The article, written by Electrophysiologist Dr. Douglas Zipes of Indiana University, is already generating a buzz among cardiologists in Ohio, according to Dr. Terri Stewart-Dehner, a cardiologist at Christ Hospital near Cincinnati.

“Anyone in cardiology has heard of Dr. Zipes. He is very well respected,” said Dr. Stewart-Dehner.

Stewart-Dehner said any article published in “Circulation” has great significance and will be taken very seriously by cardiologists around the world.

“Peer reviewed is a big deal,” said Stewart-Dehner. “It means the article goes through a committee just for consideration into the journal. Then cardiologists review the validity of the research; it means it’s a reputable article.”

The conclusions of Dr. Zipes’ article, which looks at eight cases involving the TASER X26 ECD states: “ECD stimulation can cause cardiac electric capture and provoke cardiac arrest resulting from ventricular tachycardia/ventricular fibrillation.  After prolonged ventricular tachycardia/ventricular fibrillation without resuscitation, asystole develops.”

Speaking on behalf of the American Heart Association, Dr. Michael Sayre with Ohio State Emergency Medicine, said, “Dr. Zipes’ work is very well respected.  It’s a credible report.  It’s a reminder to police officers and others who are using these tools that they need to know how to do CPR and know how to use an AED.”

Dr. Zipes has been discounted by the manufacturer of the Taser, Taser International, because he has been paid to testify against the weapon, but Dr. Zipes says the fact that his research has withstood the rigorous process of review by other well-respected cardiologists and was published in this prestigious journal proves his case.

“It is absolutely unequivocal based on my understanding of how electricity works on the heart, based on good animal data and based on numerous clinical situations that the Taser unquestionably can produce sudden cardiac arrest and death,” said Dr. Zipes.

Dr. Zipes says he wrote the article, not to condemn the weapon, but to properly warn police officers of its potential to kill so that they can make good policies and decisions as to the proper use of the weapon, and so that they will be attentive to the possible need for medical care following a Taser stun.

The Taser, used by law enforcement agencies across Ohio and by some 16,000 law enforcement agencies around the world, was marketed as non-lethal. Since 2001, more than 500 people have died following Taser stuns according to Amnesty International, which said in February that stricter guidelines for its use were “imperative.”

In only a few dozen of those cases have medical examiners ruled the Taser contributed to the death.

It was nearly nine months ago 18-year-old Everette Howard of North College Hill died after police used a Taser on him on the University of Cincinnati’s campus.

The Hamilton County Coroner’s Office has still not released a “cause of death,” but the preliminary autopsy results seemed to rule out everything but the Taser. The office is now waiting for results from a heart specialist brought in to review slides of Howard’s heart.

The late Coroner Anant Bhati said in an exclusive interview before he died in February that he had “great respect” for Dr. Zipes and that he too believed the Taser could cause cardiac arrest. He said he just wasn’t ready to say that it caused Everette Howard’s death until a heart specialist weighed in on the investigation.

Dr. Bhati also agreed with Dr. Zipes that the weapon should come under government supervision and be tested for its electrical output regularly.

Taser International has said that because the Taser uses compressed Nitrogen instead of gun powder to fire its darts, it is not regulated and testing of the weapon is not legally required.

The company also says the Taser fires two darts, which enter a subject’s skin and send electricity into the body in order to incapacitate the subject so that officers can get a subject into custody without a physical fight.

Research shows the Taser has saved lives and reduced injuries among officers.

Taser International has changed its safety warnings over the years.

A WCPO report in October showed that Taser International’s website stated in its summary conclusion on cardiac safety, “There is no reliable published data that proves Taser ECDs (Tasers) negatively affect the heart.”

With the publication of Dr. Zipes’ article, Dr. Stewart-Dehner says it can be argued that statement is no longer the case.

The new statement on Taser International’s website quotes a May Department of Justice study on deaths following Taser stuns. It states, “While exposure to Conducted Energy Devices (CEDs) is not risk free, there is no conclusive medical evidence that indicates a high risk of serious injury or death from the direct effects of CED’s (Tasers).”

