People who wish to look after their heart health are aware that regularly eating vegetables is key.
A new study from Edith Cowan University (ECU) in Joondalup, WA, in Australia finds that leafy greens and other vegetables high in nitrates in particular confer significant cardiovascular benefits.
Researchers found that daily consumption of a cup of vegetables rich in nitrates is associated with better heart health.
“Our results have shown that, by simply eating 1 cup of raw (or half a cup of cooked) nitrate-rich vegetables each day, people may be able to significantly reduce their risk of cardiovascular disease.”
Green leafy vegetables high in nitrates includespinach, lettuce, arugula (also known as rocket), Chinese cabbage, and parsley. Non-leafy vegetables with strong nitrate content include radishes, fennel, and beet.
The researchers estimate that cooking reduces a vegetable’s nitrate content by about 50%, but that is still enough to promote heart health.
Dr. Bondonno said, “The greatest reduction in risk was for peripheral artery disease — 26% — a type of heart disease characterized by the narrowing of blood vessels of the legs. However,” she added, “we also found people had a lower risk of heart attacks, strokes, and heart failure.”
The authors note that their findings are consistent with four earlier studies.
The researchers analyzed 23 years of data for 56,468 residents of Denmark who participated in the Danish Diet, Cancer, and Health Study. All individuals filled out a food frequency questionnaire, and the resulting data was cross-referenced against public health records.
Analysis revealed that people in the highest fifth of intake of vegetable nitrates exhibited a 2.58 mm Hg, or millimeters of mercury, lower systolic blood pressure — which is the first value in a blood pressure reading — compared with those in the lowest intake group (after adjustments for possible confounding differences between the groups).
The higher the nitrate intake, the greater the fall in blood pressure. The top intake group ate an average of 141 milligrams (mg) of nitrate per day. This is equivalent to 2–2.5 cups of leafy vegetables daily.
In contrast, the impact of nitrate intake on hospitalizations across all types of cardiovascular disease (CVD) plateaued at 59 mg per day. It did not increase with further nitrate intake.
Overall, there was a 15% reduction in CVD admissions over the 23 years of follow-up, compared with those with the lowest nitrate intake, which was 23 gm per day. The greatest reduction in risk — at 26% — was seen in hospitalizations for peripheral artery disease.
Speaking to Medical News Today, Dr. Edo Paz of K Health, who was not involved in the research, said he considers the study significant due to its large sample size and lengthy follow-up period.
“However,” he noted, “this is an observational study, and there are some key limitations as a result.” He explained:
“In particular, it is highly likely that people who eat vegetables have other healthy behaviors that are different than those people who do not eat vegetables. For instance, these participants may be more likely to maintain a healthy weight, exercise more, smoke less, etc. Even though the authors try to account for these variables, this is still a key limitation inherent to observational studies in general.” – Dr. Edo Paz
Just a cup
The study suggests that the equivalent of a cup of raw or half a cup of cooked green leafy vegetables of this kind a day is just about the right amount for long-term heart health. “We did not see further benefits in people who ate higher levels of nitrate-rich vegetables,” said Dr. Bondonno.
“People don’t need to be taking supplements to boost their nitrate levels,” Dr. Bondonno said, “because the study showed that one cup of leafy green vegetables each day is enough to reap the benefits for heart disease.“
Dr. Paz told MNT: “It’s important to remember that everything should be eaten or consumed in moderation. If extreme amounts of nitrate are ingested, it could lead to methemoglobinemia, which is a condition in which red blood cells have reduced ability to carry oxygen.”
“Fortunately, methemoglobinemia is relatively rare and is more commonly caused by nitrate contamination of drinking water.”
Dr. Bondonno does not recommend juicing vegetables if you want to enjoy the optimal nitrate benefit, since juicing removes pulp and fiber.
On the other hand, blending vegetables is fine. She recommends including a cup of spinach in a berry smoothie as an easy, enjoyable way for people to consume their vegetables.
The unmistakable taste and smell of coffee — not to mention its ability to perk people up in the morning — have made it one of the world’s most popular beverages.
Better still, observational studies indicate that coffee may protect against cardiovascular disease, diabetes, Parkinson’s disease, and certain cancers.
Prospective studies, which follow people over time, have provided evidence that drinking this beverage is safe for most people and is associated with lower mortality rates.
However, a new study suggests that some of the supposed health benefits of coffee for cardiovascular health may have been overblown. The research was limited to white British participants.
As a result of the caffeine that coffee contains, excessive consumption can cause unpleasant symptoms such as tachycardia (a fast resting heart rate) and palpitations.
Drinking coffee can also lead to a moderate, temporary increase in blood pressure.
So it may come as a surprise that regular coffee drinkers either have normal or reduced blood pressure compared with people who do not drink coffee.
One explanation may be that coffee drinkers develop a physiological tolerance for the effects of caffeine.
But a new study suggests that people with a high genetic risk of cardiovascular disease unconsciously reduce how much they drink to avoid unpleasant cardiovascular symptoms.
The research found that individuals with high blood pressure, angina, or arrhythmia drank less caffeinated coffee and were more likely to drink decaffeinated coffee.
Crucially, there was strong evidence that their genetic vulnerability to cardiovascular disease led to their reduced consumption of coffee.
This rules out the alternative explanation that consuming less coffee made them more vulnerable to cardiovascular disease.
“Whether we drink a lot of coffee, a little, or avoid caffeine altogether, this study shows that genetics are guiding our decisions to protect our cardio health,” Professor Elina Hyppönen, who led the research and directs the Australian Centre for Precision Health at the university.
“If your body is telling you not to drink that extra cup of coffee, there’s likely a reason why,” she adds. “Listen to your body — it’s more in tune with your health than you may think.”
In observational studies, this effect could give the false impression that coffee prevents high blood pressure and protects the heart.
In reality, people vulnerable to high blood pressure may simply avoid drinking coffee because, for them, the caffeine is more likely to cause unpleasant symptoms.
The scientists drew on information about 390,435 white British participants aged 39–73 years who are part of a medical and genetic database called UK Biobank.
On recruitment, participants reported their regular coffee consumption. Researchers also measured their blood pressure and heart rate and noted any cardiovascular symptoms.
Participants with high blood pressure, angina, or arrhythmia consumed less caffeinated coffee compared with those without these symptoms.
To determine whether regular coffee consumption caused the symptoms, or whether the symptoms triggered a reduction in coffee consumption, the researchers used a statistical technique called Mendelian randomization.
This technique exploits the random inheritance of genetic variants that increase a person’s risk of a particular outcome later in life — in this case, the association between blood pressure and heart rate with habitual coffee consumption.
Because factors, such as lifestyle or diet, cannot change a person’s genetic sequence, any associations that the researchers discovered must be due to the gene variants rather than any other factors.
When they analyzed the data, it showed that having a particular genetic variant determined how much coffee a person drank.
“What this means is that someone who drinks a lot of coffee is likely more genetically tolerant of caffeine, as compared to someone who drinks very little,” says Prof. Hyppönen.
“Conversely, a noncoffee drinker, or someone who drinks decaffeinated coffee, is more likely prone to the adverse effects of caffeine and more susceptible to high blood pressure,” she adds.
