Smoking. High blood pressure. High cholesterol. Lousy diet. Being overweight or obese.... They're more pedestrian, but the old standbys rarely disappoint.
C-reactive protein, on the other hand, has. A telltale sign of inflammation in the body, the protein is not proving to be one of the causes of heart disease that some had thought. That reality check is the subject of much discussion today. A Reuters story states: "Measuring a compound called C-reactive protein helps identify people with heart disease, but ... there is no reason to think that elevated levels of the substance itself cause heart problems."
The story refers to two new studies published in the Journal of the American Medical Assn.
One study specifically dismisses C-reactive protein's significance in the development of heart disease. It's essentially just a sign of inflammation, the researchers said, not a cause.
The other study suggested that, while it and other biomarkers might help predict cardiovascular problems, the substances are unlikely to be useful in determining treatment.
So don't stress over your blood's level of C-reactive protein. A quick self-analysis can tell you much of what you need to know about your heart disease risk.
If those low-carb diets are too meat-reliant -- or if you're worried about your LDL cholesterol levels -- consider the Eco-Atkins. It's similar to the traditional Atkins diet, but minus the animal products. Yep -- vegetarian.
All that meat in the typical low-carb, high-protein diet still makes some doctors leery, as it turns out. So although Atkins-like diets have been found to reduce insulin resistance and raise HDL, or good, cholesterol, the diets cause some concern because they haven't done much for LDL, or bad, cholesterol levels. At the same time, doctors have been hard-pressed to deny such diets' effectiveness for weight loss, at least in the short term.
So researchers in a new study decided to replace the animal proteins in a low-carb, high-protein diet with vegetable proteins.
In a study of 47 overweight people, researchers at St. Michael's Hospital in Canada put half of the participants on a variation of the Atkins diet (i.e. the Eco-Atkins) and some on a more traditional vegetarian regimen.
Like its forebear, the Eco-Atkins diet was low-carb, but the specifics vary dramatically. In the newer version:
* 31% of calories came from vegetable protein (in order of reliance: gluten, soy, fruits and vegetables, nuts and cereals).
* 43% of calories came from fats (again, in order of reliance: nuts, vegetable oils, soy products, avocado, cereals, fruits and vegetables and seitan products).
* 26% of the calories came from carbs.
The other diet was a high-carbohydrate, low-fat, lacto-ovo diet (dairy and eggs allowed). Carbs made up 58% of the calories, with fats accounting for 25% and protein 16%.
Both diets provided significantly fewer calories than its participants likely would have preferred -- 60% of estimated calorie requirements.
So, not surprisingly, both groups lost weight.
But the folks on the Eco-Atkins diet had greater reductions in LDL and total cholesterol than did the folks in the higher-carb diet.
The abstract of the study, published June 8 in the Archives of Internal Medicine, reaches this conclusion:
A low-carbohydrate plant-based diet has lipid-lowering advantages over a high-carbohydrate, low-fat weight-loss diet in improving heart disease risk factors not seen with conventional low-fat diets with animal products.
Fairly enough, the Low Carb Diets Blog takes issue with the diet used as a comparison:
They could have compared a regular mixed low-carb diet to a vegan or vegetarian low-carb diet. Or compare a high-carb vegan diet to a low-carb vegan diet, where the food sources for the various macronutrients were similar, and only the proportions varied. As it is, the reasons for the results are already being questioned in various media ("It's the soy!" "No, it's the fiber!") as well as in the conclusions written by the authors themselves.
I love that vegetarianism is becoming more mainstream, but I wish that people would just call it what it is and stop trying to put cute names on it to mask it.
But it seems hard to deny there's some potential in this eating plan...
--Tami Dennis
Photo: Soybeans are the friend of vegan dieters. In this study, however, gluten was a better friend. Credit: Kari Goodnough / Bloomberg News
Heart attack patients may not always need to see their doctors face to face to get good rehab care. Online updates of their progress may work just as well.
In a study published in the European Society of Cardiology Tuesday, Australian researchers found that electronic communication with a healthcare provider could have similar life-saving effects to the more traditional in-person cardiac rehabilitation programs.
The scientists examined prevention programs in which at least half of the contact between healthcare providers and their patients took place through telephone, Internet or videoconferencing. They compared these patients with similar people who received no intervention, examining cholesterol levels, blood pressure, weight, physical activity, physical and psychological quality of life and smoking status.
Patients who received care electronically had significantly reduced risk factors and increased quality of life compared with the control, nonintervention groups. They lost weight, exercised more, smoked less, and had lower blood pressure and cholesterol levels.
The only factor that did not measurably improve with intervention was mental health. This was not necessarily due to a stagnant mental status, however: Heart attack patients tend to experience an improvement in mood with the passage of time even without intervention, says study co-author Julie Redfern, of the ANZAC Research Institute in Sydney, Australia.