Here is Taser International’s complete response to Dr. Zipes’ article:

While our medical advisors haven’t had a chance to review the details, it is noteworthy that the sole author, Dr. Douglas Zipes, has earned more than $500,000 in fees at $1,200 per hour as a plaintiff’s expert witness against TASER and police. Clearly Dr. Zipes has a strong financial bias based on his career as an expert witness, which might help explain why he disagrees with the findings of independent medical examiners with no pecuniary interest in these cases as well as the U.S. Department of Justice’s independent study that concluded, “There is currently no medical evidence that CEDs pose a significant risk for induced cardiac dysrhythmia in humans when deployed reasonably” and “The risks of cardiac arrhythmias or death remain low and make CEDs more favorable than other weapons.”

Steve Tuttle

Vice President of Communications

Source: NewsNet5.com

When subjected to stress, the coronary arteries of men and women react differently, potentially putting women at greater risk of adverse events, according to Chester A. Ray, PhD, and colleagues from Penn State College of Medicine in Hershey, Pa.

Using 17 healthy adults (eight women), the researchers measured baseline heart rate, blood pressure, and coronary blood flow, and then subjected the participants to mental arithmetic, which included verbal interruptions to increase stress, and measured their vitals again.

There were no differences in heart rate and blood pressure of either sex under stress. However, coronary blood flow increased in men but not in women. The results could explain why women tend to have more heart troubles after stressful events, such as losing a spouse, researchers said in a statement.

The study was presented at the Experimental Biology 2012 meeting in San Diego.

Small Scanner May Boost Bedside Care

A pocket-size ultrasound scanner performed well in an acute setting when tested against a standard echocardiography machine, according to a study online in the European Heart Journal of Cardiovascular Imaging.

Trained cardiologists performed the imaging with the Vscan ultrasound device in 104 patients in need of urgent care. Results showed “excellent” agreement between the two echo technologies in regard to left ventricular systolic function and pericardial effusion (Kappa: 0.89 and 0.81, respectively).

Evaluation of the aortic, mitral, and tricuspid valve function and the left ventricular size produced only “good or moderate” agreement (Kappa: 0.55 to 0.66), reported Ariane Testuz, MD, and colleagues from University Hospital in Geneva, Switzerland. The Vscan device does not have pulse-wave or continuous Doppler functions.

Vitamin D During Winter May Be Good for BP

In Denmark, where winters can be long, dark, and cold, additional dietary vitamin D could lower blood pressure, according to a study presented at the European Society of Hypertension meeting in London.

A total of 112 patients from a hospital at the 56th Northern latitude were randomized to vitamin D supplementation or placebo; 90% of these patients were found to be vitamin D deficient.

After 20 weeks, those taking additional vitamin D had a significant drop in central systolic blood pressure and a nonsignificant reduction in ambulatory blood pressure, reported Thomas Larsen, MD, and colleagues from Holstebro Hospital in Denmark.

Statins and the Risk of Diabetes

Although statins increase the risk of new-onset diabetes, clinicians should continue to prescribe them because there is a greater reduction in cardiovascular events, according to a perspective article in the New England Journal of Medicine.

The JUPITER trial and other meta-analyses have shown a concomitant increase in incidence diabetes in statin users and a significant reduction in adverse events, wrote Allison B. Goldfine, MD, from Harvard Medical School in Boston.

The underlying mechanism for the diabetes risk is not understood, and it appears to be a class effect. In addition, the FDA recently added a warning to the drugs about the risk of diabetes.

Goldfine called for more studies “to define the risks of statin-induced diabetes.” But in the meantime, “clinicians should monitor glucose or glycated hemoglobin in patients with multiple risk factors for diabetes who take statins.”

Renal Artery Ablation Helps BP

Six-month pooled results from the Symplicity HTN-2 randomized clinical trial confirm previous observational data showing renal denervation significantly reduces blood pressure in patients with resistant blood pressure.

