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.

If It can Happen to Michael Jackson, It Can Happen to Anyone…

The world is in shock and mourning Michael Jackson’s sudden death reportedly due to cardiac arrest. As people are posting tributes to him everywhere, he is being remembered as “The King of Pop”, “Icon”, “Legend”, but there is one thing that we all need to remember is that he was human just like all of us.

Michael’s unexpected passing away at just 50 leaves behind a good lesson for us. We need to stop and think seriously. Yes, this is a catastrophic tragedy, and all of us are perplexed thinking how could someone like Michael, who was not obese, had a thin stature, physically active as a dancer, very athletic die of cardiac arrest. It is not very uncommon for healthy looking people to have heart disease; and cardiac arrest is the first sign of heart disease.

Someone asked me a question this morning “Dr. Kapur, given that the initial explanation of the sudden death of Michael Jackson was cardiac arrest - can you explain the relevance or relationship of that event to Cardiometabolic Syndrome?”

Cardiac arrest occurs when there is disruption of electrical signals in heart muscles, which therefore prevents the heart from pumping blood effectively, causing a heart attack. There are more chances of getting a cardiac arrest when there has been previous heart damage due to a heart attack (blockage of arteries). This does not mean that someone who has not had any previous event cannot have a cardiac arrest. It has been reported by several studies that people with high cholesterol, high blood pressure and/or with family history of heart disease or diabetes are at risk of dying of heart disease even when they appear thin and healthy. Stress, smoking and drug abuse have been shown to have an added risk. So, even when we are athletic, thin looking with no family history of heart disease, we need to be aware of our cholesterol and triglycerides at all times.

“What steps should those who might be reflecting upon their own ‘heart health’ take to insure that they are being smart about preventative steps?”

Healthy eating, active lifestyle and monitor your health regularly without waiting for your doctor to tell you what to do is the key. Check cholesterol levels and In addition to cholesterol levels, it is important to check glucose and inflammatory markers like C-reactive protein, which is emerging as an independent risk factor for heart disease. It is recommended that people care for their own health and wellness by monitoring their cardiometabolic markers like cholesterols, triglycerides, hemoglobin A1c and C-reactive protein and not wait for their doctor to suggest these tests. This is because even doctors will not suggest these tests until they see any symptoms; so why wait until any symptoms appear. Heart disease and diabetes are like an iceberg that is hundred times larger than what is seen on top. These diseases start way before the actual symptoms appear. It is smart to be proactive and take steps to prevent such diseases.

As we all say “Adieu” to Michael, let us learn a lesson that he leaves behind for us…

What is Cardiometabolic Risk?

Soft Drinks, Fruit Drinks, Energy Drinks and Cardiometabolic Risk

It really depends upon how much we like soft drinks, fruit drinks, energy drinks or any other type of sweetened caloric beverages before we can make a choice between our cravings and our cardiometabolic risk. Scientific research has shown a number of times in the past how much we have to be watchful of our caloric consumption, not just from the food we consume but also from the beverages we enjoy. Nurses’ Health Study has shown about 49% increase in the risk of coronary heart disease in women due to regular soft drink consumption. Nurses’ Health Study II has also shown a direct link between sweetened drinks and increased risk of diabetes, irrespective of total body weight. Framingham study has suggested a strong association between metabolic syndrome and soft drink intake. Another recent research study reported about 44% increased chances of getting diagnosed with metabolic syndrome if someone consumed one soft drink every day as compared to those who did not drink such sweetened caloric beverages frequently.

Unfortunately, there is a rising trend in the consumption of flavored and sweetened energy drinks, fruit drinks, vitamin water especially in United States and the intake of these beverages has tripled in last few years, which is now emerging as a major cause of obesity in children and also conditions like weight gain, insulin resistance and other cardiovascular risk factors in adults.

We have definitely seen some direct or indirect effects of the sweetened caloric drinks on our overall health and wellness. Several articles have been published in this direction, both scientific and in lay press; many research studies have identified statistically significant associations between soft drink consumption and increased body weight, diabetes and heart disease. There is no doubt about adverse and unhealthy effects of most of the sugar and fizzy drinks and I think there is no need for us to wait for further evidence to prove it again. It is time to do something about correcting the mistakes we have made so far.