It's well-known that formal, face-to-face, 6- to 8-week programs in which patients are given education and counseling on practices such as nutrition and physical activity, along with exercise classes, consistently reduce the risk of further cardiac events and enhance patients' quality of life. But in Europe, Australia and the United States, only one-third of eligible patients attend such sessions.
It’s also known that heart attack patients who do not attend such programs have higher mortality rates, and those who do manage to make it to meetings face rigid structure and time constraints. Perhaps for that reason, the drop-out rate is high: about one-third of patients who start rehab don't complete the program.
Electronic communication tends to be more frequent, flexible and individualized, which improves ease of access and removes the barriers of distance and time, Redfern says. And, she adds, it's possible -- though not proven -- that this type of communication may turn out to be less expensive as well.
A new weapon for heart disease may lie in nanoparticles that can attack plaque in the arteries of the heart. A nanoparticle is a microscopic particle that is small enough to enter cells and carry out functions within cells. One nanometer is a billionth of a meter. In comparison, the diameter of a human hair is 100,000 nanometers. Researchers are very high on using nanoparticles in medicine. The National Institutes of Health has an ambitious research program testing nanoparticles to find tiny cancer cells before tumors form, repair broken or damaged parts of cells or as vehicles to deliver medicines where they are needed in the body. Nanoparticles are made from common materials, but when reduced to nanosize, the physical properties of these materials become uniquely altered and can perform new functions.
In the new study, published online this week in the Proceedings of the National Academy of Sciences, scientists at UC San Barbara developed a fat-based collection of molecules that form a sphere called a micelle. The micelle contained a peptide (a building block of protein) that binds to the surface of plaque. Plaque is that sticky stuff that builds up in arteries and can trigger heart attacks and strokes.
In the study, mice that had been fed a high-fat diet were injected with micelles. The micelles were designed to locate the plaque and deliver a drug that inhibits blood clotting. The researchers used a fluorescent dye to show that the micelles attached to the plaque.
"The key to why nanomedicines are thought to be so promising is one can make them carry out many functions, which isn't possible with a simple drug," said the lead author of the study, Erkki Ruoslahti of the Burnham Institute for Medical Research at UC Santa Barbara. He calls such inventions "Theranostics," meaning a particle that functions both as a diagnostic tool and to deliver a therapy.
The researchers also showed that the micelles were able to target the most vulnerable plaques, which could rupture and cause a heart attack or stroke.
The study was supported by the National Institutes of Health. More information on the nanotechnology research project can be found on the NIH website.
Professional football players are large and getting larger -- for the last 30 years, players have shown a substantial increase in body mass index, leading some health experts to wonder if they've become more at risk for cardiovascular disease.
But it seems their fitness levels may provide protection from that bulk on some levels. A new study in the May 27 issue of the Journal of the American Medical Assn. looked at cardiovascular disease risk factors among current NFL players and healthy young men to see how they compared, and found that the groups are similar in many ways.
Researchers examined the health of 504 active NFL players on 12 teams in 2007, looking at their health histories; height and weight; neck, waist and hip circumferences; body composition; fasting glucose; cholesterol and triglycerides; blood pressure; pulse; and electrocardiograms.
That information was compared with data from the Coronary Artery Risk Development in Young Adults Study. A sample of 1,959 men matched in age and race to the football players was analyzed.
Overall, the NFL players were heavier and taller than the CARDIA group, but despite being heftier they had lower average fasting glucose and showed no major differences in total cholesterol, HDL or LDL cholesterol, or triglycerides. There were also fewer smokers among the athletes. However, high blood pressure was more prevalent among the football players.
Researchers speculate that the players' fitness level could be responsible for tamping down some of those cardiovascular risks, but having high blood pressure doesn't take them completely off the hook. Areas they propose looking into to solve that mystery include the effect of strength training, long-term use of non-steroidal anti-inflammatory drugs, sleep disordered breathing, and salt intake.
Heart disease is the leading cause of death in the United States, but a survey shows that only 19% of people with heart disease said it was picked up during routine health screening.
Of 1,573 heart disease patients surveyed, more than half said their ailment wasn't diagnosed until they began having symptoms, such as chest pain, shortness of breath or an actual heart attack. An additional 22% said they were diagnosed while being treated for other health issues. While some of the survey respondents did not seek medical help until they began having symptoms, others said they saw a doctor regularly, yet were not diagnosed with heart disease before having symptoms. Early diagnosis of heart disease begins with an evaluation of a patient's weight, blood pressure, cholesterol, smoking and exercise habits and family history.
"Many individuals do not show symptoms and go undiagnosed until the disease is in an advanced state, often when they have actually had a heart attack," the lead author of the study, Dr. Sandra J. Lewis, said in a news release. Lewis is from the Northwest Cardiovascular Institute in Portland, Ore.
Adults over age 20 should be screened for heart disease risk factors every two to five years, Lewis said. People with diabetes are at higher risk for heart disease and need even more rigorous screening. The study was published Monday in the International Journal of Clinical Practice.
