NATIONAL RANKING
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
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.
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
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.”
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.
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.
The brain has a central role in regulating appetite and energy balance. Metabolic adaptations to weight loss include1-5:
References:
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13 cancers are associated with excess weight and obesity
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.
Physician-initiated discussions motivate patients to lose weight and change behavior6,7
Physician-initiated discussions motivate patients to lose weight and change behavior6,7
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
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
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But U.S. experts greet report with caution, urge further research
Welcome to our UpToDate library. The information shared below is provided to you as an educational and informational source only and is not intended to replace a medical examination or consultation, or medical advice given to you by a physician or medical professional.
Haleh Milani, MD, FACC, is the medical director of Central Park West Physicians, a multispecialty group practice with cardiology, internal medicine, primary care and an endocrinologist located at: 115 Central Park West, Suite 1, New York, NY 10023, and 3220 Fairfield Avenue, Riverdale, NY 10463. Call: 212.543.3400 or fax: 212.873.1960.
