Stress and Heart Disease

How Does Aging Affect your Heart?

Fruit Drinks, Energy Drinks and Heart Disease

Vitamin D Deficiency, Obesity and Cardiometabolic Risk: Is there any Relationship?

Until now we have been talking about several different risk conditions like adiposity, cardiovascular disease, diabetes, osteoporosis, hormone imbalance, vitamin D deficiency and other related disorders. After spending billions of dollars in medical research, we have collected huge amount of data and a wealth of information. It is time to get serious and make use of this information. Let me put it this way, we have collected most of the pieces of a big puzzle and now it is time to put together these pieces and complete the puzzle. We all recognize that our bodies do not work in isolation and so we need to look at all the body systems together as one system, which controls how we live our lives. I believe we may already have answers to so many questions. We may not have to spend more money into research to collect more data, which might create more confusion for us and more challenge to analyze all that new data. We could keep debating over what we should or should not do, but for now, since I titled this piece with a focus on role of vitamin D in obesity and cardiometabolic risk, let me discuss how vitamin D is emerging as a strong candidate to consider when we accumulate few extra pounds in our bodies, especially around our abdomen.

Now that holidays are over and New Year has begun, many of us are busy exercising and trying to shed those extra pounds we gained enjoying cookies and treats. Most of us have been indoors by the fireplace, especially in the Northwest where I live and where sun is known to be a luxury. Of course I do not have any reason to envy those who are in Midwest, especially after reading the newspaper this morning to see how most of the country is under the grip of winter chills with temperatures as low as 52 below zero in the Midwest. My point is that we have not had a chance to get out and get some sunlight so we could make some vitamin D. We all know how important is, sun exposure for endogenous production of vitamin D in the skin. There is evidence now that vitamin D is implicated in the cardiovascular morbidity and mortality, in addition to its role in musculoskeletal health. There is also some evidence that vitamin D deficiency is associated with obesity. We could argue that this association is indirect because obese individuals are less active and thus they get less sunlight exposure. However, some studies have shown that since vitamin D is fat soluble and therefore stored in fat tissue, which makes it less bio-available when there is more fat tissue. Obesity has been shown to have connection with insulin resistance and metabolic syndrome. Does that mean there is a link between insulin resistance, metabolic syndrome and vitamin D deficiency? The answer is yes, because some computed tomography imaging studies combined with measurements like BMI and waist circumference have suggested that vitamin D may be related to variation in regional adiposity and thus could be implicated in insulin resistance and metabolic syndrome, thereby connected indirectly with all biochemical mechanisms including inflammatory pathways leading to conditions like diabetes, atherosclerosis and coronary heart disease.

A recent study by Susan et al. that appeared in the January 2010 issue of Diabetes journal has shown that vitamin D deficiency is related with increased BMI; there is an inverse relation of 25-hydroxyvitamin D [25(OH)D] with subcutaneous and abdominal fat even in individuals who are lean with low BMI; and finally there is strong correlation between 25(OH)D and markers of insulin resistance, especially connected with abdominal adiposity. One could argue that some other factors like limited physical activity or low vitamin D intake may have caused the observed correlations, but the good thing is that this study took into consideration those confounders too as their subjects were all young to middle aged, with little comorbidities and low medication use. The study showed independent association between subcutaneous fat or visceral fat with 25(OH)D. It is also discussed that only differences in sunlight exposure are not enough to account for vitamin D concentration differences between obese and non-obese individuals. I will not go into too many details here about biochemical mechanisms that have been discussed to explain possible association of vitamin D with adiposity. Several findings have suggested multiple mechanisms involved with good evidence that vitamin D deficiency is implicated in obese individuals and thus connected with insulin resistance and related disorders.