Psychological effects
Medical News Today asked Prof. Hyppönen whether the psychological effects that some people experience when they drink a lot of coffee, such as anxiety and agitation, could also play a role.
“This is not something that we looked at in our study, but any unpleasant sensation that an individual feels in response to coffee consumption is likely to reduce their wish to drink coffee,” said Prof. Hyppönen.
MNT asked Dr. Edo Paz, a doctor atdigital primary care platform K Health, about the effects of drinking too much coffee.
He responded:
“[D]rinking too much coffee can result in headache, anxiety, tremors, and difficulty sleeping. With regards to the heart, in particular, excess coffee intake can result in palpitations and may trigger events in the heart, such as abnormal heart rhythms, in susceptible individuals.”
The problem of reverse causation
The findings of the new research suggest that observational studies that found an association between coffee consumption and better health may have fallen prey to “reverse causation.”
In other words, heart health issues led people to drink less coffee, rather than the other way round.
Prof. Hyppönen said Mendelian randomization studies had cast doubt on other apparent protective effects.
For example, epidemiological studies have led people to infer that moderate alcohol consumption protects against cardiovascular disease, and that having excess weight reduces mortality compared with moderate weight.
“According to [Mendelian randomization] studies, there does not appear to be any benefit for having [excess weight] versus [slim or moderate] weight, with the possible exception for smokers,” she said.
Smoking reduces appetite and hence weight, but it also has links with a wide range of negative effects on health.
“Also for alcohol, [the] evidence suggests linear increases in blood pressure and stroke risk, with no benefit for light alcohol consumption,” she added.
While further studies are necessary using a more diverse population, this study suggests using a considered, personalized approach when promoting high coffee intakes.
High blood pressure is a dangerous condition that can damage your heart. It affects one in three people in the US and 1 billion people worldwide (1Trusted Source, 2).
If left uncontrolled, high blood pressure raises your risk of heart disease and stroke.
But there’s good news. There are a number of things you can do to lower your blood pressure naturally, even without medication.
Regular exercise can help lower your blood pressure.
Exercise is one of the best things you can do to lower high blood pressure.
Regular exercise helps make your heart stronger and more efficient at pumping blood, which lowers the pressure in your arteries.
In fact, 150 minutes of moderate exercise, such as walking, or 75 minutes of vigorous exercise, such as running, per week, can help lower blood pressure and improve your heart health (3Trusted Source, 4Trusted Source).
What’s more, doing even more exercise than this reduces your blood pressure even further, according to the National Walkers’ Health Study (5Trusted Source).
Bottom line: Walking just 30 minutes a day can help lower your blood pressure. More exercise helps reduce it even further.
2. Reduce your sodium intake
Salt intake is high around the world. In large part, this is due to processed and prepared foods.
For this reason, many public health efforts are aimed at lowering salt in the food industry (6Trusted Source).
Many studies have linked high salt intake with high blood pressure and heart events, including stroke (7Trusted Source, 8Trusted Source).
However, more recent research indicates that the relationship between sodium and high blood pressure is less clear (9Trusted Source, 10).
One reason for this may be genetic differences in how people process sodium. About half of people with high blood pressure and a quarter of people with normal levels seem to have a sensitivity to salt (11Trusted Source).
If you already have high blood pressure, it’s worth cutting back your sodium intake to see if it makes a difference. Swap out processed foods with fresh ones and try seasoning with herbs and spices rather than salt.
Bottom line: Most guidelines for lowering blood pressure recommend reducing sodium intake. However, that recommendation might make the most sense for people who are salt-sensitive.
3. Drink less alcohol
Drinking alcohol can raise blood pressure. In fact, alcohol is linked to 16% of high blood pressure cases around the world (12Trusted Source).
While some research has suggested that low-to-moderate amounts of alcohol may protect the heart, those benefits may be offset by adverse effects (12Trusted Source).
In the U.S., moderate alcohol consumption is defined as no more than one drink a day for women and two for men. If you drink more than that, cut back.
Bottom line: Drinking alcohol in any quantity may raise your blood pressure. Limit your drinking in line with the recommendations.
When you’re chronically stressed, your body is in a constant fight-or-flight mode. On a physical level, that means a faster heart rate and constricted blood vessels.
When you experience stress, you might also be more likely to engage in other behaviors, such as drinking alcohol or eating unhealthful food that can adversely affect blood pressure.
Several studies have explored how reducing stress can help lower blood pressure. Here are two evidence-based tips to try:
Listen to soothing music: Calming music can help relax your nervous system. Research has shown it’s an effective complement to other blood pressure therapies (21Trusted Source, 22Trusted Source).
Work less: Working a lot, and stressful work situations, in general, are linked to high blood pressure (23Trusted Source, 24).
Bottom line: Chronic stress can contribute to high blood pressure. Finding ways to manage stress can help.
7. Eat dark chocolate or cocoa
Here’s a piece of advice you can really get behind.
While eating massive amounts of dark chocolate probably won’t help your heart, small amounts may.
That’s because dark chocolate and cocoa powder are rich in flavonoids, which are plant compounds that cause blood vessels to dilate (25Trusted Source).
A review of studies found that flavonoid-rich cocoa improved several markers of heart health over the short term, including lowering blood pressure (25Trusted Source).
For the strongest effects, use non-alkalized cocoa powder, which is especially high in flavonoids and has no added sugars.
Bottom line: Dark chocolate and cocoa powder contain plant compounds that help relax blood vessels, lowering blood pressure.
8. Lose weight
In people with overweight, losing weight can make a big difference to heart health.
According to a 2016 study, losing 5% of your body mass could significantly lower high blood pressure (26Trusted Source).
In previous studies, losing 17.64 pounds (8 kilograms) was linked to lowering systolic blood pressure by 8.5 mm Hg and diastolic blood pressure by 6.5 mm Hg (27Trusted Source).
To put that in perspective, a healthy reading should be less than 120/80 mm Hg (4Trusted Source).
The effect is even greater when weight loss is paired with exercise (27Trusted Source).
Losing weight can help your blood vessels do a better job of expanding and contracting, making it easier for the left ventricle of the heart to pump blood.
Bottom line: Losing weight can significantly lower high blood pressure. This effect is even more significant when you exercise.
9. Quit smoking
Among the many reasons to quit smoking is that the habit is a strong risk factor for heart disease.
Every puff of cigarette smoke causes a slight, temporary increase in blood pressure. The chemicals in tobacco are also known to damage blood vessels.
Surprisingly, studies haven’t found a conclusive link between smoking and high blood pressure. Perhaps this is because smokers develop a tolerance over time (28).
Still, since both smoking and high blood pressure raise the risk of heart disease, quitting smoking can help lessen that risk.
Bottom line: There’s conflicting research about smoking and high blood pressure, but what is clear is that both increase the risk of heart disease.
10. Cut added sugar and refined carbs
There’s a growing body of research showing a link between added sugar and high blood pressure (29, 30, 31).
In the Framingham Women’s Health Study, women who drank even one soda per day had higher levels than those who drank less than one soda per day (32).