The multicenter, controlled trial randomized patients to a control group who were maintained on antihypertensive medications, or to the treatment group, who received receiving renal denervation along with antihypertensive medications.

A group of 84 patients who underwent catheter renal denervation, which included those that crossed over (35), had a mean reduction of 28.3 mm Hg in systolic blood pressure and 10.4 mm Hg in diastolic pressure (P<0.001), Markus Schlaich, MD, of the Baker IDI Heart and Diabetes Institute of Melbourne, Australia, and colleagues reported at the European Society of Hypertension meeting in London.

Schalich noted that researchers saw no evidence of renal impairment, and renal function measures remained unchanged.
Source: MedPageToday.com

Compared with patients who did not receive an NSAID, those given at least one prescription of a NSAID following hospitalization for a first-time myocardial infarction (MI) had statistically significant increased rates of subsequent atrial fibrillation, 23%, and of a subsequent stroke, 25%, in an analysis that adjusted for possible confounders, Dr. Anne-Marie Schjerning Olsen and her associates reported in a poster at the meeting.

The findings add to existing evidence that NSAID treatment poses a cardiovascular risk to certain patients. Further, the results highlight the need to assess cardiovascular risk and balance that risk from NSAID treatment against its possible benefit before prescribing these drugs, they said.

Last year, Dr. Olsen and her associates reported results from another analysis using the same database showing that NSAID use by patients following a MI boosted their risk for death or a second MI.

The new study reviewed nationwide hospitalization and pharmacy records for 88,458 Danish residents who were at least 30 years old, were hospitalized for a first-time MI during 1997-2009 and had no history of prior atrial fibrillation. Their mean age was 68 years, and 64% were men. During follow-up, 46% of the patients filled at least one prescription for an NSAID. In addition, during the study period, 9,578 of the post-MI patients were hospitalized for atrial fibrillation, and 7,687 were hospitalized for a stroke.

Among the NSAID users, the incidence of atrial fibrillation in the post-MI patients was 26.9 cases/1,000 person-years, and the stroke incidence was 21.2 cases/1,000 person-years, reported Dr. Olsen, a cardiology researcher at Gentofte Hospital in Copenhagen, and her associates.

In an analysis that adjusted for age, gender, calendar year, concomitant drug use, and comorbidities, use of any type of NSAID boosted the atrial fibrillation risk by 23% and the stroke risk by 25%, compared with the risk in patients who did not take an NSAID.

The greatest adverse effect was linked with rofecoxib (Vioxx) treatment, which was associated with a 35% increased risk for atrial fibrillation and a 2.5-fold increased risk for stroke, both statistically significant differences, compared with non–NSAID users.

Other individual NSAIDs in the analysis included celecoxib (Celebrex), which was linked with a statistically significant, roughly 80% increased rate of stroke compared with non–NSAID users. Celecoxib did not have a significant impact on atrial fibrillation rate. Ibuprofen and diclofenac each boosted the rate of atrial fibrillation and of stroke by about the same amount as did all of the NSAIDs together. Naproxen did not have a statistically significant effect on either end point.

Dr. Olsen said that she had no disclosures.

Source: FamilyPracticeNews.com

In the study, 20 different trials including nearly 160,000 randomly selected patients with high blood pressure were treated with renin-angiotensin-aldosterone system (RAAS) inhibitors or control treatment, such as placebo or normal care with a mean follow up of 4.3 years. RAAS inhibitors showed a 5% reduction in all-cause mortality and a 7% reduction in cardiovascular mortality when compared with control antihypertensive therapy.

However, in a stratified study according to the class of drug, the overall all-cause mortality reduction was a result of the beneficial effect of the class of ACE inhibitors, showing a significant 10% reduction, whereas the AT1 receptor blockers (ARBs) had no reduction.

“The guideline recommended goal of antihypertensive treatment is mortality reduction, however this is the first study that scientifically evaluates the value of RAAS inhibitors on mortality in their main indication of hypertension,” said lead author Prof Laura van Vark, Department of Cardiology at Erasmus in Rotterdam, Netherlands.

