Fmr. Vice Pres. Cheney reflects on his life with a heart pump - CNN video

Source: CNN

Chocolate consumption is inversely associated with coronary heart disease

Cocoa and dark chocolate are rich in flavonoids and may lower blood pressure.

5,000 people aged 25-93 years participated in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study.

Compared to subjects who did not report any chocolate intake, odds ratios for coronary heart disease (CHD) were:

- 1.0 for subjects consuming chocolate 1-3 times/month
- 0.74 for subjects consuming chocolate 1-4 times/week
- 0.43 for subjects consuming chocolate 5+ times/week

Consumption of non-chocolate candy was associated with a 49% higher prevalence of CHD comparing 5+/week vs. none per week [OR = 1.49].

Consumption of chocolate is inversely related with prevalent CHD in a general United States population.

References:

Chocolate consumption is inversely associated with prevalent coronary heart disease: the National Heart, Lung, and Blood Institute Family Heart Study. Djoussé L, Hopkins PN, North KE, Pankow JS, Arnett DK, Ellison RC. Clin Nutr. 2011 Apr;30(2):182-7. Epub 2010 Sep 19.
Image source: Wikipedia, public domain.

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

Risk of heart attack and stroke goes up during holidays - Mayo Clinic video

From the Mayo Clinic YouTube channel: Are you at an increased risk of heart attack and stroke? Studies show the incidents rise during December and January, but particularly on Christmas Day and New Year's Day. Stay safe.

Jon Lord (70), a Hammond organ player, and a founding member of Deep Purple, who is currently recovering from cancer, says it very well: "Party hearty but look after yourselves. I wish you success and happiness, and above all I wish you health."



Jon Lord - Child In Time, 4 March, 2009, Palace of Arts (MÜPA), Budapest, Hungary.

Happy New Year!

References:

Jon wishes you a Happy New Year

Vincent van Gogh: "I'd like to show by my work what such an eccentric, such a nobody, has in his heart"

How a genius feels: "I'm a nonentity, an eccentric, an unpleasant person"

March 30th is the birthday of Vincent van Gogh, born in Holland in 1853, a famous painter and also great letter-writer. His letters were lively, engaging, and passionate; they also frequently reflect his struggles with bipolar disorder.

He wrote: "What am I in the eyes of most people — a nonentity, an eccentric, or an unpleasant person — somebody who has no position in society and will never have; in short, the lowest of the low. All right, then — even if that were absolutely true, then I should one day like to show by my work what such an eccentric, such a nobody, has in his heart."

He wrote thousands of letters to his brother Theo over the course of his life. Theo's widow published the van Gogh's letters to her husband in 1913.

Doctors' Day in a high-risk profession: suicide rate of U.S. doctors is one per day

This quote serves as a good reminder how people with depression may have an altered perception of themselves. March 30 is also National Doctors' Day in the U.S. Other countries celebrate Doctors' Day on different dates.

More than a quarter of primary care doctors reported being "burnt out." The United States loses the equivalent of at least one entire medical school class (approximately 400 physicians) each year to suicide.

In other words, 300-400 doctors in the United States kill themselves every year, or roughly 1 per day. Male doctors have suicide rates 1.4 times that of the general population, while female doctors have twice the rate of depression and 2.3 times the suicide rate when compared with women who are not physicians.

A conversation could save a life: "Are you OK?" Day

Hugh Jackman shows his support for R U OK?Day, a national day of action in Australia that aims to prevent suicide by encouraging people to connect with colleagues, friends and loved ones and ask simply: "Are you OK?" This may help your medical colleagues too:



References

Writer's Almanac. NPR, 2012.
High-risk profession: Suicide rate of U.S. doctors is one per day
Help for Today's Tense, Frustrated Doctors. Medscape, 2009.
http://www.medscape.com/viewarticle/710904
Doctors have higher rates of suicide than the general population: 40% higher for male doctors, 130% for female doctors http://goo.gl/ckTm
R U OK? Day
Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."



Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

The link between stress and heart disease

In this video from the Cleveland Clinic, Steven Nissen, MD, talks about the important lesson war has taught us about stress and its effect on the heart. One of the best ways to manage stress is regular exercise.



