Tai Chi Boosts Quality of Life in Heart Failure

By Nancy Walsh, Staff Writer, MedPage Today

Heart failure patients may experience improvements in their quality of life and mood by participating in a tai chi exercise program, a randomized study suggested.

The small study of patients with chronic systolic heart failure found that disease-specific quality of life -- measured on the Minnesota Living with Heart Failure Questionnaire -- showed benefits among those who took tai chi, with scores falling from a median of 28 at baseline to 9 at 12 weeks, according to Gloria Y. Yeh, MD, of Harvard in Boston, and colleagues.

Another Possible Risk Factor For Heart Disease Revealed By NIH-Funded Study

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Abnormal heart rate turbulence is associated with an increased risk of heart disease death in otherwise low-risk older individuals, according to a study funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

This study appears in the Journal of Cardiovascular Electrophysiology.

Among the nearly 1,300 study participants, heart rate turbulence, which reflects how well the heart reacts to occasional premature contractions, was an even stronger heart disease risk factor than elevated levels of C-reactive protein. CRP is a potential heart disease biomarker that has emerged in recent years.

Study participants considered at low risk of heart disease based on traditional risk factors were on average 8 to 9 times more likely to die of heart disease during the roughly 14-year follow-up period if they had abnormal heart rate turbulence values. Traditional risk factors include age, gender, high blood cholesterol, high blood pressure, obesity, diabetes, and smoking. Low-risk individuals with elevated CRP in their blood were about 2.5 times more likely to die than those with normal or low CRP.

"These findings suggest that apparently healthy people might be at increased risk of death from cardiovascular disease, and heart rate turbulence may help us identify them," said Susan B. Shurin, M.D., acting director of the NHLBI. "It will be important to see if we can replicate this finding in other populations."

This study followed 1,272 adults aged 65 and older as part of the NHLBI's Cardiovascular Health Study. Participants were categorized as healthy (no sign of heart disease risk except possibly diabetes), subclinical (some signs of heart disease) or clinical (had a cardiovascular event, such as a heart attack). At the onset, participants underwent 24-hour monitoring of their hearts' electrical activity through a small electrocardiographic, or ECG, device called a Holter monitor attached to their skin.

Abnormal heart rate turbulence and CRP levels both appeared to independently correlate with an increased likelihood of dying of heart disease in the group that was categorized as healthy, even after controlling for other risk factors. Abnormal heart rate turbulence - present in about 7 percent of the study participants - also predicted an increased likelihood of heart disease death in the subclinical and clinical groups, though these results were not as pronounced.

Heart rate turbulence refers to how smoothly the heart rate returns to normal after a premature ventricular contraction, a fairly common event in which the second portion of a heart beat is triggered too soon. Due to the improper timing between the atrial and ventricular contractions, the ventricles haven't fully filled with blood and therefore do not push out enough blood to the body. The brain detects this sub-optimal release of blood and instantly increases the heart rate to pump more blood. However, this overcompensation raises blood pressure, causing the brain to react again and lower the heart rate until blood pressure returns to normal.

By analyzing the heart's electrical signals, physicians can measure the magnitude of the initial heart rate jump (turbulence onset) and the speed at which heart rate returns to normal (turbulence slope), and then determine if the heart rate turbulence response is normal or abnormal.

"A heart rate turbulence measurement is insightful because it offers a sign of how well the autonomic, or subconscious, nervous system is functioning," said study author Phyllis K. Stein, Ph.D., a research associate professor of medicine and director of the Heart Rate Variability Laboratory at Washington University School of Medicine in St. Louis. "If someone's heart doesn't react well to these uncoordinated beats that might mean it's not good at reacting to other issues like sudden stress or severe arrhythmias."

Researchers don't yet know if abnormal heart rate turbulence can be treated or prevented. In the meantime, said Stein, interest might grow within the medical community in measuring heart rate turbulence in clinical practice. Currently, this type of measurement is not widely available.

"This study shows a great potential value for heart rate turbulence in diagnostic settings," said Robin Boineau, M.D., a medical officer in the NHLBI's Division of Cardiovascular Sciences. "It appears that signs of heart rate turbulence are also generally present a year or more before clinical manifestations of heart disease, indicating that this may be an opportunity for disease prevention in addition to disease prediction."

In addition to the NHLBI, the National Institute of Neurological Disorders and Stroke also contributed funding to this study.

