TIME Heart Disease

Daily Aspirin May Not Prevent Heart Attacks

Aspirin
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Taking low dose aspirin may not help people with high blood pressure, high cholesterol or diabetes to avoid a heart event

There’s a lot of evidence that taking low doses of aspirin daily can help heart attack patients avoid a second event. Aspirin’s ability to reduce inflammation and keep blood from forming vessel-blocking clots can be a life-saver. But what about the many Americans who take it daily hoping to avoid a first heart attack or stroke? The data there is more conflicting, and a large new study in JAMA published Monday suggests it may not make much of a difference.

The Food and Drug Administration recently said there was not enough evidence to support the idea that aspirin can prevent a first heart attack. So researchers in Japan decided to investigate the issue among 14,646 volunteers between the ages of 60 years and 85 years. Between 2005 and 2007, these participants, none of whom had had any heart events, but all of whom had at least one of the risk factors that could make them vulnerable, were randomly assigned to take a low-dose aspirin every day or not. They were allowed to continue taking whatever medications they were already or, or begin taking new drugs if their doctor prescribed them during the study.

Now, reporting in JAMA, scientists say that after five years, the study’s review board ended the trial when it was clear that there were no significant differences between the two groups when it came to heart attacks, strokes, other heart events or death. In that time, 58 people in the aspirin group died of heart-related causes, while 57 in the non-aspirin group did. Overall, 2.77% of those taking aspirin had a heart attack or stroke, compared to 2.96% among those not taking the drug — a difference that was not statistically significant.

MORE: A Low Daily Dose of Aspirin Can Cut Deaths From 3 Kinds of Cancer

The results add to the growing data on what role aspirin can play in preventing first heart events; previous studies showed that the over-the-counter drug was linked to anywhere between a 12% to 23% lower risk of events compared to non-aspirin use. But concerns over aspirins side effects, which include gastrointestinal bleeding, have made doctors more wary of recommending it for patients who have not yet had a heart event. Studies on aspirin in this group of otherwise healthy people are also difficult to conduct, since many people currently take multiple medications for various heart risks, including blood pressure drugs and cholesterol-lowering medications, making it difficult to determine what effect aspirin may have.

That’s why three other studies are currently investigating aspirin’s potential role in helping patients who have not yet had heart disease to avoid having heart attacks or strokes. One involves those with diabetes, another focuses on those with multiple heart-disease risk factors and the final trial concentrates on people over 70. Until those results are available, the authors say that patients should discuss with their doctors whether daily low-dose aspirin can help them to lower their risk of having a heart attack. For some, the benefits may outweigh the risks of bleeding, while for others, the side effects may not be worth the risks.

 

TIME Exercise/Fitness

5 Reasons to Exercise That Aren’t Weight Loss

Why you shouldn't give up the gym

Despite conventional calorie-burning wisdom, some people appear to not lose weight when they exercise, says a new study published in The Journal of Strength and Conditioning Research. In fact, some actually gain weight, and it’s not all muscle mass.

The study, by Arizona State University in Phoenix researchers, looked at 81 sedentary, overweight women who exercised three times a week for 30 minutes in a lab. After 12 weeks, the researchers found that some women lost weight while others gained weight. But when they tried to identify what was causing the differences, they couldn’t come to any conclusions. “In reality, most people do not achieve or sustain weight loss, no matter what method they try,” wrote New York Times writer Gretchen Reynolds on Wednesday.

Basically, major bummer. But there are many other reasons to exercise besides trying to shed a few pounds, and they’re equally important for your health:

1. Memory Loss: Chronic inflammation and hormonal imbalances are a couple of factors that can play a part in memory loss, and exercise can help both. Exercise promotes better blood flow through the body, and the brain works better with a healthy blood supply. For example, a 2012 study published in the Journal of Alzheimer’s Disease showed that people who spent time on a stationary bike had better memory recall than those who were sedentary.

