Because of its long standing use in Western herbalism, researchers wanted to determine if the use of Hawthorn tree extract would affect lifespan in patients with congestive heart failure. The herb is believed to improve the function of heart muscle and improve performance. Individuals with end stage congestive heart failure often die because the heart is no longer able to pump the blood efficiently and fluid backs up in the lungs and venous system.

The study enrolled more than 2,600 men and women with congestive heart failure. They were then randomized to receive Hawthorn extract or placebo in addition to their conventional medication.

After 6 and 18 months on the extract patients had an improved chance of living, but this difference disappeared at 24 months. The risk of cardiac related death was 20 percent lower in patients receiving the extract, a difference which may seem small, but can be a huge advantage to those living with advanced congestive heart failure.

The results of the study were presented at the annual American College of Cardiology meeting in New Orleans last month.

Though a benefit was observed at 18 months, the primary outcome was to find signficant benefit after 2 years or 24 months, which was not evdient by this study.

The study, presented at the 2007 annual meeting of the American College of Cardiology and published in The New England Journal of Medicine, examined whether drug therapy and angioplasty with stents were superior to drug therapy alone in reducing the risk of heart attack and death. Researchers from Buffalo General Hospital administered drug therapy to 2,287 patients with stable heart disease, chest pain and 70 percent blockage in one or more heart arteries. About half of the participants also had angioplasty with stents (percutaneous coronary intervention or PCI).

The researchers found that 19 percent of participants in both groups died or had a heart attack over the five year follow-up period. Furthermore, there were no significant differences between both groups for stroke, hospitalization for acute coronary syndrome, or myocardial infarction. Although the angioplasty group initially reported a better quality of life and less episodes of chest pain following PCI, the differences diminished over the five year follow-up period.

"As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy," the study authors conclude.

REFERENCES:
1. Boden W et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease, March 28,2007; vol356, released online ahead of publication.

Heart disease is the number two killer of women in the US. Myocardial infarctions, or heart attacks and stroke are one of the leading causes of hospital admissions each year. Many factors contribute to the development of heart disease in women, including obesity, high blood pressure, high cholesterol, and family predisposition.

Recently more research has been focused on the causes or factors involved in the development of heart disease in women. And within this research doctors and scientists have been trying to determine how to prevent the onset of heart disease.

Information about diet and heart disease incidence was gathered from more than 34,000 in the Iowa Women's Health Study. Then the total flavonoid content of the food was determined and compared to to heart disease incidence over the follow-up period of 16 years.

Diets high in flavonoids were linked to a 10-22 percent decrease in heart disease, coronary artery disease, and stroke in postmenopausal women. The most notable flavonoids to offer this protection were anthocyanidins, flavones, and flavanones.

Many dark fruits and vegetables are high in flavonoids, as are onions, garlic, and chocolate.

The authors were pleased with the findings, but suggest that further studies are needed to solidify the relationship between flavonoid intake and heart disease risk.

Researchers in Maryland enrolled about 630 women in a study aimed at providing more information about chest pain and symptoms of heart disease in women. Women were enrolled and answered questions about their emotions including issues with anger and how they expressed their emotions. Each woman also underwent an angiography, a procedure that looks for blockages in the main coronary ateries supplying blood to heart.

The results of the study were published in the December issue of the Journal of Women's Health.

They found that women who outwardly expresesd their anger, and who had previous risk factors for heart disease were most likely to have blockages in their coronary arteries. Women who had risk factors for heart disease but did not outwardly express their anger were not as likely to have blockages.

However, symptom severity was not associated with artery blockage, but was associated with anger expression. The women who were the most hostile had the most severe symptoms, but not necessarily any relationship with evidence for coronary artery disease.

So the authors believe that anger, whether related to blockages or not, may significantly impact symptoms of heart disease. The primary complaints associated with anger include sharp chest pain, pressure in the chest, or heaviness.