Because there are usually no symptoms associated with high blood pressure, most patients don’t realize they have the disease, nor do they know about medication needed. Treatments for high blood pressure may cause side effects, making it a challenge to patients’ adherence. This is why there is a strong need for medications with beneficial effects on mortality.

Hypertension is a major risk factor for cardiovascular disease, claiming nearly eight million lives worldwide each year, which represent 13% of all deaths. Medication and healthy lifestyle modifications, such as no smoking and regular physical activity, generally lead to better blood pressure readings, however for many patients medication is also still necessary.

Source: MedicalXpress.com

More than one-third of patients who had a stroke of unknown origin were found to have complex carotid plaques in nonstenosed arteries, according to a small study.

MR imaging showed the prevalence of complicated type VI plaques, according to American Heart Association classification, in 12 of 32 carotid arteries ipsilateral to the stroke, compared with no such findings in the contralateral arteries, reported Tobias M. Freilinger, MD, from Ludwig-Maximilians-University Munich, and colleagues.

In three-quarters of the plaques, intraplaque hemorrhage was the most common diagnostic feature, followed by fibrous plaque rupture in 50%, and surface thrombus in 33%, according to results published in this month’s JACC: Cardiovascular Imaging.

“The realization that even apparently ‘minor’ atherosclerosis may harbor high-risk disease should change our perception of what constitutes risk for a patient,” wrote Alan Moody, MD, from Sunnybrook Health Sciences Center in Ontario, Canada, in an accompanying editorial.

Also reported in the journal, Alistair C. Lindsay, MBChB, from the University of Oxford in the U.K., and colleagues found that slightly more than half of 41 patients who suffered a transient ischemic attack had type VI plaques compared with eight asymptomatic controls.

Lindsay’s group identified the three most common features as intraplaque hemorrhage, cap rupture, and surface thrombus. These features were in carotid arteries that were not considered significantly stenotic.

They also found that only two plaques showed signs of healing at 6-weeks’ follow-up. Moody said that “this represents an ongoing source for thromboemboli and a potential therapeutic target for secondary prevention.”

TAVI Benefits Low-Flow, Low-Gradient Stenosis

Prognosis can be improved for patients with low-flow, low-gradient aortic stenosis by performing transcatheter aortic valve implantation (TAVI), a small study found.

Overall, 15 patients with low-flow, low-gradient aortic stenosis had worse 6-month mortality rates after TAVI compared with 112 other patients (33% versus 13%), reported Michael Gotzmann, MD, from University-Hospital Bergmannsheil in Bochum, Germany, and colleagues.

However, 10 surviving low-flow, low-gradient patients exhibited improved ejection fractions (36% versus 46%) at 6 months, as well as a better 6-minute walk test, according to the study published in the April Catheterization and Cardiovascular Interventions.

Although low-flow, low-gradient aortic stenosis is rare, occurring in 5% of patients with aortic stenosis, prognosis is dim whether treated conservatively or with surgical repair. TAVI offers an option for older patients with multiple comorbidities who are at a high surgical risk, researchers concluded. Patients received the CoreValve prosthesis.

Prior studies have concluded that this patient population should not automatically be excluded from operational options, but instead should be evaluated on a case-by-case basis.

Xarelto Maker Seeks PE Approval in EU

On the heels of positive results from the EINSTEIN-PE trial, German drugmaker Bayer has submitted a request to the European Union to approve rivaroxaban (Xarelto) for the treatment of pulmonary embolism (PE) and the long-term prevention of recurrent deep vein thrombosis (DVT) and PE.

EINSTEIN-PE found that the oral anticoagulant rivaroxaban worked as well as low-molecular weight heparin and warfarin in treating pulmonary embolism, but with less bleeding.

The results were reported at the recent American College of Cardiology meeting and simultaneously published in the New England Journal of Medicine.

