Heart Health: sports & physical activities outweigh risks

A November 2024 study by Laval University published in the Canadian Journal of Cardiology, said,

• "The unavailability of automated external defibrillators (AEDs) highlights a critical gap in emergency preparedness, especially in the context of five of the six activities with the highest death frequencies (cycling, hunting, jogging, hiking or walking, and swimming), which often occur in locations where AEDs are not readily accessible. As Québec is currently working on AED-related legislation, these results underscore the necessity for a comprehensive approach that extends beyond public places to ensure adequate (AED) coverage for activities in rural or remote areas, where the risks are pronounced and immediate access to emergency care is crucial."

• "Reducing premature mortality is a priority for most clinicians, including cardiologists, general internists, and family physicians, but certainly for those involved in the care of athletes and active individuals. While placement of AEDs in remote settings (e.g., hunting or ski cabins) or in areas with high exercise traffic, as well as drone-delivered AED networks, are intriguing strategies, maintenance requirements and financial investments may limit feasibility. While still in development and undergoing regulatory approvals in many countries, ultraportable AEDs may offer advantages in the future. However, at present, there is no convincing evidence to support device performance or clinical, or safety outcomes, calling for further research on their effectiveness, particularly in sports and recreation-related settings, before considering widespread uptake."

• "Our prior studies have shown that sudden death during sport is an extremely rare phenomenon. Diseases or conditions, for example, hypertrophic cardiomyopathy, which are often considered conditions likely to be associated with catastrophic events such as cardiac arrest, are much less dangerous than most people believe. We believe athletes should be permitted to make their own decisions about what is safe or not safe for them depending on their values and preferences, rather than be told what is ‘allowed’ versus ’not allowed.’ Overall, we think that engaging in vigorous and even competitive physical activity for most individuals with heart disease is relatively safe."

Heart Health & Sitting

In a November 2024 study by Mass General Brigham said,

• “Sedentary risk remained even in people who were physically active, which is important because many of us sit a lot and think that if we can get out at the end of the day and do some exercise we can counterbalance it. However, we found it to be more complex than that.”  

• “Our data supports the idea that it is always better to sit less and move more to reduce heart disease risk, and that avoiding excessive sitting is especially important for lowering risk of heart failure and cardiovascular death,”  

• “Exercise is critical, but avoiding excessive sitting appears separately important."

Work Stress and Heart Health

An August 2024 study by Laval University in Quebec City said,

• “Our study suggests that work-related stressors may be relevant factors to include in preventive strategies,”

• “Recognizing and addressing psychosocial stressors at work are required to foster healthy work environments that benefit both individuals and the organizations where they work.”

• “The effectiveness of workplace interventions to reduce psychosocial stressors that may also reduce the risk of AFib should be investigated in future research efforts,”

• “Our research team previously conducted an organizational intervention designed to reduce psychosocial stressors at work, which was shown to effectively reduce blood pressure levels. Examples of organizational changes implemented during the intervention included slowing down the implementation of a large project to prevent increased workload; implementing flexible work hours; and holding meetings between managers and employees to discuss day-to-day challenges.”

Using MRI-based technique to predict risk of heart failure

An August 2023 study by the University of East Anglia and Queen Mary University of London said,

“This breakthrough suggests that heart MRI could potentially replace invasive diagnostic tests. Participants with higher heart pressure measured by MRI had a fivefold increased risk of developing heart failure over six years.” 

“Additionally, we identified key risk factors for developing high heart pressure: age over 70, high blood pressure, obesity, alcohol consumption and male gender.“ 

“By combining these factors, we developed a model to predict individual heart failure risk. This advancement enables prevention, early detection and treatment of heart failure, which could save many lives.” 

Fruit and Vegetables, Benefits for Those with Hypertension

An August 2024 study by Dell Medical School, The University of Texas at Austin, the lead author said,

"As a nephrologist (kidney doctor), my acid-base laboratory studies ways by which the kidney removes acid from the blood and puts it into the urine. Our animal studies showed years ago that mechanisms used by kidneys to remove acid from the blood can cause kidney injury if the animals were chronically (long term) exposed to an acid-producing diet. Our patient studies showed similar findings: that is, an acid-producing diet (one high in animal products) was kidney-harmful, and one that is base-producing (one high in fruits and vegetables) is kidney-healthy. Other investigators showed that a diet high in fruits and vegetables is heart-healthy. We hypothesized that one way that fruits and vegetables are both kidney- and heart-healthy is that they reduce the amount of acid in the diet and therefore the amount of acid that kidneys have to remove from the body."