Another study found that having one less sugar-sweetened beverage per day was linked to lower blood pressure (33Trusted Source).
And it’s not just sugar — all refined carbs, such as the kind found in white flour — convert rapidly to sugar in your bloodstream and may cause problems.
Some studies have shown that low carb diets may also help reduce blood pressure.
One study on people undergoing statin therapy found that those who went on a 6-week, carb-restricted diet saw a greater improvement in blood pressure and other heart disease markers than people who did not restrict carbs (34Trusted Source).
Bottom line: Refined carbs, especially sugar, may raise blood pressure. Some studies have shown that low carb diets may help reduce your levels.
11. Eat berries
Berries are full of more than just juicy flavor.
They’re also packed with polyphenols, natural plant compounds that are good for your heart.
Polyphenols can reduce the risk of stroke, heart conditions, and diabetes, as well as improving blood pressure, insulin resistance, and systemic inflammation (34).
One study assigned people with high blood pressure to a low-polyphenol diet or a high-polyphenol diet containing berries, chocolate, fruits, and vegetables (35).
Those consuming berries and polyphenol-rich foods experienced improved markers of heart disease risk.
Bottom line: Berries are rich in polyphenols, which can help lower blood pressure and the overall risk of heart disease.
12. Try meditation or deep breathing
While these two behaviors could also fall under “stress reduction techniques,” meditation and deep breathing deserve specific mention.
Both meditation and deep breathing may activate the parasympathetic nervous system. This system is engaged when the body relaxes, slowing the heart rate, and lowering blood pressure.
There’s quite a bit of research in this area, with studies showing that different styles of meditation appear to have benefits for lowering blood pressure (36Trusted Source, 37Trusted Source).
Deep breathing techniques can also be quite effective.
In one study, participants were asked to either take six deep breaths over the course of 30 seconds or simply sit still for 30 seconds. Those who took breaths lowered their blood pressure more than those who just sat (38Trusted Source).
Try guided meditation or deep breathing. Here’s a video to get you started.
Bottom line: Both meditation and deep breathing can activate the parasympathetic nervous system, which helps slow your heart rate and lower blood pressure.
13. Eat calcium-rich foods
People with low calcium intake often have high blood pressure.
While calcium supplements haven’t been conclusively shown to lower blood pressure, calcium-rich diets do seem linked to healthful levels (39Trusted Source, 40Trusted Source).
For most adults, the calcium recommendation is 1,000 milligrams (mg) per day. For women over 50 and men over 70, it’s 1,200 mg per day (41).
Bottom line: Calcium-rich diets are linked to healthy blood pressure levels. You can get calcium through eating dark leafy greens and tofu, as well as dairy.
14. Take natural supplements
Some natural supplements may also help lower blood pressure. Here are some of the main supplements that have evidence behind them:
Aged garlic extract: Researchers have used aged garlic extract successfully as a stand-alone treatment and along with conventional therapies for lowering blood pressure (42Trusted Source, 43Trusted Source).
Berberine: Traditionally used in Ayurvedic and Chinese medicine, berberine may increase nitric oxide production, which helps decrease blood pressure (44Trusted Source, 45Trusted Source).
Whey protein: A 2016 study found that whey protein improved blood pressure and blood vessel function in 38 participants (46Trusted Source).
Fish oil: Long credited with improving heart health, fish oil may benefit people with high blood pressure the most (47Trusted Source, 48).
Hibiscus: Hibiscus flowers make a tasty tea. They’re rich in anthocyanins and polyphenols that are good for your heart and may lower blood pressure (49Trusted Source).
Bottom line: Researchers have investigated several natural supplements for their ability to lower blood pressure.
15. Eat foods rich in magnesium
Magnesium is an important mineral that helps blood vessels relax.
While magnesium deficiency is pretty rare, many people don’t get enough.
Some studies have suggested that getting too little magnesium is linked with high blood pressure, but evidence from clinical studies has been less clear (50Trusted Source, 51Trusted Source).
Still, eating a magnesium-rich diet is a recommended way to ward off high blood pressure (51Trusted Source).
You can incorporate magnesium into your diet by consuming vegetables, dairy products, legumes, chicken, meat, and whole grains.
Bottom line: Magnesium is an essential mineral that helps regulate blood pressure. Find it in whole foods, such as legumes and whole grains.
Take home message
High blood pressure affects a large proportion of the world’s population.
While drugs are one way to treat the condition, there are many other natural techniques, including eating certain foods that can help.
Controlling your blood pressure through the methods in this article may, ultimately, help you lower your risk of heart disease.
SHOP FOR OVER-THE-COUNTER REMEDIES
If you want to buy any of the over-the-counter remedies listed in this article, then they are available online.
Humans first drank caffeinated tea more than 4,000 years ago in China. Since then, it has become one of the most popular drinks worldwide, second only to water.
Both green and black teas are brewed from the leaves of the same shrub, Camellia sinensis, but green tea, which is made from unfermented leaves, contains more antioxidants.
Oxidation during the fermentation process of black tea reduces its antioxidant levels.
Several studies have found that green tea inhibits the formation of cancers, lowers high blood pressure, and reduces the risk of heart disease.
However, the molecular mechanism responsible for the effect on blood pressure has been unclear until now.
Scientists at the University of California, Irvine (UCI) and the University of Copenhagen, in Denmark, have found that antioxidants in tea open ion channels and can relax the muscles that line blood vessels.
The discovery could guide the design of more effective antihypertensive drugs, which could potentially improve the health of millions of people around the world.
According to the National Heart, Lung, and Blood Institute, controlling or lowering high blood pressure can help prevent chronic kidney disease, heart attacks, heart failure, and possibly dementia.
The Centers for Disease Control and Prevention (CDC) report that almost half of all adults in the United States have hypertension. It estimates that in 2018, the condition played a role in the deaths of nearly half a million people in the country.
The new study first shows that two antioxidants in tea, known as catechins, open a protein channel in the membranes of the smooth muscle cells that line blood vessels. This allows positively charged potassium ions to leave the cells.
Channels in nerve and muscle cells maintain voltages across their membranes by allowing negative and positive ions to pass in and out in a controlled way. They are “voltage-gated,” which means that they respond to changes in this voltage by opening or closing.
The researchers found that the catechins in green tea activate a particular type of potassium ion channel, called KCNQ5.
Previous work by some of the same scientists suggests that this protein channel may underlie the antihypertensive effects of several plants used as folk medicines for millennia.
Voltage sensor
For the new study, the researchers used computer modeling and mutated versions of the channel protein to show that the two catechins bind to a section that senses voltage changes.
“This binding allows the channel to open much more easily and earlier in the cellular excitation process,” explains senior study author Prof. Geoffrey Abbott, of the Department of Physiology & Biophysics at the UCI School of Medicine.
In theory, this should make the muscle cells less “excitable” and therefore less likely to contract. They should instead relax, dilating the blood vessel and reducing blood pressure.
To test this theory, Prof. Abbott’s co-authors at the University of Copenhagen measured changes in tension in the walls of arteries from rats. Their findings confirmed that the two catechins from tea relax and dilate arteries by activating the KCNQ5 ion channel.
