Stem Cell Treatment Might Reverse Heart Attack Damage

Heart Disease

MONDAY, Feb. 13 (HealthDay News) — Stem cell therapy’s promise for healing damaged tissues may have gotten a bit closer to reality. In a small, early study, heart damage was reversed in heart-attack patients treated with their own cardiac stem cells, researchers report.

The cells, called cardiosphere-derived stem cells, regrew damaged heart muscle and reversed scarring one year later, the authors say.

Up until now, heart specialists’ best tool to help minimize damage following a heart attack has been to surgically clear blocked arteries.

“In our treatment, we dissolved scar and replaced it with living heart muscle. Such ‘therapeutic regeneration’ has long been the holy grail of cell therapy, but had never been accomplished before; we now seem to have done it,” said study author Dr. Eduardo Marban, director of the Cedars-Sinai Heart Institute in Los Angeles.

However, outside experts cautioned that the findings are preliminary and the treatment is far from ready for widespread use among heart-attack survivors.

The study, published online Feb. 14 in The Lancet, involved 25 middle-aged patients (average age 53) who had suffered a heart attack. Seventeen underwent stem cell infusions while eight received standard post-heart attack care, including medication and exercise therapy.

The stem cells were obtained using a minimally invasive procedure, according to the researchers from Cedars-Sinai and the Johns Hopkins Hospital in Baltimore.

Patients received a local anesthetic and then a catheter was threaded through a neck vein down to the heart, where a tiny portion of muscle was taken. The sample provided all the researchers needed to generate a supply of new stem cells — 12 million to 25 million — that were then transplanted back into the heart-attack patient during a second minimally invasive procedure.

One year after the procedure, the infusion patients’ cardiac scar sizes had shrunk by about half. Scar size was reduced from 24 percent to 12 percent of the heart, the team said. In contrast, the patients receiving standard care experienced no scar shrinkage.

Initial muscle damage and healed tissue were measured using MRI scans.

After six months, four patients in the stem-cell group experienced serious adverse events compared with only one patient in the control group. At one year, two more stem-cell patients had a serious complication. However, only one such event — a heart attack — might have been related to the treatment, according to the study.

In a news release, Marban said that “the effects are substantial and surprisingly larger in humans than they were in animal tests.”

Other experts were cautiously optimistic. Cardiac expert Dr. Bernard Gersh, a professor of medicine at Mayo Clinic, is not affiliated with the research but is familiar with the findings.

“This study demonstrates that it is safe and feasible to administer these cardiac-derived stem cells and the results are interesting and encouraging,” he said.

Another specialist said that while provocative and promising, the findings remain early, phase-one research. “It’s a proof-of-concept study,” said interventional cardiologist Dr. Thomas Povsic, an assistant professor of medicine at the Duke Clinical Research Institute, in Durham, N.C.

And Dr. Chip Lavie, medical director of Cardiac Rehabilitation and Prevention at the John Ochsner Heart and Vascular Institute, in New Orleans, also discussed the results. He said that while the study showed that the cardiac stem cells reduced scar tissue and increased the area of live heart tissue in heart attack patients with moderately damaged overall heart tissue, it did not demonstrate a reduction in heart size or any improvement in the heart’s pumping ability.

“It did not improve the ejection fraction, which is a very important measurement used to define the overall heart’s pumping ability,” Lavie noted. “Certainly, much larger studies of various types of heart attack patients will be needed before this even comes close to being a viable potential therapy for the large number of heart attack initial survivors.”

Povsic concurred that much larger studies are needed. “The next step is showing it really helps patients in some kind of meaningful way, by either preventing death, healing them or making them feel better.”

It’s unclear what the cost will be, Povsic added. “What society is going to be willing to pay for this is going to be based on how much good it ends up doing. If they truly regenerate a heart and prevent a heart transplant, that would save a lot money.”

Marban, who invented the stem cell treatment, said the while it would not replace bypass surgery or angioplasty, “it might be useful in treating ‘irreversible’ injury that may persist after those procedures.”

As a rough estimate, he said that if larger, phase 2 trials were successful, the treatment might be available to the general public by about 2016.

Advertisements

Dr. R.K. Tongia – Profile

Heart Disease

Name: Dr. R.K. Tongia
Designation:

HOD & Senior Consultant

Brief Description:

Dr. R.K.Tongia is Head of the Department – Cardiology. Dr. Tongia is M.B.B.S. & M.D. (Medicine &Therapeutics) from S.M.S.Medical College Jaipur, ECFMG Certification from Educational Comm for Foreign Medical Graduates Philadelphia, USA; M.R.C.P. Royal College of Physicians of Ireland, Dublin. He has 30 years of rich experience. He has been awarded FRCP by Royal College of Physicians of Edinburgh, UK; FRCPI by Royal College of Physicians of Ireland, Dublin; FACC by American College of Cardiology, USA.
Areas of Expertise:

Cardiology

Location:

Jaipur

MORE DETAILS

Languages spoken
    English, Hindi
Previous experience Prior to joining FEHJ, Mr. Tongia was sharing his expertise as Consultant Cardiologist and Executive Director for Tongia Heart and General Hospital Jaipur.
Professional Memberships
  • Medical Practitioners Society, Jaipur
  • Society of Nuclear Medicine of India
  • Indian Federation of Ultrasound in Medicine & Biology
  • International Medical Sciences Academy
  • Pediatrics Cardiac Society of India
  • Private Hospital & Nursing Homes Society, Jaipur.
Education and fellowships
  • ECFMG Certification from Educational Comm for Foreign Medical Graduates Philadelphia, USA;
  • M.R.C.P. Royal College of Physicians of Ireland, Dublin
  • M.B.B.S. & M.D. (Medicine &Therapeutics) from S.M.S. Medical College Jaipur,
Specialty Interests
    Regular community initiative programs like Public Lectures, Free Medical Camps, Heart Hospital CPR Training Program.
Awards & Honors He has been awarded FRCP by Royal College of Physicians of Edinburgh, UK; FRCPI by Royal College of Physicians of Ireland, Dublin; FACC by American College of Cardiology, USA.