The co-investigator Maninder Kahlon said,

"Importantly, fruits and vegetables achieved the latter two benefits with lower doses of medication used to lower blood pressure and reduce cardiovascular disease risk. This means that one can get the kidney health benefits with either fruits and vegetables or NaHCO3, but we get the blood pressure reduction and reduced cardiovascular disease risk with fruits and vegetables, but not with NaHCO3. This supports our recommendation that fruits and vegetables should be ‘foundational’ treatment for patients with hypertension, because we accomplish all three goals (kidney health, lower blood pressure, and reduced cardiovascular disease risk) with fruits and vegetables, and we can do so with lower medication doses.”

"Dietary interventions for chronic disease management are often not recommended and even less often executed because of the many challenges to get patients to implement them. Nevertheless, they are effective, and in this instance, kidney and cardiovascular protective. We must increase our efforts to incorporate them into patient management and more broadly, make healthy diets more accessible to populations at increased risk for kidney and cardiovascular disease.”

Undetected Heart Valve Disease in 'Healthy' Over-60s

A June 2024 study by the University of East Anglia said,

• “This study focused on understanding how widespread heart valve issues of any severity are among healthy, symptom-free adults without any known heart diseases. “

• “We examined almost 4,500 individuals aged 60 and older from three regions in the UK: Norfolk, West Midlands, and Aberdeen, using echocardiography, which is an ultrasound of the heart.”  

• “Our findings showed that more than 28pc of these adults had some form of heart valve disease, although reassuringly it was only mild in the majority of the cases. “ 

• “The data also indicated that age was the main factor associated with these heart valve problems, meaning that the older a person is, the higher their chance of having a significant valve issue.” 

• “The main problems are caused by the valve not opening fully (valve stenosis) which restricts the flow of blood, or the valve not closing properly (valve regurgitation) which means blood can leak back in the wrong direction.” 

• “These problems can put extra strain on the heart and make the heart work harder. Over time, it can increase the risk of having a heart attack, stroke and other heart conditions.” 

• “The diagnosis of heart valve disease mostly relies on transthoracic echocardiography, however this is normally only carried out if symptoms are reported or if an unusual murmur is heard during a physical examination. 

• “This can be challenging in the elderly because mild symptoms may be masked by reduced physical activity and impaired mobility. 

• “This study reveals that many older adults have heart valve issues, even if they don't show any symptoms and we would suggest that if people do develop any new symptoms or signs that could indicate heart disease to discuss this with their doctor. “

• “As our population ages, this information can help healthcare providers understand the scale of valve disease and streamline routine care methods and screening programs to ensure that we can cope with the demand in the future.“

• “This way, they can better identify and help those at risk before problems become serious.” 

• "This important research using a very large group of people without symptoms showed that over a quarter of participants had a previously undetected heart valve condition.  

• “Further research will be required to build on these strong foundations and develop methods to test the feasibility of disease identification in these individuals.”

• “Whilst we have made strides, there is still more to be done to eradicate heart disease for good. It is essential that we keep funding lifesaving research, so fewer people have to go through heart break." 

Salt Restriction & Heart Conditions

A June 2024 study in the European Journal of Clinical Investigation concluded that there is no proven clinical benefit to this strategy for patients with heart failure saying “Doctors often resist making changes to age-old tenets that have no true scientific basis; however, when new good evidence surfaces, we should make an effort to embrace it,”

Anger and Blood Vessels

In a May 2024 study by Columbia University Irving Medical Centre it was said

• “Impaired vascular function is linked to an increased risk of heart attack and stroke,”

• “Observational studies have linked feelings of negative emotions with having a heart attack or other cardiovascular disease events. The most common negative emotion studied is anger, and there are fewer studies on anxiety and sadness, which have also been linked to heart attack risk.”

• “We saw that evoking an angered state led to blood vessel dysfunction, though we don’t yet understand what may cause these changes,”

• “Investigation into the underlying links between anger and blood vessel dysfunction may help identify effective intervention targets for people at increased risk of cardiovascular events.”