Milky tea
The authors are confident that adding a dash of milk to black tea does not reduce its antihypertensive effects.
Milky tea, applied directly to cells in the lab, failed to activate their KCNQ5 channels. But this is likely not the case when a person drinks it.
Prof. Abbott explains:
“We don’t believe this means one needs to avoid milk when drinking tea to take advantage of the beneficial properties of tea. We are confident that the environment in the human stomach will separate the catechins from the proteins and other molecules in milk that would otherwise block [the] catechins’ beneficial effects.”
The scientists also discovered that warming green tea to 35°C increased the activation of KCNQ5.
However, lovers of iced tea need not be concerned.
“Regardless of whether tea is consumed iced or hot, this temperature is achieved after tea is drunk, as human body temperature is about 37°C,” says Prof. Abbott. “Thus, simply by drinking tea, we activate its beneficial, antihypertensive properties.”
Electrical activity in the brain
KCNQ5 also exists in the membranes of nerves in the brain, where it helps regulate electrical activity and signal transmission.
People with a disorder called epileptic encephalopathy have a version of the channel protein that does not respond effectively to voltage changes, which leads to frequent seizures.
The study authors point out that catechins can cross the blood-brain barrier, which prevents larger molecules, including some drugs, from entering the brain.
In theory, drugs modeled on catechin molecules could, therefore, help correct the cause of epileptic encephalopathy.
“Discovery of their ability to activate KCNQ5 may suggest a future mechanism to fix broken KCNQ5 channels to ameliorate brain excitability disorders stemming from their dysfunction,” the researchers conclude.
Globally, heart disease is the number one cause of death. It is responsible for 17.9 million deaths each year.
According to the Centers for Disease Control and Prevention (CDC), in the United States, one person dies every 36 seconds from cardiovascular disease. Heart disease accounts for 1 in 4 deaths in the U.S.
As February is American Heart Month, today, we will tackle some persistent myths about heart disease.
1. Young people do not need to worry about heart disease
It is true that heart disease is more likely to affect people over the age of 65, but 4–10% of heart attacks occur in people under the age of 45 years, mainly in men. In addition, it is how we live our lives as children, adolescents, and adults that lays the groundwork for heart health as we age.
For instance, eating a diet that is high in trans and saturated fats or smoking tobacco slowly increases the risk of heart disease as we age. Changes to lifestyle today build the foundation for a healthier heart in later life.
In the U.S. as a whole, heart disease mortality has slowly dropped since the 1970s, although the trend seems to be slowing. However, in some regions, rates have increased.
One study that investigated heart disease mortality in different age groups in the U.S. found that “over 50% of counties [experienced] increases in heart disease mortality from 2010 through 2015 among adults aged 35–64 years.”
2. People should avoid exercise if they have heart disease
This is a myth. Exercise helps strengthen the heart muscle and improve blood flow around the body.
In August 2020, the European Society of Cardiology published guidelines on exercise in patients with cardiovascular disease. Prof. Sanjay Sharma, who was involved in creating the guidelines, explains:
“The chance of exercise triggering a cardiac arrest or heart attack is extremely low.” However, he also adds a note of caution: “People who are completely inactive and those with advanced heart disease should consult their doctor before taking up sports.”
3. I take cholesterol-lowering drugs, so I can eat whatever I like
Some drugs, such as statins, reduce the level of cholesterol in the blood. However, this does not mean that a person who is taking statins can consume foods containing saturated fats with abandon.
Cholesterol is either consumed in the food that you eat or produced in the liver. Statins block an enzyme in the liver that is necessary for producing cholesterol, reducing overall blood cholesterol levels. However, this means that ingested cholesterol can still make it into the blood.
In short, statins may just be able to override the adverse effects of a poor diet, but a poor diet will increase risk of other independent risk factors for heart disease, such as obesity, hypertension, and diabetes.
4. Heart disease runs in my family, so there is nothing I can do to stop it
If close family members have experienced heart disease, it could mean that you have an increased risk. However, it is not set in stone, and there are a number of ways to reduce the risk, even for people with a genetic susceptibility.
It is also worth noting that if heart disease runs in the family, it may not be a sign of genetic susceptibility. Families tend to share lifestyle factors, such as diet and exercise habits, both of which can impact the risk of heart disease.
5. Vitamins can prevent heart disease
Although most vitamins, taken at the recommended doses, are unlikely to be bad for heart health, there is no evidence that taking any vitamin supplements can reduce the risk of heart disease. And they certainly cannot replace a healthful diet and regular exercise.
For instance, a systematic review and meta-analysis looked for associations between multivitamin and mineral supplements and a number of cardiovascular outcomes, including coronary heart disease and stroke.
The analysis, published in 2018, took data from 18 existing studies, including 2,019,862 participants.
The authors concluded that multivitamin and mineral “supplementation does not improve cardiovascular outcomes in the general population.”
According to Victoria Taylor, the nutrition lead at the British Heart Foundation: “There are no shortcuts when it comes to nutrition — supplements are not a replacement for healthy food. You might be prescribed a vitamin or mineral supplement by a health professional for other reasons, but we do not recommend people take multivitamins to help prevent heart and circulatory diseases.”
6. I have smoked for years, there is no point stopping now
This is a myth. Smoking tobacco is a major cause of heart disease. As soon as a person stops smoking, the health benefits begin. The National Institute on Aging write:
“It doesn’t matter how old you are or how long you’ve been smoking, quitting smoking at any time improves your health. When you quit, you are likely to add years to your life, breathe more easily, have more energy, and save money.”
They also explain that you will lower the risk of heart attack and stroke and have better circulation.
7. Heart disease only really affects men
This is a myth, as heart disease is the leading cause of death in both men and women. In 2017 in the U.S., 24.2% of men and 21.8% of women died from heart disease.
However, when strokes, which have similar risk factors, are added in, the figures are even more similar between men and women: 28.7% of men and 28% of women died from heart disease or stroke.
It is a common misconception that only men are affected by heart disease. It is true that men tend to develop cardiovascular disease at an earlier age than women and have a greater risk of coronary heart disease. However, women have a higher risk of stroke.
One paper explains, “Although the incidence of [cardiovascular disease] in women is usually lower than in men, women have a higher mortality and worse prognosis after acute cardiovascular events.”
8. Cardiac arrest and heart attack are the same
Heart attacks and cardiac arrests are not the same thing. A heart attack is a circulation problem. It occurs when the coronary artery, which carries oxygenated blood to the muscles of the heart, becomes blocked.
A cardiac arrest is an “electrical problem,” where the heart stops pumping blood around the body effectively. Cardiac arrests are often caused by a heart attack.
During a heart attack, an individual is likely to be conscious. During a cardiac arrest, they are almost always unconscious. Both are a medical emergency.
9. Coughing during a heart attack can save your life
According to some sources, coughing vigorously during a heart attack — so-called cough CPR — can save your life.
This is an internet distortion of a paper published over 40 years ago, which showed that patients who had a cardiac arrest during arteriography in hospital and who coughed every 1–3 seconds stayed conscious for an additional 39 seconds.
There is no evidence that this technique works in the community for heart attacks that are not induced by medical procedures.