Centre for Cardiac Sciences

Heart Disease

DR. JAMSHED J DALAL is a rare triple Doctorate, having a Doctorate in Medicine, a Doctorate in Cardiology from Mumbai and a PhD from UK

Specialist in coronary angiography and angioplasty. He did his first coronary angiography in UK in 1978 and since then has done more than 15000 cases over 30 years. He also began the angiography program, available in only four hospitals in Mumbai in 1984 along with a handful of cardiologists.

Involved in the coronary angioplasty program since the invention of angioplasty procedure and is involved in teaching the procedure to doctors in India and China over the last 20 years.

As the Chief Cardiologist at the Holy Family Hospital in Bandra, set up the ICCU unit at the hospital.

In 1987 as the Honarary Cardiologist at the newly constructed Hinduja Hospital, Dr. Dalal set up the Cardiac Catheterization Lab at the hospital and started the coronary angiography and angioplasty procedures. Headed the department for 8 years to establish it as a leading centre in India .

In 1995 also joined the still under construction Lilavati Hospital and helped along with others to set up the hospital along with the department of cardiology. Since inception to leaving the hospital in 2009 remained the coordinator of the Cardiovascular Division and guided the Specialty to international levels.

In 1999, helped along with two other colleagues to setup and establish the Wockhardt Heart Hospital at Mulund, Mumbai. Once again creating a world class cardiology facility in the eastern suburbs.

In 2008 he has now joined the Kokilaben Dhirubhai Hospital as the Director – Centre for Cardiac Sciences. He has already fully established the coronary and peripheral vascular and surgical program, and is in the process of starting the paediatric cardiology and electrophysiology specialities.

Teenage health campaigns ‘reduce adult heart risks

Heart Disease

Health campaigns targeted at teens could help reduce their risk of heart problems as adults, a study suggests.

Smoking can have a big impact on general health and cholesterol levels in later life

Smoking can have a big impact on general health and cholesterol levels in later life

Concerns have been raised that warning signs like high cholesterol are being seen in the young, laying the foundation for future health problems.

But the study of more than 500 people found those with high cholesterol at 15 could normalise it by their mid-30s.

The Australian research is published in Archives of Pediatrics and Adolescent Medicine.

Participants in the Australian study had levels of cholesterol and other blood fats measured in 1985 when they were aged 9, 12 or 15.

They were measured again between 2004 and 2006, an average of 20 years later.

High risk levels in this study were defined as a total cholesterol level of 240 miligrams per deciliter or higher (6.2mmol/l).

The average total cholesterol level in the UK is 5.5mmol/l for men and 5.6mmol/l for women.

Height, weight, waist circumference, skin-fold thickness, smoking habits and cardio-respiratory fitness were also measured in the study.

Good and bad

Of those participants who had high-risk cholesterol levels in their youth, those who stopped smoking or lost weight became low-risk in adulthood, while those who increased their body weight or who started smoking were more likely to maintain those high-risk levels 20 years later.

Costan Magnussen, lead study author from the University of Tasmania, said their findings were important.

“They suggest that beneficial changes in modifiable risk factors in the time between youth and adulthood have the potential to shift those with high-risk blood lipid and lipoprotein levels in youth to low-risk levels in adulthood,” he said.

He added that prevention programmes targeted at the young could also benefit those who develop bad habits as they get older.

Dr John Coleman, chairman of the Association for Young People’s Health, said: “This reseach gives a very clear example of why we need to invest more in adolescent health and make it a higher priority.

“It is clear that young people’s lifestyle choices have a long term impact on their health and it is cost effective and sensible to work with them to encourage healthy habits.”

Mike Knaptonof the Brtish Heart Foundation said: “All teenagers can do something to improve their cholesterol.

“We should all be eating five portions of fruit and veg a day. And, most importantly, the message is don’t smoke.”

Warning over combining common medicines for elderly

Heart Disease

Combinations of commonly used drugs – for conditions such as heart disease, depression and allergies – have been linked to a greater risk of death and declining brain function by scientists.

Taking multiple common drugs has been linked to brain decline and death

Taking multiple common drugs has been linked to brain decline and death

They said half of people over 65 were prescribed these drugs.

The effect was greatest in patients taking multiple courses of medication, according to the study in the Journal of the American Geriatrics Society.

Experts said patients must not panic or stop taking their medicines.

The researchers were investigating medicines which affect a chemical in the brain – acetylcholine. The neurotransmitter is vital for passing messages from nerve cell to nerve cell, but many common drugs interfere with it as a side effect.

Eighty drugs were rated for their “anticholinergic” activity: they were given a score of one for a mild effect, two for moderate and three for severe. Some were given by prescription only, while others were available over the counter.

A combined score was calculated in 13,000 patients aged 65 or over, by adding together the scores for all the medicines they were taking.

A patient taking one severe drug and two mild ones would have an overall score of five.

Deadly consequences

Between 1991 and 1993, 20% of patients with a score of four or more died. Of those taking no anticholinergic drugs only 7% died.

Patients with a score of five or more showed a 4% drop in ratings of brain function.

Other factors, such as increased mortality from underlying diseases, were removed from the analysis.

Continue reading the main story

“Start Quote

Do not stop your medicines without taking advice first”

Dr Clare GeradaRoyal College of GPs

However, this study cannot say that the drugs caused death or reduced brain function, merely that there was an association.

Dr Chris Fox, who led the research at the University of East Anglia, said: “Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anticholinergic effects.

Dr Clare Gerada, chairman of the Royal College of GPs, said the findings of the study were important.

She told patients: “The first thing is not to worry too much, the second thing is to discuss it with your doctor or the pharmacist, and the third thing is do not stop your medicines without taking advice first.”

She said doctors reviewed medication every 15 months and were aware of the risks of combining different drugs.

Dr Fox said he wanted to conduct further research to investigate how anticholinergic drugs might increase mortality.

