Even one cigarette a day greatly raises cardiovascular risk, experts warn

Impact of one daily cigarette on risk of heart disease and stroke greater than previously thought

Even one cigarette a day greatly raises cardiovascular risk, experts warn

Impact of one daily cigarette on risk of heart disease and stroke greater than previously thought

Read more: https://www.theguardian.com/society/2018/jan/24/even-one-cigarette-a-day-greatly-raises-cardiovascular-risk-experts-warn

Afternoon heart surgery has lower risk of complications, study suggests

Heart attacks and heart failure less common in patients having heart operations in the afternoon as opposed to the morning, say researchers

Patients undergoing open heart surgery in the afternoon have a lower risk of potentially fatal complications than those undergoing operations in the morning, new research suggests.

The study found that events including heart attacks and heart failure were less common among those who had undergone a valve replacement operation in the afternoon.

The finding appears to be linked to the ability of the heart tissue to recover after being starved of blood supply during surgery an effect the researchers say is influenced by the cells biological or circadian clock.

While the study suggests patients might fare better if they undergo afternoon surgery, Professor David Montaigne, first author of the research from the University of Lille in France, said it also highlighted another approach to reduce complications.

We have to find a drug that can alter the circadian clock to induce a jet lag, he said, noting that it could also help to improve patient outcomes for heart attacks and organ transplantation.

Writing the in Lancet, Montaigne and colleagues report how they looked at the outcomes of 596 patients, half of whom had valve surgery in the morning, and half in the afternoon. While 18% of morning surgery patients experienced a major cardiac event such as a heart attack or heart failure in the following 500 days, only 9% of those who had afternoon surgery experienced such events.

The team then randomly assigned 88 valve surgery patients to either morning or afternoon operations and monitored levels of a protein in their blood linked to heart tissue damage.

The results reveal that afternoon surgery patients had lower levels of the protein after their operation, suggesting about 20% less damage to the heart than those who underwent morning surgery.

Delving deeper, the team took biopsies from 14 morning surgery patients and 16 afternoon surgery patients, finding that tissue from the latter recovered better after being deprived of oxygen.

Further analysis found 287 genes within the cells that showed different levels of activity depending on whether the cells were from morning or afternoon patients genes which have, in many cases, previously been linked to the circadian clock.

With a time-of-day effect also found in the recovery of mouse heart tissue, the team explored the impact of tinkering with the activity linked to one of the body clock genes, both using drugs and by looking at mice without the gene. Both approaches improved the recovery of the heart tissue at the time of day when it was typically worse.

Dr John ONeill, an expert in circadian rhythms from the MRC Laboratory of Molecular Biology, said the research backed up previous work in mice and fruitflies that had explored the genes involved in the body clock work which scooped a trio of scientists the Nobel prize for medicine earlier this month.

The biological clock, the circadian rhythm, is in every single cell of the body, therefore it affects the biological activity of each cell type, commensurate with the function of those cells, he said, adding that in healthy humans the heart is known to follow a daily pattern of activity and is not at its optimum performance in the morning.

But, he noted, since systems including that of inflammation are also influenced by circadian rhythms, they too might play a role in the different outcomes for morning and afternoon surgeries.

Whats more, said ONeill, the study did not consider whether the surgeons performed the operation better in the afternoon, adding that more work was need to explore whether the findings would hold for patients at other hospitals, or for other types of surgery.

It is not the case that every single medical intervention is necessarily going to be best dealt with in the afternoon, he said, adding that the research did not mean that patients should try to jet lag themselves before surgery.

Professor Bryan Williams, chair of medicine at University College London, described the new research as fascinating and elegant, adding that the study builds on the fact that cardiovascular events, such as heart attacks, are more common in the morning. What this research suggests is that an intrinsic body clock within cells of the heart may render these cells more susceptible to injury during cardiac surgery in the morning versus the afternoon, he said.

