Hypertension is a key risk factor for cardiovascular disease

Courtesy The American Heart Association

DALLAS - High levels of lipoprotein(a), a type of “bad” cholesterol, may be associated with a 24% higher risk of cardiovascular disease among people who have hypertension, however, CVD risk was not higher among those without hypertension, according to new research published today in Hypertension, an American Heart Association journal.

“High blood pressure is a known cardiovascular disease risk factor, and lipoprotein(a) is a type of inherited ‘bad’ cholesterol that may also lead to cardiovascular disease,” said lead study author Rishi Rikhi, M.D., M.S., a cardiovascular medicine fellow at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “We found that among people with hypertension who have never experienced a stroke or heart attack before, lipoprotein(a) seems to increase the risk of cardiovascular disease and risk of a major cardiovascular event like heart attack or stroke.”

Hypertension is a key risk factor for cardiovascular disease. In this study, hypertension was defined as a top number of 140 mmHg or higher, a bottom number of 90 or mmHg or the use of blood pressure medication. In 2017, the Association updated its definition of hypertension to be a top number of 130 mmHg or higher or a bottom number of 80 mmHg or higher.  Previous studies have indicated that when a person has hypertension and lipid imbalance, or dyslipidemia, their cardiovascular disease risk substantially increases. According to the study’s authors, there is less information on how much of an affect lipoprotein(a) may have on cardiovascular disease risk among people with hypertension.

Lipoproteins, which are made up of protein and fat, carry cholesterol through the blood. The subtypes of lipoproteins include low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipoprotein(a), or Lp(a). Much like LDL cholesterol, lipoprotein(a) cholesterol may deposit and build up in the walls of blood vessels, thus increasing a person’s risk of a heart attack or stroke.

The research used health data from the Multi-Ethnic Study of Atherosclerosis (MESA) study, an ongoing community-based study in the U.S. of subclinical cardiovascular disease—meaning the disease is discovered before there are clinical signs and symptoms. MESA is a research study including nearly 7,000 adults that began in 2000 and is still following participants in six locations across the U.S.: Baltimore; Chicago; New York; Los Angeles County, California; Forsyth County, North Carolina; and St. Paul, Minnesota. At the time of enrollment in the study, all participants were free from cardiovascular disease.

The current study included 6,674 MESA participants who had lipoprotein(a) levels and blood pressure assessed and for whom there was documented cardiovascular disease event data throughout MESA’s follow-up exams in approximately 2001, 2003, 2004, 2006, 2010, 2017 and in telephone interviews every 9 to 12 months to gather interim data on new diagnoses, procedures, hospitalization and deaths. The study’s participants were from diverse racial and ethnic groups: 38.6% self-identified as white adults; 27.5% self-identified as African American adults; 22.1% self-identified as Hispanic adults; and 11.9% self-identified as Chinese American (n=791) adults.  Additionally, more than half of the group was female (52.8%).

To evaluate the potential correlation between hypertension and lipoprotein(a) on the development of cardiovascular disease, the researchers first categorized the participants into groups based on their lipoprotein(a) levels and blood pressure measures obtained once at baseline:

• Group 1 (2,837 people): lipoprotein(a) levels less than 50 mg/dL and no hypertension.
• Group 2 (615 people): lipoprotein(a) levels greater than or equal to 50mg/dL and no hypertension
• Group 3 (2,502 people): lipoprotein(a) levels less than 50mg/dL and hypertension
• Group 4 (720 people): lipoprotein(a) levels ≥ 50mg/dL and hypertension

Participants were followed for an average of approximately 14 years and cardiovascular events, including heart attack, cardiac arrest, stroke or death from coronary artery disease, were tracked.

The study’s results include:

• A total of 809 of the participants experienced a cardiovascular disease event.
• Lipoprotein(a) levels had an effect on hypertension status that was statistically significant (meaning it was not due to chance).
• When compared to Group 1 (low lipoprotein(a) levels and no hypertension), Group 2 (higher lipoprotein(a) levels and no hypertension) did not have an increased risk for cardiovascular disease events.
• Less than 10% of Group 1 (7.7%) and Group 2 (participants 8%) had cardiovascular disease events.
• Participants in Groups 3 and 4, all of whom had hypertension, demonstrated a statistically significant increase in risk for cardiovascular disease events when compared to those in Group 1.
• Approximately 16.2% of the people in Group 3 (lower lipoprotein(a) levels and hypertension) had cardiovascular disease events, and 18.8% of the participants in Group 4 (higher lipoprotein(a) levels and hypertension) experienced cardiovascular disease events.

“We found that the overwhelming amount of cardiovascular risk in this diverse population appears to be due to hypertension,” Rikhi said. “Additionally, individuals with hypertension had even higher cardiovascular risk when lipoprotein(a) was elevated. The fact that lipoprotein(a) appears to modify the relationship between hypertension and cardiovascular disease is interesting, and suggests important interactions or relationships for hypertension, lipoprotein(a) and cardiovascular disease, and more research is needed.”

Everyone can improve their cardiovascular health by following the American Heart Association’s Life’s Essential 8: eating healthy food, being physically active, not smoking, getting enough sleep, maintaining a healthy weight, and controlling cholesterol, blood sugar and blood pressure levels. Cardiovascular disease claims more lives each year in the U.S. than all forms of cancer and chronic lower respiratory disease combined, according to the American Heart Association.

Many adults with Type 2 diabetes in the U.S. are not meeting optimal heart health targets

by American Heart Association

DALLAS — Fewer than 1 in 5 adults with Type 2 diabetes in the U.S. are meeting targets to reduce heart disease risk. Fortunately, available therapies can help when combined with new approaches that address social determinants of health and other barriers to care, according to a new American Heart Association scientific statement published today in the Association’s flagship journal Circulation. A scientific statement is an expert analysis of current research and may inform future clinical practice guidelines.

"This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and to develop new best practices to advance Type 2 diabetes treatment and care and reduce CVD risk," said Joshua J. Joseph, M.D., M.P.H., FAHA, chair of the statement writing group and an assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University College of Medicine in Columbus, Ohio. "Far too few people – less than 20% of those with Type 2 diabetes – are successfully managing their heart disease risk, and far too many are struggling to stop smoking and lose weight, two key CVD risk factors. Health care professionals, the health care industry and broader community organizations all have an important role to play in supporting people with Type 2 diabetes."

Type 2 diabetes is the most common form of diabetes, affecting more than 34 million people in the U.S., representing nearly 11% of the U.S. population, according to the U.S. Centers for Disease Control and Prevention’s 2020 National Diabetes Statistics Report, and cardiovascular disease (CVD) is the leading cause of death and disability among people with Type 2 diabetes (T2D). Type 2 diabetes occurs when the body is unable to efficiently use the insulin it makes or when the pancreas loses its capacity to produce insulin. People with T2D often have other cardiovascular disease risk factors, including overweight or obesity, high blood pressure or high cholesterol. Adults with T2D are twice as likely to die from CVD — including heart attacks, strokes and heart failure — compared to adults who do not have T2D.

The new scientific statement, based on the writing group’s extensive review of clinical trial results through June 2020, addresses the gap between existing evidence on how best to lower cardiovascular risk in people with T2D and the reality for people living with T2D. Targets to reduce CVD risk among people with T2D include managing blood glucose, blood pressure and cholesterol levels; increasing physical activity; healthy nutrition; obesity and weight management; not smoking; not drinking alcohol; and psychosocial care. Greater adherence to an overall healthy lifestyle among people with T2D is associated with a substantially lower risk of CVD and CVD mortality.

"In the United States, less than 1 in 5 adults with T2D not diagnosed with cardiovascular disease are meeting optimal T2D management goals of not smoking and achieving healthy levels of blood sugar, blood pressure and low-density lipoprotein (LDL) cholesterol, also known as ‘bad’ cholesterol," Joseph said.

