Some Fats Actually May Help the Heart

Fewer than half of Americans realize there are two types of dietary fat that actually help their hearts, a new survey shows.

So, while many have heeded the warnings about the cardiovascular dangers of trans fats and saturated fats, the American Heart Association (AHA) now thinks people need to pay more attention to the cardiovascular benefits conferred by polyunsaturated and monounsaturated fats.

As a result of its recent survey, the AHA’s new Face the Fats campaign has harnessed the power of the Internet to encourage people to view these lesser known fats with new respect.

“We’re trying to take education to the next level and say when you have the opportunity to choose, choose the better fat, not the bad fat,” says Dr. Clyde W. Yancy, medical director of the Baylor Heart and Vascular Institute in Dallas and the incoming president of the AHA.

HDL Continues to “Sweep” the Bad Away

The campaign’s Web page presents information at varying levels of sophistication.

The pages include an interactive quiz on fats, menus, recipes, and a Fats 101 course. A Fats Translator calculates a body-mass index from the input of height, weight, age, and level of activity.

The index is a scale ranging from underweight to obesity.

The AHA decided to go digital in this phase of its campaign because “the Web really is becoming the world’s premier information source, so we have to be there,” adds Dr. Yancy.

“When we have lots of polyunsaturated and monounsaturated fats in our diet, our HDL cholesterol goes up and helps protect our arteries from clogging up and hardening,” explains Lona Sandon at the University of Texas Southwestern Medical Center in Dallas.

“HDL kind of acts like a broom and sweeps up the artery-damaging molecules and takes them away,” she says.

Trans fats and saturated fats are more able to stick to blood vessel walls and harden arteries, adds Dr. Yancy.

This process can lead to the rupture of an artery or obstructed blood vessels that can cause heart attacks, strokes, or blood vessel disease.

Moderation on all Fats Advised

Sandon supports the idea of greater education on the different forms of dietary fat.

“I think it’s still very confusing for people,” she says. “They don’t know if they should be eating low fat, what kind of fat.”

She also advises moderation in consumption of any kind of fat. All fats have nine calories per gram, she explained, so even too much of the better fats can lead to weight gain. “They’re healthy, but you can’t go wild with them,” she says.

The Face the Fats campaign is funded by $7 million received from McDonalds USA as part of the settlement of a California class action lawsuit brought by a consumer advocacy group, bantransfat.com, according to the AHA.

McDonald’s recently announced that it has eliminated trans fats from its fried foods by changing to a canola-based cooking oil.

Always consult your physician for more information.

Heart Disease in Men Linked to Teen Years

Normal developmental changes during the teenage years leave young adult men at higher risk of heart disease than their female counterparts, researchers report in the journal Circulation.

“Women’s protective advantage against heart disease starts young,” says lead author Dr. Antoinette Moran, at the University of Minnesota Children’s Hospital.

In adults, a set of factors increases the risk of heart disease.

These factors include high blood pressure, smoking, obesity, physical inactivity, abnormal cholesterol levels, and insulin resistance (a pre-diabetic condition in which the body cannot use insulin effectively).

Good Cholesterol Decreased in Males

To track the risk factors, researchers followed 507 Minneapolis school children from ages 11 to 19, when they had all reached sexual maturity. Fifty-seven percent of the children were male, 80 percent were Caucasian, and 20 percent were African American.

During the study, the researchers made 996 observations on the group, noting blood pressure, insulin sensitivity (opposite to insulin resistance), body mass index (BMI) and other body composition measures, blood glucose, and cholesterol measurements.

“We wanted to see which risks emerge first and how they relate to one another in normal, healthy school kids without diabetes or other major illnesses,” says Dr. Moran.

At age 11, boys and girls were similar in their body composition, lipid levels, and blood pressure, the researchers say.

Boys and girls became heavier during adolescence, increasing in body mass index and waist size. As expected during puberty, changes in body composition differed sharply between genders, with percentage of body fat decreasing in boys and increasing in girls.