Tips for managing stress (watch the 2-minute BBC video embedded below)

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park



Read more: http://www.bbc.co.uk/scotland/brainsmart 

Participation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

 If nothing else helps, consider this: Chewing gum may reduce stress and improve memory

What are the New Risk Markers for Coronary Heart Disease?

Traditional CHD risk factors used in the Framingham risk score (FRS) predictions include:

- age
- gender
- systolic blood pressure
- treatment of hypertension
- total and high-density lipoprotein cholesterol levels
- smoking
- diabetes

The newer CHD risk factors include:

- N-terminal fragment of prohormone B-type natriuretic peptide levels
- von Willebrand factor antigen levels
- fibrinogen levels
- chronic kidney disease
- leukocyte count
- C-reactive protein levels
- homocysteine levels
- uric acid levels
- coronary artery calcium [CAC] scores
- carotid intima–media thickness
- peripheral arterial disease
- pulse wave velocity

Adding coronary artery calcium [CAC] scores to the FRS improved the accuracy of risk predictions.

Levels of N-terminal fragment of prohormone B-type natriuretic peptide also improved risk predictions but to a lesser extent.

Improvements in predictions with other newer markers were marginal.

References:

Evaluation of Newer Risk Markers for Coronary Heart Disease Risk Classification: A Cohort Study. Maryam Kavousi et al. Ann Intern Med. 20 March 2012;156(6):438-444.
Image source: Gray's Anatomy, 1918, public domain.

Comments from Twitter:

Michael Mirochna, MD @DocRockne:  unfortunately, no evidence they help with OUTCOMES

Genetic Marker For Heart Disease Risk - Cleveland Clinic video

From Cleveland Clinic YouTube channel: February is Heart Awareness Month. Meet a young woman who survived a heart attack the day before her college graduation and then discovered a genetic link to heart disease she never knew she carried.

How the heart actually pumps blood - TED-Ed animation

For most of history, scientists weren't quite sure why our hearts were beating or even what purpose they served. Eventually, we realized that these thumping organs serve the vital task of pumping clean blood throughout the body. But how? Edmond Hui investigates how it all works by taking a closer look at the heart's highly efficient ventricle system.

Lesson by Edmond Hui, animation by Anton Bogaty.



View full lesson here: http://ed.ted.com/lessons/how-the-heart-actually-pumps-blood-edmond-hui

Video tour of the Cleveland Clinics new heart center with its architects

"Take a video tour of the Cleveland Clinics new heart center with NBBJ architects Edwin Beltran, senior associate, and Lisa Baker, ASID, IIDA. The nearly 1-million-square-foot Miller Family Pavilion serves as the main entrance to Cleveland Clinic and the home of the Cleveland Clinic Heart & Vascular Institute.

The double-height main lobby is bright with soaring luminous white walls, terrazzo floors, frosted interior glass, and floor-to-ceiling windows that infuse the space with natural light."

C-reactive protein (CRP) associated with risk of coronary heart disease, stroke, vascular mortality, and death from several cancers and lung disease

Associations of C-reactive protein (CRP) concentration with risk of major diseases can best be assessed by long-term prospective follow-up of large numbers of people.

This Lancet meta-analysis included records of 160,309 people without a history of vascular disease from 54 long-term prospective studies.

Risk ratios (RRs) were 1·23 for coronary heart disease; 1·32 for ischaemic stroke; 1·34 for vascular mortality; and 1·34 for non-vascular mortality.

CRP concentration has continuous associations with the risk of:

- coronary heart disease
- ischaemic stroke
- vascular mortality
- death from several cancers and lung disease

The relevance of CRP to such a range of disorders is unclear. Associations with ischaemic vascular disease depend considerably on conventional risk factors and other markers of inflammation.

Is is still a topic of debate is whether CRP has a causal role in the development of cardiovascular disease.

However, even if CRP might not be involved in the causal pathway of atherogenesis and plaque rupture, it may still be a valuable tool in cardiovascular medicine.

In primary prevention, lovastatin therapy was more cost effective in people with increased CRP concentrations.

