Keeping Active, Not Smoking Can Reduce but Not Abolish CV Risks of Obesity

News Author: Shelley Wood
CME Author: Désirée Lie, MD, MSEd

From Heartwire — a professional news service of WebMD

June 16, 2008 — What people do, whether they smoke, and what they eat can mitigate the adverse cardiovascular effects of obesity, but they cannot do away with them altogether, researchers say. While other studies have investigated the relationship between fitness and fatness, this latest study also factors in dietary habits and smoking.

"Our study confirms the findings observed in some epidemiological studies, that although physical activity is important, it does not abolish the excess cardiovascular risk observed among the obese," first author on the study, Dr Majken K Jensen (Aarhus University Hospital, Aalborg, Denmark), told heartwire. The results, Jensen continued, "suggest that both obesity and physical activity affect the risk of acute coronary syndrome (ACS) and that the lowest risk is observed among the leanest individuals who are the most physically active. The new information is really not on physical activity, but that we extended the investigation to include the role of obesity in combination with other lifestyle risk factors."

Jensen et al report the results of their study published online June 9, 2008 in Circulation.

Does weight matter?

Jensen and colleagues reviewed a median of 7.7 years of follow-up data for the almost 55,000 participants in the Danish Diet, Cancer, and Health study. All participants were middle-aged (50-64 years) and free of coronary artery disease (CAD) and cancer at baseline.

"Some people might think that it doesn't matter if they are overweight as long as they are active," Jensen explained. "Or, similarly, think that it doesn't matter that they are overweight because they otherwise adhere to a healthy lifestyle, with regard to not smoking, eating healthy, and being physically active. We wanted to explore this further."

They found that developing acute coronary syndromes over this period was significantly associated with increased body-mass index (BMI): for every unit of BMI increase, risk of ACS was increased by 5% in women and by 7% in men.

Nonsmokers who were obese had a reduced risk of ACS as compared with people who were obese and heavy smokers (≥ 15 g/day). Similarly, obese but physically active people (≥ 3.5 hours per week) fared slightly better than inactive obese subjects (less than one hour per week). By contrast, adherence to a Mediterranean-style diet, suggested by high scores on the Mediterranean diet scale, appeared to have no impact on risk of future events in obese subjects.

Pearls for Practice

• Increasing BMI vs healthy BMI is associated with a strong and graded increase in the risk for ACS in men and women.
• The increased risk for ACS in obese participants is further increased by the presence of hypertension, diabetes, hypercholesterolemia, smoking, and a sedentary lifestyle but not by lack of adherence to the Mediterranean diet.

Stroke Treatment and Prevention Are Not the Same in Men and Women

Helmi L. Lutsep, MD

Posted 02/01/2008 ; http://www.medscape.com/viewarticle/569133?src=mp

Major acute stroke treatment and prevention trials have shown significant differences in the natural history of stroke and the effects of stroke treatment and prevention in men and women.

Women have worse outcomes after acute stroke than men if they do not receive thrombolytics. However, women have more benefit than men with acute stroke treatment, as shown in a pooled analysis of intravenous tissue plasminogen activator trials and in a post hoc analysis of a study investigating intra-arterial prourokinase.^[1,2] The findings emphasize the need to consider acute stroke treatment in women, who currently tend to receive treatment less often than men.^[3]

Because the best data demonstrate major differences in how men and women respond to prevention strategies, different approaches must be used. For example, aspirin has not been shown to prevent strokes in men believed to be healthy at the initiation of the trial.^[4] On the other hand, healthy women, especially those over the age of 65, can benefit from taking aspirin, 100 mg on alternate days, for stroke prevention.^[5]

Women with stenosis of the carotid artery have a lower risk of recurrent stroke than men. Comparison of surgical and medical treatment of symptomatic carotid artery stenosis shows no benefit from surgery in women with moderate stenosis, although there is benefit in men.^[6] This finding should lead to fewer referrals of women than men for carotid surgery. On the other hand, women with symptomatic intracranial stenosis have a higher risk of recurrent stroke than do men.^[7] Endovascular treatment could have greater benefit in women than men with intracranial stenosis, although this remains to be proven.

Physicians should understand these substantial gender differences and tailor their treatment and prevention strategies appropriately. All future clinical trials involving studies of stroke must also give serious consideration to gender differences.

Sweet Soft Drinks, Fructose Linked to Increased Risk for Gout

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

http://www.medscape.com/viewarticle/569656?src=mp

February 4, 2008 — Consumption of soft drinks sweetened with sugar and fructose is strongly associated with an increased risk for gout, according to the results of a prospective cohort study reported in the February 1 Online First issue of the BMJ.

