Heart Disease Newsletter
February 6, 2017
When we are no longer able to change a situation, we are challenged to change ourselves.
                                                            -- Viktor Frankl
In this Issue
• Can Pregnancy Harm Your Heart?
• What to Do If You Think You're Having a Heart Attack
• Small Study Links E-Cigarettes to Potential Heart Trouble
• Timing of Your Meals Might Reduce Heart Risks

Can Pregnancy Harm Your Heart?

Links uncovered between preterm birth, multiple children and future cardiac problems

THURSDAY, Feb. 2, 2017 (HealthDay News) -- Pregnancy might affect a woman's risk of future heart problems, two new studies suggest.

A woman's risk of atrial fibrillation -- an abnormal heart rhythm -- rises with each pregnancy, up to a nearly 50 percent increased risk with six or more pregnancies, according to the results from one study.

"There's something about pregnancy itself that predisposes women toward this risk," said lead author Dr. Jorge Wong. He's a cardiologist with the Population Health Research Institute at McMaster University in Hamilton, Ontario.

Meanwhile, a second study reports that women who experience a preterm delivery have a 40 percent higher increased risk of heart attack or stroke later in life.

Neither of these studies proves a direct cause-and-effect relationship between pregnancy and heart problems, both teams of researchers noted.

For the heart rhythm report, researchers reviewed data from 34,639 participants in the Women's Health Study, an ongoing project conducted by Harvard Medical School and Brigham and Women's Hospital in Boston.

After an average 20 years' follow-up, researchers found that 1,532 cases of atrial fibrillation had developed among the women. Atrial fibrillation is an irregular heart beat that increases the risk of stroke or heart failure.

Analysis revealed that women with a single pregnancy had a 15 percent increased risk of atrial fibrillation compared to women who never were pregnant, after researchers controlled for other heart risk factors.

Two or three pregnancies were associated with a 20 percent increased risk of atrial fibrillation, four to five pregnancies with a 36 percent increased risk, and six or more with a 46 percent increased risk, the researchers said.

Pregnancy causes many potentially damaging changes in a woman's body, and researchers speculate that additional pregnancies might expose women to more injury.

"For some unknown clear reason, these add up to developing atrial fibrillation later in life," Wong said.

Significant fluctuations in hormones and inflammation occur during pregnancy, which might have an impact on heart health, Wong said.

"There are also documented cardiac changes that happen due to pregnancy which are always thought to completely resolve at the end of the pregnancy," Wong added. "But it's also been speculated that in women who have multiple pregnancies, these structural changes may take longer to resolve."

Both studies appear in a special women's issue of the American Heart Association journal Circulation, published Feb. 2.

The other study involved data from more than 70,000 participants in a separate Harvard-led women's health research project, the Nurses' Health Study.

Researchers used the data to investigate the association between a premature delivery and future heart disease.

"There's a growing number of studies that indicate women who have complicated pregnancies may be at increased risk of developing cardiovascular disease in the decades after pregnancy," said lead author Lauren Tanz.

Tanz is a doctoral candidate with the Harvard T.H. Chan School of Public Health. She and her colleagues found that women who deliver a baby before 37 weeks gestation in their first birth have a 40 percent greater risk of later heart disease, compared to women whose deliveries occurred on time -- at or after 37 weeks.

Further, women who deliver before 32 weeks gestation are at twice the risk compared to full-term deliveries, according to findings.

But Tanz thinks preterm deliveries may be a signal of future heart problems rather than the cause of those problems.

She hypothesizes that these women may have heart risk factors that are not strong enough for doctors to detect, but that do affect their pregnancy enough to cause a premature birth.

"The preterm delivery is an early warning sign that these women may be at increased risk," Tanz said. She noted that the American Heart Association already considers other pregnancy-related health problems such as pre-eclampsia and gestational diabetes to be risk factors for future heart trouble.

Both studies stem from increased research interest in the differences between men's and women's heart health, said Dr. Mary Ann Bauman, a spokeswoman for the American Heart Association.

"We haven't really understood all of the mechanisms of women and heart disease," Bauman said. "Women aren't just men with ovaries. We need to understand these differences."

Tanz said it couldn't hurt for women who have delivered preterm or have experienced multiple pregnancies to pay extra attention to their heart health. They should make sure to eat right, exercise, never smoke and limit their alcohol consumption.

"Since we know cardiovascular risk develops over a lifetime, it's never too soon for a woman to adopt these habits," Tanz said.

More information

For more about heart health and pregnancy, visit the American Heart Association.