“The absolute priority when you think you or someone else is having a heart attack is to call [the emergency services]. This way, paramedics can assess and aid you, and you’ll get to hospital as fast as possible. There is no medical evidence to support ‘cough CPR.’”
10. People with heart disease should avoid eating all fat
A person with cardiovascular disease certainly should reduce their intake of saturated fats — which are found in foods such as butter, biscuits, bacon, and sausages — and partially hydrogenated and trans fats, which are found in foods such as baked goods, frozen pizzas, and microwave popcorn.
However, unsaturated fats can provide benefits. For instance, there is some evidence that omega-3, which is a polyunsaturated fat, might protect heart health.
The American Heart Association recommend “that all adults eat fish (particularly fatty fish) at least 2 times a week. Fish is a good source of protein and is low in saturated fat. Fish, especially oily species like mackerel, lake trout, herring, sardines, albacore tuna, and salmon, provide significant amounts of the two kinds of omega-3 fatty acids shown to be cardioprotective, [eicosapentaenoic acid] and [docosahexaenoic acid].”
They also recommend eating plant-derived omega-3 fatty acids. These can be found in tofu and other forms of soybeans; walnuts, flaxseeds, and their oils; and canola oil.
The take-home
Heart disease is common, but it is not inevitable. There are lifestyle changes that we can all implement to reduce the risk of developing cardiovascular problems, whatever our age.
Researchers have raised alarm over rising cases of hypertension among teenagers and adolescents especially those in secondary schools across the nation.
In fact, several studies concluded that the prevalence of hypertension in Nigerian children is high and appears to be increasing and there is need for routine Blood Pressure (BP) and urinalysis check for all children in especially those in clinics and wards.
Indeed, studies suggest a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. They say efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity.
According to a study published in the journal The Lancet Public Health and titled “Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis”, hypertension in children and adolescents is becoming a major concern, not only because of its rising prevalence, but also because of evidence suggesting that hypertension tracks from childhood to adulthood. Almost half of adults with hypertension had elevated blood pressure values during childhood.x
Furthermore, several studies have suggested that elevated blood pressure in childhood correlates with carotid intima-media thickness, atherosclerosis, left ventricular hypertrophy, and kidney failure in adulthood. Consequently, the study recommended early diagnosis and control of hypertension in childhood are likely to have an important effect on long-term outcomes of hypertension-related cardiovascular complications.
A recent study published in European Journal of Medical and Health Sciences concluded: “There is a noteworthy prevalence of hypertension among adolescent public secondary school students in Nnewi. This was significantly higher among the female gender, lower socioeconomic level and students with minimal physical activity. Waist circumference in the obese/overweight category very likely predicts hypertension.”
The study titled “Blood Pressure Profiles And Determinants Of Hypertension Among Public Secondary School Students In Nnewi, Southeast Nigeria” was conducted by Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.
According to the researchers, hypertension and associated factors among adolescents have not been given the deserved attention in health care, more so as hypertensive children end up as hypertensive adults with serious co-morbidities. This is even more expedient among public school students, who in our environment are generally of lower socioeconomic status than those in private schools.
The researchers set out to determine the Blood Pressure (BP) profiles and association of obesity indicators, socioeconomic level and physical activity with hypertension among public secondary school students.
A cross-sectional school-based assessment of blood pressure (BP), body mass index (BMI), weight to height ratio (WHR), waist circumference (WC), physical activity and socioeconomic level among 593 students aged 10 – 17 years in public schools in Nnewi, Southeast Nigeria was carried out.
The results of the study showed the mean systolic BP increased with age and was higher for girls than for boys.x
“The prevalence of systolic hypertension and prehypertension were 8.4 per cent and 6.6 per cent respectively, while that of diastolic hypertension and prehypertension were 5.7 per cent and 11.8 per cent respectively. Both systolic and diastolic hypertension occurred in 2.4 per cent of students. Girls had a higher prevalence of hypertension – both systolic and diastolic. There was no significant gender difference in the prevalence of systolic hypertension and prehypertension between early and late adolescents.
Early adolescent males were more likely to have diastolic hypertension and prehypertension compared to late adolescent males, while no difference in prevalence was noted among the females. Systolic hypertension was more evident in the lower socioeconomic level, those with minimal physical activity, and those in the obese/overweight categories of BMI, WC, and WHR,” the researchers noted.
Blood pressure is recorded as two numbers: Systolic blood pressure (the first number) – indicates how much pressure your blood is exerting against your artery walls when the heart beats.
Diastolic blood pressure (the second number) – indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.
Which number is more important? According to studies, typically, more attention is given to systolic blood pressure (the first number) as a major risk factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and an increased incidence of cardiac and vascular disease.
However, either an elevated systolic or an elevated diastolic blood pressure reading may be used to make a diagnosis of high blood pressure. According to recent studies, the risk of death from ischemic heart disease and stroke doubles with every 20 mm Hg systolic or 10 mm Hg diastolic increase among people from age 40 to 89.
The abbreviation mm Hg means millimeters of mercury. Mercury was used in the first accurate pressure gauges and is still used in medicine today as the standard unit of measurement for pressure.x
Another study titled “Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria” and published in Italian Journal of Pediatrics concluded: “Our study revealed a relatively high prevalence rate of hypertension and prehypertension among adolescents studied and these were more common among female subjects.
“It is therefore recommended that periodic screening and monitoring of blood pressure of adolescents should be incorporated into the school health programme, while general public health education on hypertension and its associated risk factors should be strengthened.”
The researchers are from University of Nigeria Teaching Hospital (UNTH) Enugu.
According to the researchers, hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood.
To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu State, a study of 2,694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as prehypertension, hypertension and BMI were obtained.x
The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4 per cent and 17.3 per cent respectively with a higher rate in females (6.9 per cent) than males (3.8 per cent). Prevalence of prehypertension among males and females were 14.3 per cent and 20.1 per cent respectively. The prevalence of obesity was 1.9 per cent. Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended.
Meanwhile, hypertension has been defined by levels of BP above, which lowering BP will reduce the cardiovascular risk associated with elevated BP and this level has been classically documented at 140/90 mmHg in adults. The new 2017 American College of Cardiology/American Heart Association guideline set hypertension stage 1 at greater than 130/80 mmHg rather than 140/90 mmHg as in the European guidelines.
According to a study titled “Hypertension in children: Could the prevalence be on the increase?” and published in the Nigerian Medical Journal, factors such as age, height, and gender are important factors in interpreting BP values in children. The most widely used definition of hypertension in children is delineated as BP greater than 95 per cent of expected BP for age, gender, and height.
The researchers from the Departments of Paediatrics, College of Medicine, Enugu State University of Technology and College of Medicine, University of Nigeria, Nsukka, Nigeria; and Child Survival Unit, Medical Research Council, Fajara, The Gambia, said unlike in adults where essential hypertension is very common, both secondary and essential (primary) hypertension are seen in children– primary hypertension being influenced by factors such as birth weight, maturity during birth, heredity, and diet while secondary is influenced by renal abnormalities, coarctation of the aorta, medications, neoplasm, etc.
