Young People With Depression At Increased Risk Of Heart Disease Mortality

The negative effects of depression in young people on the health of their hearts may be stronger than previously recognized. Depression or a history of suicide attempts in people younger than 40, especially young women, markedly increases their risk for dying from heart disease, results from a nationwide study have revealed.

The results are published in the November 2011 issue of Archives of General Psychiatry.
"This is the first study looking at depression as a risk factor for heart disease specifically in young people," says senior author Viola Vaccarino, MD, PhD, chair of epidemiology at Emory's Rollins School of Public Health. "We're finding that depression is a remarkable risk factor for heart disease in young people. Among women, depression appears to be more important than traditional risk factors such as smoking, hypertension, obesity and diabetes which are not common in young women."

First author is Amit Shah, MD, a cardiology fellow at Emory University School of Medicine. The researchers analyzed data from 7,641 people between the ages of 17 and 39 who participated in the NHANES-III (National Health and Nutrition Examination Survey-III), a nationwide survey conducted by the National Center for Health Statistics between 1988 and 1994. Deaths were tracked through 2006.

Women with depression or a history of attempted suicide had a three times higher risk of dying from cardiovascular disease and a 14 times higher risk of dying from ischemic heart disease (heart attack). The corresponding figures for men were 2.4 times higher risk for cardiovascular disease and 3.5 times higher risk for ischemic heart disease.

Many previous studies of depression and heart disease included older individuals, who generally have a larger burden of heart disease risk factors and associated diseases that may confound the results.

This is the first study to examine a history of suicide attempts along with depression as a marker for future mortality from cardiovascular disease. Also, unlike most previous studies of depression and heart disease, the authors examined major depression, which was assessed with a clinical interview based on accepted diagnostic criteria, instead of using questionnaire scores for depression symptoms. The authors suggest that clinical diagnosis may be "a more robust risk indicator."

Use of antidepressants was not included as a risk factor because less than six percent of those with depression or a history of attempted suicide reported their use, and no cardiovascular-related deaths occurred in that subgroup.

The researchers considered the possibility that depressed people may have more lifestyle-related risk factors such as smoking and poor diet. They found a significant link to heart disease risk coming from depression and suicide attempts, even after correcting statistically for unhealthy behaviors.

"Direct physiological effects of depression may play a greater role than lifestyle factors in this young population," the authors write.

Depression may increase risk of heart disease through physiological mechanisms, such as lower heart rate variability and increased cortisol (a stress-related hormone) and inflammation.

"This is a group that normally should be low risk," Vaccarino says. "Studying these individuals more intensively could be important for understanding how depression affects the heart."

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Abused Girls May Have Higher Risk Of Heart Disease, Stroke As Adults

Sexually and physically abused girls may have higher risks for heart attacks, heart disease and strokes as adults, according to research presented at the American Heart Association's Scientific Sessions 2011.
In the study, compared to women who weren't molested or raped as children or teens, women who reported:

• Repeated episodes of forced sex in childhood or adolescence had a 62 percent higher risk of cardiovascular disease as adults.
• Severe physical abuse in childhood or adolescence was associated with a 45 percent increased risk of cardiovascular events.

Mild to moderate physical or sexual abuse was not associated with increased risk.
"The single biggest factor explaining the link between severe child abuse and adult cardiovascular disease was the tendency of abused girls to have gained more weight throughout adolescence and into adulthood,' said Janet Rich-Edwards, Sc.D., M.P.H., lead author of the study and associate professor in the Department of Medicine at Brigham and Women's Hospital in Boston, Mass.