2. Stress: Exercise has long been prescribed as a way to burn off steam and relax. It’s even recommended as a way to fight depression. How? Exercise keeps the brain occupied, and keeps the stress hormone cortisol in check which can lower symptoms for anxiety and restlessness, according to The Exercise Cure, by sports medicine physician Dr. Jordan Metzl. After a rough day at work or before a big exam or interview, even just a walk around the block can ease nerves.

3. Fatigue: It may sound counterintuitive, but working out can actually make you less tired than skipping the gym. A 2007 University of Georgia study showed that sedentary people could lower their fatigue by 65% if they started engaging in regular low intensity exercise. Increasing energy through exercise is also a safer and cheaper alternative to turning to quick fixes like energy drinks.

4. Cardiovascular disease: Getting regular exercise does the heart some good. In a 2012 study, researchers found that people who partook in moderate intensity exercise like brisk walking compared to leisurely walking reduced their chances of developing risk factors for heart disease and diabetes. The effect might be related to exercise’s benefits on lowering inflammation in the body.

5. Lower back pain: Back pain is a very common ailment, and studies have shown that the right kind of exercises like strength training can lower pain. Exercise is also one of the simplest ways to protect your body from future injuries.

 

MONEY Health Care

How to Protect Your Heart Health—and Save Big on Medical Costs

Heart Monitor
The costs of treating heart disease in America has hit $444 billion a year. Justin Lambert—Getty Images

A single heart attack could leave you on the hook for thousands. That’s just one reason prevention pays off.

You may have heard that heart disease is America’s biggest killer, but it’s also one of America’s costliest health problems. More than a third of adults in the U.S. have heart disease, and treatment costs totaled $444 billion in 2010, according to the Centers for Disease Control and Prevention. Yet heart disease is largely preventable, and most of us can do our part to avoid it — and the associated high medical bills.

“The patient who has a heart attack and comes to the emergency room within 90 minutes and is seen immediately…can be discharged the next day and return to work in a week or two,” says cardiologist Lawrence Santora, medical director of the Orange County Heart Institute and Research Center. “The cost is about $1,000 or so for the cardiologist and $15,000 to $20,000 for the hospital.”

In fact, the average cost of treating a patient admitted to a hospital with a heart attack is $18,200 according to Medicare data. Unfortunately, you don’t get to opt for the average charge, and if an ambulance brings you to one of the higher-cost emergency rooms for cardiology, the total tab for a single heart attack could be $100,000 or more.

That’s the cost without insurance. But even with health coverage, you’ll still have to pay out-of-pocket costs, which normally include your deductible and co-insurance. The cap on deductibles this year is $6,350 for an individual and $12,700 for a family, and rises to $6,500 and $13,000 in 2015. However, that includes only what you spend on covered items. Anything that your insurance doesn’t cover is billed at full price and does not count toward your deductible.

It’s hard to know what a heart attack will cost you because every hospital sets charges for individual services. The total cost of a heart attack varies widely across the country, and even within some metro areas. To get an idea of average costs in your area, check out this comparison tool by NerdWallet.

A single heart attack with no complications isn’t common, though. “The patient who delays coming to the hospital usually has more extensive heart muscle damage,” says Santora. “This is when costs skyrocket. A severely damaged heart muscle can lead to congestive heart failure and a lifetime of future hospital admissions.”

The Best Prevention

Fortunately, it’s far cheaper to prevent and detect heart disease early. While many people are genetically predisposed to heart problems, there are two ways you can protect yourself: a healthy lifestyle and early detection. When compared to the high cost of heart disease, and especially ailments such as heart attack and stroke, these are well worth the investment.

So what does that healthy lifestyle entail? It’s not as strict or as difficult as you might think, according to the American Heart Association. Just an average of 30 minutes of exercise each day, five days per week, and a few dietary changes will do.

“Do any exercise you enjoy,” Santora says. “A reasonable target is 150 minutes of aerobic exercise per week and light weight training for 20 minutes, three times per week. Buying a pedometer and walking 10,000 steps per day is another simple method to lower heart risk.”