Electrical signals cannot cross the gap between brain cells; neurotransmitters pass the message on

Electrical signals cannot cross the gap between brain cells; neurotransmitters pass the message on

A more modern study is also thought to be desirable. Practices and drugs have changed since the data was collected two decades ago.

Ian Maidment, an NHS pharmacist in Kent and Medway, believes the situation may now be even worse.

He said the use of anticholinergic drugs had “probably increased as more things are being treated and more drugs are being used.”

Brain decline

Reduction of the neurotransmitter acetylcholine has already been implicated in dementia.

The drug Aricept is given to some patients with Alzheimer’s disease to boost acetylcholine levels.

Dr Susanne Sorensen, head of research at the Alzheimer’s Society, said a 4% drop in brain function for a healthy person would feel like a slow, sluggish day.

“If you are at a level where one little thing pushes you over into confusion, then that is much more serious,” she added.

“However, it is vital that people do not panic or stop taking their medication without consulting their GP.”

Rebecca Wood, chief executive of Alzheimer’s Research UK, said: “This comprehensive study could have some far-reaching effects. The results underline the critical importance of calculated drug prescription.”

Heart disease deaths highest in north-west England

Heart Disease

Deaths due to heart disease in England are most common in the North West, primary care trust figures indicate.

Figures for deaths through coronary heart disease show there is a North-South health divide

Figures for deaths through coronary heart disease show there is a North-South health divide

The mortality rate in one PCT, Tameside and Glossop, is almost four times that of Kensington and Chelsea in London.

Three of the five worst death rates are found in the North West, while the South has the lowest rates of deaths through coronary heart disease.

The charity Heart UK used 2009 figures released by the NHS Information Centre to compile the report.

Among the areas with the highest deaths through coronary heart disease are Blackburn with Darwen PCT, Leicester City PCT and Manchester PCT.

Some of the lowest rates of death through heart disease are found in Westminster PCT, East Sussex Downs and Weald PCT, Dorset PCT and Surrey PCT.

But within some of the big cities, the picture is more complicated than a simple North-South divide.

Kensington and Chelsea has extremely low rates of heart deaths – 36.91 people out of every 100,000.

Just a few miles away, Islington City PCT has rates three times higher at 114.12 out of every 100,000 people.

Heart UK chief executive Jules Payne said no matter where they lived, people could reduce their risk of having a heart attack or stroke through being aware of the risk factors.

“There are simple changes that people can make to improve their heart health.

“Those diagnosed with heart problems should take a proactive approach towards their health – knowing their cholesterol and blood pressure numbers and weight, going for regular check-ups and speaking to their doctor if they have any concerns.

“For those with a family history of heart disease, small changes to diet and lifestyle for example can help reduce the risk of cardiovascular disease.”

The wide geographical variation across England highlighted by the report confirms other studies that have revealed a North-South divide on health.

Dr Jessica Allen, of University College London, is one of the authors of a landmark report on health inequalities in England, the Marmot Review.

“Significant variations in risk of suffering heart disease across England are shocking but sadly not unexpected,” she said.

“We know that many health conditions relate to social and economic status and these largely explain the variations in life expectancy and health status that we see across England between regions and within smaller areas.

“It is still the case in England, as in most other countries, that the richer you are the healthier you are likely to be and the longer you will live.”

Heart Research UK lifestyle manager Barbara Dinsdale said: “Geographical health inequalities exist throughout the UK, which means that the incidence of heart disease varies regionally.

“People living in deprived communities, in particular, are at greater risk of developing heart disease due to several risk factors such as poor diet, lack of exercise and access to health education and advice.”

Heart UK is launching a ‘hotspots’ campaign to raise awareness of the inequalities across England and encourage patients to look after their health.

Heart patients not getting ‘most appropriate’ drugs

Heart Disease

More than half of heart patients in Scotland at high risk of stroke are not receiving the most appropriate treatment, according to a new report.

The report reviewed cardiology services across Scotland

The report reviewed cardiology services across Scotland

Scrutiny body Healthcare Improvement Scotland has published the “most comprehensive picture yet” of cardiology services across the country.

It found 53% of patients who should be getting a blood thinning drug were not.

Meanwhile low-risk patients are being given more powerful medication when they should just be taking aspirin.

The report paints an in-depth picture of the strengths and weaknesses of heart disease services in Scotland, and includes detailed plans for how improvements to services can be made.

Cardiovascular disease is the leading cause of death in the UK and coronary heart disease results in nearly 10,000 deaths every year in Scotland.

The report raised concerns about treatments prescribed to people with atrial fibrillation, a common heart rhythm disorder with a high risk of stroke.

While nearly 80% of people with this diagnosis receive some form of blood-thinning drug, less than half (47%) of higher risk patients are receiving the most appropriate treatment, Warfarin.

At the same time 31% of low-risk patients, who should be treated with aspirin alone, are receiving a blood-thinning drug which exposes them unnecessarily to a higher risk of bleeding complications.

Vital services

Dr Martin Denvir, clinical lead for the heart disease improvement programme, said: “Within three years of starting this improvement programme we are now publishing a groundbreaking report which sets out in detail just what has been achieved in Scotland – and what is still to be done.

“This is the most comprehensive picture yet of heart disease services in Scotland.

“The journey towards perfect care for all patients is by no means over, but our findings clearly identify what is already being done well, what needs improvement and how we can measure our improvement and progress towards best quality of care.”

The report also found that although all health boards have risk assessment programmes in place to identify people at high risk of heart disease and stroke, these programmes are not provided comprehensively for all high-risk groups in the general population.

It also said the Scottish Ambulance Service provides a well-trained and rapid response to emergency calls and reaches 71% of patients with suspected heart disease within eight minutes.

The report makes a number of key recommendations to improve patient care, including a review of the prescribing of blood-thinning drugs.

It said patients at low risk of stroke should not routinely be prescribed Warfarin.

Andy Carver from the British Heart Foundation (BHF) welcomed the report and said: “It is an important step in improving the accountability of NHS boards for the delivery of vital services for heart patients.