Rivaroxaban, a factor Xa inhibitor, is already approved in the EU for the prevention of stroke in patients with atrial fibrillation; the prevention of venous thromboembolism following hip and knee replacement surgery; the treatment of DVT; and the prevention of recurrent DVT and PE following an acute DVT in adult patients.

The company also has requested approval from the EU and the FDA to use rivaroxaban for acute coronary syndromes.

Clopidogrel Study Findings Questioned

A letter-writing campaign in the April 11 issue of the Journal of the American Medical Associationsuggests that a clopidogrel genotyping study by Michael Holmes, MBBS, MSc, from the University of London, and colleagues is flawed on several levels.

The original meta-analysis published last year found that the CYP2C19 genotype is not a significant predictor of clinical outcomes in patients treated with clopidogrel (Plavix).

A letter from Alan R. Shuldiner, MD, Mark R. Vesely, MD, and Adam Fisch, BS from the University of Maryland School of Medicine in Baltimore, noted that these results are in contrast with previous analyses.

Shuldiner and colleagues, as well as a group at Brigham and Women’s Hospital in Boston and Scripps Translational Science Institute in La Jolla, Calif., said that Holmes should not have included studies where clopidogrel was used for indications other than coronary stenting.

It may be that CYP2C19 is “less important for patients taking clopidogrel for other indications,” Shuldiner and co-authors wrote.

The second group also noted that Holmes and colleagues found statistically significant reductions in fatal and nonfatal myocardial infarction and an increase in stent thrombosis, so their evidence does not support their conclusion.

In reply, the researchers said they used the “totality of evidence” and cautioned against “focusing on a selected subgroup of outcomes, particularly when there is evidence of selective outcome reporting.”

Based on these letters, however, Holmes and colleagues revisited their study and included only studies where clopidogrel was used during PCI. They found a “modest” summary relative risk of 1.22, which also remains “affected by small-study bias,” they said.

Shuldiner et al. also stated that the Holmes study did not provide any evidence for JAMA editorialist Steven Nissen, MD, to say the FDA had no basis for issuing a boxed warning for clopidogrel, and that waiting for prospective randomized trials would deny patients access to “potentially life-saving individualized alternative therapies.”

Nissen, who is based at the Cleveland Clinic, replied that making decisions based on observational studies or “inappropriate use of surrogate endpoints” puts patients in harm’s way. He cited the use of hormone therapy for women based on observational data that ultimately was shown to increase mortality.

Rather than lower the standards for pharmacogenomic, these studies should adhere to the same rigorous standards applied to other medical advances, Nissen concluded.

Source:  MedPageToday.com

Researchers found that people with high blood pressure whose blood pressure varies significantly between each arm are at higher risk of cardiovascular death over 10 years.

The study supports “inter-arm difference as a simple indicator of increased cardiovascular risk,” say a team led by Dr. Andrew Gould, of the Peninsula College of Medicine and Dentistry in Plymouth, England.

The new findings echo those of a study published in January in The Lancet. That study, also conducted by researchers at Peninsula College, reviewed data from 28 studies looking at differences between systolic blood pressure [the top number in a reading] between the right and left arms.

The team found that a difference of 15 millimeters of mercury (mm Hg) or more between readings was linked with an increased risk of narrowing or hardening of the arteries supplying the lower limbs, called peripheral vascular disease.

In the new study, Gould and colleagues looked at 230 patients with high blood pressure. They found that, after adjusting for age and gender, there was a 9 percent increased risk of death over the next 10 years for every one mm/Hg difference in blood pressure reading between the arms.

The findings suggest that blood pressure should be routinely measured in both arms for patients undergoing treatment for hypertension, the researchers report March 20 in the online edition of the BMJ.

One expert in the United States agreed with the findings.

“As the recent article points out, blood pressure readings in the right and left arm may differ by a few points,” said Dr. Kevin Marzo, chief of cardiology at Winthrop-University Hospital in Mineola, N.Y. “However, a difference of more than 10 points [mm/Hg] could suggest trouble and alert the physician to intensify treatment strategies for preventing a heart attack or stroke. The ‘vital’ signs should include blood pressure in both arms — a screening test that adds no cost, little time and potentially so critical to initiating lifesaving treatment.’