Worldwide, the prevalence of hypertension in children ranges between one per cent and five per cent, with a significant proportion of them under-diagnosed. The prevalence of hypertension in children and adolescents in the United States of America is 3.3 per cent, whereas in Europe, prevalence ranging from 2.2 per cent to 22 per cent has been documented. Across Africa, the prevalence also varies between 0.2 per cent and 24.8 per cent, with a pooled figure of 5.5 per cent.
In Nigeria, various studies have also demonstrated similar prevalence rates in the neighborhood of 3.5 per cent and six per cent. In 2013, in Enugu, southeast Nigeria, Ujunwa et al. reported a prevalence of 5.4 per cent. A similar study in 2014 on pre-school children in Enugu, Nigeria, noted a comparatively low prevalence rate of elevated BP prevalence of 1.9 per cent.x
The authors opined that the prevalence of hypertension in children mighy still be on the increase. A higher prevalence value, however, may be expected when other groups of children are considered since BP increases with growth and development and results in hypertension during the first two decades of life. Although the pathogenesis of raised BP in obese children is not widely understood, evidence abounds on other comorbid conditions, which further accentuate the risk of hypertension. Aside from the risks associated with it, childhood hypertension is a major killer and one of the most common health concerns in children worldwide.
There is also substantive evidence linking it with long-term cardiovascular risk in adulthood. Therefore, it is of public health importance.
The researchers noted: “BP measurement is usually done for adults and has proven to be crucial in the assessment of cardiovascular health. This important measurement is not usually done routinely for children, although childhood hypertension detection is a measurement identifying potential future morbidity (essential hypertension) or existing underlying disease (secondary hypertension). In general, screening of children for hypertension is focused on essential hypertension since this is usually asymptomatic in children and may go unnoticed, but later becomes a risk in adulthood. Secondary hypertension comes to the fore with the presentation of the underlying disease. Consequently, childhood essential hypertension has been termed a strong predictor of hypertension in the adult population.
“Interestingly, identifying children with elevated BP and successfully treating them will have an impact on long-term outcomes of cardiovascular disease as well as a sizeable effect on hypertension-related morbidity and mortality. The cost implication of treating adults with raised BP will be addressed when attention is paid to childhood primary hypertension. To further understand the degree of attention that should be given to hypertension in childhood, knowledge of its prevalence and factors associated with it need to be continuously emphasized. It can also inform the need for routine BP check in children and adolescents in the routine children’s clinic.”
Meanwhile, as part of efforts to curb non communicable diseases including hypertension, the World Health Organisation (WHO) on Tuesday, launched a year-long global campaign for World No Tobacco Day 2021 – “Commit to Quit.” The new WHO Quit Challenge on WhatsApp and publication “More than 100 reasons to quit tobacco” are being released today to mark the start of the campaign.
The COVID-19 pandemic has led to millions of tobacco users saying they want to quit. The campaign will support at least 100 million people as they try to give up tobacco through communities of quitters.
“Commit to Quit” will help create healthier environments that are conducive to quitting tobacco by advocating for strong tobacco cessation policies; increasing access to cessation services; raising awareness of tobacco industry tactics, and empowering tobacco users to make successful quit attempts through “quit & win” initiatives.
WHO, together with partners, will create and build-up digital communities where people can find the social support they need to quit. The focus will be on high burden countries* where the majority of the world’s tobacco users live.
WHO welcomes new contributions from partners, including private sector companies that have offered support, including Allen Carr’s Easyway, Amazon Web Services, Cipla, Facebook and WhatsApp, Google, Johnson & Johnson, Praekelt, and Soul Machines.x
Quitting tobacco is challenging, especially with the added social and economic stresses that have come as a result of the pandemic. Worldwide around 780 million people say they want to quit, but only 30 per cent of them have access to the tools that can help them do so. Together with partners, WHO will provide people with the tools and resources they need to make a successful quit attempt.
“Smoking kills eight million people a year, but if users need more motivation to kick the habit, the pandemic provides the right incentive,” said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus.
WHO released a scientific brief earlier this year showing that smokers are at higher risk of developing severe disease and death from COVID-19. Tobacco is also a major risk factor for noncommunicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes. Moreover, people living with these conditions are more vulnerable to severe COVID-19.
Both global and regional cessation tools will be rolled out as part of the campaign. WHO’s 24/7 digital health worker to help people quit tobacco is available in English and will soon be released to support people in Arabic, Chinese, French, Russian, and Spanish.
“Millions of people worldwide want to quit tobacco – we must seize this opportunity and invest in services to help them be successful, while we urge everyone to divest from the tobacco industry and their interests,” said Dr. Ruediger Krech, Director of Health Promotion.
To create environments conducive to quitting tobacco, WHO has worked with partners and countries around the globe to implement tobacco control measures that effectively reduce the demand for tobacco.
WHO calls on all governments to ensure their citizens have access to brief advice, toll-free quit lines, mobile and digital cessation services, nicotine replacement therapies and other tools that are proven to help people quit. Strong cessation services improve health, save lives and save money.
Nigeria is one of the 22 campaign focus countries.
Two studies involving postmenopausal females found that sedentary behavior increased their risk of developing heart failure and that walking lowered their risk of high blood pressure.
For people spending more time at home as a result of the COVID-19 pandemic, the new research provides an impetus to go for more walks and avoid sitting too long in front of computer or television screens.
In the two studies, which the University at Buffalo (UB), NY, led, researchers found that postmenopausal females who went for brisk walks and spent less time sitting or lying down during their waking hours had a lower risk of hypertension and heart failure, respectively.
“Walking and moving are simple activities that can be easily integrated into our daily lives,” says Jean Wactawksi-Wende, Ph.D., dean of UB’s School of Public Health and Health Professions (SPHHP) and a co-author of both studies.
The research drew upon data collected over several years from females who took part in the Women’s Health Initiative. The participants were 50–79 years of age at the start of the studies.
The results suggest that regardless of overall levels of physical activity, walking more and being less sedentary can benefit cardiovascular health.
“Sit less, walk more for heart health,” advises Michael LaMonte, Ph.D., research associate professor of epidemiology at the SPHHP.
LaMonte was the senior author on the paper that linked walking to a reduced risk of hypertension and first author on the paper that found an association between sedentary behavior and an increased risk of heart failure.
Walking and hypertension
The walking research followed 83,435 females who did not have a diagnosis of hypertension, heart failure, coronary heart disease, or stroke at the start of the study.
All of the participants reported that they could walk at least one block without assistance.
During the average follow-up period of 11 years, 38,230 participants received a diagnosis of hypertension.
After adjusting for other possible contributing factors, including other types of physical exercise, the participants who walked the most were 11% less likely to develop hypertension than those who walked the least.
Participants who were among the fastest walkers had a 21% lower risk of hypertension compared with those who walked the slowest.
Even after adjusting the figures to account for the overall amount of time that each participant spent walking and the distance they covered, a walking speed of at least 2 miles per hour was associated with a significant reduction in the risk of hypertension.
The study suggests that walking briskly has a more significant effect on hypertension risk than either the total distance or the duration of walks.