As for diet, that’s also pretty simple, according to Santora. Stick to a Mediterranean diet and avoid processed meats whenever possible—although steak and other lean, unprocessed red meats are fine a few times a week—to keep your heart healthiest, he says.

“Don’t focus on cholesterol,” Santora says. “The cholesterol you ingest doesn’t raise the levels in your blood—it’s animal saturated fats that do that.” In other words, eggs and plant-based cholesterol are fine.

The Tests You Need

Lifestyle changes aren’t the only preventive measures you can take. Under the Affordable Care Act, many preventive services are free, including those that help improve heart health. Obesity and diet counseling, aspirin, blood pressure screenings, and cholesterol screenings are all provided free of charge as long as you have an ACA-compliant health plans.

Early detection means visiting your doctor regularly, sometimes getting diagnostic scans like echocardiograms or CT scans, and seeking immediate medical treatment whenever you suspect heart problems. Under the ACA a visit to your primary care doctor is also free once per year. Preventive and diagnostic measures are also likely to be covered in part by your health plan, because prevention saves insurance companies money down the road as well, according to the American Heart Association.

That monthly $60 gym membership fee is looking more and more like a bargain.

Read more from NerdWallet Health, a website that empowers consumers to find high quality, affordable health care and lower their medical bills.

TIME Heart Disease

A Gut Bacteria Compound Is Linked To Heart Failure

Most Americans know that diet and heart health are connected, but a new study in the Journal of the American College of Cardiology looks at a surprising reason as to why.

When your food gets to your stomach, your gut bacteria get to work. And when those bacteria digest carnitine, which is almost exclusively found in red meat, and choline, found in high-fat dairy products and egg yolks, they produce a metabolite called trimethylamine N-oxide, or TMAO. That’s bad news for your heart, because earlier animal research found that TMAO helps transport cholesterol to the arteries, where it forms dangerous plaques that can lead to heart disease.

Stanley Hazen, MD, PhD, department chair of Cellular and Molecular Medicine at Cleveland Clinic’s Lerner Research Institute, and his team measured the blood levels of TMAO in 720 stable patients with heart failure and followed them over five years, wondering if TMAO would help predict who would be in better shape—and who would be still alive.

It did. TMAO levels predicted mortality rates “very strikingly” over the five-year period: More TMAO in the blood meant a 3.4-fold increased risk of mortality—even after adjusting for all the traditional risk factors, Hazen says.

“It suggests that we’ve now learned a new link in the cause [of heart failure],” Hazen says. “It suggests that the impact of dietary manipulation and changes in gut microbe composition may be a way to impact the development and the adverse prognosis in heart failure.”

TMAO research is still fairly new. Just last year in a study of 2,595 people, Hazen’s team found that meat eaters had higher levels of carnitine and greater risk of heart disease, stroke and heart attack than their vegan and vegetarian peers.

Still, Hazen doesn’t think it’s necessary for everyone to stop eating meat altogether. “What we are now trying to do is come up with a therapy that will prevent formation of TMAO, and hopefully prevent the development of cardiac disease…and the development of heart failure in its adverse prognosis,” Hazen says.

“I like kind of joking around, I’m hoping to come up with the pill that allows me to keep eating steak.”

TIME Heart Disease

How Mindfulness Protects Your Heart

Mauro Speziale—Getty Images

Tuning in to your body is good for your health

Self-aware people have better heart health, a new study suggests.

People who are mindful score higher on healthy heart indicators, according to recent findings published in the International Journal of Behavioral Medicine from Brown University researchers. The team looked at whether having something called “dispositional mindfulness”—which means you’re the type of person who’s very aware and attentive to what you’re feeling and thinking at any given moment—was a factor for heart health. They found a pretty significant connection: people with high mindfulness scores had an 83% greater prevalence of good cardiovascular health.

Having dispositional mindfulness doesn’t necessarily mean you’re regularly practicing mindfulness processes, like meditation. For some people, being more present is a natural part of their personality. For the rest of us, some say, it can be learned.