“We will continue to watch closely and help ensure that these standards are implemented to help people prevent heart disease and make sure services for heart patients are the best possible in all parts of the country.”

Chest Heart & Stroke Scotland’s chief executive David Clark said “We recognise that there has been real progress as a result of the Heart Disease Improvement Programme and that Scotland has some world-class centres for the treatment of heart disease.

“However, we also have to recognise that there is some way to go until every patient has the correct treatment every time.”

Bounce Back from a Cold or Flu Fast

Heart Disease

11 best ways to soothe symptoms and speed up recovery

Pick the right natural remedy

If you feel symptoms coming on, zinc or Cold-fX (a supplement that contains ginseng) could help shorten symptoms, research shows. Your body needs the mineral zinc to produce germ-fighting white blood cells, but don’t overdo it. More than 50 mg a day can actually backfire and suppress your immune system.

Ginseng bolsters levels of white blood cells and crucial immune system proteins called interleukins. Other remedies, like echinacea, Airborne, and—as previously mentioned—vitamin C, are not as effective as these, research shows.

28 Days to a Healthier Heart

Heart Disease

Lower heart disease risk by 92% with a simple change each day

Heart Health Day 25: Steer Clear of Secondhand Smoke

Got friends or coworkers who smoke socially? Stay away when they light up and your heart will thank you. The effects on the cardiovascular system due to passive smoking are, on average, 80 to 90% as great as those due to active smoking, research shows. Even brief (minutes or hours) exposure to secondhand smoke can have cardiovascular effects nearly as great as long-term active smoking.

28 Days to a Healthier Heart

Heart Disease

Lower heart disease risk by 92% with a simple change each day

Heart Health Day 19: Meditate for 5 Minutes

Practicing a form of meditation in which you focus awareness on the present moment can reduce the effects of daily stressors. Ride out a stress storm by simply closing your eyes and quietly focusing on your breathing for 5 to 10 minutes.

7 Heart Tests That Could Save Your Life

Heart Disease

Think a stress test and a simple blood workup are all you need to assess your heart attack risk? Wrong.


Genetic Tests

How They Work: A blood sample is tested at a lab for mutations of the KIF6 and APOE genes.

Cost: $130 each

Duration: 5 minutes

Why They’re Heart Smart: A common variation in the KIF6 gene and two mutations in the APOE gene raise your heart disease risk. “You have no control over your genes,” says Dr. Agatston, “but these tests can help your doctor better tailor your treatment to head off a heart attack.”

Get Them If: You’re 40 or older.

What the Results Mean: “The KIF6 gene test predicts how effective statins are likely to be at heading off a future heart attack,” says Dr. Agatston. A recent study found that people with a certain variant of KIF6 had a better response to statin treatment, with a 41% drop in heart attack risk, while people without this mutation didn’t respond as well, with a 6% drop. “So we’ll use a different treatment in these cases,” he says– typically, a fenofibrate or niacin. As for the APOE gene, certain people with those variants have a much greater response to a low-saturated-fat diet. “So they may not need medication if they’re diligent about avoiding saturated fat,” Dr. Agatston says.

Next Steps: A drug to lower cholesterol, changes in diet, or both.

7 Heart Tests That Could Save Your Life

Heart Disease

Think a stress test and a simple blood workup are all you need to assess your heart attack risk? Wrong.


Advanced Lipid Profile and Lipoprotein(a) Test

How They Work: Unlike the traditional cholesterol blood test, which measures total cholesterol, HDL, LDL, and triglycerides, the advanced test also looks at particle size. This is important because some particles are big and fluffy, so they tend to bounce off artery walls as they travel through the body. Others are small and dense, meaning they can penetrate the artery lining and form clumps of plaque. (Think beach balls versus bullets.) The Lp(a) blood test analyzes a specific type of cholesterol that can triple heart risk.

Cost: $19 each

Duration: 5 minutes

Why They’re Heart Smart: Sizing up your particles gives a clearer picture of heart risk than the conventional test: Having a lot of large particles cuts risk, while small ones raise it. The more Lp(a) you have, the worse it is too–it makes LDL particles extra sticky, so they cling to the lining of blood vessels, causing plaque and clots.

Get Them If: You have a family history of heart disease.

What the Results Mean: “You do not want more than 15% of your particles to be the small, dense type,” says Dr. Agatston. For Lp(a), levels above 30 mg/dl put you at increased risk.

Next Steps: If you have small particles, your doctor may prescribe a drug to increase their size, most likely a fenofibrate (such as TriCor or Trilipix) or niacin (vitamin B3), along with a healthy diet and exercise. Niacin is also the best treatment for high Lp(a).

Clinical Trials

Heart Disease

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of heart diseases and conditions, as well as ways to prevent or treat them.

Many more questions remain about heart diseases and conditions, including heart attacks. The NHLBI continues to support research aimed at learning more about heart attacks. For example, NHLBI-supported research includes studies that explore:

  • How new therapies can help treat heart attacks and improve quality of life for people who have had heart attacks
  • The benefits of using certain tests, such as cardiac MRI, to evaluate people who have had heart attacks
  • The factors that may play a role in causing heart attacks in women younger than 55 years of age

Much of this research depends on the willingness of volunteers to take part inclinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to heart attacks, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

Causes of Heart Disease

Heart Disease

Cardiovascular disease can take many forms: high blood pressure, coronary artery disease, valvular heart disease, stroke, or rheumatic fever/rheumatic heart disease. According to the World Health Organization, cardiovascular disease causes 12 million deaths in the world each year. Cardiovascular disease is responsible for half of all deaths in the United States and other developed countries, and it is a main cause of death in many developing countries as well. Overall, it is the leading cause of death in adults.

In the United States, more than 60 million Americans have some form of cardiovascular disease. About 2600 people die every day of cardiovascular disease. Cancer, the second largest killer, accounts for only half as many deaths.