But Williams agreed that it was too soon to consider rescheduling heart surgeries to the afternoon, and that large-scale, robust clinical trials would be needed to probe the effect further. This would be needed to change practice because the logistical implications of doing so would be huge and require definitive proof that there is a real benefit, he said.

Read more: https://www.theguardian.com/science/2017/oct/26/afternoon-heart-surgery-has-lower-risk-of-complications-study-suggests

Blood-thinning drugs ‘can reduce risk of dementia by up to 48%’

Research strongly suggests that patients taking anticoagulants for irregular heartbeat could be protected against dementia and stroke

Blood-thinning drugs could protect against dementia and stroke in people with an irregular heartbeat, research suggests.

A study found that patients being treated for atrial fibrillation (AF) were less likely to develop dementia if they were taking anticoagulants. Their risk was reduced by up to 48% compared with others with the same condition who were not prescribed the drugs.

Scientists analysed health record data from more than 444,000 Swedish AF patients.

While the findings could not prove cause and effect, they strongly suggested blood-thinning pills protect against dementia in patients with the condition, the team said.

Atrial fibrillation increases the risk of stroke and blood clots, which some experts think may appear in the brain and help trigger dementia.

Dr Leif Friberg from the Karolinska Institute in Stockholm, Sweden, who co-led the study, said: As a clinician I know there are AF patients who have a fatalistic view on stroke. Either it happens or it does not. Few patients are fatalistic about dementia, which gradually makes you lose your mind.

No brain can withstand a constant bombardment of microscopic clots in the long run. Patients probably want to hang on to as many of their little grey cells for as long as they can.

In order to preserve what youve got, you should take care to use anticoagulants if you are diagnosed with AF, as they have been proved to protect against stroke and, which this study indicates, also appear to protect against dementia.

The researchers identified everyone in Sweden who had been given a diagnosis of AF between 2006 and 2014. Monitoring each persons progress provided 1.5m years of follow-up during which 26,210 patients were diagnosed with dementia.

Prescribed blood thinners include the drugs warfarin, apixaban, dabigatran, edoxaban and rivaroxaban. Their protective effect was greater the earlier treatment started after a diagnosis of AF, the scientists found.

Friberg said patients should begin taking the drugs as soon as possible and continue using them.

He added: Doctors should not tell their patients to stop using oral anticoagulants without a really good reason. To patients, I would say dont stop unless your doctor says so.

The study, published in the European Heart Journal, found no difference in dementia prevention between the older blood-thinning drug warfarin and newer anticoagulants.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: Strokes caused by a clot blocking the blood vessels in the brain are a major cause of dementia, and atrial fibrillation is an important risk factor as it increases the chances of these clots forming.

By treating AF patients with blood-thinning drugs, you reduce the risk of both stroke and dementia.

Dr Carol Routledge, head of science at Alzheimers Research UK, said: The findings highlight a need to investigate this link further, but the nature of the study prevents us from firmly concluding that anticoagulants reduce the risk of dementia.

It will be important to see the results of other ongoing studies in this area, as well as teasing apart the exact relationship between anticoagulants and the risk of different types of dementia.

Read more: https://www.theguardian.com/science/2017/oct/25/blood-thinning-pills-irregular-heartbeat-patients-dementia-stroke

New Study Reveals What A Single Energy Drink Does To Your Body

Energy drinks are loaded with stimulants and, more often than not, sugar as well. That shouldnt come as a shock; its in the name. So surprise surprise, chugging these things is probably not great for your body. But with headlines suggesting just one can of the stuff could raise your heart disease risk, some Red Bull connoisseurs may already be panicking about their poor tickers.

The results of this latest study are not quite so sinister. What it actually revealed was that drinking a 480-milliliter (16-ounce) canof one particular brand of energy drink could lead to increased blood pressure and a rise in stress hormone levels in healthy adults. These short-term changes could predispose an individual to a higher risk of cardiovascular disease.

The investigation, conducted by Mayo Clinic scientists, involved just a small number of participants: 25 adults with an average age of 29, 14 of whom were men. Their mean body mass index was in the middle of the healthy range (25), none of them were smokers, and as far as they were aware they were not afflicted with any diseases.

