.

Emerging vascular risk factors in women: Any differences from men?
The incidence and severity of both traditional and emerging cardiovascular disease (CVD) risk factors as well as the response to treatment may differ between genders. In this narrative review, several emerging CVD risk factors (i.e. inflammatory and haemostatic markers, endothelial dysfunction, homocysteine, lipid disorders, microalbuminuria/proteinuria, coronary artery calcium score, arterial stiffness, periodontitis, inflammatory bowel syndrome, obstructive sleep apnea, impaired glucose metabolism, metabolic syndrome and non-alcoholic fatty liver disease) are discussed in the context of gender differences. Overall, women are more likely to have higher C-reactive protein and adiponectin levels as well as a higher prevalence of metabolic syndrome and non-alcoholic steatohepatitis compared with men. In contrast, men have greater tumor necrosis factor-alpha, homocysteine and uric acid levels as well as higher coronary artery calcium score than women. Furthermore, arterial stiffness, obstructive sleep apnea syndrome, non-alcoholic fatty liver disease, progression of renal dysfunction and impaired fasting glucose are more prevalent in men. Men are also reported to have smaller low-density lipoprotein particles than women, whereas men and postmenopausal women have higher levels of serum cholesterol and triglyceride sub-classes compared with premenopausal women. Hormone replacement therapy (HRT) may also affect vascular risk in women. Briefly, postmenopausal women have a higher CVD risk compared with premenopausal women.

Study shows minorities had lower risk of coronary heart disease than whites
In a study of more than 1.3 million Kaiser Permanente members in Northern California that stretched over 10 years, researchers found that blacks, Latinos and Asians generally had lower risk of coronary heart disease compared to whites. The study was published today in American Journal of Preventive Medicine. “Racial and ethnic differences in diabetes, cardiovascular-disease risk factors and their outcomes, especially in blacks, are well documented, but population health estimates are often confounded by differences in access to high-quality health care,” said lead author Jamal S. Rana, MD, PhD, of the Division of Cardiology and Clinical Adjunct with Division of Research at Kaiser Permanente Northern California. The findings echo those of a 2014 study published in the New England Journal of Medicine, which showed that racial disparities between black and white Medicare beneficiaries covered by Kaiser Permanente in the western United States have been nearly eliminated for cardiac risks and diabetes markers, even as these disparities persisted among patients in managed health care systems in other regions of the United States.

In pursuit of the causes of cardiac hypertrophy
Specific genes are responsible for determining cell growth and differentiation during the early stages of cardiac development. Reactivation of these genes later in life can lead to an abnormal thickening of the heart muscle. Researchers from Charité—Universitätsmedizin Berlin lead by Professor Silke Rickert-Sperling have been able to identify the underlying molecular mechanism. The study, published in the journal Nucleic Acids Research*, was the first to describe the role a very specific protein plays in the development of this common type of heart disease. Cardiac hypertrophy, an abnormal thickening of the heart muscle, develops in response to constant exposure to increased stress on the heart, such as that exerted by high blood pressure. When the cells of the heart increase in size, they are said to become ‘hypertrophic’ (a condition that is characterized by a thickening of the walls of the heart). The chambers of the heart become smaller, and the heart muscle loses elasticity, impairing the heart’s ability to pump blood. Cardiac hypertrophy is also a major risk factor for cardiomyopathy (weakening of the heart muscle), a serious condition that often leads to heart failure and death. For this current study, researchers from the Experimental and Clinical Research Center, an institution jointly run by Charité and the Max Delbrück Center for Molecular Medicine (MDC), were joined by researchers from the Max Planck Institute for Molecular Genetics (Berlin) and Harvard Medical School (Boston). Together, they described a novel molecular pathway underlying this condition.