So, for now the message is, let us watch out for those extra calories that we throw into our bellies. I am not asking you to stop enjoying cookies and left over treats from holidays, but what I am saying is that it is time we pay more attention to what we eat, how much we eat and what we do to metabolize all the extra calories we consume. Let us take good care of our waistline and if we see someone with a big waist, let us help them by making them aware of how vitamin D deficiency could be something to look for. How do we know we are vitamin D deficient? Well- there are tests available that can help us determine the vitamin D levels in our body and how much supplement do we need to replenish healthy levels. To make our life easy, there is a dried blood spot test available, which involves convenient home collection of sample, which is simply mailed to the laboratory and analyzed. You do not have to get out of home, get an appointment with a lab or phlebotomist, drive across town or take off from work. Does that not sound good? Feel free to email me (skapur@zrtlab.com) if you wish to share some thoughts or need more information. Let us continue this discussion.

New Definition of Metabolic Syndrome

Did you know the new definition of Metabolic Syndrome? Did you know that waist circumference is now one of five criteria that physicians can use to diagnose metabolic syndrome?

The ATP III guidelines earlier did not consider the waist circumference as an important criteria, to diagnose metabolic syndrome, but a recent statement published online on October 5, 2009 in Circulation actually is a step forward to streamline the use of abdominal obesity in determination of risk of developing metabolic syndrome. The new statement on metabolic syndrome is a combined effort by International Diabetes Federation (IDF), the National Heart, Lung, and Blood Institute (NHLBI), the World Heart Federation, the International Atheroschlerosis Society, and the American Heart Association (AHA).

According to the new definition, people with any three of the following five criteria are considered to have the metabolic syndrome:
1. Increased waist circumference (population and country specific cut points)
2. High triglycerides (≥150 mg/dL)
3. Reduced HDL cholesterol (<40 mg/dL for males and <50 mg/dL for females)
4. Elevated blood pressure (Systolic ≥130 mm Hg and/or diastolic ≥ 85 mm Hg
5. Increased fasting glucose ≥ 100 mg/dL

First Michael Jackson and Now Billy Mays- Is There Something In Common?

First Michael Jackson and now Billy Mays, both died at a young age of 50 and both of them likely due to heart disease. Is this just coincidence or is there something common. Should we worry about the number 50?

Does the word “Stress and hypertension” ring the bell when you think of celebrities?

Billy Mays was in an airline accident a day before. Someone said ,”He survived the accident but probably this stressed the hell out of his heart which just never caught up…”. This is not just one time stress though; this is not because of a single event that one gets a heart attack. Heart disease develops overtime and several factors could contribute to this problem. “Mays suffered from hypertensive heart disease, and the wall of the left ventricle of May’s heart and the wall of one of his arteries were enlarged” said Vernard Adams, Hillsborough County Medical Examiner. So, is this hypertension that killed Billy Mays? Well, it is likely that he died of heart attack in his sleep, but it might take few more weeks to perform several tests to determine the exact cause of his death.

Although, a direct relationship between stress and hypertension is still unclear but stress can indirectly cause hypertension through repeated blood pressure increases and also by affecting the nervous system to produce hormones that raise blood pressure. Could an airline accident have caused sudden elevations in Mays’ blood pressure damaging his heart?

Hypertension is one of the most significant contributor to heart disease and stroke. Unfortunately one third of those who suffer from hypertension are unaware of their condition as it is asymptomatic. As a result, almost two thirds of those remain untreated or undertreated.
High blood pressure does not cause any symptoms, at least in its early stages and so it becomes very important to monitor your blood pressure regularly, once every year, if you think you are normal and have no risk conditions or disease. High blood pressure causes weakening of the arteries, which makes them more susceptible to damage and plaque build-up around their walls. This results in a condition called atherosclerosis.

What is considered to be normal blood pressure? Less than 120/80 mmHg is normal. What is Pre-hypertension? When the blood pressure is between 120/80 and 140/90, it is known as moderately high and the individual is pre-hypertensive. Finally, what is hypertensive? Blood pressure of 140/90 or higher (130/80 for diabetics) is called hypertension. So, the goals of therapy should be to lower the blood pressure to less than 140/90 for those without diabetes and to less than 130/90 for those with diabetes.