For patients found to have different blood pressure readings in their arms, subsequent monitoring should be performed in the arm with the higher reading because doing so would help determine necessary treatment, Dr. Dae Hyun Kim of Harvard Medical School added in an accompanying journal editorial.

Further research is needed to establish the link between different blood pressure readings in the arm and death risk, Kim added.

Source: health.usnews.com

Team leader, cardiologist Eric Topol, explains that if this test is demonstrated to be reliable after further studies, doctors will be better equipped and informed to intervene with patients at very high risk of an imminent heart attack, and thus prevent the attack and the subsequent damage it can cause.

The authors explain that acute myocardial infarction is currently highly unpredictable, despite recent progress in the diagnoses and treatments of coronary artery disease. They add that doctors desperately need a clinical measurement that can predict an impending heart attack.

In this study, a blood test was devised that identifies specific cells that flake off when the blood vessel walls weaken – they are called CECs (circulating endothelial cells), and signal the initial stages of acute myocardial infarction.

Cardiologists believe that a heart attack typically commences days before the formation of a clot (which blocks blood flow to the heart). During the initial stages of a heart attack, the walls of the blood vessel weaken, they become eroded, attracting inflammatory cells, which in turn harm and damage the endothelial cells that line the inside of blood vessels. Endothelial cells are those that form the cellular lining of a tissue. Severe inflammation causes the CECs to mutate, they clump together, break off and get into the bloodstream.

The study involved 94 participants, 50 of them had had a heart attack while the other 44 had not (healthy controls). CEC blood levels among those who had had a heart attack were over four times higher compared to those in the healthy control group.

Not only were CEC blood levels much higher among the heart attack patients, but also their CECs had changed; they had either become larger, misshapen, and/or many had multiple nuclei.

Diagram showing where the endothelial cells are, lining the walls of blood vessels

Topol said:

“For the first time, we can isolate these cells through techniques that were not available in 1999. They are like a window into the process that underlies an imminent heart attack.”

Heart disease kills nearly 600,000 people in the USA each year – it is the leading cause of death in the country. People commonly come into emergency rooms suffering from chest pains, undergo diagnostic tests that reveal nothing unusual, are sent home, and suffer a heart attack with days. In a considerable number of cases, CECs sloughing off the interior wall of a blood vessel become involved in a series of events that results in a blood clot.

Topol said:

“It is the clot that cuts off the blood supply and serves as the proximate cause of a heart attack. Eventually, a plaque ruptures and a blood clot develops.”

Source: MedicalNewsToday.com

The study, which was published last month in The Journal of the American College of Cardiology, examined health information about more than 3,100 adults who’d visited the Cooper Clinic in Dallas for medical checkups. During the exams, physicians gathered information about each person’s cardiovascular health, including blood pressure, cholesterol profile, abdominal girth and body fat percentage. They also measured the patients’ aerobic fitness using treadmill tests.

For years, scientists and the news media have been debating the relative risks of being fat but fit. While it might seem as if aerobic fitness could ameliorate many of the health problems associated with extra body fat, studies on the topic have produced mixed results. Some have suggested that being in shape virtually eliminates the health risks of extra pounds, especially in terms of heart health. But others have come to the opposite conclusion, finding that excess fat contributes to heart disease and premature death, even if someone is physically active.

Many of these studies, though, have compared people’s fitness and fatness at only one point in time, which is an artificial measure because, as we all know from experience, bodies change.

So, for the new study, scientists from the University of South Carolina and other institutions turned to Cooper Clinic data that covered the same patients over the course of at least six years and three checkups.

They chose 3,148 adult men and women, most in their 40s at the start of the study and all normally active but not athletes. None at first had any indications of heart disease or other risk factors, like high blood pressure or cholesterol.