New research offers reassurance over multiple artery procedures for heart attack victims
A new study has examined the effects on the heart of treating multiple narrowed arteries - rather than just one - at the time of a heart attack. Specialist heart doctors increasingly treat patients with large heart attacks urgently with a procedure under local anaesthetic. The blocked blood vessel (artery), which causes the heart attack is opened by inserting a small metal scaffold (stent) at the blockage to hold the artery open. Now a study led by Dr Gerry McCann, NIHR Career Development Fellow from the University of Leicester and Leicester’s Hospitals, has examined whether treating more than one artery has an adverse effect on the heart. Dr McCann said: “Up to 50% of patients treated for a blocked artery also have other narrowed, but not totally blocked, heart arteries. Two recent studies in patients with heart attacks and multiple narrowed arteries have suggested that treating all of the narrowed arteries may be better than just treating the blocked artery.

Study finds tree nut consumption may lower risk of cardiovascular disease
A new study published in the American Journal of Clinical Nutrition found that consuming tree nuts, such as walnuts, may lower the risk of cardiovascular disease.1 After conducting a systematic review and meta-analysis of 61 controlled trials, one of the authors, Michael Falk, PhD, Life Sciences Research Organization, found that consuming tree nuts lowers total cholesterol, triglycerides, LDL cholesterol, and ApoB, the primary protein found in LDL cholesterol. These are key factors that are used to evaluate a person’s risk of cardiovascular disease. Walnuts were investigated in 21 of the 61 trials, more than any other nut reviewed in this study. “Our study results further support the growing body of research that tree nuts, such as walnuts, can reduce the risk of cardiovascular diseases,” said Dr. Falk. “Tree nuts contain important nutrients such as unsaturated fats, protein, vitamins and minerals. Walnuts are the only nut that provide a significant amount (2.5 grams per one ounce serving) of alpha-linolenic acid (ALA), the plant-based form of omega-3s.” Beyond finding that tree nuts lower total cholesterol, triglycerides, LDL cholesterol and ApoB, researchers also found that consuming at least two servings (two ounces) per day of tree nuts, such as walnuts, has stronger effects on total cholesterol and LDL. Additionally, results showed that tree nut consumption may be particularly important for lowering the risk of heart disease in individuals with type 2 diabetes.

Heart CT scans outperform stress tests in spotting clogged arteries
Results of a head-to-head comparison study led by Johns Hopkins researchers show that noninvasive CT scans of the heart’s vessels are far better at spotting clogged arteries that can trigger a heart attack than the commonly prescribed exercise stress that most patients with chest pain undergo. A report on the findings comparing CT angiograms and stress tests, published online Oct. 14 in the journal Circulation: Cardiovascular Imaging, show the scans correctly identified blockages in nine out of 10 people, while stress tests picked up blockages in six out of 10. What renders the results of the new study particularly powerful, researchers say, is that each patient underwent all three tests for providing a direct, head-to-head comparison of their ability to accurately spot blockages.

Worldwide shift in heart medication delivery required: Study
Many people in the world who need essential heart medicine do not get it, even in rich countries, says new research published today in the medical journal The Lancet. In low- and middle-income countries the medicines are not widely available and, when available, are often unaffordable. In rich countries, although these medicines are available and affordable, the researchers earlier found that 35% to 50% of patients who have heart disease or previous stroke do not use the medicine. The research team for the study was led by Dr. Salim Yusuf and Dr. Rasha Khatib of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences in Hamilton, Ont. Canada. Yusuf is director of the PHRI and president of the World Heart Federation of Geneva, Switzerland.

Male and female hearts don’t grow old the same way
A federally funded analysis of MRI scans of the aging hearts of nearly 3,000 adults shows significant differences in the way male and female hearts change over time. Results of the research, led by investigators at Johns Hopkins, do not explain exactly what causes the sex-based differences but they may shed light on different forms of heart failure seen in men and women that may require the development of gender-specific treatments, the scientists say. “Our results are a striking demonstration of the concept that heart disease may have different pathophysiology in men and women and of the need for tailored treatments that address such important biologic differences,” says senior study author João Lima, M.D., M.B.A., a professor of medicine and radiological science at the Johns Hopkins University School of Medicine and director of cardiovascular imaging at its Heart and Vascular Institute. 

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