The link between obesity and cardiac disease is not merely anecdotal, there is proof for that. Now, there is further proof that even overweight causes a clustering of risk factors for cardio vascular abnormalities. A recent publication in Heart Asia, a British Medical Journal, has showed that there is not much difference between the cardio vascular risk factors in obese and overweight people. “The clutch of risk factors – glucose intolerance, hyper tension, high cholesterol – are all significantly higher among overweight and obese subjects than among normal subjects,” Vijay Viswanathan, MV Hospital for Diabetes and Prof. M.Viswanthan Diabetes Research Center said. He co-authored the article with Shabana Tharkar, also from the Indian hospital.
The study, conducted among two groups – 2021 subjects aged over 20 years, and 1289 subjects aged 8-19 years – indicated that even among overweight, 'non-obese' people, the presence of major cardiovascular risk factors was not significantly different. While the total diabetes prevalence among the obese population is 28.4 per cent, among the overweight population is 25 per cent. Again, with hypertension, the value for the obese group is 34.2 per cent, while for the overweight population it is 27.6 per cent. In contrast, the corresponding values are 16.2 per cent (diabetes) and 20.2 (hypertension).
Similarly, the study showed higher values for triglycerides and high HDL cholesterol for both these groups.
Overweight was defined as a Body Mass Index, equal to, or in excess of 25 kg/m2 and obesity, a BMI of 30 kg/m2 or above. Further worrisome is the increasing rate of overweight and obesity among both men and women from 1995 to 2008, across all age groups. Dr. Viswanathan added that this is the result of rapid urbanisation. “Obesity has already hit the Western world and it is time for Indians to wake up to the alarm bells,” according to the article. Results from previous studies show a lower risk of developing diabetes with just a five per cent initial reduction in weight, Dr. Viswanathan said.
The findings highlight the urgent need for framing direct and indirect strategies to control the rising levels of obesity in the population, in order to substantially reduce the country's non communicable diseases burden, he added. Regulating the diet, reducing intake of fast foods and high-calorie meals, and upping physical activity and exercise on a regular basis would go a long way in keeping weight under control, diabetologists advise.
The American Heart Association has compiled its annual list of the top 10 major advances in heart disease. “We have come far in the past decade, reducing heart disease deaths by more than 27 per cent,” said Ralph Sacco of the University of Miami. “But we know there is still much to be done in improving the lives of heart disease and stroke patients – and more importantly, in preventing these devastating diseases in the first place. Scientific research will help us lead the way,” said Sacco.
The highlights of the top ten advances in cardiovascular research in 2010:
1. Tailoring treatment for people with diabetes to reduce their risk of cardiovascular disease
New research from the ACCORD Study Group offered insight into specific treatments that can reduce their risk of cardiovascular disease (CVD). The first study found that aggressive blood pressure control does not reduce CVD risk in people with type 2 diabetes at high risk for CVD. In a second study, a combination therapy with a statin plus a fibrate was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for CVD.
2. New advances for patients who aren't candidates for conventional valve surgery
Two new studies have supported evidence that Transcatheter aortic valve implantation (TAVI) can improve symptoms and outcomes – including quality of life – even over the course of several years. While there are some risks associated with TAVI, including strokes and other major cardiovascular events, the catheter-based procedure offers significant progress in this area.
3. Improving the way we reverse sudden cardiac arrest
Significant studies reported that chest compression only, or ''Hands Only CPR'' for adults by bystander lay rescuers improves survival outcome. Public awareness campaigns resulted in increased use of hands only CPR, as well as improved survival rates. While the new procedure appeared successful in adults, it is important to note that using conventional chest compressions with rescue breathing is still important for children stricken with sudden cardiac arrest.
4. More options for reducing stroke risk in atrial fibrillation
For the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation (AF). Warfarin (Coumadin) has long been the standard anti-clotting drug used to reduce the risk of stroke for these patients. But it carries its own complications from bleeding, and managing the dose requires regular blood tests, making it difficult to manage for both patients and doctors. Now, several new drugs have been found to work as well as warfarin – and are simpler for patients to take – offering an important advance in this field.
5. Adjusting pacing therapies can improve outcomes for heart failure patients
New studies showed that adding additional resynchronization pacing to ICD therapy could lead to improved outcomes in an expanded group of heart failure patients. In addition, new types of ICDs (defibrillators without leads, for example) can offer options that reduce some of the risks associated with traditional devices.