Gout is the most common inflammatory arthritis in men. Its prevalence has doubled in the United States within the past few decades and increased 61% from 1977 to 1997, the same period in which sugar-sweetened soft drinks represented the largest single source of calories in the US diet with yearly per capita use increasing from 0 to 29 kg. Fructose administration in humans is associated with a rapid increase in serum levels of uric acid, which are greater in those with gout. The study authors hypothesized that increased intake of sweetened fructose-containing drinks was linked to the incidence of gout.

This is a prospective evaluation of the association between intake of sugar-sweetened soft drinks, juice, and fruit intake and the incidence of gout in a cohort of healthy men without a previous history of gout.

• Consumption of sugar-sweetened soft drinks high in fructose, fruit juices, oranges, and apples are associated with an increased risk for gout in men.
• Intake of diet soft drinks is not associated with an increased risk for gout in men.

Calcium supplements interfere with blood pressure drugs

Mayo Clinic hypertension specialist Sheldon Sheps, M.D.,

In large amounts, calcium supplements may interfere with some blood pressure medications. Interactions may occur with the following blood pressure medications:

• Thiazide diuretics. Ingesting large amounts of calcium with thiazide diuretics — such as chlorothiazide, hydrochlorothiazide and indapamide — can result in milk-alkali syndrome, a serious condition characterized by excessively high levels of calcium and a shift in the body's acid-base balance to alkaline. In general, avoid consuming more than 1,500 milligrams of calcium (supplements and food sources combined) a day if you're taking a thiazide diuretic. If you do take calcium supplements while taking a thiazide diuretic, talk to your doctor about the appropriate dose and have your blood pressure and calcium levels monitored.
• Calcium channel blockers. When taken intravenously, calcium may decrease the effects of calcium channel blockers such as nifedipine, verapamil, diltiazem and others. In fact, intravenous calcium is used to help reverse calcium channel blocker overdose. However, there's no evidence that standard calcium supplements interfere with calcium channel blockers. To be safe, check your blood pressure regularly if taking calcium channel blockers and calcium supplements concurrently.

Calcium supplements don't appear to interact with other commonly prescribed blood pressure medications, such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers or renin inhibitors. Talk to your doctor if you take high blood pressure medications and calcium supplements and are concerned about interactions.

source:http://www.mayoclinic.com/health/calcium-supplements/AN01871

Weight loss: Better to cut calories or exercise more?

Mayo Clinic dietitian Katherine Zeratsky, R.D., L.D., and colleagues answer select questions from readers.

You may be referring to a study published in the Journal of Clinical Endocrinology & Metabolism. This six-month study examined the effects of diet alone (25 percent fewer calories consumed) versus diet plus exercise (12.5 percent fewer calories consumed and 12.5 percent more calories burned) in overweight but otherwise healthy adults.

Researchers hypothesized that the diet plus exercise group would lose more body fat, but results showed equal amounts of weight and fat lost in both groups.

This confirms that weight loss is all about calories: If you burn more calories than you eat, you'll lose weight. It doesn't mean exercise isn't important. Exercise has many health benefits. Plus, it can be tough to create a calorie deficit by diet alone.

Can I lose weight if my only exercise is walking?

Mayo Clinic dietitian Katherine Zeratsky, R.D., L.D., and colleagues answer select questions from readers.

Consuming fewer calories is often the most effective way to lose weight. Still, an increase in physical activity is an important part of any weight-loss program. And walking is a great way to get started. For motivation, do the math:

To lose 1 pound, you must burn 3,500 calories.

If you cut 250 calories from your daily diet, you could lose that pound in about two weeks. If you add 30 minutes of brisk walking to your daily routine, you could burn another 150 calories a day. Make that 60 minutes of brisk walking and you could burn about 300 calories a day. Of course, the more you walk and the quicker the pace, the more calories you'll burn. Keep it up and you'll walk your way to a healthy weight. Better yet, walking can help you keep the weight off for good.

Coffee Good for Health?

Coffee May Reduce Mortality in Women

Long-term consumption of coffee may reduce the mortality rate in women, according to a study in Annals of Internal Medicine.

Researchers looked at data from some 130,000 healthy women and men from two large cohorts — the Nurses' Health Study and the Health Professionals Follow-Up Study — who regularly answered dietary questionnaires.

After roughly 20 years' follow-up and adjustment for other risk factors, they found that higher coffee consumption in women was associated with a slightly lower risk for all-cause mortality — largely due to a reduced risk for cardiovascular death. The effect was observed with as few as five to seven cups per week and was independent of caffeine intake.