Regular blood pressure checks is the first step to lowering the blood pressure in order to avoid heart problems. Antihypertensive medications are helpful but even among those using such medicines, only about 53% have their blood pressure under control. American Diabetes Association has recommended that just a 12- to 13-point reduction in blood pressure by positive lifestyle changes can reduce risk of myocardial infarction by 21%, stroke by 37% and all death from cardiovascular disease by 25%.

Positive lifestyle modifications remain the cornerstone of controlling and managing blood pressure/ hypertension, which include 1) weight loss, 2) regular aerobic activity with at least one 40-minute moderate intensity exercise every week, 3) diet rich in fruits, vegetables, potassium and calcium, 4) reduced salt intake, and 5) moderate alcohol consumption. These changes are extremely helpful in controlling the blood pressure and also blood glucose and lipid levels, thereby helping in prevention of cardiovascular disease.

Hypertension is not just a problem of adults, but children should also be monitored for high blood pressure. Children also develop hypertension due to same reasons as adults- unhealthy diet, not being active and accumulating some extra pounds. When diagnosed with high blood pressure, children should be treated with making healthy lifestyle changes aimed at weight control and increased physical activity. In some cases, pharmacologic intervention may be required.
Although age does increase your risk of getting a heart disease and you cannot do much about this, but you can definitely control other risk factors that multiply the overall risk.

Of course, heart disease has nothing to do with the number 50 and all those in their 50’s or turning 50 should not be alarmed. Celebrate your 50th year and celebrate the lives and legacies of Michael Jackson and Billy Mays, and remember it is never too late to make healthy and positive lifestyle changes.

How does stress level affect overall risk of getting heart disease?

Stress and depression, both have been linked with diabetes and heart disease. Understanding these two factors can actually help our doctor formulate a suitable treatment plan. So, it is important that we share this with our health care provider even if they forget to ask. Any kind of stress or depression can lead to more complications, if left untreated.

Stress causes release of some hormones which can further lead to elevated blood glucose levels. When the blood glucose levels increase and if there is not enough insulin being produced by the body or if the insulin is not working properly, then this results in excessive glucose in the blood, which can ultimately lead to development of diabetes.

Stress can come from many sources, including stress from one’s occupation, job strain especially in this economy as we are going through recession; many of us are losing jobs, homes, which is very sad and unfortunate. So, this stress can cause increased production of a stress hormone called cortisol, which then makes the liver produce more glucose, which means more glucose in blood and less usage of glucose by the tissues, less insulin production by our pancreas, thereby causing a condition called insulin resistance. This insulin resistance can finally lead to diabetes and/ or heart disease.

It is extremely important to maintain blood glucose levels, especially in diabetics and this can be done through stress management training. Sharing the cause of stress with the primary care doctor, family or friends is always helpful. Sometimes, social support can reduce the stress and this way it can reduce the risk of heart disease.

Similarly, depression causes several changes in our hormones thereby leading to a hormone imbalance, can decrease body’s immunity; can affect changes in bone metabolism; and can cause cardiovascular dysfunction. This can result in decreased quality of life. People living under any kind of depression are at higher risk of getting type 2 diabetes or heart disease.

What should be done to avoid becoming a victim of conditions like stress and depression?

Hormone balance, in addition to healthy diet and exercise, is the answer. Hormones affect everyday health and wellness by interacting with every single cell inside our bodies, and if these do not do their job well, a negative ripple effect is created thereby disrupting overall homeostasis resulting in damaged and disturbed physiology. Therefore, it has been suggested by various published scientific studies that keeping the hormone levels of the body in proper balance within the normal ranges helps in reducing risk of getting diagnosed with conditions like heart disease and diabetes.

Does our Heart Age?