A surprisingly large proportion – as high as 90% - of factors to effectively manage CVD with T2D includes modifiable lifestyle and societal factors. “Social determinants of health, which includes health-related behaviors, socioeconomic factors, environmental factors and structural racism, have been recognized to have a profound impact on cardiovascular disease and Type 2 diabetes outcomes,” he said. “People with T2D face numerous barriers to health including access to care and equitable care, which must be considered when developing individualized care plans with our patients.”

Shared decision-making among patients and health care professionals is essential for successfully managing T2D and CVD. A comprehensive diabetes care plan should be tailored based on individual risks and benefits and in consideration the patient’s preferences; potential cost concerns; support to effectively manage T2D and take medications as prescribed, including diabetes self-management education and support; promotion and support of healthy lifestyle choices that improve cardiovascular health including nutrition and physical activity; and treatment for any other CVD risk factors.

"One avenue to continue to address and advance diabetes management is through breaking down the four walls of the clinic or hospital through community engagement, clinic-to-community connections and academic-community-government partnerships that may help address and support modifiable lifestyle behaviors such as physical activity, nutrition, smoking cessation and stress management," Joseph said.

The statement also highlights recent evidence on treating T2D that may spur clinicians and patients to review and update their T2D management plan to also address CVD risk factors:

New ways to control blood sugar

The American Heart Association’s last scientific statement on blood sugar control was published in 2015, just as research was starting to suggest that glucose-lowering medications may also reduce the risk of heart attack, stroke, heart failure or cardiovascular death.

"Since 2015, a number of important national and international clinical trials that specifically examined new T2D medications for lowering cardiovascular disease and cardiovascular mortality risk among people with Type 2 diabetes have been completed," Joseph said. "GLP-1 (glucagon-like pepdite-1) receptor agonists have been found to improve blood sugar and weight, and they have been game changers in reducing the risk of heart disease, stroke, heart failure and kidney disease." GLP-1 medications (injectable synthetic hormones such as liraglutide and semaglutide) stimulate the release of insulin to control blood sugar, and they also reduce appetite and help people feel full, which may help with weight management or weight loss.

In addition, SGLT-2 (sodium-glucose co-transporter 2) inhibitors (oral medications such as canaglifozin, dapagliflozin, ertugliflozin and empagliflozin) have also been found to be effective in reducing the risks of CVD and chronic kidney disease. SGLT-2 inhibitors spur the kidneys to dispose of excess glucose through the urine, which lowers the risk of heart failure and slows the decrease in kidney function that is common among people with T2D.

"Cost may be a barrier to taking some T2D medications as prescribed, however, many of these medications are now more commonly covered by more health insurance plans," Joseph said. "Another barrier is recognition by patients that these newer T2D medications are also effective in reducing the risk of heart disease, stroke, heart failure and kidney disease. Increasing public awareness about the link between CVD and T2D and provide support, education and tools that help improve T2D and reduce CVD risk are at the core of the Know Diabetes by Heart™ initiative, from the American Heart Association and American Diabetes Association."

Personalized blood pressure control

The statement highlights that individualized approaches to treating high blood pressure are best. These approaches should consider ways to minimize the side effects of hypertension treatment and avoid potentially over-treating frail patients.

Importance of lowering cholesterol levels

Statin medications remain the first line of lipid-lowering therapy, and the Association suggests other types of medications may be considered for people unable to tolerate a statin or who aren’t reaching their LDL cholesterol targets with a statin. These medications may include ezetimibe, bempodoic acid, bile acid resins, fibrates and PCSK-9 inhibitors, depending on the individual’s overall health status and other health conditions.

Re-thinking aspirin use

Older adults (ages 65 years and older) with T2D are more likely than those who do not have T2D to take a daily low-dose aspirin to help prevent cardiovascular disease. However, it may be time to review if daily low-dose aspirin is still appropriate. Recently published research suggests the increased risk of major bleeding from aspirin may outweigh the benefits, and newer, more potent antiplatelet medications may be more effective for some people.

The statement reinforces the importance of a comprehensive, multidisciplinary and individualized approach to reduce CVD risk among people with T2D. Optimal care should incorporate healthy lifestyle interventions, and medications and/or treatments including surgery that improve T2D management and support healthy weight and weight loss. Social determinants of health, structural racism and health equity are important factors that must also be considered and addressed.

Why do hamburgers taste so good?

By Glenn Mollette, Guest Commentator

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Because they are bad for you. If they were healthy and good for you, they wouldn't taste near as good.

Typically, I eat healthy. My doctor prefers I stay away from red meat, fried foods, dairy and sugar. He forbids stuff like ice cream, pie and cake. I actually enjoy salmon, salads, most all vegetables and chicken. I don't have too much trouble avoiding the bad stuff.

Recently I was in one of the little towns we visit and I didn't feel great. It was one of those feel bad days. Not far away was a little joint people commonly refer to as the pool hall. On this day I knew they had exactly what I needed - one of their world-famous hamburgers. Of course, like Adam and Eve when I go astray everyone else follows along as well. All of our family decided to have deluxe hamburgers, bacon cheeseburgers, fries, while I ordered a double hamburger, one piece of cheese, ketchup, lettuce and tomato.

On the way I picked up a sack of ice-cold sugary colas. I figured we might as well do this right. I brought the food back home and we all slid right into hog heaven chowing down on those juicy hamburgers. As you know there are hamburgers and there are great hamburgers when made with lean quality meat and prepared right, etc.

Actually, a hamburger is not the end of the world for consumption. You can add healthy stuff like lettuce, tomato, onions, pickles and before you know it you almost have a health burger - not exactly. Too much red meat will start boosting your cholesterol levels that will show up when you have your blood work done. A few years back I got on a hamburger kick and after having my blood work I learned my cholesterol was 220. My doctor wanted to know what I had been doing and asked me to go into extreme moderation mode. His words were, "You don't need a heart attack."

Burgers are good sources of protein, iron and vitamin B12, but they come with a lot of problems, according to nutrition experts-particularly the fatty meat, sugary ketchup and refined grain buns. A diet of burgers will lead to obesity. My double burger had about 900 calories. The saturated fat is detrimental to your heart. My double burger had about 22 grams of saturated fat or 108 percent of my daily value. Add to this also 172 milligrams of cholesterol or 57% of the daily value based on a 2000 calorie a day diet. A one patty burger can have 258 milligrams of sodium. If you are battling high blood pressure you don't want a lifestyle of eating hamburgers.

Why do hamburgers taste so good? Because they are bad for you. But hey old friend, surely, we can eat one occasionally. Enjoy one, but then wait awhile before your next one.

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Dr. Glenn Mollette is a syndicated American columnist and author of American Issues, Every American Has An Opinion and ten other books. He is read in all 50 states. The views expressed are those of the author and are not necessarily representative of any other group or organization.

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This article is the sole opinions of the author and does not necessarily reflect the views of PhotoNews Media. We welcome comments and views from our readers.

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If your blood pressure goes up when you stand, your risk for a heart attack might, too

A nurse records a patient's blood pressure at UTSW Medical Center in Dallas, Texas. Researchers have compared heart disease risk factors, laboratory measures and the occurrence of major cardiovascular events such as heart attacks, heart-related chest pain, stroke, aneurysm of the aortic artery, and clogged peripheral arteries.

Photo: American Heart Association

American Heart Association

DALLAS, TX -— Among young and middle-aged adults with high blood pressure, a substantial rise in blood pressure upon standing may identify those with a higher risk of serious cardiovascular events, such as heart attack and stroke, according to new research published today in the American Heart Association’s peer-reviewed journal Hypertension.

“This finding may warrant starting blood-pressure-lowering treatment including medicines earlier in patients with exaggerated blood pressure response to standing,” said Paolo Palatini, M.D., lead author of the study and a professor of internal medicine at the University of Padova in Padova, Italy.