The researchers then compared the patients’ body fat and aerobic fitness during their second checkup, usually two or three years after the first. A majority of the people had, by that time, gained body fat. Paradoxically, many also had become more fit, a surprising statistic, unless you consider that these were men and women who were dutifully showing up for medical checkups and receiving repeated admonitions to exercise.

None during that second visit yet showed discernible risk factors for heart disease.

But by the time they showed up for their third checkup several years later, almost a quarter had developed high blood pressure, unhealthy cholesterol levels or a combination of risk factors called metabolic syndrome.

Those at greatest risk for these health problems were, unsurprisingly, those who’d both lost fitness and gained fat. If someone had grown less fit over the years while adding fat, he now had a 71 percent greater chance of suffering from metabolic syndrome than those who’d lost fat.

But fitness offered some protection to those who gained fat. A person who had improved fitness but added girth had a 22 percent lower risk than someone who was both fat and unfit.

Not surprisingly, dropping fat mass also reduced people’s risks of suffering from metabolic syndrome and the other health problems, but very few people in the study lost fat.

The bottom line: Exercise by itself won’t erase the heart risks of extra body fat, but it may blunt them.

“What this tells us is that both fitness and fatness matter, separately and together, for heart health,” says Duck-Chul Lee, a research fellow at the University of South Carolina who led the study.

More encouragingly, simply maintaining fitness may be all that is required to protect your heart. “We did not see a great deal of added benefit from improving fitness,” Lee says, “compared to maintaining it.”

People who had bettered their aerobic fitness had 28 percent less risk of developing high blood pressure than people who’d let their fitness slide. But those who’d merely kept up their baseline fitness throughout the study, adjusted for age (aerobic capacity declines with age, even among people who exercise regularly) had 26 percent less risk of the condition, a barely discernible difference.

“The message is simple,” Lee concludes. “So much attention gets focused on weight reduction, but reducing body fat is very difficult for most people. Our study suggests that,” in terms of heart health, “maintaining your fitness over your lifetime is just as important, and for most people is probably more achievable.” (Gretchen Reynolds, NYT)


Source: Tempo.com

Compared with women who didn’t drink, the relative risk of stroke ranged from 0.83 for drinking less than half a glass of alcohol a day to 0.79 for those who consumed up to 15 g/d, Kathryn M. Rexrode, MD, MPH, from Brigham and Women’s Hospital in Boston, and colleagues found.

The benefit was the same for ischemic or hemorrhagic stroke, they reported online in Stroke: Journal of the American Heart Association.

The investigators noted that previous associations have been seen with light to moderate drinking and reduced stroke risk. However, they said that many studies did not take into account the stroke type, nor did they break down drinking according to the amount.

In addition, most studies relied on one baseline assessment of drinking, which doesn’t account for changing patterns of consumption over time.

The findings emerged from a study of 83,578 women, ages 30 to 55, who were enrolled in the Nurses Health Study.

The researchers parsed the data according to former drinkers, abstainers, and current drinkers, as well as the amount consumed. They adjusted for a variety of potential confounders including age, smoking, hormone use, aspirin use, hypertension, and history of atrial fibrillation.

Participants completed a baseline questionnaire in 1976 and one thereafter approximately every four years, which contained data on their alcohol consumption.

The mean age at baseline was 46 and all participants in this study were free of diagnosed cardiovascular disease and cancer. Follow-up ended in 2006.

The 30% of the women were nondrinkers and 35% drank less than a half glass a day. Just 4% said they drank two to three glasses a day, and the remainder drank one to two glasses daily.

Compared with abstainers, heavier alcohol consumption was associated with smoking, a history of hypertension, increased physical activity, and a lower body mass index.

During the 26 years of follow-up, there were 1,206 ischemic and 363 hemorrhagic strokes. Another 602 were of probable/unknown subtype.

Compared with abstainers, those who were light to moderate drinkers — a half glass to a glass and a half — had a lower total risk of stroke in the fully adjusted model (HR 0.83 and 0.79, respectively).

Those who drank two or more glasses daily also had a decreased risk of total stroke, but it was still higher than the low and moderate consumption groups (HR 0.86).