Source:
NHLBI Communications Office
NIH/National Heart, Lung and Blood Institute

Happy Valentine's Day from SAGE

Happy Valentine's Day from SAGE! February is National Heart Awareness Month,and SAGE wants to ensure that your heart is healthy. Download it's fact sheet, "Ten Things Every LGBT Older Adult Should Know About Heart Disease," and share it with your friends and loved ones. Don't forget to:

305 Seventh Avenue, 6th Fl | New York, NY 10001 US

Maternal Stroke History Tied to MI Risk in Women

By Todd Neale, Staff Writer, MedPage Today

A family history of stroke -- especially among female relatives -- may help predict the risk of acute coronary syndromes in women, a large prospective study found.
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Caregiving Strain and Estimated Risk for Stroke and Coronary Heart Disease Among Spouse Caregivers – Journal Article

High caregiving stress has been associated with poor physical and psychological health, and with increased mortality among spouse caregivers. This study examined the differential effects of stress on stroke and coronary heart disease (CHD) risk by race and sex. Caregiving strain was significantly associated with higher estimated risk for men, particularly African American men, providing caregiving to their wives.

Journal Article

New Measure Trumps High-Density Lipoprotein (HDL) Levels in Protecting Against Heart Disease

ScienceDaily (2011-01-12) -- A new study shows that a different metric, a measure of HDL function called cholesterol efflux capacity, is more closely associated with protection against heart disease than HDL cholesterol levels themselves. Findings from the study could lead to new therapeutic interventions in the fight against heart disease.

Comparison of Medications for Heart Failure Finds Difference in Risk of Death

ScienceDaily (2011-01-13) -- In a comparison of the angiotensin II receptor blockers candesartan and losartan, used by patients with heart failure, candesartan was associated with a lower risk of death at 1 and 5 years, according to a new study.

Common Painkillers Linked to Increased Risk of Heart Problems

ScienceDaily (2011-01-11) -- Commonly used painkillers for treating inflammation can increase the risk of heart attacks and strokes, according to an analysis of the evidence.

Health Discovery: Heart Defibrillator Dilemma; Implant Advice, Guidelines - AARP Bulletin

by: Katharine Greider | from: AARP Bulletin

New research indicates that more than 20 percent of all heart defibrillators are surgically implanted in patients who may not be good candidates for the devices — leaving men and women who have these machines in a quandary as they may face dangerous health risks.

The research, led by Duke University heart specialist Sana M. Al-Khatib, M.D., found that patients who received a defibrillator but whose heart condition didn't match recommended criteria were more likely to die or suffer from a complication in the hospital.

What do you do if you've been implanted with a defibrillator? And if you're told you need one, how can you tell whether the advice is solid?

Here are the facts heart patients may want to consider — along with the guidelines that list which heart patients shouldn't get a defibrillator.

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Living Longer Comes With a Physical Cost - NYTimes.com

Image via CrunchBaseBy NICHOLAS BAKALAR

Americans are living longer, but those added years are more likely to be a time of disease and disability.

An analysis of government data has found that while life expectancy has steadily increased over the past decade, the prevalence of heart disease, stroke, cancer and diabetes has also increased, and disability has grown as well.

For example, in 1998 about 16 percent of men in their 70s had a mobility problem — that is, they failed one of four commonly used physical tests. By 2006, almost 25 percent failed at least one.

Writing in the January issue of The Journal of Gerontology B, the authors conclude that people live longer not because they are less likely to get sick, but because they survive longer with disease.
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World Stroke Day --- October 29, 2010

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October 29 is World Stroke Day 2010. Stroke is the third leading cause of death in the United States (1). Approximately 795,000 strokes occur annually in the United States, with an estimated cost of more than $73 billion (1). The theme for this year's World Stroke Day is "One in Six," to raise awareness that one in six persons worldwide will have a stroke in their lifetime, and that every 6 seconds, someone somewhere will die from a stroke (2,3).

This campaign stresses that the occurrence of stroke is common and widespread, but that stroke can be prevented and stroke survivors can recover and regain their quality of life with care and support. The campaign recommends the following six actions to reduce the likelihood of having a stroke:

• Know your personal risk factors, including diagnosed high blood pressure, diabetes, or high cholesterol.
• Be physically active and exercise regularly.
• Avoid obesity by eating a healthy diet with lots of fresh fruits and vegetables.
• Limit alcohol consumption.
• Avoid cigarette smoke. People who smoke should seek help to stop now.
• Learn to recognize the warning signs of a stroke and call 9-1-1 right away if someone is suspected of having a stroke.