The experimental setup was pretty simple.Participants were given a commercially available energy drink (Rockstar) and a placebo beverage to consume within five minutes. This took place on two separate days, the order of which was random, but no further than two weeks apart. The placebo was virtually indistinguishable in terms of taste, color and texture, but it didnt have any of the stimulants found in high amounts in Rockstar, and other energy drinks, like caffeine and taurine.

Image credit: Keith Homan/Shutterstock

Before each study day, participants were told to fast and abstain from both booze and caffeine. Both before each test and 30 minutes afterward a variety of measurements were taken, including caffeine and sugar levels, blood pressure, and heart rate. They also looked at norepinephrine (noradrenaline) in the blood, a stress hormone known to increase heart rate, blood pressureand the release of sugar from stores to prepare you to fight or flee a situation.

As described in JAMA, unsurprisingly, caffeine levels shot up after drinking Rockstar, but not the placebo. While heart rate and blood pressure were within the normal range and similar at the start of both the placebo and energy drink days, average blood pressure increased after consuming the latter, although heart rate remained unchanged in both conditions. Additionally, norepinephrine levelsrose after consuming Rockstar, and it is the combination of these two effects that the scientists state may predispose to increased heart disease risk.

Weve known for a while that caffeine can raise blood pressure, and considering these beverages often contain upwards of 200 milligrams of the stuff, that finding isnt particularly surprising. And weve already noted obvious limitations of the study: a small sample and using only one energy drink. Furthermore, as pointed out by Tracy Parker, Heart Health Dietician at the British Heart Foundation, the study failed to identify what precisely was responsible for the observed increase in norepinephrine and blood pressure.

“It is hard to pinpoint whether it is the caffeine, other stimulants or a combination of ingredients in energy drinks that cause this effect and whether this would lead to any heart problems,” Parker told IFLScience. “However, more research is needed into the effects of energy drinks on the body.”

Read more: http://www.iflscience.com/health-and-medicine/does-single-energy-drink-really-raise-risk-heart-attack0

Health effects of coffee: Where do we stand?

(CNN)It’s one of the age-old medical flip-flops: First coffee’s good for you, then it’s not, then it is — you get the picture.