Unfortunately, the answer is YES; the heart grows older as well as we age. Although several people like me always say “Oh I’m never getting old....I’m young at heart and will stay young forever”...which is good and this is how we should live with a positive attitude. With this type of attitude, we can sure increase our life by minimum of 5 years and may be more too.

Again, it depends upon our mental outlook and how we live, and not just the age. Science agrees with this, but at the same time, we have now come to know so many different facts about our heart health and we should realize that with increasing age, even with a positive attitude and sound mental acuity, our heart undergoes some changes, and it continues to undergo those changes even when there is no disease, even when the person is healthy and has no known risk condition or a disease.

The heart muscles start to weaken and when the heart beats, these heart muscles cannot relax completely between those beats, and when this happens they become stiff; as a result they start to function less efficiently and they don’t do their job of pumping blood very well and finally give up. The loss of good function of these heart muscles gets worse when there is any heart disease. Another thing is that as the heart grows older, it does not respond effectively to adrenaline and this is the reason that older heart cannot contract or cannot pump blood faster or vigorously when there is a need, especially when we exercise or do any physical activity. So, we should not be surprised if we see our capacity to walk briskly or to work out and exercise has decreased as compared to when we were young. We all know and have experienced that all that was so easy to do when we were 16 or 18 or 20, is extremely difficult as we get older. Our heart just doesn’t function that well any more. This is also the reason for changes in our blood pressure, normally high when the heart muscles are too stiff.

The decrease in the capacity of heart to work efficiently differs from person to person. It all depends on how we live our life, what other conditions have we developed? Do we have any other disease? How and what kind of decisions we made in life when it came to eating right or how much we exercised?

We have to realize the importance of healthy life-style changes as early as possible in our lives. It is never too late. All the risk factors basically affect overall quality of life and of course how long we live. Let us not wait till the last minute when our doctor has to tell us that it is too late. Let us take charge of our own health and wellness and do something about it.

Do you agree with me?

Heart Disease- Diabetes- Obesity: What Have we Achieved so Far?

We know that the heart disease and diabetes pose significant threats to our health, especially as we grow older and of course major challenges to the medical community. Although there have been major advancements in the medical field as far as detection and treatment of these conditions is concerned, but unfortunately these problems continue to result in serious health complications, disability and premature death. The sad part is that the overall incidence of these diseases is still going to increase as more and more people continue to age and also with rise in obesity rates, especially in US.
Did you know that few scientific studies came out in 2005 which showed that the life expectancy has declined for the first time in this country!!! How did this happen? We thought that we were working hard to create better world with so much of advancement in all field including medical science. Yes, no doubt we HAVE made a lot of progress in terms of finding cure and treatment for so many different conditions....BUT why still almost a MILLION Americans die of cardiovascular disease every year, which means 1 death every 34 seconds, and out of all those about 50% are above the age of 50 and this is just due to heart disease. What about Diabetes? Did you know that as of today almost 20 million Americans have diabetes and this number has increase by more than 60% since last 10 years, and again more than 50% people who have diabetes are above the age of 50. It is unfortunate that now we have started to see more and more cases of children with diabetes, which we could never imagine earlier, because at one point diabetes was considered as a condition in only the adults.

Can you IMAGINE how much it costs us every year in terms of dollar figure to fight against both heart disease and diabetes? Collectively, these conditions cause more than 1 million deaths every year and result in more than $620 billion in direct and indirect costs.

So, what happened? Where did we go wrong? Should we stop and rethink what did we do differently OR what did we NOT do that we have to see such increase in the prevalence of these conditions?

I think the problem is that we have a luxury of choosing a bad lifestyle and as we age we start to realize that the choices we made earlier in life were probably not the smartest ones.

What do you think?

What is CardioMetabolic Risk? Is it different from Metabolic Syndrome?

Cardiometabolic Risk is clustering of various risk factors, which put an individual at high risk of developing type 2 diabetes and cardiovascular disease. It also includes the abdominal obesity (the visceral obesity) and several other markers that have not been considered traditionally while defining overall risk of cardiovascular disease.