The study, published in the American Journal of Preventive Medicine, compared the estimated impact of three interventions to prevent sudden death. Researchers at Regions Hospital's Heart Center in St. Paul, Minnesota, examined a fictional group of participants, aged 30-84 in Olmstead County, Minnesota, in three scenarios. In the first scenario, participants receive adequate intake of omega-3s from fish oils, in the second scenario AEDs are in participant's homes and public facilities, and in the third scenario appropriate participants are given ICDs.

The researchers found that all three scenarios decreased the risk of sudden death. However, adequate omega-3 fish oil intake was found to have the best result. Participants who adequately consumed fish oils reduced the risk of sudden death by 6.4 percent, compared to 3.3 percent of the ICD group and less than 1 percent of the AED group. In addition, 75 percent of the decrease in sudden death due to omega-3s would come from raising omega-3 levels in the healthy participants. This suggests that adequate omega-3 fish oil intake may be the best way to prevent sudden cardiac death.

"Based on central values of candidacy and efficacy, raising n-3 fatty acid levels would have about eight times the impact of distributing AEDs and two times the impact of implanting ICDs," the study authors write. "Raising n-3 fatty acid levels would also reduce rates of sudden death among the subpopulation that does not qualify for ICDs."

REFERENCES:
1. Kottke TE et al. Preventing sudden death with n-3 (omega-3) fatty acids and defibrillators. Am J Prev Med 2006 Oct;31(4):316-323.

A study published in the American Journal of Epidemiology in December of 2006 found that abdominal obesity represents a greater risk than overall obesity in terms of heart disease. And the effect is more pronounced for younger men and women than for older.

In order to determine the effect of weight gain and if it matters where the weight is carried researchers at Kaiser Permanente in California looked at information on more than 100,000 men and women who enrolled in a study in the 60's and 70's. Each person was then folllowed an average of 12 years.

Measurements of height, weight, abdominal circumferance, and sagittal abdominal diameter (SAD) were taken, BMI was calculated, and health outcomes (such as incidence of heart attack) were recorded.

Those men and women with the largest SAD had a significant increase in heart disease risk, 44 and 42 percent respectively when compared to those with the smallest SAD. Interestingly these numbers did not correlate with BMI, because some of those with high SAD had a normal BMI.

But as the BMI increased, so did the SAD, and so did the risk. Those with both high weight, high BMI, and high SAD had the highest risk.

The researchers also saw a trend when it came to age. Both men and women who had increased abdominal circumference as measured by the SAD had more risk if the increase in SAD occured at a younger age.

The study sheds more light on the issue of weight and heart disease. Many physicians look at BMI only, but that may not be the best means of determining if another risk factor is truely present. And young men and women should be concerned that they are at greatest risk.

Cigarette smoking is harmful to one's health for a variety of reasons. It is high in carcinogenic compounds that increase the risk of developing numerous types of cancers. The smoke also damages the delicate tissue in the lungs causing Chronic Obstructive Pulmonary Disorders such as emphysema and bronchitis.

Cigarette smoking also causes an increase in oxidative stress in the body via the production of free radicals. These free radicals can damage organs, especially the lining of blood vessels. This damage contributes to the development of heart disease, namely coronary artery disease. Damaged blood vessels increase the likelihood that a person will experience a stroke or heart atttack.

The ban on public smoking (indoors) took effect in January of 2005. To determine if any effect on hospital admissions was related to the smoking ban researchers compared data on hospital admissions between several different time periods.

First they compared all hospital admsissions between October and December 2004 with rates the same months before and after the smoking ban.

Overall, hospital admissions for heart attacks declined by 11 percent in those under the age of 60. For those over the age of 60 there was no significant change.

The researchers support this finding with the arguement that most heart attacks in those over 60 years of age may be due to other factors, with smoking playing less a role. While younger individuals may have heart attacks due to smoking more than other factors.

Prior to the ban, from 2001 to 2004 the admission rate for heart attacks was on the rise, so the authors feel that the results from this are opposite the trend, and therefore more weight is given to the smoking ban as a primary cause for the decrease in hopsital admission.

