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 makes C-Reactive Protein so Important?

C-reactive protein (CRP) is known to increase when there is inflammation in the body. Inflammation has been linked with atherosclerosis by various different clinical research studies. Therefore, it has been suggested that testing for CRP levels in the blood can help detect an individual’s risk of getting a heart disease. However, there are two types of tests that can detect CRP levels in blood- (1) one that detects high levels of CRP and (2) the other is a highly sensitive assay that detects very low levels of CRP (hs-CRP). Higher levels of CRP could be seen in case of systemic inflammation, whereas very low increase in CRP level is observed in case of vascular inflammation, which has been linked with atherosclerosis, which means formation of fatty deposits or plaques in the inner lining of arterial walls. High levels of hs-CRP may also be helpful in determining the overall risk of stroke or peripheral artery disease. Several different studies have shown that higher levels of hs-CRP mean higher risk of heart attack. Some of the major factors that can contribute to vascular inflammation include- smoking, hypertension, hyperglycemia and/or dyslipidemia. People who do not exercise and have sedentary lifestyles may also have higher CRP levels. Patients with any of these conditions and/or who are centrally obese should be tested for hs-CRP levels; and if the levels are higher than 3.0 mg/dL, then they should be retested to confirm high levels. The CRP levels higher than 10.0 mg/dL could indicate non-cardiovascular causes of inflammation and those could include infectious diseases, some autoimmune disorders or even cancer.

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.

Dried Blood Spot Screening for Cardiometabolic Risk Markers shows Benefits of Exercise

The prevalence of diabetes and cardiovascular disease is increasing at an alarming rate. Several clinical and observational studies have demonstrated reduced risk of diabetes when physical activity increases. Simple screening tools are needed to monitor effects of treatment interventions in individuals at high risk.

At ZRT Laboratory in Beaverton, Oregon we assessed the application of dried blood spot technology to measure important cardiometabolic risk markers. Dried blood spot collection has advantages compared to conventional blood draws, such as minimal invasiveness, low sample volume, convenience of repeated measurements and ease of sample storage and transport.

Fifteen participants (28- 63 years of age) enrolled in a fitness study that included 30 minute exercise/ brisk walking five days a week for four months. Levels of insulin, hemoglobin A1c, C-reactive protein and triglycerides were measured in blood spot samples obtained by a simple and easy finger stick before and after the program. Dried blood spot samples were stored at -20C until used for analysis using modified methods developed in house from commercially available assays.

Insulin levels decreased significantly ; triglycerides dropped by 18% and C-reactive protein levels also showed significant improvement. The HbA1c levels remained unchanged during the program.

In conclusion, exercise/ brisk walking for 30 minutes five days a week for four months improved cardiometabolic risk factors independently as confirmed by dried bloodspot testing. This simple screening method has important implications for monitoring overall cardiometabolic health of high risk individuals.

Which is more important- C Reactive Protein or Cholesterol?

I wish to open this discussion to get feedback from all those clinicians and researchers out there struggling to find out which one is a better predictor of overall risk of cardiovascular events. Many of us and in fact most of us have been focussed on the cholesterol levels to determine the risk until a recently published study (JUPITER Study) in New England Journal of Medicine reported that C Reactive Protein (CRP) may be a better predictor and an independent marker of cardiovascular risk as opposed to just LDL cholesterol. The study showed that patients with high LDL cholesterol and high CRP levels were at higher risk than those with high LDL cholesterol but low CRP levels. It was also observed that patients with normal LDL cholesterol with high CRP levels are at higher risk than those with normal LDL cholesterol and low or normal CRP levels. In these patients, measuring only the LDL cholesterol may not be very helpful or in other words, these patients may not be identified as those at risk and may end up developing a coronary artery disease.

We know that CRP is released in response to any inflammation in the body. Several studies have shown a connection between inflammation and atherosclerosis, which is basically attested by the JUPITER study.

Does that mean that we should start measuring CRP levels regularly to screen or monitor patients at high risk? Is it still important to measure LDL cholesterol? Do we really need to know the triglyceride levels? Should we still look at other risk markers now that we have CRP as an emerging independent marker?

I personally feel that body does not work in isolation and relying upon just one or two risk factors may not be a smart decision. It is extremely important to consider the overall balance of major physiological functions within the body to get a comprehensive picture of overall 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.