Cardiometabolic risk is not something different from Metabolic Syndrome; neither it has been coined to replace Metabolic Syndrome. We have known that metabolic syndrome involves insulin resistance, obesity in terms of large waist, high triglycerides, high blood pressure, low HDL cholesterol. Cardiometabolic Risk includes, in addition to all these risk factors, high LDL cholesterol, Inflammation (high C-reactive protein), smoking, physical inactivity, unhealthy eating, some psychosocial issues like stress and depression and high blood glucose, in addition to race, gender, age and family history.

All of these together and also each one of these independently increase the risk of disease and other related complications. So, cardiometabolic risk is a global risk condition involving all these markers that increase an individual’s overall risk of developing type 2 diabetes and cardiovascular disease.

Therefore, it is very important to detect, treat and control for these factors well in time, before it is too late. Lifestyle modifications like weight reduction, regular exercise/ physical activity, healthy diet, quitting smoking, all have benefits in terms of reducing the risk. We must understand that improvement in any one of these health markers results in improvement in other markers because our body does not work in isolation. Similarly, when there is any one of these risk factors present in a person, there could be other related conditions also that have not been diagnosed. So, clinicians should screen patients during their regular visits for any or all of these risk factors for cardiovascular disease and diabetes.

How will the screening help?

This will help them:

1. Understand the comprehensive picture of their patient’s overall health and alert them about any possible future health condition.
2. Facilitate better communication with their patient to make better clinical decisions, one they have identified different markers.
3. Intervene at an early stage, as we know that conditions like insulin resistance and hyperglycemia occur long before the clinical diagnosis of diabetes.

Routine screening and early assessment may help both the physician and their patient work together to address important lifestyle changes like healthy eating, qutting smoking if they smoke, include 30 minutes or more of exercise or physical activity of any kind 5 days a week, to avoid risk of developing type 2 diabetes and cardiovascular disease.

Such assessments provide great tools to clinicians and their patients for a comprehensive and broader management of different health conditions, especially for cardiovascular disease and diabetes risk.

Ten Simple Lifestyle Changes to Reduce your Risk of Heart Disease

With obesity rates continuing to rise to epidemic levels, the fattening of America goes hand in hand with a cluster of health problems generally referred to as “metabolic syndrome,” including high blood pressure and high levels of the blood fats, triglyceride and/or cholesterol. Insulin resistance, where the action of insulin in the body is impaired and fails to control blood sugar levels, also complicates the picture. When these things happen all at the same time, as is generally the case, their collective impact is to raise Type II diabetes and cardiovascular disease risks simultaneously. Increasingly referred to in medical circles as the “cardiometabolic syndrome,” people with even one of its components may be at increased risk for others. Knowing what to watch for can make the difference between having, or preventing, full-blown disease; so early detection of risk factors and proactive preventive measures can help individuals lead a active, healthy and happy life.

There are 10 simple lifestyle changes that I wish to outline below, which can lower the overall risk of getting a heart disease. This information is not very new to us and we talk about the importance of all these facts in our everyday lives, but the question is how many of us consider these seriously.

More than a century and billions of dollars in medical research, hundreds and thousands of clinical trials- all have come to realize how important it is to:

1. Lose weight (especially some extra pounds accumulated in our abdomen)
2. Increase physical activity to at least 30- 60 minutes a day
3. Eat a healthy diet that includes more of whole grains, fiber, fruits and vegetables, lean meats, eggs, fish, beans and nuts
4. Quit smoking
5. Reduce stress levels
6. Manage dyslipidemia; maintain normal levels of cholesterol (both LDL-C and HDL-C) and triglycerides
7. Control hypertension
8. Limit alcohol consumption
9. Check for inflammation
10. Keep your hormones in balance

We keep asking for new tools for our physicians to formulate a magic pill, but let us stop and rethink how we can help our physicians formulate optimal treatment strategies for effective management of any or all risk conditions by considering the ten simple changes listed above.