Nearly half of Americans and about 40% of people worldwide have high blood pressure, considered to be the world’s leading preventable cause of death. According to the American Heart Association’s 2022 heart disease statistics, people with hypertension in mid-life are five times more likely to have impaired cognitive function and twice as likely to experience reduced executive function, dementia and Alzheimer’s disease.

Typically, systolic (top number) blood pressure falls slightly upon standing up. In this study, researchers assessed whether the opposite response – a significant rise in systolic blood pressure upon standing – is a risk factor for heart attack and other serious cardiovascular events.

The investigators evaluated 1,207 people who were part of the HARVEST study, a prospective study that began in Italy in 1990 and included adults ages 18-45 years old with untreated stage 1 hypertension. Stage 1 hypertension was defined as systolic blood pressure of 140-159 mm Hg and/or diastolic BP 90-100 mm Hg. None had taken blood pressure-lowering medication prior to the study, and all were initially estimated at low risk for major cardiovascular events based on their lifestyle and medical history (no diabetes, renal impairment or other cardiovascular diseases). At enrollment, participants were an average age of 33 years, 72% were men, and all were white.

At enrollment, six blood pressure measurements for each participant were taken in various physical positions, including when lying down and after standing up. The 120 participants with the highest rise (top 10%) in blood pressure upon standing averaged an 11.4 mm Hg increase; all increases in this group were greater than 6.5 mm Hg. The remaining participants averaged a 3.8 mm Hg fall in systolic blood pressure upon standing.

The researchers compared heart disease risk factors, laboratory measures and the occurrence of major cardiovascular events (heart attack, heart-related chest pain, stroke, aneurysm of the aortic artery, clogged peripheral arteries) and chronic kidney disease among participants in the two groups. In some analyses, the development of atrial fibrillation, an arrhythmia that is a major risk factor for stroke, was also noted. Results were adjusted for age, gender, parental history of heart disease, and several lifestyle factors and measurements taken during study enrollment.

During an average 17-year follow-up 105 major cardiovascular events occurred. The most common were heart attack, heart-related chest pain and stroke.

People in the group with top 10% rise in blood pressure:

• were almost twice as likely as other participants to experience a major cardiovascular event;
• did not generally have a higher risk profile for cardiovascular events during their initial evaluation (outside of the exaggerated blood pressure response to standing);
• were more likely to be smokers (32.1% vs. 19.9% in the non-rising group), yet physical activity levels were comparable, and they were not more likely to be overweight or obese, and no more likely to have a family history of cardiovascular events;
• had more favorable cholesterol levels (lower total cholesterol and higher high-density-lipoprotein cholesterol);
• had lower systolic blood pressure when lying down than the other group (140.5 mm Hg vs. 146.0 mm Hg, respectively), yet blood pressure measures were higher when taken over 24 hours.

After adjusting for average blood pressure taken over 24 hours, an exaggerated blood pressure response to standing remained an independent predictor of adverse heart events or stroke.

“The results of the study confirmed our initial hypothesis - a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure. We were rather surprised that even a relatively small increase in standing blood pressure (6-7 mm Hg) was predictive of major cardiac events in the long run,” said Palatini.

In a subset of 630 participants who had stress hormones measured from 24-hour urine samples, the epinephrine/creatinine ratio was higher in the people with a rise in standing blood pressure compared to those whose standing blood pressure did not rise (118.4 nmol/mol vs. 77.0 nmol/mol, respectively).

“Epinephrine levels are an estimate of the global effect of stressful stimuli over the 24 hours. This suggests that those with the highest blood pressure when standing may have an increased sympathetic response [the fight-or-flight response] to stressors,” said Palatini. “Overall, this causes an increase in average blood pressure.”

“The findings suggest that blood pressure upon standing should be measured in order to tailor treatment for patients with high blood pressure, and potentially, a more aggressive approach to lifestyle changes and blood-pressure-lowering therapy may be considered for people with an elevated [hyperreactor] blood pressure response to standing,” he said.

Results from this study may not be generalizable to people from other ethnic or racial groups since all study participants reported white race/ethnicity. In addition, there were not enough women in the sample to analyze whether the association between rising standing blood pressure and adverse heart events was different among men and women. Because of the relatively small number of major adverse cardiac events in this sample of young people, the results need to be confirmed in larger studies.

Grapes are a smart choice, three recipes to eat your way to better health

(Family Features) - The importance of health and wellness is top of mind for many people. There are many contributing factors to wellness such as diet, physical activity, social engagement and genetics. All are important, but a first step to wellness is choosing healthy foods to fuel the body every day, ideally foods that support health in multiple ways.

Consider grapes from California: they are convenient, healthy, hydrating and provide energy to help support healthy and active lifestyles. Eating grapes is also linked to beneficial impacts on the health of specific body parts and systems, including the heart, brain, skin and colon.

Most of grapes’ health benefits are attributed to the presence of natural plant compounds known as polyphenols, which help promote antioxidant activity and influence biological processes that support overall health. Grapes of all colors – red, green and black – are natural sources of polyphenols.

Fresh California grapes are refreshing by the handful, but they also lend a tasty burst of flavor to a wide range of recipes you can enjoy any time of day. This Heart Smart Smoothie is a deliciously healthy way to start the day; pairing grapes with nuts and seeds in No-Bake Energy Bites delivers a hearty snack to enjoy midday, after school or following a workout; and Quinoa, Cauliflower and Grape Salad is perfect at any mealtime for a powerful combo of both taste and health.

Grapes and a Healthy Brain

Research suggests regularly eating grapes as part of a healthy diet and lifestyle may contribute to improved health outcomes, including brain health.

In a study of people with early memory decline published in “Experimental Gerontology,” subjects were either fed whole grape powder equivalent to just 2 1/4 cups of grapes per day or a placebo powder. The results showed consuming grapes preserved healthy metabolic activity in regions of the brain associated with early Alzheimer’s disease, where metabolic decline takes hold.

Subjects who didn’t consume grapes exhibited significant metabolic decline in these critical regions. Additionally, those consuming the grape-enriched diet showed beneficial changes in regional brain metabolism that correlated to improvements in attention and working memory performance.

Find more nutritious recipes at GrapesFromCalifornia.com .

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No-Bake Energy Bites

Prep time: 20 minutes
Yield: 8 energy bites

• 1/3       cup raw almonds
• 1/3       cup walnuts
• 1/2       cup pitted dates
• 1 1/2    teaspoons fresh orange juice or lemon juice
• 1          pinch sea salt
• 8          seedless California grapes
• 1/3       cup chia or hemp seeds

1. In bowl of food processor, pulse almonds and walnuts 5-6 times to coarsely chop. Add dates and process until mixture is finely chopped. Add juice and process until just combined; transfer mixture to small plate.
2. Dry grapes. Pack 1 tablespoon date mixture around each grape, completely covering to seal. Repeat with remaining grapes and date mixture.
3. Roll balls in seeds to coat. Store in covered container in refrigerator up to three days.

Nutritional information per energy bite: 120 calories; 3 g protein; 12 g carbohydrates; 7 g fat (53% calories from fat); 0.5 g saturated fat (4% calories from saturated fat); 0 mg cholesterol; 20 mg sodium; 3 g fiber.

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Heart Smart Grape and Peanut Butter Smoothie

Prep time: 5 minutes
Servings: 1

• 1          cup red California grapes, chilled
• 2/3       cup unsweetened almond milk, chilled
• 1/2       cup ice cubes
• 1/2       small banana
• 1          tablespoon peanut butter
• 1          tablespoon ground flax seed
• 2          teaspoons cacao powder

1. In blender on high speed, blend grapes, almond milk, ice, banana, peanut butter, flax seed and cacao powder until smooth.

Nutritional information per serving: 350 calories; 8 g protein; 53 g carbohydrates; 14 g fat (36% calories from fat); 2.5 g saturated fat (6% calories from saturated fat); 0 mg cholesterol; 220 mg sodium; 7 g fiber.