Today, the verdict is thumbs up, with study after study extolling the merits of three to five cups of black coffee a day in reducing risk for everything from melanoma to heart disease, multiple sclerosis, type 2 diabetes, Parkinson’s disease, liver disease, prostate cancer, Alzheimer’s, computer-related back pain and more.
To stay completely healthy with your coffee consumption, you’ll want to avoid packing it with calorie laden creams, sugars and flavors. And be aware that a cup of coffee in these studies is only 8 ounces; the standard “grande” cup at the coffee shop is double that at 16 ounces.
    And how you brew it has health consequences. Unlike filter coffee makers, the French press, Turkish coffee or the boiled coffee popular in Scandinavian countries fail to catch a compound called cafestol in the oily part of coffee that can increase your bad cholesterol or LDL.
    Finally, people with sleep issues or uncontrolled diabetes should check with a doctor before adding caffeine to their diets, as should pregnant women, as there is some concern about caffeine’s effect on fetal growth and miscarriage. And some of the latest research seems to say that our genes may be responsible for how we react to coffee, explaining why some of us need several cups to get a boost while others get the jitters on only one.
    But as you know, the news on coffee has not always been positive. And the argument over the merits of your daily cup of joe dates back centuries. Let’s take a look at the timeline.
    1500’s headline: Coffee leads to illegal sex
    Legend has it that coffee was discovered by Kaldi, an Ethiopian goatherd, after he caught his suddenly frisky goats eating glossy green leaves and red berries and then tried it for himself. But it was the Arabs who first started coffeehouses, and that’s where coffee got its first black mark.
    Patrons of coffeehouses were said to be more likely to gamble and engage in “criminally unorthodox sexual situations,” according to author Ralph Hattox. By 1511 the mayor of Mecca shut them down. He cited medical and religious reasons, saying coffee was an intoxicant and thus prohibited by Islamic law, even though scholars like Mark Pendergrast believe it was more likely a reaction to the unpopular comments about his leadership. The ban didn’t last long, says Pendergrast, adding that coffee became so important in Turkey that “a lack of sufficient coffee provided grounds for a woman to seek a divorce.”
    1600’s headline: Coffee cures alcoholism but causes impotence
    As the popularity of coffee grew and spread across the continent, the medical community began to extol its benefits. It was especially popular in England as a cure for alcoholism, one of the biggest medical problems of the time; after all, water wasn’t always safe to drink, so most men, women and even children drank the hard stuff.
    Local ads such as this one in 1652 by coffee shop owner Pasqua Rose popularized coffee’s healthy status, claiming coffee could aid digestion, prevent and cure gout and scurvy, help coughs, headaches and stomachaches, even prevent miscarriages.
    But in London, women were concerned that their men were becoming impotent, and in 1674 The Women’s Petition Against Coffee asked for the closing of all coffeehouses, saying in part: “We find of late a very sensible Decay of that true Old English Vigour. … Never did Men wear greater Breeches, or carry less in them…”
    1700’s headline: Coffee helps you work longer
    By 1730, tea had replaced coffee in London as the daily drink of choice. That preference continued in the colonies until 1773, when the famous Boston Tea Party made it unpatriotic to drink tea. Coffeehouses popped up everywhere, and the marvelous stimulant qualities of the brew were said to contribute to the ability of the colonists to work longer hours.
    1800’s headline: Coffee will make you go blind. Have a cup of hot wheat-bran drink instead
    In the mid-1800s America was at war with itself and one side effect is that coffee supplies ran short. Enter toasted grain-based beverage substitutes such as Kellogg’s “Caramel Coffee” and C.W. Post’s “Postum” (still manufactured). They advertised with anti-coffee tirades to boost sales. C.W. Post’s ads were especially vicious, says Pendergrast, claiming coffee was as bad as morphine, cocaine, nicotine or strychnine and could cause blindness.
    1916 headline: Coffee stunts your growth
    While inventions and improvements in coffee pots, filters and processing advanced at a quick pace throughout the 1900s, so did medical concerns and negative public beliefs about the benefits of coffee.
    Good Housekeeping magazine wrote about how coffee stunts growth. And concerns continued to grow about coffee’s impact on common aliments of the era, such as nervousness, heart palpitations, indigestion and insomnia.
    1927 headline: Coffee will give you bad grades, kids
    In Science Magazine, on September 2, 1927, 80,000 elementary and junior high kids were asked about their coffee drinking habits. Researchers found the “startling” fact that most of them drank more than a cup of coffee a day, which was then compared to scholarship with mostly negative results.
