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Exercising More After Heart Attack Tied to Lower Mortality Rates

Heart attack survivors who step up their exercise efforts may live longer than those who remain inactive, a Swedish study suggests.

Compared to patients who were inactive for the first 10 to 12 months after their heart attack, patients who were active during that whole time were 71% less likely to die during the four-year study, researchers reported December 11 online in the Journal of the American Heart Association.

People who were inactive at first but who increased their activity levels over time, meanwhile, were 59% less likely to die during the study than their constantly sedentary counterparts, and even people who reduced their activity levels but still got at least a little exercise were 44% less likely to die.

Overall, the study involved 22,227 patients who were surveyed twice about their activity levels: at 6 to 10 weeks after a heart attack, and again 10 to 12 months afterward. After an average follow-up of about four years, 1,087 people died.

The current study offers fresh evidence of the potential to improve survival odds by exercising after a heart attack, or by trying to keep up with some workouts even if a previous level of exercise is difficult to maintain.

"If you have not been active before your (heart attack), don't worry, start now, it will improve your health and prognosis," lead study author Orjan Ekblom of the Swedish School of Sport and Health Sciences in Stockholm said by email. "If you have been active before your (heart attack) great, but keep it up."

"For individuals who cannot exercise it is important to underline that exercise is only a limited part of physical activity," Ekblom advised. Just moving more around the home, or taking slow walks, can help, along with other things like reducing stress and avoiding alcohol and tobacco.

It's possible that exercise benefits people after a heart attack in many of the same ways it does before, said Claude Bouchard of the Pennington Biomedical Research Center in Baton Rouge, Louisiana.

Among other things, exercise might help improve risk factors for cardiovascular disease like obesity, high blood pressure, elevated blood sugar, high cholesterol, excess liver fat, and chronic inflammation, Bouchard, who wasn't involved in the study, said by email.

Like other people, heart attack survivors should aim for about 150 minutes a week of moderate intensity activity, Bouchard said.

"Walking is the easiest form of activity to pursue this goal," Bouchard advised. "It has a very low risk of injury and allows for easy quantification of the exercise dose."

The study wasn't a controlled experiment designed to prove whether or how activity levels might directly influence mortality rates after a heart attack.

Another limitation is that it only asked how many days each week people got at least 30 minutes of physical activity; this doesn't help assess which types of exercise, or how much, might be ideal.

"However, based on the available literature to date, it seems like even low levels of physical activity even below the current recommendations relate to improved survival," said Trine Moholdt of the Norwegian University of Science and Technology.

While patients should check with their physicians before starting a new exercise routine, it's likely that there would be good options for people at almost any fitness level, Moholdt, who wasn't involved in the study, said by email.

"Exercise is safe and being sedentary is far more dangerous," Moholdt said.

SOURCE: http://bit.ly/2FcOtug

Mediterranean Diet Named Top Diet for 2019

By Kelly Young

The Mediterranean diet came out on top in U.S. News & World Report's annual ranking of the best diets. Last year, Mediterranean and DASH diets shared the top spot.

A Mediterranean diet is generally low in red meat, sugar, and saturated fat. It's higher in produce, nuts, legumes, olive oil, and fish. The publication ranked it high in terms of being nutritionally sound and including diverse foods. It also ranked first for best heart-healthy diet, best diabetes diet, and best diet for healthy eating.

The DASH and flexitarian diets round out the top three overall diets. In terms of weight loss, Weight Watchers ranked first.

Moderate Alcohol Consumption Linked with Atrial Electrical, Structural Changes

While previous studies have indicated that heavy alcohol consumption is an established risk factor for atrial fibrillation (AFib), a new study suggests that even moderate amounts of alcohol consumption can affect atrial electrical signaling and structure.

The study, published in Heart Rhythm, included 75 patients with AFib who underwent invasive testing and high-density electroanatomic mapping of their atria. The researchers put 25 of each into three categories (lifelong non-drinkers, mild drinkers, and moderate drinkers). Patients consuming two to seven drinks per week were considered mild drinkers, while those who consumed between 8 and 21 drinks were defined as moderate drinkers.