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What to Do If You Think You're Having a Heart Attack

Don't ignore chest pain and seek medical attention immediately, heart specialists say

FRIDAY, Feb. 3, 2017 (HealthDay News) -- Would you be able to recognize the urgent symptoms of a heart attack -- and know how to respond to it?

The heart-related deaths of such celebrities as "Star Wars" actress Carrie Fisher, singer-songwriter George Michael and actor Bernard Fox are a powerful reminder that everyone should know the symptoms of serious heart problems, the American College of Emergency Physicians (ACEP) said.

People need to take potential heart attack symptoms seriously and immediately call 911 or get to the nearest emergency department.

According to the ACEP, the most common symptoms of heart attack are:

  • Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and returns,
  • Pain that spreads to the shoulders, neck, jaw, arms or back,
  • Chest discomfort along with lightheadedness, fainting, sweating, nausea or shortness of breath.

Some less common symptoms include abnormal pain in the chest, stomach or abdomen; nausea or dizziness; shortness of breath and difficulty breathing; unexplained anxiety, weakness or fatigue; palpitations, cold sweat or paleness.

The American Heart Association says that, like men, women's most common heart attack symptom is chest pain or discomfort. But women are more likely to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

"Patients should never diagnose themselves," ACEP President Dr. Becky Parker said in a news release. "Often it takes a team of medical experts and various tests to diagnose the specific causes of chest pain. If it's a heart problem, that delay in time can prove fatal."

Heart disease is the leading cause of death in the United States, accounting for 610,000 deaths (one in every four deaths) a year, according to the U.S. Centers for Disease Control and Prevention.

About 735,000 Americans have a heart attack each year; about two-thirds of those are first time attacks. But only 27 percent of Americans are aware of all major symptoms and how to respond, according to the CDC.

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart attack.

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Small Study Links E-Cigarettes to Potential Heart Trouble

Found users were more likely to have early indicators of disease risk

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- A small study suggests that people who use e-cigarettes regularly may face an increased risk for heart disease.

Researchers said they found that 23 e-cigarette users were more likely to have two early indicators of heart risk than 19 people who did not "vape."

"This is the first study to look at these cardiac risk factors in habitual e-cigarette users. The results were a bit surprising, since it is widely believed that e-cigarettes are less harmful than tobacco cigarettes," said study co-author Dr. Holly Middlekauff. She is a professor with the division of cardiology at the University of California, Los Angeles.

Instead, she said, "we found the same types of abnormalities in our e-cigarette users that are reported in tobacco cigarette smokers, and these abnormalities are associated with increased cardiac risk."

Middlekauff stressed that the study only shows an association, not a cause-and-effect link, between e-cigarette use and increased heart risks. And, because the study did not include traditional cigarette smokers, "we cannot say if the changes are less severe in the e-cigarette users compared to age-matched tobacco cigarette smokers," she added.

"All we can conclude is that e-cigarette use has real physiologic, adverse effects," she said. "They are not harmless."

Electronic cigarettes first became available in the United States in 2006. Since then, their popularity has skyrocketed. The U.S. National Institute on Drug Abuse estimates that more than 250 brands of e-cigarettes are now sold, the researchers said.

All the e-cigarette users in the study were healthy and between the ages of 21 and 45. The e-cigarette users had been vaping almost daily for a minimum of one year. None of the participants smoked tobacco cigarettes.

All the e-cigarette users and nonusers had blood tests and heart rate variability testing, to measure various aspects of heart behavior.

The result: E-cigarette users had a higher risk for oxidative stress, in which so-called "free radical" molecules produced through breathing start to reach potentially harmful levels, the researchers said.

E-cigarettes were also found to have an increased risk for a rise in "cardiac sympathetic activity," stemming from a boost in the level of hormones produced by the adrenal gland. Ultimately, this can give rise to an increased heart rate and higher blood pressure, the researchers said.

The findings were published online Feb. 1 in the journal JAMA Cardiology.

Middlekauff said she and her colleagues are now comparing the heart effects of chronic e-cigarette use to chronic tobacco cigarette use.

It's still unclear why e-cigarettes may increase the risk for heart trouble, she said.

"I would speculate that inhaled nicotine is the culprit," Middlekauff said. "Nicotine is the most biologically active component in e-cigarette aerosol, and is an airway irritant. Nicotine increases adrenaline levels, and may activate a number of adverse systems that are harmful in the long run."

Aruni Bhatnagar is a professor of medicine with the University of Louisville's division of cardiovascular medicine. He said that, although e-cigarettes expose users to fewer chemicals than traditional cigarettes, "they contain some residual components, particularly nicotine, that may present a not insignificant problem.