“To put it simply, get your steps in, and try to make them quick,” says Connor Miller, who was the lead researcher on the study, which he worked on while obtaining his master’s in epidemiology at UB. He is now an epidemiologist at Roswell Park Comprehensive Cancer Center in Buffalo.
“Our work adds to growing evidence that you don’t necessarily have to be an avid jogger or cyclist to gain health benefits from physical activity,” he adds.
The findings of this study appear in the journal Hypertension.
Sedentary behavior and heart failure
The study of sedentary behavior followed 80,982 females who had not received a diagnosis of heart failure at the start of the study and were able to walk at least one block unassisted.
The participants regularly filled out questionnaires that included questions about the amount of time they spent sitting or lying down in their waking hours.
During the average follow-up period of 9 years, there were 1,402 cases of hospitalization for heart failure.
In their analysis, the researchers adjusted the figures to account for a wide range of other possible confounding factors, including the participants’ age, race/ethnicity, smoking status, alcohol consumption, and use of hormone replacement therapy.
Compared with the participants who reported sitting for no more than 4.5 hours a day, sitting for 4.6–8.5 hours a day was associated with a 14% increased risk of heart failure.
Sitting for more than 8.5 hours per day was associated with a 54% increased risk of heart failure.
Even among females with the highest levels of recreational physical activity, the risk of heart failure was significantly raised if they spent more than 9.5 hours per day sitting or lying down.
“This latter finding points to the need to not only promote more physical activity for heart failure prevention but to also promote interruption of sedentary time throughout the day,” says LaMonte.
In their paper, the researchers say that the risks of heart failure associated with prolonged sedentary behavior are on a par with those for obesity and diabetes.
Other studies suggest that sedentary behavior promotes the development of atherosclerosis (narrowing of the arteries supplying the heart muscle), the authors write, which, in turn, increases a person’s risk of heart failure.
Medical News Today have reported a range of other possible negative health effects of sedentary behavior, including obesity, type 2 diabetes, and cancer.
Limitations of the research
Both studies had some limitations in common.
The researchers could not rule out the possibility that some participants had undiagnosed underlying health conditions at the start of the study. These could have affected their walking and sedentary behavior.
Also, both studies relied upon the participants’ estimates of how far and fast they walked or the amount of time they spent sitting or lying down.
Finally, the study of sedentary behavior only gauged the total time that people spent sitting or lying down. Other research, using accelerometers to record participants’ movements, suggests that the length of each uninterrupted bout of sedentary behavior is also an important factor.
A newly released study found that people with heart failure who received the diabetes drug empagliflozin showed significant improvements in heart structure and function, with many experiencing a reversal of the disease.
Approximately 6.2 million adults in the United States have heart failure. As a result of its high prevalence, the national cost of healthcare services, medicines, and missed workdays related to this disorder reached an estimated $30.7 billion in 2012.
Globally, the disease affects approximately 23 million people.
What is heart failure?
Heart failure occurs when the heart cannot pump blood effectively to other parts of the body, causing symptoms that include shortness of breath, difficulty breathing, weakness and tiredness, and weight gain and swelling in the legs, ankles, feet, or stomach.
It may progress to congestive heart failure due to the buildup of fluids in the lungs, liver, and lower extremities.
Underlying causes of heart failure include coronary artery disease, high blood pressure, obesity, heart valve disease, and diabetes. Over time, these diseases may result in “adverse modeling,” which is the heart’s attempt to compensate for its added workload by getting larger, developing thicker walls, and pumping more frequently.
Among people with heart failure, about 50% present with heart failure with reduced ejection fraction (HFrEF). The lowered ejection fraction occurs when the heart’s left ventricle cannot pump blood effectively, decreasing the amount of blood that leaves the ventricle to circulate the body after each contraction.
Treatment options for heart failure include taking prescription drugs, reducing the amount of sodium in the diet, consuming a lower volume of liquids, and making any necessary lifestyle changes, such as reaching a moderate weight, quitting smoking, and eating a heart-healthy diet.
New study shows promising results
With limited heart failure treatment options available, researchers from the Icahn School of Medicine at Mount Sinai set up a clinical trial called EMPATROPISM to investigate the use of empagliflozin, a diabetes drug, for treating HFrEF in people without diabetes.
The researchers presented the trial results on November 13 at the American Heart Association (AHA) Scientific Sessions 2020, with a pre-proof appearing in the Journal of the American College of Cardiology.
In the double-blind, placebo-controlled, randomized study, the scientists divided the 84 participants, who were 18–85 years of age, into two groups. One group received 10 milligrams (mg) of empagliflozin daily, and the other took a placebo.
At the trial’s onset, all of the participants underwent baseline evaluations, which included cardiac MRI, a 6-minute walk test, and a cardiopulmonary exercise test to determine their oxygen levels. They also completed questionnaires regarding their quality of life.
After 6 months of receiving either the placebo or empagliflozin, the participants completed the same tests again.
The researchers found that approximately 80% of those who received the medication showed significant improvement in their condition, with a 16.6% improvement in left ventricle ejection fraction.
They also experienced a reduction in heart size and thickness and had less congestion, indicating that their heart failure had become less severe.
Remarkably, the investigators note that the heart returned to near normal in this group of participants.
Additionally, those who received empagliflozin experienced no severe side effects and saw improvements in their exercise levels and quality of life, which occurred relatively quickly after beginning the medication.
Although empagliflozin is an antidiabetes drug, the investigators noted no adverse blood sugar-related side effects, such as hypoglycemia, in the study participants, despite them not having diabetes.
Conversely, the study participants who took the placebo showed no improvements. Their condition either stayed the same or worsened, with a further reduced ejection fraction, increased heart size and thickness, and an abnormal change in the heart’s overall shape.
According to the researchers, the study results also explain why this medication effectively treats heart failure. They explain that it essentially reverses the adverse modeling that occurs when the heart attempts to restructure itself to compensate for changes associated with other chronic conditions.
Supporting evidence
The EMPEROR-Reduced trial, a slightly earlier study that featured in the New England Journal of Medicine, saw similar results. In this double-blind trial, 3,730 people with HFrEF took either empagliflozin (10 mg once daily) or a placebo, in addition to recommended therapy.
The results concurred with the EMPATROPISM findings, showing that people both with and without diabetes in the empagliflozin group experienced a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group.
Researchers look to the future
The EMPATROPISM study’s first author, Carlos Santos-Gallego, a postdoctoral fellow at the Icahn School of Medicine, explains the implications of these findings.
He says, “Our clinical trial’s promising results show this diabetes drug can ameliorate lives of heart failure patients with reduced ejection fraction, enhance their exercise capacity, and improve their quality of life with little to no side effects.”
“We expect this work will help lead to U.S. Food and Drug Administration [FDA] approval of empagliflozin for this patient population in the coming months.”
New research has found that short bursts of exercise may significantly improve levels of metabolites that are indicators of key physical health issues.
The research, published in the journal Circulation, offers scientists a better understanding of the beneficial effects exercise can have on a person’s health.
Health and physical activity
Scientists have known for a long time that there is a link between physical activity and better health. As the Centers for Disease Control and Prevention (CDC) say, “Regular physical activity is one of the most important things you can do for your health.”