According to the study results, moderate drinkers had lower mean global bipolar voltages (P=0.02), slower conduction velocity (P=0.04), and a higher proportion of complex atrial potentials (P=0.004) when compared to those in non-drinkers. The researchers also reported an increase in global complex potentials (P=0.04) and regional low-voltage zones in the septum and lateral wall (P < 0.05) compared to non-drinkers. Global voltage and conduction velocity did not differ significantly in mild drinkers.

“This study underscores the importance of excessive alcohol consumption as an important risk factor in AF,” lead investigator Professor Peter Kistler, MBBS, PhD, from the Heart Centre at Alfred Hospital in Melbourne, Australia, said in a press release. “Regular moderate alcohol consumption, but not mild consumption, is an important modifiable risk factor for AF associated with lower atrial voltage and conduction slowing.”

He added that the study results are “an important reminder for clinicians who are caring for patients with AFib to ask about alcohol consumption and provide appropriate counselling in those who over-indulge.”

Source: Heart Rhythm

High Blood Pressure In Young Adults Linked To Increased Risk Of Early Heart Disease And Stroke, Studies Suggest.

HealthDay (11/6, Gordon) reports that “two new studies suggest that when people under 40 develop high blood pressure, their risk of early heart disease and stroke go up significantly.” One “study found that in a group of about 5,000 young American adults, having high blood pressure was linked to as much as a 3.5 times higher risk of heart disease and stroke.” The other “study looked at nearly 2.5 million young adults from Korea, and also found that high blood pressure in young people increased their risk of premature heart disease and stroke by up to 85 percent.”

MedPage Today (11/6, Boyles) reports, “The results of the studies, both published in JAMA, suggest that following new and controversial hypertension guidelines may help identify young adults at increased risk for cardiovascular disease.” MedPage Today adds, “The American College of Cardiology (ACC)/American Heart Association (AHA) 2017 hypertension classification update reduced the threshold for hypertension from 140/90 mmHg to 130/80 mmHg, with stage 1 hypertension defined as a systolic BP (SBP) of 130 to 139 mmHg or a diastolic BP (DBP) of 80 to 89 mmHg.”

Late Dinner May Be Linked To Cardiometabolic Risk In American Hispanics, Latinos, Research Suggests.

MedPage Today (11/6, Lyles) reports that research suggests “eating a late dinner may contribute to cardiometabolic risk in American Hispanics and Latinos.” Researchers found that “people who consumed at least 30% of their energy after 6 pm had 23% higher odds of hypertension (OR 1.23, 95% CI 1.05-1.44) and 19% higher odds of prediabetes (OR 1.19, 95% CI 1.03-1.37) compared with those who ate less in the evening.” However, “eating in the evening was not associated with overweight, obesity, or central adiposity in the study.” The findings are scheduled to be presented at the American Heart Association’s Scientific Sessions. Get full ACC coverage of AHA 2018 at ACC.org/AHA2018.

Quitting Smoking Lowers Risk Of Cardiovascular Disease, Study Shows.

HealthDay (11/6, Reinberg) reports a study concluded that within five years of quitting smoking, a person has a 38 percent lower risk of stroke, heart attack, or other forms of cardiovascular disease. However, “it took 16 years after quitting for the risk of cardiovascular disease to return to the level of never smokers.” The researchers looked at data from 8,700 people in the Framingham Heart Study. The findings will be presented at the American Heart Association’s annual meeting. Get full ACC coverage of AHA 2018 at ACC.org/AHA2018.

Science has discovered that physiologic responses to weight loss trigger weight regain^1-5
Weight loss in people with obesity causes changes in appetite hormones that increase hunger and the desire to eat for at least 1 year¹
- Multiple hormones, such as ghrelin, GLP-1, and leptin, play an important role in regulating appetite⁶

The brain has a central role in regulating appetite and energy balance. Metabolic adaptations to weight loss include^1-5:

centph-img-1

References:
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WARNINGS

Overweight and obesity are associated with increased risk of 13 types of cancer. These cancers account for about 40% of all cancers diagnosed in the United States in 2014.