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Quinoa, Cauliflower and Grape Salad

Prep time: 15 minutes
Cook time: 15 minutes
Servings: 8

• 1          cup white quinoa
• 1          small head cauliflower, trimmed and cut into small florets
• 1 1/4    cups red California grapes, halved
• 3          scallions, trimmed and thinly sliced
• 2          ripe avocados, diced 1/3 inch

Dressing:

• 2          tablespoons white wine vinegar
• 1          tablespoon lime juice
• 1          tablespoon honey
• 1/2       teaspoon ground cumin
• 1/2       teaspoon dried oregano, crumbled
• 1/2       teaspoon fine sea salt
• 1/4       cup extra-virgin olive oil
• freshly ground black pepper, to taste

1. Cook quinoa according to package directions and drain on two layers of paper towels. Transfer to mixing bowl. Add cauliflower, grapes, scallions and avocado pieces.
2. To make dressing: In small bowl, whisk vinegar, lime juice, honey, cumin, oregano and salt until blended. Gradually whisk in oil. Drizzle dressing over quinoa mixture and toss gently. Season with pepper, to taste.

Nutritional information per serving: 260 calories; 5 g protein; 27 g carbo hydrates; 16 g fat (55% calories from fat); 2 g saturated fat (7% calories from saturated fat); 0 mg cholesterol; 170 mg sodium; 6 g fiber.

Recipe | Spaghetti with turkey and beef meatballs

Family Features - Making small changes to focus on your health, like following a healthy eating plan, can make a big difference in protecting your heart.

Developed by the National Heart, Lung, and Blood Institute, Dietary Approaches to Stop Hypertension (DASH) is a flexible and balanced eating plan that helps create a heart-healthy eating style for life. It requires no special foods, and instead provides daily and weekly nutritional goals to help lower two major risk factors for heart disease: high blood pressure and high LDL (bad) cholesterol.

As an added bonus, sharing DASH-friendly meals with your loved ones can help take the guesswork out of putting nutritious dinners on your family’s table. For example, this easy and delicious Turkey and Beef Meatballs with Whole-Wheat Spaghetti recipe is one the entire family can help prepare.

In addition to a following a healthy eating plan, other self-care habits like taking time daily to destress, being more physically active and getting enough quality sleep can all benefit your heart. It’s also important to know what your blood pressure, cholesterol and blood sugar levels are and what a healthy weight is for you.

Learn more about the DASH eating plan and find recipes at nhlbi.nih.gov/DASH.

Turkey and Beef Meatballs with Whole-Wheat Spaghetti
Recipe courtesy of the National Heart, Lung, and Blood Institute Prep time: 20 minutes
Cook time: 20 minutes
Servings: 4

• 3 quarts water
• 8 ounces dry whole-wheat spaghetti
• 2 cups chunky tomato sauce
• 4 teaspoons grated Parmesan cheese
• 1 tablespoon fresh basil, rinsed, dried and chopped

Turkey Meatballs:

• 6 ounces 99% lean ground turkey
• 1/4 cup whole-wheat breadcrumbs
• 2 tablespoons fat-free evaporated milk
• 1 tablespoon grated Parmesan cheese
• 1/2 tablespoon fresh chives, rinsed, dried and chopped
• 1/2 tablespoon fresh parsley, rinsed, dried and chopped

Beef Meatballs:

• 6 ounces 93% lean ground beef
• 1/4 cup whole-wheat breadcrumbs
• 2 tablespoons fat-free evaporated milk
• 1 tablespoon grated Parmesan cheese
• 1/2 tablespoon fresh chives, rinsed, dried and chopped
• 1/2 tablespoon fresh parsley, rinsed, dried and chopped

1. Preheat oven to 400 F.
2. In 4-quart saucepan over high heat, bring water to boil.
3. Add pasta and cook according to package directions. Drain and set aside.
4. To make turkey meatballs: In bowl, combine ground turkey, breadcrumbs, evaporated milk, Parmesan cheese, chives and parsley; mix well. Measure 1 1/2 tablespoons turkey mixture and roll into ball using hands. Place meatball on nonstick baking sheet. Repeat until eight turkey meatballs are made.
5. To make beef meatballs: In separate bowl, combine ground beef, breadcrumbs, evaporated milk, Parmesan cheese, chives and parsley; mix well. Measure 1 1/2 tablespoons beef mixture and roll into ball using hands. Place meatball on nonstick baking sheet. Repeat until eight beef meatballs are made.
6. Bake meatballs 10 minutes until minimum internal temperature of 165 F is reached.
7. Warm sauce, if necessary.

To serve: Serve four meatballs with 3/4 cup pasta, 1/2 cup sauce, 1 teaspoon Parmesan cheese and 1 pinch basil per portion.

Watch video to see how to make this recipe!

New medication improves survival rate for people who have suffered a stroke

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Up to 80% of strokes are preventable. Prevention goes back to what any doctor will tell you is key for a healthy life: control your blood pressure, cholesterol and diabetes through diet and exercise.

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by Tim Ditman
OSF Healthcare

URBANA - Nearly 800,000 Americans suffer a stroke each year.

Strokes can have life-altering consequences like vision, walking and swallowing difficulties. They also rank in the top five killers of Americans. For each minute a stroke goes untreated, the brain loses around 2 million cells it cannot recover.

"Getting to the hospital quickly – within four and a half hours of your onset of symptoms – is important," says Leslie Ingold, a registered nurse and stroke coordinator with OSF HealthCare.

A cutting-edge stroke drug recently rolled out at OSF HealthCare is already turning the tide for people.

Tenecteplase (TNKase ®) can be used in people experiencing a stroke and who meet certain criteria, such as a specific blood pressure, history of brain bleeds, medications taken at home and how quickly they arrived at the emergency department. TNKase is a clot-busting agent that stands to become the gold standard of this type of care, Ingold says.

"It has a lower cost. It’s something providers can mix much, much quicker," Ingold says. "And it’s given quickly in an IV push over five to 10 seconds, and we’re done."

TNKase also does a better job than its predecessor at finding and breaking up clots, and there’s a lower risk of bleeding.

"The quicker we can get oxygen flowing back into that brain tissue, the better recovery the person is going to have," Ingold says. B.E.F.A.S.T. infographic

Why it’s important

The most common type of stroke, an ischemic stroke (also sometimes called an embolic stroke), is when a clot forms and travels to the brain. When watching for one, remember the acronym B.E.F.A.S.T.

B is for balance: Watch for sudden loss of balance.

E is for eyes: Check for vision loss or eyes looking askew.

F is for face: Look for droopiness or an uneven smile.

A is for arm: Is one arm weak or numb?

S is for speech: Watch for slurred, slow speech or no speech. Ask the person to repeat a simple sentence.

T is for time. It’s the conclusion to the checklist. Time to call 9-1-1 if someone has these symptoms, even if they go away.

Another type of stroke, a hemorrhagic stroke, is when a blood vessel breaks and blood seeps into brain tissue. Ingold says hemorrhagic strokes are typically caused by a traumatic injury, like falling and hitting your head. Uncontrolled high blood pressure is also a cause.

For either type, when you arrive at the hospital, a provider will take some pictures of your brain and decide the best treatment option.

Prevention

Up to 80% of strokes are preventable, Ingold says. Prevention goes back to what any doctor will tell you is key for a healthy life: control your blood pressure, cholesterol and diabetes through diet and exercise. Avoid tobacco, alcohol and drugs. If you have an irregular heartbeat, known as atrial fibrillation, see your cardiologist regularly and follow their instructions. And get established with a primary care provider, too.

Ingold says a stroke takes 3.75 years off a person’s life, on average. And if you have a stroke, you have a 25% chance of having another one.

"We always tell people they really need to be on top of their treatment," Ingold says. "The signs and symptoms of a possible second stroke may not be the same as the first. In fact, they could be completely different. It just depends on what part of the brain the stroke affects."