CDC addresses stroke prevention through state-based programs to prevent heart disease and stroke, through the Paul Coverdell National Acute Stroke Registry, and through many other partnerships. Information about stroke and stroke prevention is available at http://www.cdc.gov/stroke, and additional information about World Stroke Day 2010 is available at http://www.worldstrokecampaign.org/pages/home.aspx. 

References

1. Lloyd-Jones D, Adams R, Brown TM, et al. Heart disease and stroke statistics 2010 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2010;121:e46--215.
2. Seshadri S, Beiser A, Kelly-Hayes M, et al. The lifetime risk of stroke: estimates from the Framingham Study. Stroke 2006;37:345--50.
3. World Health Organization. The atlas of heart disease and stroke. Geneva, Switzerland: World Health Organization; 2004.

Consumer Reports Is Rating Heart Bypass Surgical Groups - NYTimes.com

Image via CrunchBaseby Denise Grady
Medical groups that perform heart bypass surgery are now being rated alongside cars and toaster ovens in Consumer Reports.


In most parts of the country, data-based ratings of doctors are not available to patients. Only a few states, including New York, provide them.

The magazine published ratings of 221 surgical groups from 42 states online on Tuesday and will print them in its October issue. Groups are rated, not individual doctors. The groups receive one, two or three stars, for below average, average or above average. The scores were based on complication and survival rates, whether the groups used the best surgical technique and whether patients were being sent home with certain medicines that research has shown to be beneficial after this type of surgery.

For now, the information is available only to people who subscribe to Consumer Reports online or buy the magazine. But within a few months, the ratings should be posted and freely available to the public at the Web site of the Society of Thoracic Surgeons (www.sts.org/), said Dr. Fred H. Edwards, the chairman of quality and research for the society, and medical director for cardiothoracic surgery at the University of Florida in Jacksonville. The society, which has been tracking surgeons’ performance since 1989, gave the information to Consumer Reports. More than 90 percent of the nation’s heart surgery programs participate in the society’s registry.
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Get Moving! Exercise can Enhance and Extend Your Life

Regular exercise is essential to healthy aging. It lowers risk factors linked to the development of chronic disease, such as, obesity, high blood pressure, diabetes, and high levels of triglycerides. In turn, physical inactivity has been linked to the development of heart disease and stroke. The American Heart Association (AHA) cites physical inactivity as a major risk factor for developing coronary artery disease. The Centers for Disease Control and Prevention (CDC) highlights regular physical activity as one of the most important steps to take to prevent serious health problems that can occur with age.

Different activities lead to different health benefits. Some forms of exercise, such as strengthening exercises, improve flexibility and balance. Aerobic exercise increases cardiovascular fitness and endurance. Examples of aerobic activities include brisk walking, bicycling, jogging and dancing. CDC’s guidelines recommend that older adults 65+ who have no limiting health conditions participate in moderate-intense aerobic activities for at least two and a half hours every week. It also recommends including muscle-strengthening exercises, such as, lifting weights, working with resistance bands, heavy gardening, or yoga on two or more days every week. Strengthening exercises can increase a person’s flexibility and balance, which reduce the likelihood and severity of falls.

Recent Exercise Statistics for Adults 65+

Statistics published by CDC in 2009 indicate that older adults in the age range, 65 to 74 years old, exercise more than those 75+. In addition, the statistics indicate that older men exercise more than older women.
The statistics state that 38.5 percent of men, 65 to 74 years old, exercised regularly and 31.1 percent of women in the same age range exercised regularly. The numbers decrease for adults 75+. 23 percent of men 75+ exercised regularly and 14 percent of women 75+ exercised regularly.

Learn More about the Benefits of Exercise

To learn more about the benefits of exercise and tips for incorporating exercise into your life, visit these resources:

• How much physical activity do older adults need? (CDC)
• Physical Activity (AHA)
• Physical Activity for Older Adults: Exercise for Life! (American Society on Aging)
• Exercise for Seniors (Medline Plus)

CABG, PCI More Common Now in Oldest MI Patients

By Todd Neale, Staff Writer, MedPage Today

The use of revascularization procedures is increasing rapidly among patients 80 and older admitted for an acute myocardial infarction, a retrospective Canadian study found.