6. Hopeful new procedure for infants with congenital heart disease
The Pediatric Heart Network's randomized trial of Norwood shunt types in infants with single-ventricle lesions showed that the type of shunt used makes a difference in outcomes. Better transplantation-free survival at 12 months is a possibility with this new understanding of the better shunt choice for these patients. This was the first large-scale randomized trial in congenital heart surgery, offering an approach that should provide answers to other questions in the future.
7. Finding the right anti-clotting (anti-platelet) therapy
New research from the PLATO investigators has found that ticagrelor may improve outcomes and reduce adverse events better than the current standard, clopidogrel. The CURRENT-OASIS 7 Trial is exploring the optimal dosing of clopidogrel and aspirin in patient undergoing invasive surgery. These studies will help providers better understand the situations where new choices and dosages may improve results for the patient.
8. Basic science findings offer insight into future progress
Several studies this year brought the future of medicine closer to the present with new insight into emerging technologies. Findings from stem cell therapy have shown improved quality of life and survival in several early studies of patients with chronic heart failure and support the development of future cell-based therapeutics. A large animal study defined the basic mechanisms for heart muscle regeneration initiated by specific types of stem cells. The results demonstrated that these stem cells repair scarred myocardium through promotion of the generation of new heart muscle and blood vessel).
9. Using science to support healthy lifestyle behaviours
New science examining lifestyle behaviours in adults and children, with particular emphasis on physical activity and consumption pattern, show that such conditions as obesity and hypertension are positively influenced by a change in diet with decreasing sodium levels. Results from the school setting suggest that the earlier one starts to adopt healthy behaviours the better the effect on health outcomes.
10. Get With The Guidelines participation eliminates disparity gaps in care
Racial and ethnic disparities have been found in the quality of care delivered to patients with cardiovascular disease and achieving equity and addressing disparities has implications for quality, cost, risk management, and community benefit. These findings are the first to show that participating in a quality improvement program, such as Get With The Guidelines-Coronary Artery Disease, can eliminate racial and ethnic disparities of care while increasing the overall use of evidence-based care for heart attack patients.
Where did the story come from?
The study was carried out by researchers from Hopital de la Pitie and the IPC (Investigations Preventives et Cliniques) Center in Paris, France. It was funded by French public health bodies, the Caisse Nationale d'Assurance Maladie (CNAM) and the Caisse Primaire d'Assurance Maladie de Paris (CPAM-Paris). The study was published in the peer-reviewed European Journal of Clinical Nutrition.
This research was generally covered well by the media, with most stories making it clear that alcohol had not been found to improve health, but rather that people who drank moderately also had better health and social status. The messages from some headlines were more misleading, however, with Metro claiming that “Drinking wine makes you happier” and The Sun suggesting that booze “aids the body”.
The Daily Mail featured particularly clear coverage, with both its headline and article clearly explaining that the good health of moderate drinkers is more likely to be down to healthier diet, exercise and work–life balance rather than any supposed benefits of alcohol.
What kind of research was this?
This cross-sectional study analysed the relationship between alcohol intake, other cardiovascular risk factors and health status in a large French population. The aim was to evaluate potential confounding factors that may be behind the supposed cardiovascular benefits of alcohol.The researchers looked at data on the clinical and biological characteristics of nearly 150,000 people, which were gathered as part of a large ongoing cohort study.
Several observational studies have shown an association between moderate alcohol intake and a lower risk of cardiovascular disease. The lower risk is often attributed to alcohol having beneficial effects on blood levels of lipids, such as cholesterol, or on other factors, such as the effect of the antioxidants in alcoholic drinks. The researchers point out that addressing the underlying message implied by previous data, that moderate alcohol intake is good for health, is particularly important in France, which has one of the highest average individual alcohol intakes in the world.
The researchers also stress that the findings from observational studies need to be viewed with caution, so they assessed a number of key factors not taken into account by previous research. These key, but generally unexplored, factors included mental wellbeing, subjective health status and social factors.
What did the research involve?
All the people in the study underwent a clinical examination between 1999 and 2005, which included measurements blood pressure, waist circumference, cholesterol, respiratory function and heart rate. Also recorded were tobacco use, physical activity, personal medical history, current medications, social status and occupation. Stress and depression scores were assessed using validated questionnaires, and people were also asked to estimate their own health status.
Alcohol intake was quantified as the number of standardised glasses of pure alcohol (10g a glass) consumed each day, and different types of alcoholic drink were also recorded. People were divided into four groups according to their alcohol consumption: never, low (less than 1 glass a day), moderate (1-3 glasses a day) or high (more than 3 glasses a day). Former drinkers were analysed as a separate group. Established statistical techniques were used to analyse the relationship between alcohol intake and all the other factors. The results were adjusted to account for the influence of age and were also broken down by gender.