These effects are observed after only a short period of time (less than one year) and many are anxious to see what the long term effects of the smoking ban are on heart attack rates and other health conditions that are made worse or caused by smoking.

The original study was aimed at determining the effects of aspirin intake on heart disease, specifically if it changed the way blood clotted.

Aspirin is often prescribed to patients with particular types of cardiovascular disease when the risk for a heart attack or stroke is high. Both heart attacks and stroke are caused by clots that dislodge from larger blood vessels and travel through the circulatory system until they become stuck in a vessel smaller than its diameter. Blood supply and subsequently oxygen is cutt-off and the event occurs.

Aspirin makes platelets less sticky, and helps to prevent clot formation. It also helps to keep the blood thinner, so it flows through vessels easier.

And now, chocolate appears to act in a similar way. A small group of 139 chocolate eaters were included in this data. Consumption of chocolate caused the blood to clot at a slower rate compared to non-chocolate eaters.

The researchers wanted to stress that the effect was evident, but not as significant as taking aspirin. Chocolate should not replace any prescription for aspirin that your physician has given you.

These findings have prompted the researchers to begin another study measuring the effect of diets high in chocolate on heart disease risk and incidence.

The authors came to the conclusion that folic acid, in the diet and that taken as a supplement, lowers levels of homocysteine in the blood. Lower levels of homocysteine result in a decreased risk for heart disease by as much as 10-20 percent.

An interesting aspect of the review focused on a unique subset of individuals with a genetic defect that causes higher than normal levels of homocyteine. Folic acid supplementation in these people resulted in lower homocysteine and lower risk.

There are other risk factors for cardiovascular disease that can offset the benefit of folic acid. The most noteable are family history of heart attack, high blood pressure, high cholesterol, history of smoking cigarettes, and obesity. Each of these risk factors can be reduced using lifestyle measures (with the exception of family history).

Homocysteine damages the inner lining of blood vessels and makes it easier for clots to form which can result in heart attacks and strokes.

For those individuals with higher than normal levels of homocysteine, folic acid is a safe and inexpensive means of reducing risk.

The study, published in The American Journal of Clinical Nutrition, investigated the association of plant foods, dairy and meat products on the risk of high blood pressure. Researchers at various U.S. medical institutions compared the nutrient intake of 4,304 participants, aged 18 to 30, as part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, for 15 years. Food frequency questionnaires obtained from the participants were analyzed to determine nutrient intake.

The researchers found that a high intake of plant foods (including whole grains, refined grains, fruit, vegetables, nuts, or legumes) was linked to improved general health and a lower risk of high blood pressure. However, a high intake of red and processed meat was associated with a higher risk of high blood pressure.

"These findings are consistent with a beneficial effect of plant food intake and an adverse effect of meat intake on blood pressure," the study authors conclude.

REFERENCES:
1. Steffen LM et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2005 Dec;82(6):1169-1177.

The updated DASH eating plan is consistent with the 2005 U.S. Dietary Guidelines and recommends limiting saturated fat, trans fat and cholesterol. The updated guide has information on potassium, weight loss, physical activity, menus, and recipes. It also includes a food diary to note what you eat and suggestions for heart-healthy food choices at meals.

"NHLBI studies have shown that the DASH eating plan can significantly lower high blood pressure, even within the first few weeks," says Dr. Elizabeth G. Nabel, NHLBI director, in a news release. "They demonstrate that by making healthy choices in diet and physical activity, you can get on track to a healthier life."

The guide offers the following practical suggestions:

1. If you eat only one or two servings of vegetables per day, try adding an additional serving at lunch and dinner.

2. Drink fat-free or low-fat milk and decrease soda and other sweetened beverages.

3. Select whole grain foods, such as whole wheat bread or whole grain cereals for added nutrients and fiber.

4. Choose foods that are lowest in salt or sodium.

5. Take a 15-minute walk daily and slowly increase your walking time.

REFERENCES:
1. NHLBI Offers Updated Guide with Practical Information for Lowering High Blood Pressure Through Diet, NIH News, News Release, June 28, 2006:
http://www.nih.gov/news/pr/jun2006/nhlbi-28.htm

The October issue of the American Journal of Clinical Nutrition featured such an article.