Coronary artery disease, the most common form of cardiovascular disease, is the leading cause of death in America today. But thanks to many studies involving thousands of patients, researchers have found certain factors that play an important role in a person’s chances of developing heart disease. These are called risk factors.

Risk factors are divided into two categories: major and contributing. Major risk factors are those that have been proven to increase your risk of heart disease. Contributing risk factors are those that doctors think can lead to an increased risk of heart disease, but their exact role has not been defined.

The more risk factors you have, the more likely you are to develop heart disease. Some risk factors can be changed, treated, or modified, and some cannot. But by controlling as many risk factors as possible, through lifestyle changes and/or medicines, you can reduce your risk of heart disease.

Major Risk Factors

High Blood Pressure (Hypertension). High blood pressure increases your risk of heart disease, heart attack, and stroke. Though other risk factors can lead to high blood pressure, you can have it without having other risk factors. If you are obese, you smoke, or you have high blood cholesterol levels along with high blood pressure, your risk of heart disease or stroke greatly increases.

Blood pressure can vary with activity and with age, but a healthy adult who is resting generally has a systolic pressure reading between 120 and 130 and a diastolic pressure reading between 80 and 90 (or below).

High Blood Cholesterol. One of the major risk factors for heart disease is high blood cholesterol. Cholesterol, a fat-like substance carried in your blood, is found in all of your body’s cells. Your liver produces all of the cholesterol your body needs to form cell membranes and to make certain hormones. Extra cholesterol enters your body when you eat foods that come from animals (meats, eggs, and dairy products).

Although we often blame the cholesterol found in foods that we eat for raising blood cholesterol, the main culprit is the saturated fat in food. (Be sure to read nutrition labels carefully, because even though a food does not contain cholesterol it may still have large amounts of saturated fat.) Foods rich in saturated fat include butter fat in milk products, fat from red meat, and tropical oils such as coconut oil.

Too much low-density lipoprotein (LDL or “bad cholesterol”) in the blood causes plaque to form on artery walls, which starts a disease process called atherosclerosis. When plaque builds up in the coronary arteries that supply blood to the heart, you are at greater risk of having a heart attack.

Diabetes. Heart problems are the leading cause of death among people with diabetes, especially in the case of adult-onset or Type II diabetes (also known as non-insulin-dependent diabetes). Certain racial and ethnic groups (African Americans, Hispanics, Asian and Pacific Islanders, and Native Americans) have a greater risk of developing diabetes. The American Heart Association estimates that 65% of patients with diabetes die of some form of cardiovascular disease. If you know that you have diabetes, you should already be under a doctor’s care, because good control of blood sugar levels can reduce your risk. If you think you may have diabetes but are not sure, see your doctor for tests.

Obesity and Overweight. Extra weight is thought to lead to increased total cholesterol levels, high blood pressure, and an increased risk of coronary artery disease. Obesity increases your chances of developing other risk factors for heart disease, especially high blood pressure, high blood cholesterol, and diabetes.

Many doctors now measure obesity in terms of body mass index (BMI), which is a formula of kilograms divided by height in meters squared (BMI =W [kg]/H [m2]). According to the National Heart, Lung, and Blood Institute (NHLBI), being overweight is defined as having a BMI over 25. Those with a number over 30 are considered obese.

Smoking. Most people know that cigarette and tabacco smoking increases your risk of lung cancer, but fewer realize that it also greatly increases your risk of heart disease and peripheral vascular disease (disease in the vessels that supply blood to the arms and legs). According to the American Heart Association, more than 400,000 Americans die each year of smoking-related illnesses. Many of these deaths are because of the effects of smoking on the heart and blood vessels.

Research has shown that smoking increases heart rate, tightens major arteries, and can create irregularities in the timing of heartbeats, all of which make your heart work harder. Smoking also raises blood pressure, which increases the risk of stroke in people who already have high blood pressure. Although nicotine is the main active agent in cigarette smoke, other chemicals and compounds like tar and carbon monoxide are also harmful to your heart in a variety of ways. These chemicals lead to the buildup of fatty plaque in the arteries, possibly by injuring the vessel walls. And they also affect cholesterol and levels of fibrinogen, which is a blood-clotting material. This increases the risk of a blood clot that can lead to a heart attack.

Physical Inactivity. People who are not active have a greater risk of heart attack than do people who exercise regularly. Exercise burns calories, helps to control cholesterol levels and diabetes, and may lower blood pressure. Exercise also strengthens the heart muscle and makes the arteries more flexible. Those who actively burn 500 to 3500 calories per week, either at work or through exercise, can expect to live longer than people who do not exercise. Even moderate-intensity exercise is helpful if done regularly.

Gender. Overall, men have a higher risk of heart attack than women. But the difference narrows after women reach menopause. After the age of 65, the risk of heart disease is about the same between the sexes when other risk factors are similar.

Heredity. Heart disease tends to run in families. For example, if your parents or siblings had a heart or circulatory problem before age 55, then you are at greater risk for heart disease than someone who does not have that family history. Risk factors (including high blood pressure, diabetes, and obesity) may also be passed from one generation to another.

Also, researchers have found that some forms of cardiovascular disease are more common among certain racial and ethnic groups. For example, studies have shown that African Americans have more severe high blood pressure and a greater risk of heart disease than whites. The bulk of cardiovascular research for minorities has focused on African Americans and Hispanics, with the white population used as a comparison. Risk factors for cardiovascular disease in other minority groups are still being studied.

Age. Older age is a risk factor for heart disease. In fact, about 4 of every 5 deaths due to heart disease occur in people older than 65.

As we age, our hearts tend to not work as well. The heart’s walls may thicken, arteries may stiffen and harden, and the heart is less able to pump blood to the muscles of the body. Because of these changes, the risk of developing cardiovascular disease increases with age. Because of their sex hormones, women are usually protected from heart disease until menopause, and then their risk increases. Women 65 and older have about the same risk of cardiovascular disease as men of the same age.