What were the basic results?
The researchers found that:
13.7% of men and 23.9% of women did not drink at all. Total alcohol intake increased with age in both sexes. Apart from people aged under 30, most people drank wine. They found that women who drank moderate amounts of alcohol had lower body mass index, waist circumference, blood pressure and blood lipids, including LDL (“bad”) cholesterol. Men who drank moderately had lower body mass index, heart rate, blood pressure, some blood lipids (triglycerides) and fasting glucose levels, plus lower stress and depression scores.
Men who drank little or moderately were also more likely to have better self-assessed health status, social status and respiratory function. In both sexes, alcohol intake was strongly associated with higher levels of HDL (“good”) cholesterol, a finding which was independent of the type of alcoholic beverage consumed.
How did the researchers interpret the results?
The researchers concluded that moderate and low consumption of alcohol was strongly associated with several clinical, social and biological characteristics that point to overall better health status and a lower risk of cardiovascular disease. Importantly, they say, few of these factors seem causally related to alcohol consumption.
They point out that social status was “strikingly different” across the groups, with moderate alcohol consumption being a “powerful general indicator” of social status. Risk factors that have never been taken into account before, such as social and professional status, anxiety score and heart rate, were all more favourable in moderate consumers.
Their results, they say, raise the possibility that the seemingly protective effects of moderate alcohol consumption found in previous research may have been due to the researchers not fully taking account of possible confounders.
This research adds a note of caution to the results of previous studies. It concludes that moderate alcohol consumption may be a marker of better health and lower cardiovascular risk rather than a cause of these improvements.
The study's strength is that it is based on a relatively large cohort and that standardised, validated methods were used to collect clinical and biological information. The main weakness of the study is its cross-sectional design, which means that people were not followed up over time to see if they developed disease. This also meant that deaths from heart disease, for example, were not reported.
Another limitation is that alcohol intake was based on self–reported data. This leaves a possibility for error as accurate recall of alcohol consumption is notoriously hard in this type of study. Future research in this area will ideally follow people over time and carefully measure possible risk factors to establish whether alcohol has any direct, causal role in protection from heart disease.
Overall, this study has implications for public health. As the researchers say, its results suggest that it is premature to promote alcohol consumption as an independent factor for cardiovascular protection, as some have proposed based on past research.
The study, in the journal Circulation, looked at 20 relevant studies involving more than one million adults from 10 countries. Each week, the average American eats five 50-gram servings of processed meats. (A 50-gram serving is equivalent to one or two slices of deli meat or one hot dog.)
Micha said these products are likely a heart disease and diabetes hazard not because of their saturated fat and cholesterol content, which was similar to unprocessed red meat, but because they contain four times more sodium and 50 per cent more nitrate preservatives.
Peter Liu, a professor of medicine at the University of Toronto and a cardiologist at the Peter Munk Cardiac Centre, lauded the findings. “What they have found is that not all meats are created equal,” he said.
“I think now, particularly with more concern about obesity in the population, and the high salt content in our food . . . that one may actually want to make a distinction between the food that is 'natural' versus food that has been processed,” Liu said.
Liu said the food industry has been trying to reduce sodium, trans fats and preservatives in their products, but that meat companies may be encouraged to cut the amount of preservatives in processed meat further — essentially shortening a product's shelf life in order to make it healthier.
The study supports advice given by dietitians like Nastaran, who say luncheon meats, processed meats and sausages add sodium to the diet and should be consumed in moderation.
Processed meats should be avoided, Nastaran says. “Or, when you have them, make it a treat and have it few and far between.”
Micha stressed that in past research, meat consumption has been associated with an increased risk for some cancers, and that unprocessed red meat has not yet been independently evaluated for cancer risk.
“People should not use these findings as licence to eat as much unprocessed red meat as they like,” she said, but should instead eat more fruit, vegetables, whole grains, fish and nuts.
•Limit red meat (beef, pork, lamb and goat) to no more than 500 grams (16 1/2 ounces) cooked weight per week
•Select lean cuts and trim away visible fat before eating
•When possible, choose wild meat instead of meat that is raised for food
•Opt for low-temperature cooking methods — steam, stew and bake over frying, broiling and barbecuing
•When barbecuing, marinate meat first to reduce amount of cancer-causing substances by 80 to 90 per cent
•Eat very little if any cured or smoked meat like bacon, sausage, salami, hot dogs and bologna
Source: Dietitians of Canada