• “This study adds nicely to the growing evidence base that mental well-being can affect cardiovascular health, and that intense acute emotional states, such as anger or stress, may lead to cardiovascular events,”

• “For instance, we know that intense sadness or similar emotions are a common trigger for Takatsubo cardiomyopathy, and events such as earthquakes or even as a fan watching a world soccer match, which provoke stress, may lead to myocardial infarction and/or to arrhythmias. This current study very eloquently shows how anger can negatively impact vascular endothelial health and function, and we know the vascular endothelium, the lining of blood vessels, is a key player in myocardial ischemia and atherosclerotic heart disease. While not all the mechanisms on how psychological states and health impact cardiovascular health have been elucidated, this study clearly takes us one step closer to defining such mechanisms.”

New "Steps" Target

A February 2024 study by New York University at Buffalo said,

• “In ambulatory older women, higher amounts of usual daily light and moderate intensity activities were associated with lower risk of developing heart failure with preserved ejection fraction independent of demographic and clinical factors associated with heart failure risk,”

• “Accumulating 3,000 steps per day might be a reasonable target that would be consistent with the amount of daily activity performed by women in this study.”

• “This is a major, unique finding of our study because there is very little published data on physical activity and HFpEF, so we are providing new information upon which other studies can build,”

• “More importantly, [in] the most common form of heart failure seen in older women and among racial and ethnic minority groups, and at present there are few established treatment options, which makes primary prevention all the more relevant…. The potential for light intensity activities of daily life to contribute to the prevention of [this type of heart failure] in older women is an exciting and promising result for future studies to evaluate in other groups, including older men,”

• “…conveying how much activity is always a challenge to incorporate as part of clinical and public health recommendations,”

• “Steps per day is easily understood and can be measured by a variety of consumer-level wearable devices to help people monitor their physical activity levels.”

• “It appeared that intensity of stepping did not influence the lower risk of heart failure as results were comparable for light intensity steps and for more vigorous steps,”

• “Our results showing heart failure prevention in older women might be enhanced through walking around 3,000 steps or so per day at usual pace is very relevant given the current emphasis at the federal level on identifying an amount of daily physical activity that can be referenced against steps per day for cardiovascular health and resilience to incorporate in future public health guidelines.”

Diabetes, Cardiovascular Disease, Chronic Kidney Disease

A January 2024 study by Professor Edward Gregg, Head of the School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland, and colleagues said, “As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes. While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggests any success with remission is associated with later health benefits.”

JOURNAL

Diabetologia

ARTICLE TITLE

Impact of remission from type 2 diabetes on long‑term health outcomes: findings from the Look AHEAD study

ARTICLE PUBLICATION DATE

18-Jan-2024

COI STATEMENT

See full paper for disclosures

Biomarkers for Heart Risk

A January 2024 study by St Jude Children’s Research Hospital said,

• “This may be a much more sensitive way to identify childhood cancer survivors that might benefit from intervention at an earlier stage,”

• “We were somewhat surprised by the magnitude of risk for declining heart function over such a relatively short period in individuals with abnormal GLS and NT-proBNP, suggesting a need for early and effective interventions that we hope will prevent progression to heart failure over time.”  

•  “This means doing more for patients at greatest risk while avoiding unnecessary tests for patients who will not benefit from them,”

• “A survivor with a normal ejection fraction at baseline with abnormal ranges of both biomarkers was at a fourfold increased risk for a worsening ejection fraction in the next five years,”

•  “One of the promising aspects of our findings is that both of these measures are readily available and, therefore, have the potential to impact care more immediately. Most cardiologists are already using GLS … and NT-proBNP has been around for a long time.” 

•  “The exciting part of this study is that it potentially helps to identify a population that we would have otherwise looked at and said, ‘You’re at risk for abnormal heart function, but everything looks good today. We’ll reevaluate your heart in two to five years,’”

• “Whereas now we have reason to believe those with abnormal biomarkers are a particularly high-risk group that may benefit from closer follow-up or more proactive interventions to reduce risk. The findings set the stage for future studies evaluating novel screening and early intervention strategies that we hope will ultimately improve survivors’ cardiac health and well-being.”  

Beetroot Juice and Chronic Obstructive Pulmonary Disease

A December 2023 study at Imperial College London said,

• “There is some evidence that beetroot juice as a source of nitrate supplementation could be used by athletes to improve their performance, as well as a few short-term studies looking at blood pressure. Higher levels of nitrate in the blood can increase the availability of nitric oxide, a chemical that helps blood vessels relax. It also increases the efficiency of muscles, meaning they need less oxygen to do the same work.”
  