    1970’s and ’80’s headline: Coffee is as serious as a heart attack
    A 1973 study in the New England Journal of Medicine of more than 12,000 patients found drinking one to five cups of coffee a day increased risk of heart attacks by 60% while drinking six or more cups a day doubled that risk to 120%.
    Another New England Journal of Medicine study, in 1978, found a short-term rise in blood pressure after three cups of coffee. Authors called for further research into caffeine and hypertension.
    A 38-year study by the Johns Hopkins Medical School of more than a 1,000 medical students found in 1985 that those who drank five or more cups of coffee a day were 2.8 times as likely to develop heart problems compared to those who don’t consume coffee. But the study only asked questions every five years, and didn’t isolate smoking behavior or many other negative behaviors that tend to go along with coffee, such as doughnuts. Or “Doooonuts,” if you’re Homer Simpson.
    Millennium headline: Coffee goes meta
    Now begins the era of the meta-analysis, where researchers look at hundreds of studies and apply scientific principles to find those that do the best job of randomizing and controlling for compounding factors, such as smoking, obesity, lack of exercise and many other lifestyles issues. That means that a specific study, which may or may not meet certain standards, can’t “tip the balance” one way or another. We take a look at some of the years. The results for coffee? Mostly good.
    2001 headline: Coffee increases risk of urinary tract cancer
    But first, a negative: A 2001 study found a 20% increase in the risk of urinary tract cancer risk for coffee drinkers, but not tea drinkers. That finding was repeated in a 2015 meta-analysis. So, if this is a risk factor in your family history, you might want to switch to tea.
    2007 headline: Coffee decreases risk of liver cancer
    Some of these data analyses found preventive benefits for cancer from drinking coffee, such as this one, which showed drinking two cups of black coffee a day could reduce the risk of liver cancer by 43%. Those findings were replicated in 2013 in two other studies.
    2010 headline: Coffee and lung disease go together like coffee and smoking
    A meta-analysis found a correlation between coffee consumption and lung disease, but the study found it impossible to completely eliminate the confounding effects of smoking.
    2011 headline: Coffee reduces risk of stroke and prostate cancer
    A meta-analysis of 11 studies on the link between stroke risk and coffee consumption between 1966 and 2011, with nearly a half a million participants, found no negative connection. In fact, there was a small benefit in moderate consumption, which is considered to be three to five cups of black coffee a day. Another meta-analysis of studies between 2001 and 2011 found four or more cups a day had a preventive effect on the risk of stroke.
    As for prostate cancer, this 2011 study followed nearly 59,000 men from 1986 to 2006 and found drinking coffee to be highly associated with lower risk for the lethal form of the disease.
    2012 headline: Coffee lowers risk of heart failure
    More meta-analysis of studies on heart failure found four cups a day provided the lowest risk for heart failure, and you had to drink a whopping 10 cups a day to get a bad association.
    2013 headline: Coffee lowers risk of heart disease and helps you live longer
    For general heart disease a meta-analysis of 36 studies with more than 1.2 million participants found moderate coffee drinking seemed to be associated with a low risk for heart disease; plus, there wasn’t a higher risk among those who drank more than five cups a day.
    How about coffee’s effects on your overall risk of death? One analysis of 20 studies, and another that included 17 studies, both of which included more than a million people, found drinking coffee reduced your total mortality risk slightly.
    2015 headline: Coffee is practically a health food
    As a sign of the times, the U.S. Department of Agriculture now agrees that “coffee can be incorporated into a healthy lifestyle,” especially if you stay within three to five cups a day (a maximum of 400 mg of caffeine), and avoid fattening cream and sugar. You can read their analysis of the latest data on everything from diabetes to chronic disease here.
    2017 headline: Yes, coffee still leads to a longer life
    The largest study to date on coffee and mortality surveyed 520,000 people in 10 European countries and found that regularly drinking coffee could significantly lower the risk of death.
    Another study with a focus on non-white populations had similar findings. That study surveyed 185,000 African-Americans, Native Americans, Hawaiians, Japanese-Americans, Latinos and whites. The varying lifestyles and dietary habits of the people observed in both studies led the authors to believe that coffee’s impact on longevity doesn’t have to do with how its prepared or how people drink it — it has to do with the beverage’s biological effect on the body.
    But stay tuned. There’s sure to be another meta-study, and another opinion. We’ll keep you updated.