Contributing Risk Factors 

Stress. Stress is considered a contributing risk factor for heart disease because little is known about its effects. The effects of emotional stress, behavior habits, and socioeconomic status on the risk of heart disease and heart attack have not been proven. That is because we all deal with stress differently: how much and in what way stress affects us can vary from person to person.

Researchers have identified several reasons why stress may affect the heart.

Stressful situations raise your heart rate and blood pressure, increasing the your heart’s need for oxygen. This need for oxygen can bring on angina pectoris, or chest pain, in people who already have heart disease.

During times of stress, the nervous system releases extra hormones (most often adrenaline). These hormones raise blood pressure, which can injure the lining of the arteries. When the arteries heal, the walls may harden or thicken, making is easier for plaque to build up.

Stress also increases the amount of blood clotting factors that circulate in your blood, and makes it more likely that a clot will form. Clots may then block an artery narrowed by plaque and cause a heart attack.
Stress may also contribute to other risk factors. For example, people who are stressed may overeat for comfort, start smoking, or smoke more than they normally would.

Sex hormones. Sex hormones appear to play a role in heart disease. Among women younger than 40, heart disease is rare. But between the ages 40 and 65, around the time when most women go through menopause, the chances that a woman will have a heart attack greatly increase. From 65 onward, women make up about half of all heart attack victims.

Birth control pills. Early types of birth control pills contained high levels of estrogen and progestin, and taking these pills increased the chances of heart disease and stroke, especially in women older than 35 who smoked. But birth control pills today contain much lower doses of hormones. Birth control pills are considered safe for women younger than 35, who do not smoke or have high blood pressure.

But if you smoke or have other risk factors, birth control pills will increase your risk of heart disease and blood clots, especially if you are older than 35. According to the American Heart Association, women who take birth control pills should have yearly check-ups that test blood pressure, triglyceride, and glucose levels.

Alcohol. Studies have shown that the risk of heart disease in people who drink moderate amounts of alcohol is lower than in nondrinkers. Experts say that moderate intake is an average of one to two drinks per day for men and one drink per day for women. One drink is defined as 1?fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine, or 12 fl oz of beer. But drinking more than a moderate amount of alcohol can cause heart-related problems such as high blood pressure, stroke, irregular heartbeats, and cardiomyopathy (disease of the heart muscle). And the average drink has between 100 and 200 calories. Calories from alcohol often add fat to the body, which may increase the risk of heart disease. It is not recommended that nondrinkers start using alcohol or that drinkers increase the amount that they drink.

It is never too late梠r too early梩o begin improving heart health. Some risk factors can be controlled, while others cannot. But, by eliminating risk factors that you can change and by properly managing those that you cannot control, you may greatly reduce your risk of heart disease.

Little Fact:

Lipitor is the best selling prescription drug for lowering blood cholesterol levels.

General Information on Heart Disease

Heart Disease

You’ve seen the stories time and again: Exercise to prevent coronary artery disease. Eat better to reduce your risk of coronary heart disease. Stop smoking to stop heart disease. Lower your cholesterol to lower your odds of developing cardiovascular disease.

Coronary artery disease? Coronary heart disease? Heart disease? Cardiovascular disease? What are all these things? And what’s the difference, anyway?

Perhaps you’ve been bombarded so often with warnings and advice about your heart that you simply don’t pay attention anymore. Or you don’t know what these conditions mean or exactly how destructive they can be to your health.

Understanding the various terms and how they’re often used — sometimes incorrectly — can help you sort through the morass. And if you know more about the various types of cardiovascular disease, and the havoc they can wreak on your body, you may be more inclined to take steps to prevent them. You’ll also know more about the ways all of the different manifestations of cardiovascular disease interact to affect your health, and you’ll learn how you can best control your risks.

Defining cardiovascular disease 

First, consider cardiovascular disease. Cardiovascular disease is a broad, all-encompassing term. It’s not a single condition or disorder in itself. Rather, it’s a collection of diseases and conditions. In fact, some types of cardiovascular disease can even cause other types of cardiovascular disease.

To get technical, cardiovascular disease refers to any disorder in any of the various parts of your cardiovascular system, which is made up of your heart and the blood vessels throughout your body, explains Brooks Edwards, M.D., a cardiologist at Mayo Clinic, Rochester, Minn..

Cardiovascular disease, then, has two main components:

Diseases of the heart (cardio)
Diseases of the blood vessels (vascular)

Although you may hear a lot about preventing cardiovascular disease, sometimes you can’t prevent it. That’s because some types of cardiovascular disease are congenital — you’re born with them. Other forms are acquired — you develop them over the course of your lifetime. These acquired conditions are the forms you can often help prevent by doing such things as exercising regularly, eating a balanced diet or quitting smoking. And they make up the vast majority of cardiovascular diseases.

So, if you have something wrong with your heart, such as an abnormality of the heart muscle (cardiomyopathy), that’s a type of cardiovascular disease. Likewise, an aneurysm, a bulging section of blood vessel, also is a type of cardiovascular disease. And even varicose veins are technically classified as a cardiovascular disease.

But what about those news reports that say cardiovascular disease is the No. 1 killer of American men? What does that mean, really?

Are they getting aneurysms? Dying of varicose veins? Did they have a congenital heart defect that couldn’t be successfully treated? Just what do those reports mean? Adding to the confusion are the different ways that major organizations and agencies, including the Centers for Disease Control and Prevention and the American Heart Association, define cardiovascular disease.

It’s no wonder you’re left scratching your head. But to help sort through all of that and help you become a health-savvy consumer the next time you read one of those reports, here’s a closer look at just what cardiovascular disease is.

Diseases of the heart 

The heart consists of a muscle (myocardium) that pumps blood, arteries that supply blood to the heart muscle, and valves to ensure that the blood is pumped in the correct direction. At any point in the pumping process, or in any part of the heart, something can go awry. The diseases and conditions affecting the heart are collectively known as heart disease.