  “At the end of the study, we found that the blood pressure of people taking the nitrate-rich beetroot juice drink was lower and their blood vessels became less stiff. The juice also increased how far people with COPD could walk in six minutes compared to placebo.”
  
  “This is one of the longest-duration studies in this area so far. The results are very promising, but will need to be confirmed in larger, longer-term studies.”

• “COPD cannot be cured so there is a pressing need to help patients live as well as they can with the condition and to reduce their risk of cardiovascular disease.”
  
  “Patients taking part in this trial generally found the beetroot juice supplement acceptable and they saw benefits in terms of their blood pressure and mobility. This suggests they may see improvements in everyday life and should have a lower risk of heart disease and stroke, but we will have to study patients for longer to confirm if this is the case.”
  
  “Beetroot juice has been consumed widely and tested in other research, so it has the potential to be a safe treatment for people with COPD.”

heart health, sitting, activity

A November 2023 study by the University College London said,

• “The big takeaway from our research is that while small changes to how you move can have a positive effect on heart health, intensity of movement matters. The most beneficial change we observed was replacing sitting with moderate to vigorous activity – which could be a run, a brisk walk, or stair climbing – basically any activity that raises your heart rate and makes you breathe faster, even for a minute or two.”

• “Though it may come as no surprise that becoming more active is beneficial for heart health, what’s new in this study is considering a range of behaviours across the whole 24-hour day. This approach will allow us to ultimately provide personalised recommendations to get people more active in ways that are appropriate for them.”

• “We already know that exercise can have real benefits for your cardiovascular health and this encouraging research shows that small adjustments to your daily routine could lower your chances of having a heart attack or stroke. This study shows that replacing even a few minutes of sitting with a few minutes of moderate activity can improve your BMI, cholesterol, waist size, and have many more physical benefits.”

• “Getting active isn’t always easy, and it’s important to make changes that you can stick to in the long-term and that you enjoy – anything that gets your heart rate up can help. Incorporating ‘activity snacks’ such as walking while taking phone calls, or setting an alarm to get up and do some star jumps every hour is a great way to start building activity into your day, to get you in the habit of living a healthy, active lifestyle.”

Gut Bacteria and Hypertension

An October 2023 study at the University of Toledo said that,

• “The question we always ask is, can we exploit microbiota to help our health, for which optimal blood pressure is a cardinal sign. Until now, we have simply said changes in microbiota play a role in elevated blood pressure or hypertension. Those are important findings, but they don’t always have an immediately translational application,” she said. “This is the first time we have shown that we really can do this. It’s a proof of principle that you can use microbiota to make products that measurably improve your health.”

• “Females therefore appear to readily accept all the help they can get from gut microbiota supplying ACE …For now, this is a theory that requires further experimental proof.”

• “There have been questions about microbiome medicine — is it a fad or is it real? This is an extremely exciting demonstration that we can exploit bacteria to work for us, and it works for high blood pressure, something that affects a significant portion of the population … It’s that ray of hope that you may not need traditional medications to keep your blood pressure in check.”

• “It is a real possibility that we can use bacteria to correct hypertension. This is a big deal, and the concept could be applied to other diseases … For example, if you are unable to control your sugar, can we have a bacteria make a protein that can lower your blood glucose? There are still a lot of questions that need answered, but now we know the paradigm works.”

muscle mass, heart disease, diabetes

An October 2023 report presented to the Annual Meeting of the European Association for the Study of Diabetes (EASD) said,

• “Our results suggest that the increased risk of death in individuals with diabetes who have low muscle mass isn’t mediated or influenced by frailty, poor blood sugar control or microvascular complications but due to the loss of muscle itself.  More research is needed to determine just how sarcopenia increases the risk of death.”

• “For most people with type 2 diabetes and overweight or obesity, guidelines recommend nutrition, physical activity and behavioural therapies to achieve and maintain weight loss.”

• “However, there are limitations to assessing treatment goals based on weight loss alone because body weight cannot distinguish between fat and muscle mass and so does not reveal if someone is sarcopenic.”

• “It is important to consider body composition when treating obesity and managing weight in people with diabetes.”

cholesterol and predicting heart disease

An August 2022 study by the Knight Cardiovascular Institute at Oregon Health & Science University, Portland said, 

• “The goal was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that’s true for all ethnicities,” 

• “It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions.”  