    Read more: http://www.cnn.com/2015/08/14/health/coffee-health/index.html

    Does Fatherhood Make Men Healthier?

    With Fathers Day here yet again, its time to address the question on everyones mind: What is the health impact of being a father?

    As with all critical questions relating to life and death, there is medical literature to help guide us. First, the epidemiologic: The proportion of adults who choose not to be parents is growing and sits at 20 percent or so. Most of the data is from women and for good reasonfemales have a shorter, more knowable duration of fertility. Plus they always know when they are a parent.

    A guy, however, may impregnate and run, never knowing of the child he left behind (see: 1,001 traveling salesman and milkman jokes). Plus, he can remain potent a long while: Strom Thurmond fathered several children in his seventies while Saul Bellow last became a father at age 84.

    Given the vagueness of the starting and stopping point for men, it is unsurprising that I could find no report that estimated the proportion of childless men. There is however a mature vocabulary for men and women alike: Childlessness can be voluntary or involuntary, has an upbeat newish namechild-freecountless blogs and spirited books, and a political slant around the notion that reproducing is somehow self-adoring and short-sighted.

    The medical side of fatherhood (or its lack) has mostly focused on that group of men who are involuntarily fatherlessi.e., those who have tried but never successfully fathered children. The group that prefers not to procreate represents an unknowable proportion in the various studies but likely sits in the minority.

    Various outcomes have been examined. These include cancer, heart disease, and overall mortality. Each article, though, carries the same extremely important caveat: The causal link between offspring number and medical condition is uncertain at best. Most investigators hypothesize that a subtle hormonal derangement such as too much or too little estrogen or androgen (the hormones involved in determining sexual characteristics) is known to affect the risk of heart disease and stroke and also may render a person less fertile. Therefore the medical problem and the childless state may be consequences of the same physiology and not a linear cause and effect.

    Therefore, a well-performed study of more 137,000 men recruited to an AARP cohort found that married men who have no children have a higher risk of dying from cardiovascular disease than men with two or more children, which might be explained by the fact that the same hormone imbalance that was reducing fertility also was increasing risk for cardiovascular disease. These authors, from leading institutions across the U.S., including Stanford and the National Cancer Institute, concluded that their findings agreed with more than a half-dozen similar studies finding an uptick in heart disease among the childless.

    Ditto for prostate cancer, though in the other direction. Prostate cancer, like heart disease, appears related to subtle hormone imbalances; that is why the disease is often treated by using feminizing hormones. Several studies have sought to correlate risk of prostate cancer with number of offspring; most but not all show a lower risk among childless men. Perhaps, authors have speculated, the men who are not able to father because of a touch too much feminizing hormone are protected from some risk for prostate cancer risk by the same imbalance.

    A large Danish study addressing these issues made quite a flurry at the end of 2012 (here, here, and here for example). Any study on population-based disease rates from Denmark should make the newsthey lead the world in well-performed, dispassionate, and statistically balanced inquiry.

    This exploration found that, compared to the childless, the risk of premature mortality for those who had children was sharply reduced: Men with children had half the rate and women, one-fourth. The fine lines of the article (which were not so fine at all but loudly trumpeted) were not read carefully by some. Thankfully, a watchdog group of unskewers at the Science Media Centre examined the actual facts. The group studied was an altogether skewed collection of 21,276 Danish couples who had sought help in an infertility clinic. The researchers then compared the health outcomes of those who successfully did or did not successfully become pregnantand the difference in rates was startling.

    Yet the actual number of premature deaths, as the Science Media group (and the authors themselves) pointed out, went from a really really really small number to just a really really small one. And more importantly, the group studiedthose already seeking help for infertilitywas not representative of the adults who have children without difficulty or those who opt for the child-free life.

    Perhaps then it is time for a new tradition: the Fathers Day resolution, an annual promise dads everywhere should make to embrace the acuteness of the male condition, its fragility in modern life. After all, Fathers Day is the lone moment in the year that celebrates being, well, just a guy. Oh sure, the Super Bowl and all its macho imitators are commemorations of some repulsive male urge best ignored. But being a son or a father or both is its own glorious reward and, man, thats something worth celebrating.

    Read more: http://www.thedailybeast.com/articles/2014/06/14/does-fatherhood-make-men-healthier

    Real Open Heart Surgery | Social Medical Network

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    Dr. Nabil Munfakh and Dr. Sunil Prasad perform open heart surgery on a patient suffering from heart disease involving her heart valve and arteries.
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    Open Heart Surgery Performed at Christian Hospital in St. Louis, Missouri

    Dr. Nabil Munfakh and Dr. Sunil Prasad perform open heart surgery on a patient suffering from heart disease involving her heart valve and arteries.

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