The JUPITER trial recently showed that, in people with relatively normal LDL cholesterol concentrations and CRP higher than 2 mg/L, rosuvastatin reduced cardiovascular risk. Even if CRP turns out to be not directly causal in cardiovascular disease, it might be useful to identify individuals at cardiovascular risk and to evaluate the efficacy of our preventing and therapeutic interventions.

References:
C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. The Lancet, Volume 375, Issue 9709, Pages 132 - 140, 9 January 2010.
C-reactive protein and cardiovascular risk: more fuel to the fire. S Matthijs Boekholdt a b, John JP Kastelein b. The Lancet, Volume 375, Issue 9709, Pages 95 - 96, 9 January 2010.

C reactive protein concentration itself is unlikely to be even a modest causal factor in coronary heart disease - BMJ, 2011. http://goo.gl/d5lCH
Image source: C-reactive protein. Wikipedia, GNU Free Documentation License.

Nearly everyone in the U.S. carries BPA - the chemical may increase risk of heart disease

From WebMD:

More than 90% of Americans carry the plastics chemical BPA in their bodies. But those with the highest BPA levels have the highest risk of heart disease.

BPA -- bisphenol A -- is one of the world's most heavily produced chemicals used to make PVC pipes, epoxy resins that line food cans, food packaging, and drink containers.

There's no way to avoid BPA entirely: It's in food, water, and air.

Some ways to reduce exposure to BPA:

- Don’t microwave polycarbonate plastic food containers. Polycarbonate containers that contain BPA usually have a No. 7 on the bottom.

- Reduce your use of canned foods. Eating just one canned soup/day for 5 days leads to 1,000% increase in bisphenol A (BPA) in the urine (WebMD, 2011).

- When possible, opt for glass, porcelain, or stainless steel containers, particularly for hot food or liquids.

Identification in plastics (Wikipedia)

There are seven classes of plastics used in packaging applications. Type 7 is the catch-all "other" class, and some type 7 plastics are made from bisphenol A monomer. Type 3 (PVC) can also contain bisphenol A as an antioxidant in plasticizers.

Types 1, 2, 4, 5, 6 do not use bisphenol A during polymerization or package forming.

References:

BPA May Be Linked to Heart Disease Risk. WebMD.
Controversy continues over safety of bisphenol A - Type “bisphenol A” (BPA) in PubMed & you get more than 6000 results. Lancet, 2011.

Exposures to dioxins and PCBs are associated with reduced growth during the peripubertal period http://goo.gl/w0WBO
Gestational BPA exposure affected behavioral and emotional domains at 3 years of age, especially among girls. Pediatrics, 2011.

Image source: Bisphenol A. Wikipedia, public domain.

Related:

Video: "Help Your Heart With the Mediterranean Diet"

Help Your Heart With the Mediterranean Diet from ChefMD.

Two fish dishes per week can help your heart

From CNN:

Most Americans eat very little fish compared to chicken and beef (just under 7 pounds a year vs. more than 100 pounds.

Some farmed fish like tilapia and catfish have significantly lower levels of omega 3s than their wild counterparts. Experts say you should choose wild-caught species whenever possible.

Although most fish naturally contain omega 3 fatty acids, oily fish (such as salmon, herring, and trout) are the richest sources. Healthy people should consume two 3.5-ounce servings of fish per week, which provides approximately 500mg of omega 3s per day.

When cooking fish, keep calories in check by broiling, grilling, baking, or steaming it instead of frying. Fresh herbs, spices, and/or citrus contribute great flavor without an excess of sodium.

Try experimenting with different tastes -- add an Asian flair with a gingery teriyaki glaze or go Mediterranean with a creamy cucumber-dill sauce made with low-fat Greek yogurt.

References:
An easy fish recipe to help your heart. CNN.

"Fishy treatment": Women (older than 49 yo) who eat more than 3 servings of fish/week are 16% less likely to experience a stroke. "Fish consumption in many countries, including the U.S., is far too low, and increased fish consumption would likely result in substantial benefits in the population". Reuters, 2010. http://goo.gl/VMec9
Five Fab Fish Dishes. Health.com.

Recipes for Health - Getting More Fish in Your Diet - NYTimes.com.

