Heart News and Notes

Here are our summaries of the ten most read articles in Journal Watch Cardiology last year:

1. The JUPITER trial concluded that four out of five Americans over 50 should get statins even with normal cholesterol.
2. Travel increases the risk of blood clots forming in the legs, increasing with duration, according to a meta-analysis.
3. A meta-analysis confirmed that statins save lives in people without known cardiovascular disease.
4. A study confirmed that NSAIDS should not be used by heart failure patients - too many risks.
5. At one hospital the best test to diagnose unconsciousness - blood pressure change on sitting or standing - was less used than costly and inconclusive tests.
6. An observational study found that taking proton pump inhibitors to lower the risk of stomach bleeding due to Plavix increases the risk of cardiac events.
7. A meta-analysis found no net benefit for aspirin in people without known cardiovascular disease: less heart attack, more hemorrhagic stroke.
8. When warfarin raised INR too much, Vitamin K helped lower INR, but didn’t prevent bleeding, in a multi-center study.
9. A trial meant to decide how to treat diabetics with heart disease came to no clear decision.
10. TIPS (The Indian Polycap Study) found that the five-drug pill was effective and convenient for reducing risk factors.

Last month the American Heart Association issued a list of seven factors that promote “ideal cardiovascular health.” Only about 5 percent of Americans meet these criteria:

1. Never smoked or quit more than a year ago.
2. Keep BMI under 25.
3. Physical activity, 150 minutes moderate or 75 minutes vigorous intensity each week.
4. Eat a healthy diet according to AHA guidelines.
5. Keep total cholesterol under 200.
6. Keep blood pressure under 120/80.
7. Keep fasting blood glucose under 100.

The American Heart Association guidelines for a healthy diet are:

• 4.5 cups a day of fruits and vegetables,
• two or more servings of fish per week,
• less than 450 calories a week of sugar-sweetened drinks,
• three or more one-ounce servings a day of whole grains, and
• less than 1500mg of sodium per day.

Clyde W. Yancy, M.D., president of the American Heart Association, identified last year’s ten most important research results, listing them in no particular order. Here are our summaries:

1. Weight loss was equally successful with low-carbohydrate, low-fat, and other diets, as long as the calorie count was the same.
2. Laws against public smoking led to substantially fewer heart attacks, and one factor was second hand smoke.
3. Quality saves lives: hospitals with “Get With the Guidelines” awards had lower mortality.
4. Ticagrelor, a new anti-clotting drug, worked better than clopidogrel (Plavix) to prevent cardiovascular events.
5. Treatment of Marfan syndrome (an inherited disorder with cardiac complications) can be monitored by measuring circulating transforming growth factor-b (TGF-b).
6. Dabigatran, a new oral blood thinner, worked better than warfarin to prevent stroke in atrial fibrillation patients.
7. Scientists grew beating heart muscle from mouse embryo stem cells - perhaps leading to repair of damaged hearts.
8. Studies identified eight genes associated with blood pressure - possibly helping to understand hypertension.
9. Risk factors in younger people were shown to affect their risk of heart disease later in life.
10. Active heart muscle cells were produced from induced pluripotent stem (IPS) cells in humans - suggesting that a heart might be repaired with a patient’s own tissue.

As reported above, the American Heart Association wants you to keep your BMI below 25 - that’s about 128 pounds at a height of 5’0", 155 at 5’6", and 184 at 6’0". Below that your weight is normal; above it you’re overweight, and above a BMI of 30 you’re obese.

Some studies have found that while overweight people have more heart attacks than normal weight people, they have better survival once they have a heart attack.

Now an analysis of two Australian studies of older people has found that overweight is safest. More than 9000 people age 75 to 80, about half men, half women, gave data on their height, weight, and lifestyle. During a ten year followup, the overweight oldsters had about 13 percent less mortality than either the normal weight or the obese groups.

The researchers point out that the BMI classifications were based on studies of young and middle-aged people. They also found that a sedentary lifestyle doubled the death rate of women but only raised the mortality of men by about one-quarter.

Maybe the message for slightly tubby oldsters is: move it around, but don’t lose it!