The latest recommendation from the US preventive task force is to take aspirin (low dose) to prevent both heart disease and colon cancer in adults aged 50-59, who have significant risk factors.
The guidelines are published in the Annals of Internal Medicine:
- Low-dose aspirin is recommended for adults aged 50–59 who have at least a 10% risk for a cardiovascular event in the next decade, low bleeding risk, and a life expectancy of at least 10 years; patients must also be willing to take aspirin daily for at least 10 years.
- For adults aged 60–69 fitting the above criteria, the decision to start aspirin should be an individual one.
- For patients younger than 50 and older than 69, there is not enough evidence to make recommendations.
90% of heart attacks can be prevented by working on these 9 modifiable risk factors–
- High cholesterol
- Psychosocial stressors
- High blood pressure
- Abdominal fat
- No alcohol intake
- Inadequate exercise
- Irregular consumption of fruits and vegetables
Annals of Internal Medicine reports that people who have a normal body mass index (weight to height ratio) but abdominal fat are at high risk for heart related deaths.
Using National Health and Nutrition Examination Survey data, researchers studied more than 15,000 adults with BMIs greater than 18.5. Normal being 18-24.
After a mean follow-up of 14 years, waist-to-hip ratio (WHR), but not BMI, was associated with higher overall mortality risk. Among men with normal BMI, those with central obesity had an 87% higher total mortality risk than men without central obesity. Similarly, women with normal-weight central obesity had a 48% higher mortality risk than women with similar BMI but no central obesity.
The recommended waist circumference for men is less than 102 cm, and for women is less than 88 cm.
According to two Spanish studies in Diabetologia, elevated nighttime blood pressure may promote development of adult onset diabetes, and taking medication to control blood pressure at bedtime, might actually help reduce that risk.
In the first study, 2700 adults who were not diagnosed with diabetes, periodically underwent 48-hour ambulatory BP monitoring. Over 6 years’ median follow-up, 7% developed diabetes. Risk for diabetes was greater with higher levels of sleep-time systolic BP and with smaller BP declines during sleep. Systolic BP during sleep was the second most significant predictor of diabetes, behind fasting glucose.
In the same study group, patients with high BP, were randomized to take at least one of their BP medications before bed or to take all of their BP medications in the morning. Compared with the morning group, the nighttime group had better ambulatory BP control (particularly during night sleep) and was at significantly reduced risk for developing diabetes (12% vs. 5%). When taken at bedtime, angiotensin-receptor blockers, angiotensin-converting-enzyme inhibitors, and beta-blockers showed greater benefit.
As most of you have probably read, the FDA has announced that food manufacturers must remove partially hydrogenated oils — the major source of artificial trans fats in processed foods in three years.
After June 18, 2018, companies must petition the agency for approval to add partially hydrogenated oils to their products. This we hope will reduce heart disease and prevent thousands of heart attacks per year.
ProPublica has published a searchable scorecard to help patients choose a surgeon. It includes the complication rates of roughly 17,000 surgeons at 3600 hospitals across the country.
Using Medicare data for inpatient stays from 2009 to 2013, they focused on eight common elective surgeries (e.g., knee or hip replacement, angioplasty, gall bladder removal, prostate removal). They calculated the 30-day readmission rate for surgery-related complications, such as infections, blood clots, uncontrolled bleeding, and misaligned orthopedic devices and adjusted for factors including patient health and age, among other things.
Overall complication rates were 2% to 4%. Roughly 11% of surgeons were responsible for about a quarter of the complications.
The scorecard is searchable by surgeon, hospital, city, and state.
An interesting article about young women and their habits– according to a study done by the Journal of the American College of Cardiology, young women with healthy habits are less likely to develop coronary heart disease or cardiovascular risk factors as they age,
They looked at six criteria in women aged 27-44 years of age
normal body mass index
physical activity of at least 2.5 hours weekly
television viewing of 7 hours or less weekly
moderate alcohol consumption
and a healthy diet —
These women had almost no heart disease and low rates of type 2 diabetes, hypertension, and high cholesterol after 20 years’ follow-up.
Compared with women who met none of the criteria, those meeting all six had a 92% reduction in risk for coronary heart disease and a 66% reduction in CV risk factors. Of note, only about 5% of study participants met all six criteria.
Cytisine, a partial agonist of nicotinic acetylcholine receptors, helps smokers quit tobacco more effectively than nicotine-replacement therapy (NRT), according to a New England Journal of Medicine study. The plant-based agent has been used for smoking cessation in Eastern Europe for decades but is largely unavailable elsewhere.
Some 1300 adult daily smokers who were motivated to quit smoking were randomized to receive cytisine tablets for roughly 3.5 weeks or NRT (patches plus gum or lozenges) for 8 weeks. Both groups also received behavioral support via three brief telephone calls over 8 weeks.
The primary outcome — self-reported continuous abstinence at 1 month — was higher with cytisine than with NRT. Similarly, abstinence rates favored cytisine at 2 and 6 months. Cytisine was associated with more adverse events (mostly nausea, vomiting, and sleep disorders), but only 5% of participants discontinued the drug because of side effects.
An editorialist notes that cytisine is inexpensive and, if made widely available, could make smoking cessation pharmacotherapy affordable for many smokers.