For ischemic stroke, the hazard ratios were 0.88, 0.86, and 0.82, respectively, and for hemorrhagic they were 0.82, 0.76, and 0.88, respectively.

The heaviest drinkers — two to three glasses a day — had an increased total and ischemic stroke risk (HR 1.06 and 1.17, respectively) but a slight decreased risk for hemorrhagic stroke (HR 0.97).

Researchers did not find any significant differences when data were stratified by age, hypertension, aspirin use, hormone therapy, or smoking. However, moderate drinkers without a history of atrial fibrillation had a lower risk of total stroke.

Results were similar in an adjusted model that did not include hypertension, and they were similar between the different alcohol types. The risk of stroke also was similar for those who drank but gave it up for various reasons.

These results are generally consistent with other studies in terms of the overall lower risk for low and moderate drinkers, with an increased risk for heavier drinkers, when compared with abstainers, Rexrode and colleagues said.

They suggested that lower levels of alcohol consumption may be anti-thrombotic and atherogenic, “leading to increased high-density lipoprotein, decreased platelet aggregation, clot formation, and increased fibrinolysis.”

The study was limited by the use of self-reported data, and the authors acknowledged that there was limited power to assess heavy alcohol consumption.

The study was suppported by the National Heart, Lung and Blood Institute of the National Institutes of Health.

The authors reported they had no conflicts of interest to declare.


Source: MedPageToday.com

Traditional yoga is done by slowly stretching the body into a variety of poses while focusing on breathing and meditation. “Yoga is designed to bring about increased physical, mental and emotional well-being,” said M. Mala Cunningham, Ph.D., counseling psychologist and founder of Cardiac Yoga. “Hand in hand with leading a heart-healthy lifestyle, it really is possible for a yoga-based model to help prevent or reverse heart disease. It may not completely reverse it, but you will definitely see benefits.”

AHA Recommendation for Physical Activity

For overall health benefits to the heart, lungs and circulation, perform any moderate- to vigorous-intensity aerobic activity using the following guidelines:

• Get the equivalent of at least 150 minutes of moderate intensity aerobic physical activity (2 hours and 30 minutes) each week.
• You can incorporate your weekly physical activity with 30 minutes a day on at least five days a week.
• Physical activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.
• Include flexibility and stretching exercises.
• Include muscle strengthening activity at least two days each week.

Yoga can be used to improve heart health as a preventive measure or after facing a cardiac event, said Cunningham, who has taught yoga for 40 years and is also president of Positive Health Solutions.

Why  yoga?
Thinking prevention? As part of an overall healthy lifestyle, Cunningham said yoga can help lower blood pressure, increase lung capacity, improve respiratory function and heart rate, and boost circulation and muscle tone. It can also improve your overall well-being while offering strength-building benefits.

Yoga also has proven benefits for those who have faced cardiac arrest, heart attack or other heart event, according to Cunningham. “The acute emotional stress of such an event certainly has a significant and adverse effect on the heart,” she said. “That’s where yoga can be a tremendous benefit to manage the stress.” For example, Cunningham said that half of bypass surgery patients go through depression, facing emotions ranging from anxiety to grieving. “All these things come into play when you’ve got a potentially chronic disease to manage for the rest of your life.”

The calming benefits of yoga may help with that — and you may see benefits right away. After your first yoga class, your blood pressure will likely be lower, you’ll be relaxed and you’ll feel better, Cunningham said.

Long-term, sustained yoga may play a role in improving overall health, according to Cunningham.

“The more energy you put into it, the more you’re going to get out of it,” she said. “After 12 weeks, you may see a dramatic increase in exercise functionality, and blood pressure and cholesterol levels may decrease.”
If you have heart disease, diabetes or are obese, check with your doctor before starting a yoga program. “I highly recommend going to a qualified and trained cardiac medical yoga instructor,” Cunningham said.  To find an instructor in your area, check with your local cardiac rehab center or visit cardiacyoga.com.