Like cardiovascular disease, the term heart disease is somewhat loose and broad, and it’s often used that way. You may see reports urging you to avoid smoking so that you reduce your risk of heart disease, for instance. And you can. Or that heart disease is the leading killer of both men and women. And it is.

But neither exercise nor healthy diet nor low cholesterol can protect you against all forms of heart disease. There are many types of heart disease, and not all are the consequences of unhealthy lifestyle habits. Some forms of cardiomyopathy are caused by viruses, for instance. And some babies are born with Ebstein’s anomaly, a defect in one of the heart’s valves that causes blood to leak and prevents the heart from working at top efficiency.

Most often, when you hear a report about preventing heart disease, it’s really a call to prevent coronary artery disease or coronary heart disease.

Coronary artery disease. These are diseases of the arteries that supply the heart muscle with blood. Sometimes known as CAD, coronary artery disease is the most common form of heart disease in industrialized nations and far and away the leading cause of heart attacks.

Coronary artery disease generally means that blood flow through the arteries has become impaired. The most common way such obstructions develop is through a condition called atherosclerosis, a largely preventable type of vascular disease.

The actively contracting heart muscle needs a steady supply of oxygen and nutrients to function. They’re delivered by blood vessels known as coronary arteries.

Over the course of your lifetime — actually starting in early childhood — these arteries, whose inner lining is normally smooth, can slowly become clogged with clumps of fats, cholesterol and other material, called atherosclerotic plaques. You may also know this as hardening or narrowing of the arteries. The inner walls of arteries become narrow slowly because of a buildup of these plaques, or suddenly by a rupture of a plaque and the formation of a blood clot around the ruptured plaque.

As a result, the supply of blood — with its oxygen and nutrients — going to the heart muscle is choked off (myocardial ischemia). As less blood reaches the heart, it can’t function normally, and you begin experiencing the physical consequences.

Chest pain (angina pectoris) occurs, for instance, when the oxygen demand of the heart muscle exceeds the oxygen supply because of that narrowing in the coronary arteries. When the imbalance of oxygen supply lasts for more then a few minutes, heart muscle can begin to die, causing a heart attack (myocardial infarction). This may occur without symptoms (silent heart attack), especially in people with diabetes.

In addition, the lack of blood, even briefly, can lead to serious disorders of the heart rhythm, known as arrhythmias or dysrhythmias. Coronary artery disease can even cause sudden death from an arrhythmia without any prior warning.

These consequences of coronary artery disease are also types of cardiovascular disease in their own right and, in turn, can cause even more types of cardiovascular disease — weaving a complex interplay of cause and effect. A heart attack, for instance, can lead to congestive heart failure, and both of these conditions are types of cardiovascular disease.

There’s another confusing twist to coronary artery disease: It’s sometimes used synonymously with coronary heart disease. But you can impress your cardiologist on the next visit — if not your colleagues around the water cooler — if you know they’re not technically the same things.

Rather, coronary heart disease is a more encompassing term that refers to diseases of the coronary arteries and their resulting complications — angina, a heart attack and even scar tissue caused by the heart attack. All are technically coronary heart diseases. Remember, coronary artery disease is disease only of the arteries.

Cardiomyopathy. These are diseases of the heart muscle. Some forms of cardiomyopathy are genetic, while others occur for reasons that are less well understood. The most common type of cardiomyopathy in developed nations is ischemic cardiomyopathy, which is caused by the loss of heart muscle from a heart attack resulting from coronary artery disease. Some forms of cardiomyopathy affect the contraction of the heart (systolic dysfunction) while other forms affect the filling, or relaxation, phase of the heart (diastolic dysfunction).

Valvular heart disease. These are diseases of the valves within the heart. Blood flows in the correct direction within the heart because of a series of valves. When a valve is diseased, blood flow may become obstructed, a condition known as valvular stenosis. Or a valve may leak, causing a condition known as valvular insufficiency or valvular regurgitation. You may be born with valvular disease, or the valves can become infected and damaged by bacteria or other microorganisms, a condition known as infectious endocarditis.

Pericardial disease. These are diseases of the sac (pericardium) that encases the heart. Diseases of the pericardial sac can secondarily affect the heart itself. There are several types of pericardial disease, including inflammation (pericarditis), fluid accumulation (pericardial effusion) and stiffness (constrictive pericarditis). These forms can occur alone or together. Causes and consequences vary. For instance, pericardial effusion can occur after a heart attack and, as a result, prevent your heart from working efficiently.

Congenital heart disease. These are forms of heart disease that develop before birth (congenital). Some may be apparent right at the time of birth, while others may not be detected until later in life. Congenital heart disease can affect the formation of the heart’s chambers, muscle or valves, and include such conditions as narrowing of a section of the aorta (coarctation) and Ebstein’s anomaly.

Congestive heart failure. Congestive heart failure occurs when the heart no longer pumps normally, although it does continue to work to some degree. With less effective pumping, vital organs don’t get enough blood, causing such signs and symptoms as shortness of breath, fluid retention and fatigue. This condition may develop suddenly or over many years. Congestive heart failure occurs as a result of other cardiovascular conditions that have damaged or weakened the heart. Among them are coronary artery disease, cardiomyopathy, valvular heart disease, and some forms of congenital heart disease.

Diseases of the blood vessels

High blood pressure. High blood pressure (hypertension) is perhaps the most common form of cardiovascular disease in the Western world, affecting about one in four Americans. It’s also one of the most preventable and treatable types of cardiovascular disease.

But it’s more than just a type of cardiovascular disease. High blood pressure is also a cause of cardiovascular disease and a risk factor for cardiovascular disease.

Blood pressure is determined by how much blood your heart pumps out and how narrow your arteries are. The more your heart pumps and the narrower your arteries — say they’re clogged from atherosclerosis — the higher your blood pressure, and the harder your heart has to work to pump the same amount of blood.

High blood pressure has far-reaching and serious health consequences. For one thing, it accelerates the development of atherosclerosis, which, in turn, makes high blood pressure worse and further increases the risk of other cardiovascular complications.