During the study, changes in several cardiovascular risk factors or risk markers differed significantly between boys and girls:

• Triglycerides (a type of fat in the blood) increased in males and decreased in females.
• High-density lipoprotein (HDL or “good”) cholesterol decreased in males and increased in females.
• Systolic blood pressure (the first number in the blood pressure reading, measuring the pressure when the heart contracts) increased in both, but significantly more in the males.
• Insulin resistance, which had been lower in the boys at age 11, steadily increased until the young men at age 19 were more insulin resistant than the women.

Researchers found no gender difference in two other cardiovascular risk factors, total cholesterol, and low-density lipoprotein (LDL or “bad”) cholesterol.

“By age 19, the boys were at greater cardiovascular risk,” notes Dr. Moran. “This is particularly surprising because we usually think of body fat as associated with cardiovascular risk, and the increasing risk in boys happened at the time in normal development when they were gaining muscle mass and losing fat.”

Although girls gained cardiovascular protection when their proportion of body fat was increasing, excess fat is still a cause for concern.

“Obesity trumps all of the other factors and erases any gender-protective effect,” says Dr. Moran. “Obese boys and girls and men and women all have higher cardiovascular risk.”

Women’s Hormones May Offer Protection

The researchers say further studies are needed to better understand the development of cardiovascular protection during adolescence.

“That the protection associated with female gender starts young is fascinating and something that we don’t understand very well,” explains Dr. Moran.

“That this protection emerges during puberty and disappears after menopause suggests that sex hormones give women a protective advantage,” he says.

“There’s still a lot that needs to be sorted out in future studies – estrogen may be protective or testosterone may be harmful,” says Dr. Moran.

Dr. Moran says that this is normal physiology and not something that is influenced by lifestyle factors.

Always consult your physician for more information.

Triglycerides Linked to Risk for Heart Disease

High levels of triglycerides are strong predictors of cardiac trouble and this strengthens the case for including measurement of the blood fats in prevention programs, says a study in the Journal of the American College of Cardiology.

“Triglycerides traditionally have been viewed as second-class citizens,” says lead author Dr. Michael Miller, at the University of Maryland Medical Center.

“LDL cholesterol has always taken center stage,” says Dr. Miller. “We know that LDL is intimately involved in bringing cholesterol to scavenger cells, which deposit them to form plaques in the arteries.

“This study shows that triglycerides in and of themselves are also lipids to blame,” notes Dr. Miller.

Under 150 on Triglycerides is Best

The original study was designed to test the effectiveness of two LDL-lowering statins called Pravachol® and Lipitor® in reducing recurring coronary disease after a heart attack.

The new study went over the data on the 4,162 participants in the trial, looking at the association between triglyceride levels and the incidence of heart problems and death.

“The patients who had heart attacks came back after 30 days,” says Dr. Miller. “We measured LDL levels and triglyceride levels and followed them over the next two years, evaluating for the occurrence of new events and death. If a patient had triglyceride levels below 150 [milligrams per deciliter], there was a 27 percent lower risk of having a new event over time,” he says.

“After multiple adjustments for such things as age, diabetes, high blood pressure, and obesity, the risk reduction was 20 percent,” Dr. Miller explains.

Unlike LDL cholesterol, for which there is a recommended blood level of 70 or below, there is no recommended blood triglyceride level but 150 milligrams per deciliter or below is “considered as desirable,” says Dr. Miller.

When the participants were divided into four groups on the basis of both LDL and triglyceride levels, those in the group with under 150 for triglycerides and under 70 for LDL did the best.

They had a 28 percent lower risk than those in the group with the highest readings for both LDL and triglycerides, he says.

“At the present time, we don’t have a recommendation for triglyceride lowering, so the next logical step is a study to determine whether lowering triglycerides and LDL reduces risk more than lowering LDL alone,” he says. Two such studies are in progress, he notes.

Mediterranean Diet a Good Approach

Previous research has already pointed toward such a connection: A study that appeared in the medical journal Neurology last December found a link between triglycerides and stroke risk.