The researchers studied the associations of child and adolescent abuse with confirmed cardiovascular disease events such as heart attacks and strokes from 1989-2007 among 67,102 women in the Nurses' Health Study II. Eleven percent reported forced sexual activity during childhood and adolescence and 9 percent reported severe physical abuse.
Associations of severe abuse were stronger for stroke than for heart attack. Risk factors such as adult body mass index, smoking, alcohol use, hypertension and diabetes accounted for 41 percent of the association of severe physical abuse and 37 percent of the association of forced sex with cardiovascular disease events. "These traditional cardiovascular risk factors explain about 40 percent of the association we see between abuse and cardiovascular disease - which suggests that other factors may play an important role, such as increased stress reactivity among people with a history of abuse," said Rich-Edwards.
Researchers conducted the study with primarily white nurses, so further research should be done with different socio-demographic groups, Rich-Edwards said.

"Women who experience abuse need to take special care of their physical and emotional well-being to reduce their risk of chronic disease," Rich-Edwards said. "Primary care health professionals need to consider childhood abuse histories of women as they transition into adulthood but to help the health professionals prevent cardiovascular disease among women with a history of abuse, we need to learn more about specific psychological, lifestyle, and medical interventions to improve the health of abuse survivors."

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Sugary Drinks May Increase Heart, Diabetes Risk In Women, Even Of Normal Weight

Women who drink two or more sugary drinks a day, even if they are of normal weight, appear to be at higher risk of heart disease and diabetes, according to a new study presented over the weekend to the American Heart Association's (AHA's) Scientific Sessions 2011, which is running from 12-16 November, in Orlando, Florida. An abstract of the study is available to view online in the AHA journal Circulation.
Sugar-sweetened drinks includes beverages such as carbonated sodas or flavored waters with added sugar.

Previous studies have examined and found links between drinking sugar-sweetened beverages and obesity, high blood fats, high blood pressure, and type 2 diabetes. But studies following large, ethnically diverse populations looking at links with cardiovascular risk factors are sparse, said the researchers.
Lead author Dr Christina Shay, an assistant professor at the University of Oklahoma Health Sciences Center in Oklahoma City and colleagues, compared middle-aged and older women who consumed two or more sugar-sweetened drinks to women who drank one or less a day.

They found that women who drank two or more such drinks a day were significantly more likely to develop larger waists and have impaired fasting levels of glucose. They were also nearly four times as likely to develop high triglycerides, a type of blood fat linked to increased risk of heart disease.
They didn't find any such links in men.
Shay said in a press statement:
"Women who drank more than two sugar-sweetened drinks a day had increasing waist sizes, but weren't necessarily gaining weight. These women also developed high triglycerides, and women with normal blood glucose levels more frequently went from having a low risk to a high risk of developing diabetes over time."
"Most people assume that individuals who consume a lot of sugar-sweetened drinks have an increase in obesity, which in turn, increases their risk for heart disease and diabetes. Although this does occur, this study showed that risk factors for heart disease and stroke developed even when the women didn't gain weight," she added.
For the study, Shay and colleagues examined data from 4,166 African-American, Caucasian, Chinese-Americans and Hispanic adults who took part in the the Multi-Ethnic Study of Atherosclerosis (MESA). The participants, aged from 45 to 84 years, had completed food-frequency questionnaires when the study started in 2000-2002.
During five years of follow-up, the participants underwent three exams from which the researchers were able to assess changes in body weight, waist size, levels of high density lipoproteins (HDL "good" cholesterol), levels of low density lipoproteins (LDL "bad" cholesterol), triglycerides, levels of fasting glucose, and presence of type 2 diabetes.
The study was conducted at Northwestern University's Department of Preventive Medicine in Chicago, where Shay used to be based.

She and her colleagues noted that the metabolic influence of sugar-sweetened beverages is "complex and is not homogenous between men and women".
They said we know that women need fewer calories than men, so it looks like when a higher proportion comes from drinking sugar-sweetened drinks, they therefore experience a higher cardiovascular risk.

But exactly how such drinks influence cardiovascular risk, what biological mechanisms might be involved, is still somewhat unclear and warrants further investigation, said the researchers, who are planning to do just that.

Funds from the National Heart, Lung, and Blood Institute helped pay for the study.