Fishing For Answers: How To Choose Fish and Seafood | Summer Tomato http://goo.gl/0OBf

Image source: Gadus morhua, Atlantic cod. Wikipedia, public domain.

3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death

The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.

Reducing dietary salt by 3 g per day (1200 mg of sodium per day) is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. Such an intervention would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.

The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels.

References:

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. NEJM, 2010.
http://content.nejm.org/cgi/content/short/362/7/590
Sweat Bees prefer sweaty people because the human diet is so salty that their perspiration is saturated with that essential nutrient. WSJ, 2012.

Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License.

Barbara Walters, US TV Anchor, to Undergo Heart Surgery to Replace a "Faulty Valve" - Sounds Like Aortic Stenosis

Walters announced that she will undergo surgery to replace a "faulty" heart valve later this week.

"You know how I always say to you how healthy I am. ... I've never missed a day's work," she began. "Later this week, I'm going to have surgery to replace one faulty heart valve."

From her description, the valve defect sounds like aortic stenosis. For a variety of reasons, mitral stenosis is a less likely possibility in the differential diagnosis.

Best wishes for successful surgery and speedy recovery!

References:
Barbara Walters to Undergo Heart Surgery. ABC.

Barbara Walters' Heart Surgery. WebMD.

Cheap fast food "enticing people to eat more because they think they're saving money when they're really buying heart disease"

"Fake foods are more affordable. It's enticing people to eat more because they think they're saving money when they're really just buying heart disease."

References:
10 Questions for Jillian Michaels. TIME, 2010.

Video: Heart Disease Myths Dispelled by a Cleveland Clinic Cardiologist

Cleveland Clinic — May 14, 2010 — Dr. Rimmerman, cardiologist and author of "The Cleveland Clinic Guide to Speaking With Your Cardiologist,"dispels common myths regarding heart disease.

The Beautiful Game can kill you: soccer/football managers and viewers at high risk for heart disease

Almost half of England's football managers have "significant" heart problems and their life-consuming, high-pressure jobs are a "recipe for potential disaster" according to cardiovascular experts. This is hardly surprising considering the range of emotions demonstrated by Fabio Capello (age 64), the current manager of the England national football team, in the videos below:



A stressful soccer match affects everybody involved including the spectators.

The Fédération Internationale de Football Association (FIFA) World Cup, held in Germany from June 9 to July 9, 2006, provided an opportunity to examine the relation between emotional stress and the incidence of cardiovascular events. Cardiovascular events occurring in 4,000 patients in the greater Munich area were prospectively assessed by emergency physicians during the World Cup.

On days of matches involving the German team, the incidence of cardiac emergencies was 2.66 times that during the control period. For men, the incidence was 3.26 times that during the control period, and for women, it was 1.82 times that during the control period.

On those days, the highest average incidence of events was observed during the first 2 hours after the beginning of each match.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.


Video: Angry Capello [ Algeria Vs England ].

References:

Nearly half of football managers suffer serious heart problems. Independent, 2005.
Cardiovascular events during World Cup soccer. N Engl J Med. 2008 Jan 31;358(5):475-83.

Super Bowl may trigger heart attacks - CNN, 2011.
Top Soccer Players Are Seen to Have Superior Brain Function - NYTimes, 2012 -- Good to know, NYT.

Increasing Diet Polyunsaturated Fat in Place of Saturated Fat Reduces Risk of Coronary Heart Disease

Reduced saturated fat (SFA) consumption is recommended to decrease coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.

The overall pooled risk reduction was 19% (RR = 0.81), corresponding to 10% reduced CHD risk (RR = 0.90) for each 5% energy of increased PUFA.

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

References:

Mozaffarian D, Micha R, Wallace S (2010). Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med 7(3): e1000252. doi:10.1371/journal.pmed.1000252
The long history of dieting fads: "soap should be eaten for its diuretic properties", wrote a prominent surgeon in 1810. Lancet, 2012.
How We Eat: Analyzing Half a Million Meals - 5 INFOGRAPHICS

Top diets of 2012 - from Cleveland Clinic health blog http://buff.ly/X2I4BJ

Image source: Varieties of meat, Wikipedia, public domain.