Men who drank more coffee also saw a benefit, but the association did not reach statistical significance.

The authors say that coffee's potential perks could be due to its effects on inflammation, endothelial function, and insulin sensitivity.

Annals of Internal Medicine article (Free abstract; full text requires subscription

Vit D deficiency increases heart attacks in men

Vitamin D Deficiency Associated with Increased MI Risk in Men

Low levels of vitamin D in men are associated with double the risk for myocardial infarction, reports Archives of Internal Medicine.

Researchers assessed plasma 25-hydroxyvitamin D concentrations in some 18,000 men aged 40 to 75. After 10 years, roughly 450 men had had a nonfatal MI or fatal coronary artery disease. This group was matched to a control group (from among the participants) free of cardiovascular disease.

Men who had deficient vitamin D levels (15 ng/mL or less) were at significantly higher risk for MI by follow-up, compared with men whose levels were at least 30 ng/mL (relative risk, 2.4). The results remained significant after adjustment for cardiovascular risk factors and lipid levels.

The authors propose several possible mechanisms for the association — among them, vitamin D's effects on vascular smooth muscle cell growth, vascular calcification, inflammation, and blood pressure (through the renin-angiotensin system).

Archives of Internal Medicine article (Free abstract; full text requires subscription

International Travel Health Guide

Physician's First Watch for July 16, 2007

David G. Fairchild, MD, MPH, Editor-in-Chief

CDC Releases Updated "Yellow Book" on International Travel

CDC Releases Updated "Yellow Book" on International Travel

The CDC has released its biennial revision of "the yellow book," a health guide for international travel.

The book describes travel-related infections and diseases endemic to each region. Changes in the latest edition include updates on recommended immunizations, developments in malaria treatment and prevention, advice for avoiding deep vein thrombosis while flying, and a section on avian influenza.

The yellow-covered book, officially titled "CDC Health Information for International Travel 2008," is available free online (and can also be purchased in bookstores).

Margarine or Butter?

Margarine usually tops butter when it comes to heart health.

Margarine is made from vegetable oils, so it contains no cholesterol. Margarine is also higher in "good" fats — polyunsaturated and monounsaturated — than butter is. These types of fat help reduce low-density lipoprotein (LDL), or "bad," cholesterol, when substituted for saturated fat. Butter, on the other hand, is made from animal fat, so it contains cholesterol and high levels of saturated fat.

But not all margarines are created equal — and some may even be worse than butter. Most margarines are processed using a method called hydrogenation, which results in unhealthy trans fats. In general, the more solid the margarine, the more trans fats it contains — so stick margarines usually have more trans fats than do tub margarines. Like saturated fats, trans fats increase blood cholesterol and the risk of heart disease. In addition, trans fats can lower high-density lipoprotein (HDL), or "good," cholesterol levels.

When selecting a margarine, choose one with the lowest trans fat content possible and less than 2 grams total of saturated plus trans fats. Manufacturers are required to list saturated and trans fats separately on food labels. Also, margarines fortified with plant sterols can help reduce LDL cholesterol levels by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams. The American Heart Association recommends foods fortified with plant sterols for people with levels of LDL cholesterol over 160 milligrams per deciliter (4.1 mmol/L).

However, if you don't like the taste of margarine and don't want to give up butter completely, consider using whipped butter or light or reduced-calorie butter. There are also spreadable butters with vegetable oils added. Per serving, these products have less fat and calories than regular butter. The important thing is to use these products in small amounts — just enough to add flavor to the foods you're eating.

Mayo Clinic cardiologist Martha Grogan, M.D.

Home BP Monitoring

• Home Is Where the Heart Is: Call for Greater Use of Home Blood-Pressure Monitoring