"So, I would say that what is being reported here is important, but not really startling," said Bhatnagar, who cowrote an editorial accompanying the study and serves as director of the American Heart Association's Tobacco Center.

Gregory Conley, president of the American Vaping Association, criticized the study findings.

"This study, like so many performed by researchers looking to generate headlines, fails to compare the effects of vaping nicotine-containing liquid with other activities, such as smoking cigarettes, using non-nicotine liquid or drinking coffee," Conley said.

"Even if such comparisons were used, the value of this paper is limited, as it is not exactly breaking news that nicotine has short-term impacts on the cardiovascular system," he said.

More information

Visit the U.S. National Institute on Drug Abuse for more on e-cigarettes.

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Timing of Your Meals Might Reduce Heart Risks

American Heart Association report suggests eating more earlier in the day may be healthier

TUESDAY, Jan. 31, 2017 (HealthDay News) -- People who want a healthy heart should be mindful of not only what they eat, but when they eat, according to a new scientific statement from the American Heart Association (AHA).

The report is a response to the growing evidence that timing matters when it comes to heart disease risk, said Marie-Pierre St-Onge, the lead author of the statement.

The various organs of the body have their own "clocks," St-Onge explained, and that may affect how we handle food at different times of the day and night.

"For example, later in the evening, it's harder for the body to process glucose [sugar], compared with earlier in the day," said St-Onge, an associate professor of nutritional medicine at Columbia University in New York City.

The new statement highlights what's known -- and what's not -- about meal timing and heart health.

The statement lacks specific rules, such as "Never eat after 8 p.m.," or "Everyone should eat breakfast."

It does, however, suggest that people spread out their calories over a "defined" period of the day -- as opposed to either eating a lot over a short period, or grazing from morning until night.

Based on the evidence, the AHA says, it's probably a good idea to get a large share of your calories earlier in the day.

"A long fasting duration at night is better than a long fast during the day," St-Onge said.

But there's no declaration that breakfast is the most important meal of the day.

The evidence, St-Onge said, is just not clear enough to make specific recommendations on breakfast.

A number of studies have found that breakfast eaters are generally healthier than breakfast skippers: They tend to weigh less, have better blood pressure and cholesterol numbers, and have lower risks of type 2 diabetes and heart disease, according to the AHA.

The problem is, those studies don't prove that breakfast deserves the credit. And few trials have actually tested the effects of "assigning" people to eat breakfast, the AHA says.

Based on what studies have been done, adding breakfast doesn't seem to aid weight loss, the report said.

Of course, if breakfast skippers simply add an extra meal to their day, they'll gain weight, St-Onge pointed out.

A few small trials have, however, suggested that breakfast can help regulate blood sugar and insulin levels, according to the AHA.

Sonya Angelone is a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. And she was clear in her support of eating breakfast.

"I think it's very important to eat breakfast every day," Angelone said.

Just as important, she said, is to hydrate after a long liquid-free night. Coffee does "count," she noted, but a glass of water is better.

According to Angelone, breakfast is critical because it's hard to get all the nutrients you need in just two meals a day -- even if you snack.

That raises another question: Should people eat "three square meals," or is it better to stick with small, but more-frequent meals?

That's not clear, according to the AHA.

Studies that track people in the real world have found that those who eat more often during the day have a lower risk of obesity and better cholesterol levels.

On the other hand, the AHA says, small trials that have tested the effects of altering meal frequency have mostly come up empty. When daily calories are kept constant, meal frequency may not affect people's weight, levels of "good" HDL cholesterol or other factors that affect heart health.

Of course, there is no one-size-fits-all approach to eating, St-Onge said.

Some people, she noted, do well with "grazing" throughout the day -- as long as the food choices are healthy, and they do not keep grazing until midnight.

"If you're someone with good control over your diet, maybe grazing is a good idea," St-Onge said. "But if it's difficult for you to stop eating once you start, it's probably not a good idea."

According to Angelone, frequent eating may not be wise for people with resistance to insulin -- the hormone that regulates blood sugar. Insulin resistance is seen in people with type 2 diabetes or "pre-diabetes."

If those people eat often, Angelone explained, their insulin levels may never have a chance to drop.

In general, St-Onge said, "mindfulness" is critical. Often, people eat not because they're hungry, but to deal with emotions, she said.

"Ask yourself why you're eating," St-Onge said. "Is it because you're stressed or sad or bored? Ask yourself whether you're really hungry right now."

The statement was published online Jan. 30 in the AHA journal Circulation.

More information

The AHA has more on diet and heart health.

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