Researchers at Harvard used a cohort of women from the Nurse's Health Study to analyze the relationship between coffee consumption and blood vessel dysfunction. They also wanted to look at inflammatory markers in the blood related to coffee consumption.

The study did not find the same results as the previous studies. In fact, it found that women who consumed coffee may incur some protection against blood vessel dysfunction. In this study the beneficial effect was observed with at least one cup a month.

Women also had lower levels of inflammatory markers in their blood if they drank coffee.

How is it that children, even those as young as 5 years of age, are showing signs of narrowed arteries? The primary reason may lie with the epidemic of young people who are overweight or obese.

Children and teenagers today are overwhelmed with commercials and advertisements for processed and fast foods that are usually high in calories and fat and low in nutrients. As the standard diet has changed from the four food groups to fast food and soft drinks, many young Americans are obese.

With this rise in obesity there has also been a rise in the number of children and teenagers diagnosed with conditions usually first seen in later decades. Conditions such as high cholesterol, high blood pressure, and Type 2 diabetes are now being diagnosed in 10 year olds.

The report mentioned above is based on data gathered from more than 3,600 children age 5 thru 18 who underwent evaluation for blood vessel narrowing and heart disease risk factors.

Canadian researchers used the data to determine any signs that point to atherosclerosis in children with and without risk factors for heart disease.

Those children who were either overweight or obese, or who had high blood pressure, high cholesterol, or diabetes were more likely to show signs of narrowed arteries than children without risk factors.

The findings prompted the researchers to conclude that parents need to pay closer attention to the diet of their children and encourage healthy food choices and daily exercise to combat the development of heart disease and atherosclerosis.

Healthcare providers should also monitor dietary habits of children more carefully, and when needed order diagnostic testing when needed. This includes checking cholesterol in children and teenagers at risk, and those with a significant family history of heart disease.

A recent review of all literature on the use of selenium for heart disease was published in the American Journal of Clinical Nutrition. The authors determined that selenium has been associated with a decreased risk for heart disease in observational studies, but randomized clinical trials designed to evaluate selenium as a treatment or preventative measure did not find similar results.

So based on this analysis, the authors state that selenium should not be a recommened treatment alternative for preventing cardiovascular disease.

But selenium does have some merit as a preventative measure, based on observational studies. But it seems that these studies do not carry as much weight as the "gold standard"--randomized clinical trial. Perhaps this study will prompt future research into seleniums role in preventing heart disease.

Plant stanols work in the GI tract to limit the absorption of cholesterol and fat in the diet, thereby lowering the total amount in the body. They are usually more effective for individuals who have high cholesterol because of reasons other than family history.

For the study 67 men and women with previously diagnosed high cholesterol were randomized to one of two groups. The first group consumed two cocoa snack bars a day containing 1.5 grams of plant stanols for 6 weeks. The second group consumed cocoa bars minus the stanols for the same period of time. Levels of total, LDL, and HDL cholesterol were measured in the blood before and after the study. Researchers also measured levels of fat soluble vitamins to determine if the stanols had any effect on their absorption.

Those individuals in the plant stanol cocoa bar group had a significant reduction in both total and LDL cholesterol after the six week period. They also had increases in their HDL, or good cholesterol. Total cholesterol was lowered by an average of 4.7 percent and LDL by an average of 6 percent. The control group did not have any significant reduction in total or LDL cholesterol.

Absorption of fat soluble Vitamins A and E was not affected by the treatment, but beta carotene was lower in the plant stanol group.

The authors concluded that cocoa bars enriched with plant stanols are an effective and possibly enjoyable way to lower ones cholesterol. The study was funded in part by the maker of the bars. Hopefully another study will support the use of cocoa bars as a means of lowering cholesterol.