And research published in the Journal of the American Medical Association (JAMA) last July showed that when high triglyceride levels showed up in nonfasting cholesterol tests, there was an increased risk for a future heart attack.

Dr. Leslie Cho of the Women’s Cardiovascular Center at the Cleveland Clinic, notes that the new report “is not a huge surprise.”

She says, “The unique thing about this study is that even if you control bad LDL cholesterol to less than 70, you still need to look at triglycerides.”

The problem with triglycerides is that “they are the most unstable fats in the body,” so that at least two readings are needed to get an accurate measure of blood levels, she explains.

Dr. Miller says, “I am proactive about both LDL cholesterol and triglycerides.”

Several measures can be taken to lower triglyceride levels – many of them are already recommended on general principles for reduction of coronary risk.

One is to eat a Mediterranean diet, rich in fish. Omega-3 fatty acids can lower triglyceride levels, as can niacin, and exercise has a beneficial effect, says Dr. Miller. Statins also have some triglyceride-lowering effect, he notes.

“If you can effectively get both LDL cholesterol and triglycerides down, you are going to do better,” says Dr. Miller.

Always consult your physician for more information.

Surgery Tops Stents for Multiple Heart Blockages

Bypass surgery provides a lower risk of death and heart attacks than do stents for people with blockages of at least two heart arteries, says a report in the New England Journal of Medicine (NEJM).

The finding is far from the last word on the stent-versus-surgery debate in such cases, says study author Dr. Edward L. Hannan, at the State University of New York at Albany.

“But there isn’t any other study right now that is better than this,” he says. “Physicians need to inform patients about these results and need to engage in a dialogue that includes these findings to determine what is the proper treatment for multi-vessel disease.”

Further Studies Will Define State-of-the-Art

Dr. Hannan studied the outcomes of more than 17,400 procedures for people with multiple blocked coronary arteries.

The outcomes were consistently better in an 18-month follow-up for bypass surgery than for the artery-opening procedure called angioplasty followed by insertion of a drug-coated tube known as a stent.

For example, 92.1 percent of those who had surgery for three blocked arteries had no heart attacks and were alive, compared to 89.7 percent of those who got stents.

For those with two blocked arteries, the comparable numbers were 94.5 percent for surgery and 92.5 for stent implants.

The study was not a randomized, controlled trial, which is regarded as the gold standard for medical research.

It was observational, meaning that the researchers simply recorded what happened in medical practice rather than trying to control all the factors involved in choosing a treatment.

“But the randomized trials done in the past have not necessarily been better,” explains Dr. Hannan. “They were restricted to patients who were not very sick, and they also did not recognize that when you compare two treatments, some patients might not prefer the one that is more invasive.”

Surgery is more invasive than angioplasty, since it requires the chest to be cut open. Angioplasty is done by threading a flexible tube called a catheter through a blood vessel into the heart.

One shortcoming of the study is the relatively short follow-up period of 18 months, says Dr. Joseph P. Carrozza, at Harvard Medical School, who wrote an accompanying editorial.

“One would like to see patients followed for up to five years,” says Dr. Carrozza.

“There is nothing in this study that makes us feel surgery is the treatment of choice for patients with multi-vessel disease,” he adds.

Such a verdict will have to wait on the results of several randomized trials now underway, says Dr. Carrozza.

“This is just one piece of evidence we have right now before we get the final word, he explains.

And yet, Dr. Carrozza says, “This is the first really large study to look at this issue now” and thus should be considered by physicians and heart patients requiring treatment for blocked coronary arteries.

Types of Stents Compared in Second Study

Another report in the same issue of the journal compared the safety of bare-metal to drug-coated stents for so-called “off-label” uses – implants for conditions where there is no formal government approval.

About half of all stent implants are for such conditions.

Questions have been raised about the safety of drug-coated stents in off-label conditions, said a report by a group led by Dr. Oscar C. Marroquin, at the University of Pittsburgh.