For such patients living in Quebec, rates increased for both percutaneous coronary intervention (from 2.2% to 24.9%) and coronary artery bypass grafting (from 0.8% to 3.1%) from the mid-1990s through 2006, Louise Pilote, MD, PhD, of McGill University in Montreal, and colleagues reported online in CMAJ.

And despite a similar rise in the prevalence of comorbidities in this population, one-year mortality declined from 46.5% to 40.9% (P<0.001), possibly related to the greater use of revascularization procedures and recommended medications.

"Substantial numbers of revascularization procedures are now being performed in very old patients for whom such procedures were not even considered a decade ago," they wrote. "In the context of an aging population and limited healthcare resources, it is imperative to determine whether such drastic changes in practice are cost-effective."
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Clean Teeth Again Linked to Healthy Heart from MedPage Today

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By Crystal Phend, Senior Staff Writer, MedPage Today

Regular toothbrushing could help stave off cardiovascular disease, according to a nationally-representative study in Scotland.

Individuals who rarely or never brushed were 70% more likely to have a heart attack or other cardiovascular disease event (P<0.001) even after controlling for many other factors, found researchers led by Richard Watt, MSc, PhD, of University College London.

Even brushing once a day rather than twice a day was associated with a significant 30% increase in the risk of these fatal or nonfatal events.

Low-grade inflammation appeared to be playing a role, although whether it is a causal role remains uncertain, Watt's group reported online in BMJ.

These increases in risk could have a "profound public health impact," they wrote in the study.
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BP Variation Linked to CVD from MedPage Today

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by Michael Smith, North American Correspondent, MedPage Today

If your blood pressure fluctuates up and down over time, you may be at increased risk of cerebrovascular disease, researchers said.
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Genetically Determined Triglycerides Linked to CHD

By Nancy Walsh, Contributing Writer, MedPage Today

Individuals genetically hardwired for higher concentrations of triglycerides may have a higher risk of coronary heart disease, according to a meta-analysis that connects the dots between triglyceride levels and heart problems.

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Afib Linked to Dementia Incidence and Mortality

By Crystal Phend, Senior Staff Writer, MedPage Today

Atrial fibrillation appears independently linked to all forms of dementia, particularly in later middle age, researchers found.

Atrial fibrillation patients 70 or younger were 2.3 times more likely to develop Alzheimer's disease than those without the heart rhythm disorder, after multivariate adjustment (P=0.001), in a large prospective cohort study by T. Jared Bunch, MD, of Intermountain Medical Center in Murray, Utah, and colleagues.
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Study Suggests Doctors Overlook Effects Of Implanted Heart Defibrillators In Dying Patients

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(Medical News Today) The Associated Press reports that heart defibrillators implanted in a patient's chest may disrupt a quiet death, but doctors and relatives of people dying of non-heart related diseases often don't consider that issue. "It's not unusual for health professionals to avoid the topic, says Dr. Nathan Goldstein of New York's Mount Sinai Medical Center. His research, published this month in Annals of Internal Medicine, suggests most hospices - expert in end-of-life care - aren't making defibrillator decisions part of their routine." The devices can cause "painful, repeated shocks" in some patients if they are not turned-off. "Nearly 60 percent of hospices he examined had at least one patient shocked within the past year, sometimes multiple times at once. Yet just one in 20 hospices had a method even to identify who harbored the implant when they entered the program. But with more than 100,000 implantable cardioverter-defibrillators, or ICDs, inserted every year, more and more families ... will face the question" (Neergaard, 3/15).
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Medical News: FDA Okays Statin for Primary Prevention - in Cardiovascular, Prevention from MedPage Today

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By Peggy Peck, Executive Editor, MedPage Today, Executive Editor, MedPage Today

The FDA has approved rosuvastatin (Crestor) for primary prevention of cardiovascular disease, making it the first statin to receive this indication.

The new labeling, recommended by an FDA advisory panel late last year, also marks the first time that a drug label will include an indication based on the biomarker highly-sensitive C-reactive protein, an inflammatory marker.

The new indication would be for men 50 or older and women 60 or older who have fasting LDL of less than 130 mg/dL, a highly-sensitive CRP of 2.0 mg/L or greater, triglycerides of less than 500 mg/dL, and no prior history of heart attack or stroke, or coronary heart disease risk.
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• AstraZeneca gets OK for expanded Crestor use (seattletimes.nwsource.com)