• “What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for cardiovascular disease,” 

• “It could mean that in the future we don’t get a pat on the back by our doctors for having higher HDL cholesterol levels.”  

• “When it comes to risk factors for heart disease, they cannot be limited to one race or ethnicity …They need to apply to everyone.”  

The National Heart, Lung, and Blood Institute (NHLBI)’s Division of Cardiovascular Sciences said,

• “HDL cholesterol has long been an enigmatic risk factor for cardiovascular disease,” 

• “The findings suggest that a deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.” 

Choice of grains, heart disease

An October 2022 study by the Isfahan Cardiovascular Research Center and Cardiovascular Research Institute at Isfahan University of Medical Sciences in Isfahan, Iran, said,

• “There are many factors involved in why people may be consuming more refined grains as opposed to whole grains and these cases differ between people, but some of the most important factors to consider include the economy and income, job, education, culture, age and other similar factors,” 

• “A diet that includes consuming a high amount of unhealthy and refined grains can be considered similar to consuming a diet containing a lot of unhealthy sugars and oils.”

• “As more studies demonstrate an increase in refined grains consumption globally, as well as the impact on overall health, it is important that we find ways to encourage and educate people on the benefits of whole grain consumption,” 

• “Tactics to consider include teaching improved dietary choices in schools and other public places in simple language the general population can understand, as well as on television programs and by continuing to do high level research that is presented at medical conferences and published in medical journals. Clinicians must also be having these conversations with each other and their patients.”

Physical activity in the morning, lowest risk of heart disease and stroke

A November 2022 study by Leiden University Medical Centre, the Netherlands.

• “It is well established that exercise is good for heart health, and our study now indicates that morning activity seems to be most beneficial,” 

• “The findings were particularly pronounced in women, and applied to both early birds and night owls.”

• “This was an observational study and therefore we cannot explain why the associations were more marked in women. Our findings add to the evidence on the health benefits of being physically active by suggesting that morning activity, and especially late morning, may be the most advantageous. It is too early for formal advice to prioritise morning exercise as this is quite a new field of research. But we hope that one day we can refine current recommendations simply by adding one line: ‘when exercising, it’s advised to do so in the morning’.”

Olive Oil and Cardiovascular Disease

A January 2022 study by Department of Nutrition at Harvard T.H. Chan School of Public Health said, 

“Our findings support current dietary recommendations to increase the intake of olive oil and other unsaturated vegetable oils,” 

“Clinicians should be counseling patients to replace certain fats, such as margarine and butter, with olive oil to improve their health. Our study helps make more specific recommendations that will be easier for patients to understand and hopefully implement into their diets.”

“It’s possible that higher olive oil consumption is a marker of an overall healthier diet and higher socioeconomic status. However, even after adjusting for these and other social economic status factors, our results remained largely the same,” 

“Our study cohort was predominantly a non-Hispanic white population of health professionals, which should minimize potentially confounding socioeconomic factors, but may limit generalizability as this population may be more likely to lead a healthy lifestyle.”

“The current study and previous studies have found that consumption of olive oil may have health benefits. However, several questions remain. Are the associations causal or spurious? Is olive oil consumption protective for certain cardiovascular diseases, such as stroke and atrial fibrillation, only or also for other major diseases and causes of death? What is the amount of olive oil required for a protective effect? More research is needed to address these questions.”

Eating vegetables and cardiovascular disease

A February 2022 study by the Nuffield Department of Population Health at the University of Oxford, the Chinese University of Hong Kong, and the University of Bristol said,

• “The UK Biobank is a large-scale prospective study on how genetics and environment contribute to the development of the most common and life-threatening diseases. Here we make use of the UK Biobank’s large sample size, long-term follow-up, and detailed information on social and lifestyle factors, to assess reliably the association of vegetable intake with the risk of subsequent CVD,” 

• “Our large study did not find evidence for a protective effect of vegetable intake on the occurrence of CVD. Instead, our analyses show that the seemingly protective effect of vegetable intake against CVD risk is very likely to be accounted for by bias from residual confounding factors, related to differences in socioeconomic situation and lifestyle.”

• “This is an important study with implications for understanding the dietary causes of CVD and the burden of CVD normally attributed to low vegetable intake. However, eating a balanced diet and maintaining a healthy weight remains an important part of maintaining good health and reducing risk of major diseases, including some cancers. It is widely recommended that at least five portions of a variety of fruits and vegetables should be eaten every day.”