13 cancers are associated with excess weight and obesity

centph-img-2

^aCancer in the tissue covering brain and spinal cord
^bCancer of blood cells
^cPost-menopasual women
- Overall, the rate of new cancer cases has decreased since the 1990s but increases in overweight- and obesity-related cancers are likely slowing this progress.

Reference

2. CDC. Cancers Associated with Overweight and Obesity Make up 40 percent of Cancers Diagnosed in the United States. https://www.cdc.gov/media/releases/2017/p1003-vs-cancer-obesity.html. Accessed February 23, 2018.

A 5% to 10% weight loss may improve obesity-related comorbidities^1-5
- Support from health care professionals can help patients achieve clinically significant and maintained weight loss⁶

Physician-initiated discussions motivate patients to lose weight and change behavior^6,7

A 5% to 10% weight loss may improve obesity-related comorbidities^1-5
- Support from health care professionals can help patients achieve clinically significant and maintained weight loss⁶

Physician-initiated discussions motivate patients to lose weight and change behavior^6,7

Patients are less likely to start the dialogue for many reasons, including:
- Potential for hearing hurtful comments about their weight⁸
- Fear of being blamed for their weight problems⁹
- Shame and embarrassment about their weight⁹
To achieve sustainable weight loss, long-term intervention is often required¹⁰

References:

3. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.

4. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481-1486.

5. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56(2):320-328.

6. Tuomilehto H, Seppa J, Uusitupa M, et al. The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med. 2014;15(3):329-335.

7. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):1619-1626

Patients are less likely to start the dialogue for many reasons, including:
- Potential for hearing hurtful comments about their weight⁸
- Fear of being blamed for their weight problems⁹
- Shame and embarrassment about their weight⁹
- To achieve sustainable weight loss, long-term intervention is often required¹⁰

centph-img-3

References:

10. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. NEngl J Med. 2002;346(6):393-403.

11. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481-1486.

12. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56(2):320-328.

13. Tuomilehto H, Seppa J, Uusitupa M, et al. The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med. 2014;15(3):329-335.

14. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):1619-1626

Identifying and Managing Sleep Disorders in Primary Care

Wondering if you are at risk of having high levels of lipoprotein? We know all about it!

TRAVEL HEALTH PROVIDER INITIATIVE

JULY/AUGUST 2017 NEWSLETTER

Check out the latest Zika Virus video from the New York City Department of Health and Mental Hygiene!

Current Zika Virus Recommendations

Check the World Map of Areas with Risk of Zika before you travel.
The recommendations for travelers to areas with risk of Zika are:
CURRENT PREGNANCY: Women who are pregnant (in any trimester) should not travel to areas with risk of Zika. Men who have traveled to an sexual intercourse for the duration of the pregnancy.
MOSQUITO AVOIDANCE: Prevent mosquito bites while traveling to areas with Zika virus transmission, and for three weeks after returning to the U.S.
PLANNING PREGNANCY: If you or your partner are trying to get pregnant, consider avoiding nonessential travel to areas with a CDC Zika travel notice. Women should wait at least eight weeks after travel before trying to get pregnant. Men should either consistently and correctly use condoms during sexual intercourse or not have sexual intercourse for at least six months after travel to an area with Zika virus transmission.
SYMPTOMS AFTER TRAVEL: Zika virus testing should be offered to people with symptoms of Zika virus disease, including pregnant women and others who develop symptoms during or following travel.

Outbreaks & Security Concerns

Africa

Check the World Map of Areas with Risk of Zika to find out about countries in Africa with risk of Zika. Refer to the Current Zika Virus Recommendations above on how to prevent Zika virus infection when traveling to these countries.
Cases of polio have been reported in Nigeria. The CDC recommends that all travelers to Nigeria be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.
Cases of polio have been reported in the Democratic Republic of the Congo. The CDC recommends that all travelers to the Democratic Republic of the Congo be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.

Asia

Check the World Map of Areas with Risk of Zika to find out about countries in Asia with risk of Zika. Refer to the Current Zika Virus Recommendations above on how to prevent Zika virus infection when traveling to these countries.
Chinese health authorities have confirmed human cases of avian influenza A (H7N9).Travelers to China should practice hygiene and cleanliness, eat food that is fully cooked, and avoid touching birds.