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Traffic, Pollution and Heart Attacks

If you're at risk for a heart attack, sitting in heavy traffic and inhaling the fumes could help bring one on within hours. A large, recent study from the London School of Hygiene and Tropical Medicine suggests that the risk of heart attack rises and stays higher than normal for six hours after inhaling those noxious fumes from automotive exhaust. After that, the risk goes back to baseline. Commenting on the study, the director of the British Heart Foundation said that pollution possibly affects heart health by temporarily thickening the blood making it more likely to clot. The investigators analyzed data from more than 79,000 people in 15 areas of the UK who had heart attacks between 2003 and 2006. The research team also referenced the time of day that the heart attacks occurred, plus levels of traffic pollution (including carbon monoxide and ozone) at those times in different parts of the country, to reach their conclusion that the risk rises in the six hours after exposure to the fumes. Their recommendation: if you're at risk for heart attack, stay out of heavy traffic.

My take? We've known for some time that exposure to high levels of air pollution correlates with an increased rate of heart attacks, as well as stroke and deaths due to hospitalizations for heart disease, heart failure and lung problems. Earlier studies have also shown that air pollution is associated with atherosclerosis, the build-up of plaque along arterial walls. This study indicates there may be a more critical time-line to the increased risk. The advice to reduce your exposure to heavy traffic is a good one for many reasons, but it isn't something everyone can readily accomplish. To help lower your overall risk, don't smoke, control your blood pressure, get regular exercise and eat a low-glycemic diet.

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Female Shift Workers May Be At Higher Risk Of Heart Disease

Women hospital staff working night shifts may be compromising their own health as they try to improve the health of patients, Dr. Joan Tranmer told the Canadian Cardiovascular Congress 2011, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

Dr. Tranmer's study investigated the connection between shift work and risk factors for heart disease in female hospital employees who worked both shift and non-shift rotations.
As a former nurse familiar with shift work and because of her concern about the health of the female hospital work force, Dr. Tranmer questioned whether late nights were taking their toll on the health of her fellow hospital employees. "As I walked through the hospital and talked with my colleagues, I was concerned about what I was seeing in a lot of the workers," she said. "We did not know if this is related to shift work or other aspects of hospital work".
Her study reinforced what she observed about the health of female hospital employees. Dr. Tranmer studied 227 women ranging in age between 22 and 66 (with a mean age of 46) from two hospitals in southeastern Ontario. The study included not only nurses but a variety of staff, including administrative employees as well as lab and equipment technicians, who worked a variety of rotations.

She examined each of the women's possible risk factors associated with metabolic syndrome. The syndrome's five indicators are abdominal obesity (elevated waist circumference), high blood pressure, elevated blood glucose, elevated triglycerides, and low levels of high-density lipoprotein (HDL) cholesterol, also known as 'good cholesterol.' The women also completed a detailed survey about their work history and lifestyle.

The findings of this study suggest that approximately one in five middle-aged women who do shift work have at least three risk indicators for heart disease.

From the group, 17 per cent had metabolic syndrome, with at least three of the identified indicators. Thirty-eight per cent had high blood pressure. Of particular concern was the finding that 60 per cent of the participants had a waist circumference greater than 80 cm (31.5 inches).

Abdominal obesity and elevated waist circumference are good predictors for risk of developing heart disease, stroke, high blood pressure, cholesterol and type 2 diabetes. The greater your waist circumference, the higher your risk of developing these conditions.

The study found that age and current shift work status were significantly associated with increased risk. Women over 45 years, those who had reached menopause, had a shift work history of more than six years, and those currently working either 12 hour shifts or rotational shifts were more likely to have metabolic syndrome.

Metabolic syndrome was present in eight per cent of those working shifts for less than six years, in 18 per cent in those working shifts for six to 15 years, and in 74 percent of those working shifts for more than 15 years. While the increase in prevalence of risk factors is also associated with age, the influence of the combination of older age and shift work on risk raises concern.