High blood pressure can also lead to stroke. That happens when a bit of cholesterol or other clump of arterial plaque breaks off and blocks blood flow to the brain. It may also happen when a tiny blood vessel in the brain ruptures because of damage sustained by high blood pressure. Stroke is sometimes considered a type of cardiovascular disease. But technically, it’s actually a result of cardiovascular disease.

In addition, high blood pressure can wreak havoc on the heart itself. It can cause coronary artery disease, congestive heart failure and heart attack. And the damage doesn’t stop there: High blood pressure can also damage other vital organs, such as your kidneys and eyes.

Aneurysms. An aneurysm is a bulge or weakness in the wall of an artery or vein. Aneurysms usually enlarge over time, and have the potential to rupture and cause life-threatening bleeding. Aneurysms can occur in arteries in any location in your body, but common sites include the abdominal aorta and the arteries at the base of the brain.

The vast majority of aneurysms occur when an artery wall becomes weak or damaged by atherosclerosis. And that means in many cases, aneurysms are another type of cardiovascular disease that’s preventable. The usual suspects in blood vessel damage are often to blame here, too — smoking, high blood pressure, and unhealthy lifestyle habits that contribute to atherosclerosis.

Brain aneurysms are a different matter and often result from a congenital weakness in the arteries at the base of the brain.

Claudication. Strictly speaking, this is a symptom of the condition occlusive arterial disease, but it’s often referred to as a disease itself. Symptoms develop when the arteries to the legs or arms become partially obstructed, compromising blood flow — similar to how coronary artery disease can cause angina. When the obstruction is mild, you may have such symptoms as extremity pain during strenuous exercise. As the disease progresses and arteries become more obstructed, you may notice symptoms with minimal or no activity at all and develop ulcers of the skin and soft tissue that don’t heal.

As with aneurysms, claudication is most often caused by preventable atherosclerosis. Claudication isn’t just a type of cardiovascular disease. It’s also a symptom of other cardiovascular disease — the pain of claudication can be a symptom that you have atherosclerosis.

Vasculitis. This is inflammation of the blood vessels. It usually involves the arteries but may also affect small veins and capillaries. The inflammation may damage the wall of the artery or vein and impair blood flow to the region of the body supplied by that vessel. Sometimes vasculitis occurs in the presence of a generalized disorder, such as lupus or rheumatoid arthritis, but it sometimes occurs without an associated disease.

Venous incompetence. This is a condition in which blood actually flows the wrong way in veins. Veins have tiny valves that are designed to promote blood flow in a forward direction, back to the heart. But if you have such conditions as infection, inflammation, abnormal blood clotting, or even high-back pressure in pregnancy, the valves may become damaged and incompetent. That allows blood to flow backward and pool in the extremities when sitting or standing, causing a variety of complications, such as prominent and painful varicose veins, skin changes and ulcers.

Venous thrombosis. This is the abnormal formation of a blood clot (thrombus) in a vein. This condition may damage the vein and its valves. In addition, clots that break off and travel in the bloodstream can lodge in the lungs, a condition known as pulmonary embolism. In some cases, this type of clot can also cause a stroke.

Varicose veins. This is a condition in which veins become gnarled, twisted and enlarged. They’re usually located on the backs of the calves or on the inside of the legs, from the groin to the ankle.

When valves in your veins don’t function properly, blood can accumulate in your lower extremities, causing the veins to bulge and twist. The veins appear blue because they contain less oxygen.

Prevention power 

“Cardiovascular disease is not a linear disease,” Dr. Edwards says. “People don’t usually have only one of these conditions that make up cardiovascular disease. Most of the time there’s a complex interplay of the conditions, and a primary disorder may cause a secondary disorder, which can lead to other disorders and make all of them worse, including the primary disorder.”

Furthermore, he notes, one cardiovascular disease can be a manifestation of another. Case in point: aneurysm. It can be a sign that you have atherosclerosis.

All of this underscores the complexity that is cardiovascular disease. But in the end, the most common forms of cardiovascular disease are high blood pressure and coronary artery disease, both of which are highly preventable.

Some preventive measures you can take:

–Don’t smoke or use other tobacco products
–Eat a varied diet, rich in fruits, vegetables and low-fat foods
–Maintain a healthy weight
–Get at least 30 minutes of exercise daily, most days of the week
–Keep your cholesterol levels in normal ranges
–Control your blood sugar if you have diabetes
–Control your blood pressure

You have the power to greatly reduce your risk of cardiovascular disease, whether it’s heart disease, coronary artery disease or coronary heart disease — or any of their numerous incarnations.

Little Fact:

Lipitor is the best selling prescription drug for lowering blood cholesterol levels.

Risk Factors Of Ischemic Heart Disease

Heart Disease

A new study has again linked low vitamin D levels with an increased risk of death. Austrian researchers say that in a study of 3,258 patients, those with the lowest vitamin D levels were twice as likely to die from heart disease and other causes as those with the highest levels. This study is the latest of several trials that have linked vitamin D to diseases such as cancer, diabetes, obesity, and hypertension.

Low vitamin D level may up death risk

Heart Disease

A new study has again linked low vitamin D levels with an increased risk of death. Austrian researchers say that in a study of 3,258 patients, those with the lowest vitamin D levels were twice as likely to die from heart disease and other causes as those with the highest levels. This study is the latest of several trials that have linked vitamin D to diseases such as cancer, diabetes, obesity, and hypertension.

HEART STATISTICS

Heart Disease
  • Coron
    ary artery disease is the single largest cause of morbidity amongst all diseases so much so that it has been classified as having reached pandemic proportions by none less than the WHO (World Health Organisation).
  • Over 7,0000,000 Indians have heart related diseases
  • 1 in 3 adults, both men and women, has some form of cardiovascular disease.
  • In 90% of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed or blocked.
  • Brain death and permanent death start to occur in just 4-6 minutes after someone experiences cardiac arrest.
  • The cardiac 64 CT scan provides 3D images of the heart so detailed that the heart disease can be detected at a very early stage.