It may be time for a new approach to helping people regain their health after suffering a heart attack. A study published today found that a different approach to rehab involving a serious amount of walking dramatically improved the health of cardiac patients.
The study compared a high-calorie-burning walking regimen to the standard cardiac rehab, which typically consists of walking, biking or rowing for 25 to 40 minutes at a brisk pace three times a week. The walking program involved walking 45 to 60 minutes a day at a moderate pace, five to six days a week. Researchers assigned 74 overweight cardiac rehab patients to one of the two programs for five months. They found the walking group had double the weight loss and a greater loss of fat mass. The walking group also had better insulin sensitivity, total cholesterol, blood pressure and a greater reduction in waist circumference. Those patients burned about 3,000 to 3,500 calories a week compared with about 700 to 800 per week among people in the standard therapy group.
"Cardiac rehab has essentially remained the same since the 1970s because it has a mortality benefit," Dr. Philip A. Ades, the lead author of the study and a professor of medicine at the University of Vermont College of Medicine said in a news release. "But it doesn't burn many calories and things have changed. Eighty percent of our rehabilitation patients are now overweight and many of them are becoming diabetic. It's a different time in terms of what we need to do in cardiac rehab."
The people in the walking group walked at a lower intensity and were comfortable doing it on their own. Most cardiac rehab is done under medical supervision, Ades noted. The participants' weight loss, an average of 18 pounds, helped keep them motivated to walk, he said. The study is published in Circulation: Journal of the American Heart Assn.
Common drugs used to treat ulcers and heartburn appear to pose a problem for people taking the blood thinner Plavix.
The drugs Nexium, Prevacid, Prilosec and Protonix, known as proton pump inhibitors, are enormously popular. But, researchers have found, they can be dangerous in heart patients taking the aforementioned anti-clotting medication.
They apparently interfere with Plavix's effectiveness, boosting the risk of heart and stroke by 50% in patients taking both drugs.
The results were presented this week at a meeting of the Society for Cardiovascular Angiography and Interventions.
Here's a fuller story from the Wall Street Journal.
People are often stunned when they undergo routine medical tests that reveal they -- unknowingly -- have had a heart attack. But a new study suggests that these silent attacks occur much more frequently than suspected and should be taken seriously.
A record of a heart attack, even the silent ones, can usually be found when a patient undergoes an electrocardiogram. Doctors look for the appearance of a specific alteration called a Q wave that signals the presence of damaged tissue. But the research reported today in the journal PLoS Medicine found that silent heart attacks, also called unrecognized myocardial infarctions or UMIs, occur that leave no telltale irregularities on ECGs.
Researchers from Duke University Medical Center looked for the frequency of heart attacks in 185 people with suspected heart disease but who had no record of heart attacks. Using an imaging technique called delayed enhancement cardiovascular magnetic resonance to look for damaged tissue, the researchers found 35% of the patients had evidence of a previous heart attack. Non-Q-wave heart attacks were three times more common than Q-wave heart attacks and were also more common among people with severe heart disease. Moreover, the study showed that people who had non-Q-wave silent heart attacks had a 17-fold higher risk of death due to heart problems compared with patients who did not have any heart damage.
"No one has fully understood how often these heart attacks occur and what they mean, in terms of prognosis," said Dr. Han Kim, the lead author of the study, in a news release. "With this study we can now say that this subset of heart attacks, known as non-Q-wave UMIs, is fairly common, at least among people with suspected coronary artery disease."
Kim, a Duke cardiologist, said that delayed enhancement cardiovascular magnetic resonance is a good method for detecting non-Q-wave heart attacks. More research is needed on how to treat patients with silent heart attacks, he said.
-- Shari Roan
Photo: "Fluttering Hearts," 1961 color lithograph. Credit: Norton Simon Museum Archives
Until the last 10 years or so, triglycerides were not thought to be terribly important to the development of heart disease. But scientists now know that an individual's level of this type of fat is as important as LDL and HDL cholesterol. Medication can help lower trigylcerides, but a natural substance may work, too.
A study of rats shows that a diet high in lipoic acid decreased triglycerides by up to 60%. The researchers, at the Linus Pauling Institute at Oregon State University, studied rats that were obese and developed higher triglycerides as they aged. But while triglyceride levels doubled in the rats fed lipoic acid, levels increased more than 400% in the rats not given supplements. Lipoic acid appears to affect triglycerides through two pathways. After eating, it increases the rate of triglyceride clearing from the bloodstream and it reduces the genetic expression of enzymes on the liver, resulting in less production of triglycerides.
Lipoic acid is found in low levels in some red meat and green leafy vegetables. The amount used in the study would amount to about 2 grams a day for a 150-pound person, said the author of the study, Regis Moreau, in a news release. Lipoic acid is safe in high doses, he said, adding that studies should be conducted in humans.
"The extent of triglyceride reduction was really dramatic," he said. "We didn't expect it to be this profound. The potential is good that this could become another way to lower blood triglycerides and help reduce the risk of atherosclerosis."
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