"Just how shift work contributes to the development of such risk factors isn't clear," says Dr. Tranmer. "It is possible that the disruption of biological rhythms, sleeping, eating, and exercise patterns may be factors." The research team is exploring these potential pathways in a current study.

A Statistics Canada survey on the work-life balance of shift workers found that long work hours were associated with role overload. Shift workers were more likely to cut back on sleep, to spend less time with their spouse, and to worry about not spending enough time with family, compared with regular day workers.

"All women should manage their weight and other risk factors, and this study shows women working shift work especially need to be aware," said Heart and Stroke Foundation spokesperson Dr. Beth Abramson. "We spend so many of our hours and days at work, it is important for employers and employees to create as healthy a work environment as possible - especially for shift workers."

She says that, given the prevalence of these cardiovascular risk factors, and in particular with abdominal obesity rates and the increasing age of the female hospital workforce, this study raises the need to examine workplace policy encouraging healthy behaviours for all employees.

She recommends that women find out how they can protect their heart health through the Foundation's The Heart Truth™ campaign (thehearttruth.ca), which educates women about identifying their risks and warning signs of heart disease and stroke, and shows them how to make lifestyle changes and take action to reduce their risk by as much as 80 per cent.

"These women work so hard caring for others, but they need to take the time to properly care of their own health," says Dr. Tranmer.

According to Statistics Canada, over 4 million workers aged 19 to 64 worked something other than a regular day shift in 2005. Of these shift workers, about 3.3 million worked full time (30 or more hours a week). Rotating shifts and irregular schedules were the most common types of shift work, accounting for 2.3 million full-time workers. Women made up 37 per cent of all full-time shift workers. The majority of women working shifts (69 per cent) worked part time.

When asked if similar conclusions could be drawn for male shift workers, Dr. Tranmer said that much of our understanding about the associations between shift work and health come from studies that have predominantly included men so she wanted to focus on the link in women.

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Women's Heart Disease Tied To Small Blood Vessels

Heart disease affects men and women in different ways. In women, symptoms of burgeoning heart disease are often more insidious, but when a heart attack strikes, it is more lethal than it is in men. Roughly 25 percent of men will die within a year of their first heart attack, but among women, 38 percent will die. Women are twice as likely as men to have a second heart attack within 6 years of their first one, and women are twice as likely as men to die after bypass surgery.

Yet after a heart attack, women's hearts are more likely to maintain their systolic function - their ability to contract and pump blood from the chambers into the arteries. According to C. Noel Bairey Merz, MD, Director of the Women's Heart Center at Cedars-Sinai Heart Institute in Los Angeles, this suggests that heart disease manifests differently in women, affecting the microvasculature (small blood vessels) instead of the macrovasculature (major blood vessels) as it does in men.
Dr. Bairey Merz provided an overview of the sex differences in heart disease at the Physiology of Cardiovascular Disease: Gender Disparities conference, October 12-14 at the University of Mississippi in Jackson. The conference was sponsored by the American Physiological Society with additional support from the American Heart Association. Dr. Bairey Merz's presentation was 'Ischemic Heart Disease in Women: Microvascular Coronary Dysfunction.'

Function Indicates Form
The heart is a muscle, and as with other muscles, depriving it of oxygen causes damage that diminishes its ability to function. Conventional wisdom notes that the most prevalent form of heart disease is coronary artery disease, in which atherosclerotic plaque narrows and eventually blocks the major arteries leading into the heart, thus cutting off the heart's supply of oxygen. The damage to the heart tends to be permanent, and after a heart attack, the heart never quite regains its former power.
But when reviewing the medical literature, Dr. Bairey Merz and her colleagues found that women's hearts were less likely than men's to lose their ability to pump blood after a heart attack, and that female heart patients were less likely to present with obstructive coronary artery disease. Instead, the oxygen deprivation and subsequent damage to the heart is more likely to occur when small blood vessels, not major arteries, become dysfunctional.
"That is the reason women are often misdiagnosed and suffer adverse events," said Dr. Bairey Merz. "Physicians have been looking for male pattern disease, when we need to start looking at female patterns." Likewise, more research is needed to develop appropriate treatments and reduce risk in women, she added.
According to Dr. Bairey Merz, the good news is that it is possible to measure damage to small blood vessels objectively. "The gold standard is reactivity testing, angiograms, and other physiologic measures, rather than anatomic study."