The CDC note that regular exercise can improve a person’s brain health; help them better manage their weight; reduce their chances of developing various diseases, including diabetes, some cancers, and cardiovascular disease; strengthen their muscles and bones; and improve mental health.
While scientists are well aware of these links, they do not fully understand the precise molecular mechanisms that help explain the link between being physically active and maintaining better health.
Metabolites
In this context, the researchers wanted to look at the association between metabolites that are indicators of health and exercise.
A person’s metabolism describes the chemical reactions that take place in their body. Metabolites either facilitate these reactions or are the end result of them. Scientists have identified relationships between exercise and certain changes in metabolites.
Dr. Gregory Lewis, section head of Heart Failure at Massachusetts General Hospital (MGH) and senior author of the study, says, “Much is known about the effects of exercise on cardiac, vascular, and inflammatory systems of the body, but our study provides a comprehensive look at the metabolic impact of exercise by linking specific metabolic pathways to exercise response variables and long-term health outcomes.”
He continues:
“What was striking to us was the effects a brief bout of exercise can have on the circulating levels of metabolites that govern such key bodily functions as insulin resistance, oxidative stress, vascular reactivity, inflammation, and longevity.”
Burst of exercise
The researchers made use of the Framingham Heart Study (FHS), a long-term study directed by the National Heart, Lung, and Blood Institute.
The researchers measured 588 metabolites in 411 middle-aged people before and immediately after 12 minutes of physical activity on an exercise bike. This allowed them to see the effect that exercise has on the metabolome.
In general, the researchers found that the short burst of exercise significantly altered 80% of a participant’s metabolites. In particular,they found that metabolites associated with adverse health outcomes when resting were reduced.
For example, high levels of glutamate have been linked to diabetes, heart disease, and hypertension, and the researchers found that these levels fell by 29% following exercise. The levels of dimethylguanidine valerate (DMGV), which are associated with liver disease and diabetes, fell by 18% following exercise.
Marker of fitness?
The researchers note that their findings may be valuable in helping doctors determine a person’s fitness levels.
Dr. Matthew Nayor, a cardiologist in the Heart Failure and Transplantation section of the MGH Cardiology Division, explains, “Intriguingly, our study found that different metabolites tracked with different physiologic responses to exercise, and might therefore provide unique signatures in the bloodstream that reveal if a person is physically fit, much the way current blood tests determine how well the kidney and liver are functioning.”
He adds, “Lower levels of DMGV, for example, could signify higher levels of fitness.”
By combining the information they gained from this analysis with blood samples taken during previous rounds of the FHS, the researchers were also able to determine the longer-term effects of exercise on a person’s metabolome.
Dr. Ravi Shah of the Heart Failure and Transplantation section of the MGH Cardiology Division notes, “We’re starting to better understand the molecular underpinnings of how exercise affects the body and use that knowledge to understand the metabolic architecture around exercise response patterns.”
He adds, “This approach has the potential to target people who have high blood pressure or many other metabolic risk factors in response to exercise, and set them on a healthier trajectory early in their lives.”
A clinical trial has found that a monoclonal antibody reduces low-density lipoprotein (LDL) cholesterol levels by 50% in people with an inherited condition called familial hypercholesterolemia.
Individuals with high levels of low-density lipoprotein (LDL) or “bad” cholesterol in their blood are at increased risk of developing atherosclerosis (narrowed arteries) and cardiovascular disease.
Cardiologists in the U.S. recommend that individuals who are at very high risk of cardiovascular disease due atherosclerosis aim for an LDL cholesterol level of around 70 mg/dl of blood.
Lifestyle changes can help reduce LDL, but people usually need to take cholesterol-lowering drugs to reach this goal. In addition, certain genetic differences can make achieving this objective more difficult for some people.
Worldwide, approximately 1 in 250 adults have an inherited condition called heterozygous familial hypercholesterolemia. This usually results from mutations in a gene for a receptor that removes LDL from the bloodstream.
Doctors usually prescribe a standard “triple therapy” of three types of cholesterol-lowering drugs for hypercholesterolemia:
A high dose of a statin, which reduces the amount of cholesterol the body produces.
A PCSK9 inhibitor, which boosts the number of LDL receptors in the liver.
Ezetimibe, which limits the absorption of cholesterol from the intestine.
For individuals whose LDL cholesterol level remains too high despite taking the maximum tolerable dose of this drug combination, a new drug called evinacumab that acts on a different target may soon be available.
A clinical trial published in The New England Journal of Medicine suggests that evinacumab could further reduce LDL levels in these individuals by around 50%.
This would be good news for people with mutations in the gene for the LDL receptor who don’t respond particularly well to PCSK9 inhibitors.
“There’s an unmet need for agents that address refractory hypercholesterolemia through a pathway that’s independent of the LDL receptor,” explains principal investigator Robert Rosenson, MD, Director of Cardiometabolic Disorders at the Icahn School of Medicine at Mount Sinai in New York, N.Y.
“If approved by the U.S. Food and Drug Administration, evinacumab may potentially fill that clinical gap for patients by reducing severely elevated LDL cholesterol,” he adds.
Breaking down lipids
Evinacumab is a monoclonal antibody that targets a protein called angiopoietin-like 3 (ANGPTL3). Normally, ANGPTL3 inhibits enzymes that break down lipids, including LDL, high-density lipoprotein (HDL), and triglycerides.
People with a faulty version of the gene that makes ANGPTL3 have abnormally low levels of these lipids in their blood. As a result, their chance of developing coronary artery disease is 41% lower than the general population.
By disabling ANGPTL3 with an antibody, drug developers hoped to recreate these beneficial effects in people with very high cholesterol levels.
In this phase II clinical trial, the researchers randomly assigned 272 people to receive either evinacumab — through intravenous or subcutaneous administration at various doses — or placebo treatments.
Most of the participants had heterozygous familial hypercholesterolemia.
After 16 weeks, LDL cholesterol had fallen by an average of 56% compared with placebo in those who received a subcutaneous dose of 450 mg of evinacumab weekly.
Among those who received a monthly intravenous injection of 15 mg evinacumab per kilogram of body weight, LDL cholesterol fell by 50.5% compared with the placebo group.
The authors note that some people prefer subcutaneous administration because they can do it themselves at home, avoiding the need to take time off work to visit a clinic.
Commenting on the findings, Dr. Rosenson concludes:
“Our study demonstrates that a regimen of either subcutaneous or intravenous evinacumab can have a significant impact on LDL cholesterol […] If approved for use in this setting, evinacumab could potentially arm cardiologists with a major new add-on therapy to bring patients with [heterozygous familial hypercholesterolemia] to or closer to their cholesterol-lowering goal.”
Racial diversity
The authors concede that their study had some limitations. For example, the numbers in each arm of the study were relatively small, and treatment lasted only 16 weeks.
In addition, the racial diversity of participants was not as broad as the researchers had hoped, so the results may not apply to all people in the wider population.
One of the people treated with subcutaneous evinacumab had difficulty breathing, and another had a mild anaphylactic reaction.
The pharmaceutical company Regeneron, which makes evinacumab, sponsored the study.