Emergency assessment needed even when stroke symptoms disappear

by American Heart Association

Dallas - Stroke symptoms that disappear in under an hour, known as a transient ischemic attack (TIA), need emergency assessment to help prevent a full-blown stroke, according to a new American Heart Association scientific statement published today in the Association’s journal Stroke. The statement offers a standardized approach to evaluating people with suspected TIA, with guidance specifically for hospitals in rural areas that may not have access to advanced imaging or an on-site neurologist.

Photo courtesy American Heart Assoc.

TIA is a temporary blockage of blood flow to the brain. Each year, about 240,000 people in the U.S. experience a TIA, although this estimate may represent underreporting of TIA because symptoms tend to go away within an hour. While the TIA itself doesn’t cause permanent damage, nearly 1 in 5 of those who have a TIA will have a full-blown stroke within three months after the TIA, almost half of which will happen within two days. For this reason, a TIA is more accurately described as a warning stroke rather than a “mini-stroke,” as it’s often called.

TIA symptoms are the same as stroke symptoms, only temporary. They begin suddenly and may have any or all of these characteristics:

• Symptoms begin strong then fade;
• Symptoms typically last less than an hour;
• Facial droop;
• Weakness on one side of the body;
• Numbness on one side of the body;
• Trouble finding the right words/slurred speech; or
• Dizziness, vision loss or trouble walking.

The F.A.S.T. acronym for stroke symptoms can be used to identify a TIA: F ― Face drooping or numbness; A ― Arm weakness; S ― Speech difficulty; T ― Time to call 9-1-1, even if the symptoms go away.

“Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room,” said Hardik P. Amin, M.D., chair of the scientific statement writing committee and associate professor of neurology and medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut. “There also is variability across the country in the workup that TIA patients may receive. This may be due to geographic factors, limited resources at health care centers or varying levels of comfort and experience among medical professionals.”

For example, Amin said, “Someone with a TIA who goes to an emergency room with limited resources may not get the same evaluation that they would at a certified stroke center. This statement was written with those emergency room physicians or internists in mind – professionals in resource-limited areas who may not have immediate access to a vascular neurologist and must make challenging evaluation and treatment decisions.”

The statement also includes guidance to help health care professionals tell the difference between a TIA and a “TIA mimic” – a condition that shares some signs with TIA but is due to other medical conditions such as low blood sugar, a seizure or a migraine. Symptoms of a TIA mimic tend to spread to other parts of the body and build in intensity over time.

Who is at risk for a TIA?

People with cardiovascular risk factors, such as high blood pressure, diabetes, obesity, high cholesterol and smoking, are at high risk for stroke and TIA. Other conditions that increase risk of a TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea and coronary artery disease. In addition, a person who has had a prior stroke is at high risk for TIA.

Which tests come first once in the emergency room?

Blood work should be completed in the emergency department to rule out other conditions

After assessing for symptoms and medical history, imaging of the blood vessels in the head and neck is an important first assessment. A non-contrast head CT should be done initially in the emergency department to rule out intracerebral hemorrhage and TIA mimics. CT angiography may be done as well to look for signs of narrowing in the arteries leading to the brain. Nearly half of people with TIA symptoms have narrowing of the large arteries that lead to the brain.

A magnetic resonance imaging (MRI) scan is the preferred way to rule out brain injury (i.e., a stroke), ideally done within 24 hours of when symptoms began. About 40% of patients presenting in the ER with TIA symptoms will actually be diagnosed with a  stroke based on MRI results. Some emergency rooms may not have access to an MRI scanner, and they may admit the patient to the hospital for MRI or transfer them to a center with rapid access to one.

Blood work should be completed in the emergency department to rule out other conditions that may cause TIA-like symptoms, such as low blood sugar or infection, and to check for cardiovascular risk factors like diabetes and high cholesterol.

Once TIA is diagnosed, a cardiac work-up is advised due to the potential for heart-related factors to cause a TIA. Ideally, this assessment is done in the emergency department, however, it could be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of having a TIA. An electrocardiogram to assess heart rhythm is suggested to screen for atrial fibrillation, which is detected in up to 7% of people with a stroke or TIA. The American Heart Association recommends that long-term heart monitoring within six months of a TIA is reasonable if the initial evaluation suggests a heart rhythm-related issue as the cause of a TIA or stroke.

Early neurology consultation, either in-person or via telemedicine, is associated with lower death rates after a TIA. If consultation isn’t possible during the emergency visit, the statement suggests following up with a neurologist ideally within 48 hours but not longer than one week after a TIA, given the high risk of stroke in the days after a TIA. The statement cites research that about 43% of people who had an ischemic stroke (caused by a blood clot) had a TIA within the week before their stroke.

Assessing stroke risk after TIA

A rapid way to assess a patient’s risk of future stroke after TIA is the 7-point ABCD2 score, which stratifies patients into low, medium and high risk based on Age, Blood pressure, Clinical features (symptoms), Duration of symptoms (less than or greater than 60 minutes) and Diabetes. A score of 0-3 indicates low risk, 4-5 is moderate risk and 6-7 is high risk. Patients with moderate to high ABCD2 scores may be considered for hospitalization.

Collaboration among emergency room professionals, neurologists and primary care professionals is critical to ensure the patient receives a comprehensive evaluation and a well-communicated outpatient plan for future stroke prevention at discharge.

“Incorporating these steps for people with suspected TIA may help identify which patients would benefit from hospital admission, versus those who might be safely discharged from the emergency room with close follow-up,” Amin said. “This guidance empowers physicians at both rural and urban academic settings with information to help reduce the risk of future stroke.”

Diet program showed remarkable weight loss success

SNS - University of Illinois researchers found that flexible, personalized diet plans were crucial for weight loss in a regimen high in protein and fiber. Participants in a 25-month study within a self-directed dietary education program achieved the most success when they devised their own plans.

An ideal addition to your diet if you are trying to lose weight is raw pears because they are high in fiber. An average, medium-sized piece usually contains about 5.5 grams of dietary fiber.

Photo: David Trinks/Unsplash

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At the one-year mark, successful dieters — 41% of participants — had shed 12.9% of their body weight, compared with the remainder of the study sample, which lost slightly more than 2% of their starting weight, according to a paper published in Obesity Science and Practice.

The dieters were enrolled in the Individualized Diet Improvement Program (iDip), which employs data visualization tools and intensive dietary education sessions to enhance participants' understanding of essential nutrients. This approach allows them to create personalized, safe, and effective weight-loss plans, said Manabu T. Nakamura, a professor in Nutrition Science at the University of Illinois Urbana-Champaign and the study's leader.

The main goal of the iDip program is centered around boosting protein and fiber intake while consuming 1,500 calories or less daily.

The iDip team created a one-of-a-kind, two-dimensional quantitative data visualization tool that plots foods’ protein and fiber densities per calorie and provides a target range for each meal. Starting with foods they usually ate, the dieters created an individualized plan, increasing their protein intake to as much as 80 grams and their fiber intake to close to 20 grams daily.

A total of 22 people finished the program, including nine men and 13 women. Most of them were between 30 and 64 years old. They said they had tried to lose weight at least twice before. Many of the participants had other health problems—54% had high cholesterol, 50% had bone or joint issues, and 36% had high blood pressure or sleep problems. Some of them also had suffered from diabetes, liver disease, cancer, or depression.

Throughout the program, participants experienced significant body transformations. They reduced their fat mass from an average of 42.6 kilograms to 35.7 kilograms after 15 months. Additionally, their waistlines shrank by about 7 centimeters after six months and a total of 9 centimeters after 15 months.

Tracking participants' protein and fiber intake, the team identified a strong link between higher consumption of these nutrients and weight loss at three and 12 months.