Dr. Bairey Merz provided an overview of the latest data about these methods and how they can be applied to help clinicians understand gender differences in the pathophysiology of heart disease during her presentation.

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Chocolate and Your Heart

The latest news about chocolate is encouraging: an analysis of several studies involving data on more than 100,000 people suggested that those who reported eating chocolate regularly lowered their risk of heart disease by more than one-third. That may be cause for celebration among chocolaholics, but of course, there's a catch to it: the studies involved were all observational - that is, they all looked at chocolate consumption and health as reported by participants. The analysis didn't directly compare those who ate a set amount of chocolate per week with those who consumed a placebo (in this case, a chocolate look-alike and taste-alike), as would be required in a clinical trial to investigate chocolate's effects on the heart. What's more, the studies included reports of consuming chocolate in all its forms - dark, milk, in drinks, cookies and desserts. And it didn't specify how much chocolate study participants ate. Still, if the analysis has any merit, people who eat lots of chocolate regularly may find that they have healthier hearts than those who don't. The analysis, from England's University of Cambridge, was published August 29 in BMJ online.
My take? Chocolate is a source of polyphenols (the same type of antioxidants found in red wine). Stearic acid, the fat it contains, doesn't affect cholesterol levels, and studies have shown that flavonoids in dark chocolate help reduce the stickiness of platelets, cells that play an important role in blood clotting. As a result, blood takes longer to clot, reducing the danger of coronary artery blockages. Chocolate's polyphenols also appear to boost levels of HDL (the "good" cholesterol) and lower LDL (the "bad" cholesterol), at least in the lab. I recommend consuming good-quality dark chocolate that is at least 70 percent cocoa as a healthy snack, as long as you don't go overboard. An ounce or two a few times a week is good for you.

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Exercise for 15 Minutes: Live Longer

Here's more evidence that even a little bit of exercise can make a big difference to your health. Researchers in Taiwan followed more than 400,000 people for an average of eight years and found that 15 minutes of exercise daily can boost life expectancy by three years. Compared to inactive individuals, participants who exercised for just under 15 minutes per day were 14 percent less likely to die from any cause during the eight years of the study, and 10 percent less likely to die of cancer. Beyond that, each additional 15 minutes of daily exercise lowered the risk of death - from any cause - by four percent, and the extra physical activity cut the risk of death from cancer by one percent. Earlier this month, a review published online in Circulation showed that people who get 150 minutes of moderate exercise per week reduce their risk of heart disease by 14 percent compared to inactive people and that exercising five hours per week can lower heart disease risk by as much as 20 percent. The new study from Taiwan was published online on August 15 by The Lancet.

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Obesity May Not Be So Dangerous

New research from Canada suggests that being obese, by itself, may not be so bad - as long as you don't have weight-related medical problems such as diabetes, high blood pressure, high cholesterol, sleep apnea and heart disease. Investigators at the University of Alberta looked at data from the U.S. National Health and Nutrition Examination Survey and were able to identify obese individuals based on lifestyle factors and medical history. They devised a five stage system for classifying obese men and women assigning scores (on a scale of 0 to 4) based on the number of health problems an individual had, with higher scores indicating individuals that had developed more of these associated problems. Bottom line: those with scores of 2 or above were 1.5 times as likely to die during the nearly two decades of the study's follow-up as those with lower scores. Scores of 3 raised the risk to 2.5 times as likely to die as low-score patients. The system may give doctors a new way to identify obese patients who would benefit most from weight loss or medical treatment.