But the study of 6,551 cases found a lower rate of complications and no increased risk of death or heart attack for drug-coated stents as compared to the bare-metal kind.

“These findings support the use of drug-eluting stents for off-label indications,” the researchers write.

That report comes on the heels of a study of off-label use of a different kind of stent, developed for use against bile duct obstructions in cancer patients.

More than 1 million patients got stents for off-label conditions between 2003 and 2006, according to a report by Dr. William Maisel, director of the Medical Safety Device Institute at Beth Israel Deaconess Medical Center in Boston.

Some 1,000 malfunctions of the devices were reported, with 81 percent of them in off-label uses.

Always consult your physician for more information.

Restless Legs Syndrome and Heart Disease Linked

Persons with restless legs syndrome, called RLS, face twice the risk of a stroke or heart disease compared to people who do not have the neurological condition, says a report in the journal Neurology.

The risk is greatest in people with the most frequent and the most severe symptoms of restless legs syndrome.

“This shows that restless legs syndrome has salience beyond just symptoms,” says Dr. David Rye, at Emory University School of Medicine in Atlanta.

Dr. Rye says the study shows that the connection should be recognized.

RLS is a neurological disorder characterized by restlessness and a need to move the legs. Symptoms start or become worse when you are resting. The symptoms occur mainly at night and can interfere with sleep.

Some 5 percent to 10 percent of the adult population suffers from the syndrome, according to the study.

Heart Study Reveals RLS Problems

The new study, the largest of its kind, looked at 3,433 men and women, with an average age of 68, who were enrolled in the Sleep Heart Health Study.

The study was originally designed to look at the cardiovascular consequences of sleep-disordered breathing.

A diagnosis of RLS was based on a questionnaire completed by all study participants. The participants also answered questions about cardiovascular disease and stroke. Almost 7 percent of women and 3.3 percent of men in the study had RLS.

Persons with the syndrome were more than twice as likely to have cardiovascular disease or stroke. The association was strongest among those who had RLS symptoms a minimum of 16 times a month and among those who said their symptoms were severe.

The study cannot prove a cause-and-effect relationship, but such a link could make physiological sense.

Most people with RLS have up to 300 periodic leg movements a night, and those movements are associated with increases in blood pressure and heart rate, say the study authors.

Also, persons with RLS often also suffer from sleep deprivation, which has been associated with cardiovascular disease.

“The direct data would suggest that the disrupted sleep and arousals that occur with RLS are really what’s contributing to hypertension and heightened autonomic nervous system activity, which in turns leads to cardiovascular [problems],” says Dr. Rye.

“But this [study] can’t answer that kind of question,” he adds

The next study should look to see if treatments for RLS reduce the risk for heart disease and stroke, says Dr. Rye.

“Nobody has done that, because nobody has recognized that there was a problem,” he says.

More Study Needed, Say Experts

One expert adds a cautionary note to the study’s findings.

“This study is very well done, and the conclusions of the study are very measured,” says Dr. Paul Greene, at New York-Presbyterian Hospital/Columbia University Medical Center.

“In other words, the authors acknowledge that they can’t prove that what they’re studying actually causes strokes or heart attacks.

“They also could have picked up people with other syndromes, neuropathies [nerve damage], and things that could influence strokes and heart attacks,” he says.

“There are a lot of ways in which this study could be misleading,” he explains. “They will have to do something to follow up on this before pushing a panic button.”

Neither physician was involved with the study, which was conducted by researchers from Harvard and other institutions.

Earlier studies showed an association between restless legs syndrome and cardiovascular disease, but the studies had limitations.

RLS has also suffered from a public image problem, which may explain why so few studies have explored the condition.

“RLS has borne the brunt of a lot of skepticism,” explains Dr. Rye. “Snoring started out the same way… It took decades to convince primary-care physicians that we have to treat sleep apnea, that it’s not just a nuisance that dad snores.

“It [sleep apnea] has a huge added risk for obesity and stroke and hypertension and cardiovascular disease,” he says.

Always consult your physician for more information.