Caribbean, Central and South America

Check the World Map of Areas with Risk of Zika to find out about countries in the Caribbean, Central and South America with risk of Zika. Refer to the Current Zika Virus Recommendations above on how to prevent Zika virus infection when traveling to these countries.
An ongoing outbreak of yellow fever has been reported in Brazil as of December 2016. Health authorities have expanded the list of areas in which yellow fever vaccination is recommended for travelers. Travelers should consult with a yellow fever vaccine provider to determine if they should be vaccinated. Because of a shortage of yellow fever vaccine, travelers may need to contact a yellow fever provider well in advance of travel.

Europe

Health officials in France have reported an outbreak of measles. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.

Middle East

The annual Hajj, or pilgrimage to Mecca, Saudi Arabia, is among the largest mass gatherings in the world. In 2017, Hajj will take place from approximately August 30 to September 4. Because of the crowds, mass gatherings such as Hajj are associated with unique health risks. Before traveling to the Hajj, travelers should visit a travel health specialist for advice, make sure they are up to date on all routine and recommended vaccines, and learn about other health and safety issues that could affect the trip.

North America

Local transmission of Zika virus has been reported in Brownsville, Texas. The CDC has issued guidance for people who live in or traveled to Brownsville, Texas any time after November 28th, 2016. Please refer to the Current Zika Virus Recommendations above on how to prevent Zika virus infection.
Miami-Dade County was previously designated as a Zika cautionary area, but that designation was removed on June 2, 2017. This means that there are no longer any travel recommendations related to Zika virus for Miami-Dade County, Florida. Although the level of risk of Zika virus transmission after a cautionary area designation is removed is not known, it is likely to be low. However, sporadic cases may still occur. For this reason, CDC recommends that people living in or traveling to Miami-Dade County continue to protect themselves from mosquito-borne illnesses.

Pacific Islands

Check the World Map of Areas with Risk of Zika to find out about Pacific Islands with risk of Zika. Refer to the Current Zika Virus Recommendations above on how to prevent Zika virus infection when traveling to these countries.

Traveler Health & Safety Tips

The CDC recommends all travelers:

Visit a health care provider, ideally, 4 to 6 weeks before their trip for personalized health advice, vaccines, and medications.
Avoid bites from mosquitoes and other bugs by using an insect repellent and wearing long-sleeved shirts, long pants, closed shoes, and hats as much as possible.
Stay safe around animals. Do not pet, handle, or feed unfamiliar animals, even pets.
Be safe on international roads. Avoid overcrowded buses and cars, always wear a seat belt, and wear a helmet when riding a bike or motorcycle.
Wash their hands often with soap and water and use a hand sanitizer, as needed.

Resources

Pre-Travel Providers’ Rapid Evaluation Portal (Pre-Travel PREP)
Up-to-date CDC recommendations based on your international traveler’s destination(s), age, and medical condition(s)
Heading Home Healthy
A program to help travelers stay healthy when they are returning home to visit friends and relatives. Supported by Global TravEpiNet, Massachusetts General Hospital and the Centers for Disease Control and Prevention.
The Travelers’ Rapid Health Information Portal (TRhIP)
Customized health information for international travelers based on CDC recommendations
United States Centers for Disease Control and Prevention
Destination-specific travel health information, recommendations, and notices http://www.cdc.gov/travel | (800) CDC-INFO | (800) 232-4636
The New York City Department of Health and Mental Hygiene Bureau of Communicable Disease
For New York City residents, call (347) 396-2600
The Global TravEpi Network
Global TravEpiNet is a national network of travel clinics across the United States. Contact us at This email address is being protected from spambots. You need JavaScript enabled to view it.

This email distribution tool is supported by funding from grant U01CK000175 of the U.S. Centers for Disease Control and Prevention (CDC) to the Massachusetts General Hospital. The tool attempts to capture up-to-date notices and alerts at the time of posting; however, components of this information are constantly changing. By using this tool, you agree that the Massachusetts General Hospital and tool developers/supporters are not liable for any adverse outcomes, including those relating to travel.
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