  Michael O'Riordan

• Monitors that use oscillometry to measure the blood pressure at the brachial artery are preferred as are those with electric inflation of cuffs and memory.
• Wrist monitors are not recommended.
• Patients should follow similar procedures for HBPM as followed in the clinical measurement of blood pressure. For example, HBPM should be performed after resting for at least 5 minutes, with the upper arm supported at the level of the heart and both feet on the floor.
• At least 2 to 3 readings should be taken at 1 sitting, during intervals as little as 1 minute. Readings first thing in the morning and at night are preferred.
• HBPM by the oscillometric method may be unreliable among patients with atrial fibrillation or frequent ectopic beats.
• Readings may be continued for at least 1 week. Medical decisions should be based on 12 or more readings.
• Up to 10% of patients will have higher home blood pressure levels vs levels measured in the medical office (masked hypertension). This form of hypertension is associated with the same cardiovascular risk as sustained hypertension and mandates treatment.
• HBPM has been demonstrated to be useful in the prediction of target organ damage, cardiovascular events, and cardiovascular mortality. It has been demonstrated to be superior to office blood pressure monitoring in the prediction of microvascular and macrovascular complications of diabetes. 4 of 5 studies comparing home vs office blood pressure monitoring found that HBPM was the stronger predictor of cardiovascular events and mortality.
• The target home blood pressure for most patients with hypertension is less than 135/85 mm Hg. HBPM is useful in patients with a blood pressure goal of less than 130/80, such as those with diabetes, coronary heart disease, and chronic kidney disease.
• HBPM may improve medication adherence and blood pressure control. Blood pressure has been demonstrated to be 2.2/1.9 mm Hg lower among patients who use HBPM.
• HBPM may be particularly useful among older adults because this group is more likely to have white-coat hypertension, and patients may also be assessed for changes in orthostatic blood pressure.
• Blood pressure during pregnancy decreases and then increases. HBPM may detect abnormalities to this pattern, suggesting preeclampsia, sooner than office visits alone.
• The usual out-of-pocket cost for a home monitoring device is $80 to $100. HBPM is generally most cost effective when used to diagnose white-coat hypertension and therefore avoid treatment with antihypertensive medication. The authors of the scientific statement call for reimbursement for these devices.
• Overall, the current statement recommends that HBPM become a routine part of the management of hypertension, especially for patients with diabetes, coronary heart disease, chronic kidney disease, suspected medication nonadherence, or substantial white-coat hypertension.

Eggs: Are they good or bad for my cholesterol?

It's understandable that you're confused. Eggs are high in cholesterol, and a diet high in cholesterol can contribute to elevated blood cholesterol levels. However, the extent to which dietary cholesterol raises blood cholesterol levels isn't clear. Many scientists believe that saturated fats and trans fats have a greater impact than does dietary cholesterol in raising blood cholesterol.

Adding to the confusion, the American Heart Association recently acknowledged that as long as you limit dietary cholesterol from other sources, it may be possible to include a daily egg in a healthy diet — a statement that was heavily reported in the media.

Here are the facts: One large egg has about 213 milligrams (mg) of cholesterol — all of which is found in the yolk. If you are healthy, it's recommended that you limit your dietary cholesterol intake to less than 300 mg a day. If you have cardiovascular disease, diabetes or high LDL (or "bad") cholesterol, you should limit your dietary cholesterol intake to less than 200 mg a day. Therefore, if you eat an egg on a given day, it's important to limit or avoid other sources of cholesterol for the rest of that day.

If you like eggs but don't want the extra cholesterol, use egg whites. Egg whites contain no cholesterol. You may also use cholesterol-free egg substitutes, which are made with egg whites. If you want to reduce cholesterol in a recipe that calls for eggs, use two egg whites or 1/4 cup cholesterol-free egg substitute in place of one whole egg.

Mayo Clinic cardiologist Gerald Gau, M.D.

Bad Breath - Prevention

Self-care

Try the following steps to improve or prevent bad breath:

• Brush your teeth after you eat. Keep a toothbrush at work to brush after eating.
• Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth.
• Brush your tongue. Giving your tongue a good brushing removes dead cells, bacteria and food debris. Use a soft-bristled toothbrush and brush your tongue with at least five to 15 strokes. Pay particular attention to the middle third of the tongue, where most of the bacteria tend to collect.
• Clean your dentures well. If you wear a bridge or a partial or complete denture, clean it thoroughly at least once a day or as directed by your dentist.
• Drink plenty of water. To keep your mouth moist, be sure to consume plenty of water — not coffee, soft drinks or alcohol. Chewing gum (preferably sugarless) or sucking on candy (preferably sugarless) also stimulates saliva, washing away food particles and bacteria. If you have chronic dry mouth, your dentist or doctor may additionally prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.
• Use a fairly new toothbrush. Change your toothbrush every three to four months, and choose a soft-bristled toothbrush.
• Schedule regular dental checkups. At least twice a year, see your dentist to have your teeth or dentures examined and cleaned.

You can teach your school-age children to brush and floss their teeth regularly and to brush their tongues to prevent bad breath. However, don't give children mouthwash to use, because many mouthwash products contain alcohol and can pose a risk for children if swallowed.

source: http://www.mayoclinic.com/health/bad-breath/DS00025/DSECTION=4