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Smoking In Relation to Men

Men are at as much risk because of smoking as are women. This is worse in case of men because smoking is a habit that thrives more commonly among the men and causes various disorders in the body which could even be fatal. Studies have shown that smoking is the most usual cause for disorders like impotency and cancer and can leave the man's whole life impaired, apart from being the cause of a whole bunch of other respiratory and heart disorders. Discoloration of the lips and darkening of the gums, along with stains on the teeth and mouth ulcers are commonly seen effects of smoking seen in men. It also is the main reason because of which the arteries which connect to the heart and the male organs gets clogged resulting in various disorders of the heart and is also the main cause several other mental and physical problems.

In fact smoking is known to cause irreparable and irreversible damage to the body. Problems like impotency and erectile dysfunction can be traced back to excessive smoking habits. This is because smoking causes blockage of the vessels that supplies blood to the genitals. Though most of the side effects of smoking are common for both men and women there are certain side effects which affects only men. Sexual health is the most affected in case of men apart from various other psychological and physical disorders. It also increases the risk of cancer and various other heart diseases and strokes. Another attribute of smoking is the fact that it increases anxiety levels though the common myth is that smoking is a stress buster. Memory is also adversely affected due to excessive smoking as smoke gradually over time kills the brain cells. Smoking is also the primary cause for increased nervousness and reduces the sharpness levels of an individual, and makes the person forgetful and careless.

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Exercise and Your Heart: A Little Bit'll Do It

It doesn't take much exercise to help reduce your risk of heart disease. A new review of 33 earlier studies on the benefits of exercise found that people who get 150 minutes of moderate exercise per week reduce their risk of heart disease by 14 percent compared to inactive people (150 minutes comes out to 30 minutes a day, five days a week). Of course, more is better, and with additional physical activity (five hours of exercise per week) you can lower your risk by as much 20 percent (again, compared to inactive folks). The review found that women benefit more from exercise than men, but the researchers aren't sure why and have suggested that the difference may be due to a statistical quirk. You might also achieve an additional risk reduction of five percent if you're up for exercising 12.5 hours per week, but the researchers conceded that the extra five percent may not be worth all that added effort. The study was published online August 1 in Circulation.

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Control your Cholesterol level naturally

In our modern scientific and digital age, every person approximately assumed that a "heart healthy" diet is and that it can significantly lead to lowering your cholesterol. Global nutritional guidelines are now universal and incorporate: For years the prevailing wisdom was that women were at minimal risk for high cholesterol and the cardiovascular disease which was sure to follow High cholesterol levels, more specifically high LDL ("bad") cholesterol levels are a main contributor to heart disease. Foods that lower cholesterol can easily be combined in your diet and will help you not just to reduce but also to manage your cholesterol levels in the long run which make strong and better through adopting some basic health tips. Cholesterol is extremely soluble within body fat however just somewhat soluble in drinking water, and able to type cholesterol esters with fatty acids.
We also know that cholesterol and other blood fats such as triglycerides are the primary forces operating behind the scenes that work to produce arterial blockage and increase the chances of heart attack or stroke. Triglycerides are early stage blood fats produced when a person consumes more calories than are required. When this occurs the liver transforms those excess calories into triglycerides, which end up as fat in body tissue. A whopping 95 percent of fatty body tissue is made up of triglycerides. If you have been tested for cholesterol you probably already know that your basic cholesterol profile measures three types of cholesterol and blood fats; HDL, LDL, and triglycerides.
Soluble fiber provided by fruit and vegetables helps eliminate cholesterol from the intestine. Avoid as much as possible or cut out altogether refined carbohydrates: white bread, rice, pasta. Refined carbohydrates have been stripped of most nutrients. Replace by: complex carbohydrates such as whole grain bread, brown rice, whole meal pasta, and oats. Complex carbohydrates contain fiber and other nutrients the body needs.

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