"Flexibility and personalization are key in creating programs that optimize dieters’ success at losing weight and keeping it off," Nakamura said. "Sustainable dietary change, which varies from person to person, must be achieved to maintain a healthy weight. The iDip approach allows participants to experiment with various dietary iterations, and the knowledge and skills they develop while losing weight serve as the foundation for sustainable maintenance."

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Shoveling heavy snow may increase risk of a heart attack or sudden cardiac episode

by The American Heart Association

Photo: Todd Trapani/Unsplash

DALLAS — Clearing sidewalks and driveways of snow may be essential to keep from being shut in, however, the American Heart Association urges caution when picking up that shovel or even starting the snowblower. Research shows that many people may face an increased risk of a heart attack or sudden cardiac arrest after shoveling heavy snow.

The American Heart Association’s 2020 scientific statement, Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective–An Update, notes snow shoveling among the physical activities that may place extra stress on the heart, especially among people who aren’t used to regular exercise. Numerous scientific research studies over the years have identified the dangers of shoveling snow for people with and without previously known heart disease.

The lead author of that scientific statement and long-time American Heart Association volunteer Barry Franklin, Ph.D., FAHA, is one of the leading experts on the science behind the cardiovascular risks of snow shoveling. He has authored a number of studies on the topic, estimating that hundreds of people die during or just after snow removal in the U.S. each year.

"Shoveling a little snow off your sidewalk may not seem like hard work. However, the strain of heavy snow shoveling may be as or even more demanding on the heart than taking a treadmill stress test, according to research we’ve conducted." said Franklin, a professor of internal medicine at Oakland University William Beaumont School of Medicine in Royal Oak, Michigan. "For example, after only two minutes of snow shoveling, study participants’ heart rates exceeded 85% of maximal heart rate, which is a level more commonly expected during intense aerobic exercise testing. The impact is hardest on those people who are least fit."

A study conducted in Canada a few years ago found that the chance of heart attack after a snowfall increased among men but not among women. The study found that, compared to no snowfall, a heavy snow – about 7-8 inches – was associated with 16% higher odds of men being admitted to the hospital with a heart attack, and a 34% increase in the chance of men dying from a heart attack.

Photo provided by AHA

Franklin said winter weather in general can contribute to the increased risk. Cold temperatures may increase blood pressure while simultaneously constricting the coronary arteries. Those factors, combined with the higher heart rate from the extra physical effort, may increase the risk for acute cardiac events. There are even studies that show an increased risk for heart attacks among people using automatic snow blowers. Similar to the extra exertion of pushing shovel, pushing a snow blower can raise heart rate and blood pressure quickly.

"The impact of snow removal is especially concerning for people who already have cardiovascular risks like a sedentary lifestyle or obesity, being a current or former smoker, having diabetes, high cholesterol or high blood pressure, as well as people who have had a heart attack or stroke," he said. "People with these characteristics and those who have had bypass surgery or coronary angioplasty simply should not be shoveling snow."

Franklin said the most important thing is to be aware of the dangers, be prepared and take it easy, including taking short breaks. Even people who are relatively healthy should note that pushing the snow with a shovel is better physically than lifting and throwing it.

The American Heart Association urges everyone to learn the common signs of heart trouble and if you experience chest pain or pressure, lightheadedness or heart palpitations or irregular heart rhythms, stop the activity immediately. Call 9-1-1 if symptoms don’t subside shortly after you stop shoveling or snow blowing. If you see someone collapse while shoveling snow, call for help and start Hands-Only CPR if they are unresponsive with no pulse.

Learn more about cold weather and cardiovascular disease here.

A healthy snack option, try Apple Nachos this week

Family Features - No matter how busy your schedule gets, it’s important to take time to nurture your physical and mental health and well-being. With busy work, school and sports schedules underway, it is good to remember to take time to cook and eat together with loved ones.

In fact, research from the "Journal of Epidemiology & Community Health" shows regular family meals make it more likely kids and adults will eat more fruits and vegetables.

Photo provided

Making healthy choices, including eating fruits, like those in Apple Nachos, and vegetables have also been linked to greater happiness, according to research published in "Canadian Family Physician," and can help you through the transition back to school, the office, or wherever your routine takes you. Pairing a healthy diet with other science-backed tips and recipes from the American Heart Association’s Healthy for Good initiative, supported by Kroger Health, can help you and your family feel your best.

Apple Nachos are a delicious dessert any time of the year. With tart apples covered in caramel and nut seeds make a delicious snack or side dish on game day or movie night.

For more free recipes and more health tips, follow this link to heart.org/healthyforgood.

Apple Nachos

Recipe courtesy of the American Heart Association’s Healthy for Good initiative

1/3 cup dried unsweetened cranberries or raisins

1/4 cup sliced unsalted almonds

2 tablespoons unsalted shelled sunflower seeds

3 medium green or red apples, cored and thinly sliced into 12 wedges each, divided

1-2 teaspoons fresh lemon juice

2 tablespoons water

1/4 cup smooth low-sodium peanut butter

1 tablespoon honey

Servings: 6

In a small bowl, stir cranberries, almonds and sunflower seeds.

Layer 18 apple wedges on a large plate or platter. Sprinkle with lemon juice to keep apples from browning.

In a small microwaveable bowl, microwave water on high for two minutes, or until boiling. Add peanut butter and honey, stirring until the mixture is smooth.

Using a spoon, drizzle half of the peanut butter mixture over apple wedges. Sprinkle with half cranberry mixture. Layer remaining apples over cranberry mixture. Drizzle with the remaining peanut butter mixture. Then sprinkle the remaining cranberry mixture over top.

Nutritional information per serving: 167 calories; 7.5 g total fat; 1 g saturated fat; 0 g trans fat; 2.5 g polyunsaturated fat; 3.5 g monounsaturated fat; 0 mg cholesterol; 66 mg sodium; 22 g carbohydrates; 4 g fiber; 15 g sugar; 4 g protein.

Managing your pills as you age; navigating today's polypharmacy

Recent study notes stroke survivors are less likely to quit smoking

Cancer survivors are more like to quit as part of their recovery

Photo courtesty American Heart Association

Stroke survivors were more likely to continue cigarette smoking than cancer survivors, raising the risk that they will have more health problems or die from a subsequent stroke or heart disease, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

"The motivation for this study was the National Cancer Institute (NCI)’s Moonshot initiative that includes smoking cessation among people with cancer. We were curious to understand smoking among people with stroke and cardiovascular disease," said Neal Parikh, M.D., M.S., lead author of the study and a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center in New York City. "In part to assess whether a similar program is necessary for stroke survivors, our team compared smoking cessation rates between stroke survivors and cancer survivors."

The investigators analyzed data collected between 2013 and 2019 from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System, a national health survey that collects information regarding chronic health conditions and health-related behaviors annually.

Researchers analyzed data from 74,400 respondents who reported having a prior stroke and a history of smoking (median age of 68 years; 45% women; 70% non-Hispanic white), and 155,693 respondents who identified as cancer survivors with a history of smoking (median age of 69 years; 56% women; 81% non-Hispanic white). Previous smoker status was defined as having smoked at least 100 cigarettes in their lifetime.

After adjusting for demographic factors and the presence of smoking-related medical conditions, researchers found that:

Stroke survivors were found to be 28% less likely to have quit smoking compared to people with cancer.

61% of stroke survivors reported that they had quit smoking.

Stroke survivors under the age of 60 were far less likely to have quit smoking (43%) compared to stroke survivors ages 60 and older (75%).

Photo courtesty American Heart Association

"If you told a stroke neurologist that 40% of their patients don’t have their blood pressure controlled or weren’t taking their aspirin or their cholesterol-lowering medication, I think they would be very disappointed,” said Parikh, who is also an assistant professor of neurology in the Department of Neurology and of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine. “These results indicate that we should be disappointed – more of our stroke patients need to quit smoking. We can and should be doing a lot better in helping patients with smoking cessation after stroke."