All along we have been saying “We are what we eat”, but now it is all about “We are what we eat…and drink”. It is not very difficult to watch what we choose to drink when we think of healthy weight loss or just when we are thirsty. I remember my grandma sharing with me benefits of drinking water, green tea, pomegranate juice for several health reasons she could outline (all appearing non-scientific at the time) as she never went to school, but now when I think of those, I feel she knew much more science than most of us scientific pundits of today.

What are we waiting for? What more proofs do we need before we do something about this problem? Why are we debating on this subject for so long? We are becoming aware of what we eat, but should we also not be concerned about what we are drinking or what we are making our children drink? Let us create a better “Healthy Tomorrow” for our generations to follow.

Let us stop and make some intelligent choices about “drinking healthy” and let us appeal to manufacturers to make healthy drinks free of any harmful effects. At the same time, let us practice and educate ourselves about picking up the right drinks in order to prevent and manage any chronic diseases like metabolic syndrome, diabetes, heart disease and other related conditions. Let us all work together.

I will be Speaking at the A4M Meeting in San Jose on September 9-12, 2009

I will be talking about "Simple Cardiometabolic Risk Screening using Bloodspot Technology" at the 17th Annual World Congress on Anti-Aging Medicine & Regenerative Biomedical Technologies on September 9-12, 2009 at the San Jose Convention Center in San Jose, CA.

The growing numbers of people with cardiovascular disease and diabetes in the United States is a consequence of metabolic disorders largely associated with obesity. As people age, the decline in hormone levels and the decrease in activity levels can combine to increase an individual’s tendency to visceral obesity, which sets up the metabolic conditions that lead to cardiovascular disease and diabetes and are referred to as cardiometabolic risk. Blood spot testing for cardiometabolic risk markers can reach a large number of people and help them control their risk by making lifestyle changes. This can significantly improve wellness in the aging population. A simple blood spot test can conveniently and accurately assess cardiometabolic risk, giving people the opportunity and motivation to control their risk with appropriate lifestyle changes. Broader screening in the aging population may be the key to reversing the growing incidence of cardiovascular disease.

How is Testosterone related with Cardiometabolic Risks?

Certain risk factors have been shown to cluster with clinical conditions like obesity, type 2 diabetes and cardiovascular problems. Such clustering of risk factors have led investigators to propose a new condition called cardiometabolic risk syndrome. Cardiometabolic risk has gained much attention recently and has been linked directly with visceral adiposity. Few investigations have implicated a direct link between centrally obese men and low levels of testosterone. Association of Testosterone with insulin resistance, obesity, diabetes and atheroschlerosis has been presented earlier but has not received much attention. Higher incidence of metabolic syndrome has also been hypothesized to be associated with decline in testosterone levels. There is evidence that testosterone replacement therapy results in reduced insulin resistance and central obesity in type 2 diabetic men. In this study, we have investigated relationship between testosterone and markers of cardiometabolic risk.

A cohort of male patient samples from ZRT database was selected for the study and categorized in tertiles based on testosterone levels with low (<300),>800). The relationship between testosterone levels and cardiometabolic risk was evaluated using bloodspot testing of insulin, hemoglobin A1c, triglycerides and high sensitivity c-reactive protein. All bloodspot assays were developed in house and showed good correlations with serum/plasma levels of risk markers tested.

A total of 124 male patient samples (41 with testosterone levels <>800 ng/dL) were tested for cardiometabolic risk markers. Mean age (+/- SD) was 50.8 (+/- 12.8). Insulin (4.7 µIU/mL) and high sensitivity c-reactive protein (1.83 mg/L) were found to be significantly lower in the highest tertile with testosterone levels greater than 800 ng/dL when compared with insulin (6.3 µIU/mL) and hs-CRP (3.46 mg/L) concentrations in the lowest tertile with testosterone levels less than 300 ng/dL. There was no significant difference observed in HbA1c and triglyceride levels in different groups.

Our data suggest that a higher testosterone level in men is associated with lower CRP and insulin concentrations. These patients may have a lower risk of developing metabolic syndrome and/or atheroschlerotic cardiovascular events.

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.