The researchers also found that stroke survivors who live in the Stroke Belt – 8 states in the southeastern United States with elevated stroke rates (North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas and Louisiana) – were around 6% less likely to have quit smoking than stroke survivors in other areas of the U.S. Increasing smoking cessation is one factor than can be addressed to reduce the disproportionately high rates of strokes and stroke deaths in the Stroke Belt.

"Important next steps are devising and testing optimal smoking cessation programs for people who have had a stroke or mini-stroke," said Parikh. "Programs for patients with stroke and cardiovascular disease should be as robust as smoking cessation programs offered to patients with cancer. At NCI-designated sites, smoking cessation programs often include a dedicated, intensive counseling program, a trained tobacco cessation specialist, and health care professionals with specific knowledge about the use of smoking cessation medications. Hospital systems could also adjust care protocols so that every stroke patient receives a consultation with a tobacco cessation specialist and is enrolled in a smoking cessation program with the option to opt out, as opposed to having to seek out a program."

A limitation of the study is that the data in the survey was self-reported – it relied on individuals to indicate if they have ever smoked or are currently smoking. The study population is also limited because it included only people who live independently in the community, rather than those living in a nursing home or other living facility.

Co-authors are Melvin Parasram, D.O., M.S.; Halina White, M.D.; Alexander E. Merkler, M.D., M.S.; Babak B. Navi, M.D., M.S.; and Hooman Kamel, M.D., M.S.. The study was supported by the New York State Department of Health Empire Clinical Research Investigator Program and the Florence Gould Endowment for Discovery in Stroke.

Debunking the myths about gout

from Family Features

When many people think of gout, they often picture swelling and pain in the big toe. However, gout - an extremely painful form of inflammatory arthritis - can occur in any joint when high levels of uric acid in the blood lead to the formation of urate crystals.

If your body creates too much uric acid or cannot clear uric acid properly, you may experience sudden and sometimes severe gout attacks, called flare-ups, that include pain, swelling or redness in your joints. The condition can disrupt many aspects of daily living, including work and leisure or family activities.

"I was diagnosed with kidney disease in 2009 and it wasn't too long after that I started dealing with gout issues," said registered nurse Theresa Caldron. "Gout affects your quality of life in a lot of different ways. You're going through days of pain and no one knows it because you don't look sick."

Because the kidneys filter and release uric acid, people with kidney disease are more likely to experience a buildup of urate crystals and, therefore, gout. In fact, 1 out of 10 people with chronic kidney disease have gout, and an even higher percentage of people with gout have kidney disease.

To help debunk some myths around the condition, the American Kidney Fund, in partnership with Horizon Therapeutics, created the "Goutful" education campaign, which aims to educate and empower patients with gout to help them live easier and prevent further health complications, especially relating to their kidneys. Consider these common myths:

Myth: Gout is rare.
Gout is a relatively common condition. More than 8 million Americans have gout, and it is the most common form of arthritis in men over 40.

Myth: Gout is a man's disease.
Anyone can get gout, but it's more common in men than women. Though men are 10 times more likely to develop gout, rates of gout even out after age 60 since gout tends to develop for women after menopause.

Myth: Only people who are obese get gout.
People of all sizes can develop gout. Though people who are obese are at higher risk, gout is more common in people who have other health problems like diabetes, high blood pressure, high cholesterol or kidney disease. Others more at-risk for gout are males 30-50 years old, Asians, Pacific Islanders, Black people, people with a family history of gout, people with organ transplants and people exposed to lead.

Myth: Gout eventually goes away on its own.
Symptoms of gout attacks often go away within a few days, but that doesn't mean gout is gone. Even if you don't feel symptoms, urate crystals can build up beneath the surface, which can cause long-term health problems like joint and kidney damage.

Myth: There are things you can eat to prevent or cure gout.
Certain foods may help decrease the level of uric acid in your body, but diet alone is not a cure for gout. People with gout who follow healthy diets may still need medicine to prevent flare-ups and lower uric acid levels. Alcohol and foods rich in purines, especially red meat and seafood, should be avoided if you are prone to gout.

If you think you might have gout, talk with your doctor or a gout specialist about your symptoms. Visit kidneyfund.org/gout to learn more about gout and kidney disease.

What we eat is the biggest risk factor for heart disease

by Tim Ditman
OSF Healthcare

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URBANA - Philip Ovadia, MD, has a roadmap for the next time you go to the grocery store: stick to the outer sections. That’s where you’ll find fruits, vegetables, dairy and less processed meats.

The further in you go, the more likely you are to encounter sugary, processed foods that can harm your health when consumed en masse.

“What we eat on a daily basis is the biggest risk factor for developing heart disease,” says Dr. Ovadia, an OSF HealthCare cardiothoracic surgeon who, himself, changed his eating habits and went on a weight loss journey.

Moreover, he says, health care experts have moved away from high fat and high cholesterol foods driving heart disease risk. That’s not a license to eat those foods all the time. But it’s more important, experts say, to keep an eye on sugary and processed foods.

Some chief examples: candy, snack cakes, cereal, cookies, chips, crackers and packaged or canned food. Think boxes, bags and colorful labels. After all, the manufacturers want you to buy the products.

And here’s one you’ll hear many doctors say: don’t drink your calories. In other words, avoid excess sugary drinks like soda and juice.

“The problem with fruit juices, as opposed to eating the fruit, is that a lot of the fiber has been stripped out of the juice,” Dr. Ovadia warns. “You’re getting very concentrated levels of sugar.”

For example, Dr. Ovadia says a glass of orange juice may contain the juice of around eight oranges. You wouldn’t think twice about downing the orange juice, but would you eat eight oranges in one sitting?

Consequences

In the short term, Dr. Ovadia says eating a lot of sugary and processed foods will cause your blood sugar level to rise.

“Increased sugar in the bloodstream is directly damaging to our blood vessels,” Dr. Ovadia says. “This is one of the things that can start the process of plaque formation, or blockages, in the blood vessels.”

Long term, Dr. Ovadia says your body can become insulin-resistant. Insulin is the primary hormone your body uses to control blood sugar level. If you’re insulin-resistant, insulin can’t do its job. Dr. Ovadia says this is a precursor to diabetes and metabolic syndrome, a cluster of unhealthy conditions. Both are “major” risks for heart disease, he says.

Some tips:

Look for “added sugar” on the food or drink label, and consider skipping that food.

Find foods that are as close to naturally occurring as possible. As Dr. Ovadia puts it: things that grow in the ground or things that eat things that grow in the ground.

“You should be able to look at your food and know exactly what’s in it,” Dr. Ovadia says. “It should have simple ingredients. You can look at them and know what they are.”

Or ask yourself: would my great grandparents have this food available? Would they even recognize it as food?

For breakfast, try fresh fruit or a hard-boiled egg instead of a biscuit. For lunch, eat a salad with ingredients you mixed instead of a pre-packaged salad. And for dinner, get a lean protein like chicken or fish from the deli counter, not sliced meat in a package.

Pay attention to how you feel after eating.

“If you find yourself getting hungry very quickly after eating, that’s a sign that food is not providing your body with the nutrition it’s looking for,” Dr. Ovadia says.

That means you shouldn’t look at junk food as “in moderation,” Dr. Ovadia says, because you’ll most always be left hungry. He prefers the phrase: “the lower junk food, the better.”

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Key takeaways:

• Sugary, processed foods are a big risk for heart disease.
• When shopping, stick to the outer aisles. Buy items with simple ingredients.
• If you feel hungry again soon after eating, the food you ate is likely not providing the body the nutrition it needs.

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High blood pressure linked to midlife changes in the brain

Younger adults who had higher cumulative blood pressure exposure (from 25 to 55 years of age) had more changes visible on brain imaging at midlife ...

by American Heart Association

NEW ORLEANS -- High blood pressure among younger adults, ages 20-40 years, appears to be linked to brain changes in midlife (average age 55) that may increase risk for later cognitive decline, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2022, a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health to be held in person in New Orleans and virtually, Feb. 8-11, 2022.

According to the American Heart Association, from 2015-2019 more than 47% of U.S. adults had high blood pressure. In 2019, the U.S. age-adjusted death rate primarily attributable to high blood pressure was 25.1 per 100,000. High blood pressure death rates for non-Hispanic Black adults were 56 per 100,000 among males and 38.7 per 100,000 for females.

Studies have found that high blood pressure disrupts the structure and function of the brain’s blood vessels, damaging regions of the brain that are critical for cognitive function.

"There are studies to suggest changes to the brain may start at a young age," said Christina Lineback, M.D., lead study author and a vascular neurology fellow at Northwestern Memorial Hospital in Chicago. "Our study provides further evidence that high blood pressure during young adulthood may contribute to changes in the brain later in life."

Researchers analyzed 30 years of follow-up including MRI brain images (performed once at the age of 30, and then again at midlife - about the age of 55 years) for 142 adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study. The CARDIA study enrolled participants from four U.S. cities (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California), in 1985-1986. In total, the study recruited more than 5,000 Black and white adults, ages 18 to 30 years, who have been followed for over 30 years.

In one follow up including 142 of the participants (42% women), researchers examined changes in brain structures in midlife (average age 55) from cumulative exposures to vascular risk factors, including high blood pressure, cholesterol, body mass index, smoking and glucose, from young adulthood to midlife. They also evaluated if there were any differences by race or ethnicity; nearly 40% of the study participants (n=55) were Black adults.

The analysis found:

Younger adults who had higher cumulative blood pressure exposure (from 25 to 55 years of age) had more changes visible on brain imaging at midlife, which may increase the risk of cognitive dysfunction in mid- and late life.

The brain changes that occurred were similar across all races and ethnic groups examined in the study when accounting for the degree of high blood pressure exposure.

"We were surprised that we could see brain changes in even this small sample of participants from the CARDIA study," Lineback said. "Given the greater likelihood of high blood pressure in some racial and ethnic groups, this study’s finding should encourage health care professionals to aggressively address high blood pressure in young adults, as a potential target to narrow disparities in brain health."

A potential next step is to develop and implement systems to better treat and monitor blood pressure in young age groups and assess for brain changes over time, according to Lineback.

A limitation of the study is that it is a retrospective analysis, which means the findings cannot prove the brain changes were caused by high blood pressure.

The study was funded by the National Heart, Lung, and Blood Institute and the National Institutes of Health. Co-authors include Simin Mahinrad, M.D., Ph.D.; Yufen Jennie Chen, Ph.D.; Todd Parrish, Ph.D.; Donald M. Lloyd-Jones, M.D., Sc.M., FAHA; and Farzaneh A. Sorond, M.D., Ph.D.

Study suggests young marijuana smokers may be at greater risk of recurrent stroke

Photo courtesy American Heart Assoc.

American Heart Association

NEW ORLEANS -- Among younger adults who had a previous stroke or a transient ischemic attack (TIA) and were later hospitalized for any cause, recurrent stroke was far more likely among patients with cannabis use disorder, according to preliminary research presented at the American Stroke Association’s International Stroke Conference 2022, a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health to be held in person in New Orleans, and virtually, Feb. 8-11, 2022.

Cannabis use disorder is defined as dependent use of cannabis despite having a psychological, physical and social functioning impairment. According to the American Heart Association, stroke rates are increasing in adults between ages 18 and 45, and each year young adults account for up to 15% of strokes in the United States.

"Since marijuana use is more common among younger people and is now legal in several U.S. states, we felt it was crucial to study the various risks it may impose," said Akhil Jain, M.D., lead author of the study and a resident physician at Mercy Fitzgerald Hospital in Darby, Pennsylvania. "First-time stroke risk among  cannabis users is already established, so it intrigued us to investigate whether continued marijuana dependence also predisposes younger people to develop further strokes."

The researchers examined health information from the National Inpatient Sample, a large, publicly available database that compiles data on more than 7 million hospital stays annually across the U.S. For this study, the sample included 161,390 adults between 18-44 years of age who had been hospitalized for any reason between October 2015 and 2017, and whose health records indicated a previous stroke (either clot-caused or bleeding stroke) or TIA.

Using hospital diagnosis codes, researchers identified patients within the sample who met the criteria for cannabis use disorder, excluding those with charts indicating their cannabis dependence was in remission. This divided the sample into 4,690 patients who had been diagnosed with cannabis use disorder and 156,700 who had not. The median age for both groups was 37 years.

The study found that when compared with patients without cannabis use disorder, patients with the condition were:

• More likely to be male (55.2% vs. 40.9%), Black adults (44.6% vs. 37.2%), or to smoke tobacco (73.9% vs. 39.6%).
• More likely to be diagnosed with chronic obstructive pulmonary disease (21.5% vs. 19.0%), depression (20.4% vs. 16.1%) or psychosis (11.2% vs. 7.5%).
• Significantly more likely to abuse alcohol (16.5% vs. 3.6%).
• Less likely to have high blood pressure (53.1% vs. 55.6%), diabetes (16.3% vs. 22.7%), high cholesterol (21.6% vs. 24.1%) or obesity (12.0% vs. 19.6%).

Compared to current hospitalizations, the analysis found:

• Among adults with cannabis use disorder, 6.9% were hospitalized for a recurrent stroke, compared to only 5.4% hospitalized without the disorder.
• After adjusting for demographic factors and relevant pre-existing medical conditions (age at admission, sex, race, payer status, median household income, type of admission, hospital bed-size, region, location/teaching status and other medical conditions including traditional cardiovascular risk factors), patients with cannabis use disorder were 48% more likely to have been hospitalized for recurrent stroke than those without the disorder.
• Cannabis use disorder was most prominent among males, young Black or white adults and those who lived in low-income neighborhoods or in the northeast and southern regions of the U.S. 

"Young marijuana users who have a history of stroke or TIA remain at significantly higher risk of future stroke. Therefore, it is essential to increase awareness among younger adults of the adverse impact of chronic, habitual use of marijuana, especially if they have established cardiovascular disease risk factors or previous stroke episodes," Jain said.

Possible mechanisms that have emerged from other research on cannabis use disorder include impairment of blood vessel function, changes in blood supply, an increased tendency towards blood-clotting, impaired energy production in brain cells, and an imbalance between molecules that harm healthy tissue and the antioxidant defenses that neutralize them.

Results from this study may not be generalizable to older adults (ages greater than 44), who are more likely to have a greater number of chronic health conditions and cardiovascular risk factors. The study is also limited in that all data was collected at a single point in time, rather than following participants over time. In addition, while the hospital coding identified cannabis use disorder, the data did not include information on the exact amount and duration of cannabis use or medications used.

"Our study is hypothesis-generating research for future prospective and randomized controlled studies. More research work is required to look deeply into this concerning clinical question. Most importantly, the impact of various doses, duration, forms of cannabis abuse, and the use of medicinal cannabis on the occurrence of recurrent strokes are critical questions that need to be answered," Jain said.

According to an August 2020 scientific statement from the American Heart Association, preliminary studies have found that cannabis use may negatively impact the heart and blood vessels. Although cannabis may be helpful for conditions such as spasticity associated with multiple sclerosis, among others, cannabis does not appear to have any well-documented benefits for the prevention or treatment of cardiovascular diseases.

Co-authors of the study include: Rupak Desai, M.B.B.S.; Terry Ricardo Went, M.B.B.S.; Waleed Sultan, M.B.B.Ch.; Dwayne Wiltshire, M.B.B.S.; Geethu Jnaneswaran, M.B.B.S.; Athul Raj Raju, M.B.B.S.; Roshna Asifali; Aamer Mohammad, M.B.B.S.; and Bisharah Rizvi, M.D.