In the study, the researchers asked 382 people to evaluate statements that measure their level of mindfulness. Participants responded to statements like “I find it difficult to stay focused on what’s happening in the present”on a six point scale ranging from “almost always” to “almost never.” The participants who scored highest with the best mindfulness scores also had very healthy scores when it came to the seven American Heart Association indicators for cardiovascular health. Those include avoiding smoking, being physically active, having a healthy body mass index, consuming decent amounts of fruits and vegetables, and maintaining good cholesterol, blood pressure and fasting blood glucose levels.

The associations appeared to be strongest with factors including smoking, BMI, fasting glucose and physical activity. “The society we live in right now is very promoting of cardiovascular disease…cigarettes are still pretty inexpensive, and jobs are sedentary,” says study author Eric Loucks, an assistant professor in epidemiology at Brown University. “People who are more mindful tend to have more awareness of where their mind and bodies are at. By increasing our awareness, we might become more aware of the impact of what we are doing on ourselves.” If a mindful person is less physically active, Loucks suggests, they might notice that they have less energy.

Mindfulness-Based Stress Reduction has been taught in some medical settings for years, and Loucks points out that mindfulness scores tend to go up with the practice. “It does seem like mindfulness can be taught,” he says. “I think it’s good for it to be available for people who are interested in it…we shouldn’t force people to go mindfulness [training] if they don’t want to go. But it has the potential to be a resource.”

The findings are still preliminary, and the reasons for the connection are still inconclusive. But if corroborated, mindfulness interventions may be non-invasive ways to help people adopt healthier behaviors.

TIME Diet/Nutrition

This Kind of Tea Lowers Blood Pressure Naturally

green tea
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The best brew for your heart

Recent research has come down squarely on the side of caffeinated morning beverages, suggesting that coffee can protect against cancer and type 2 diabetes. Tea has enjoyed a healthy reputation for years as a heart-protector, and a study published in the October issue of British Journal of Nutrition suggests it might even help lower blood pressure.

Researchers were intrigued by the inconclusive link in studies so far regarding blood pressure and tea intake, so they analyzed 25 randomized controlled trials—the gold standard of scientific research—to further explore on the association.

They found that in the short term, tea didn’t seem to make a difference for blood pressure. But long-term tea intake did have a significant impact. After 12 weeks of drinking tea, blood pressure was lower by 2.6 mmHg systolic and 2.2 mmHg diastolic. Green tea had the most significant results, while black tea performed the next best.

Those might not seem like big numbers, but small changes in blood pressure can have a significant impact on health, the study authors write. Reducing systolic blood pressure by 2.6 mmHg “would be expected to reduce stroke risk by 8%, coronary artery disease mortality by 5% and all-cause mortality by 4% at a population level,” they write.

Tea is thought to offer endothelial protection by helping blood vessels relax, allowing blood to flow more freely. It’s a high source of antioxidants that have been linked to better cardiovascular health.

The researchers weren’t able to pinpoint the optimal number of cups to drink to get the benefit, but other studies have shown protective effects at 3-4 daily cups. The researchers said they didn’t see a difference in caffeinated tea vs. decaf.

“These are profound effects and must be considered seriously in terms of the potential for dietary modification to modulate the risk of CVD [cardiovascular disease],” the authors write.

Read next: 6 Ways to Lower Your Blood Pressure Naturally

TIME Aging

5 Reasons Why Women Live Longer Than Men

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Life expectancy in the U.S. is at an all-time high, according to a recent report by the Centers for Disease Control and Prevention (CDC). And while the news that we’re living, on average, to the ripe old age of 78 years and 9 ½ months isn’t that surprising, there is one stat that is: A girl born in 2012 can expect to live to 81.2 years—almost 5 years longer than a boy baby born the same year, who’s likely live to age 76.4. Weaker sex, indeed.

“Men are biologically and sociologically at a disadvantage from the time they’re conceived to the time they die,” says Marianne Legato, MD, professor emerita of clinical medicine at Columbia University College of Physicians and Surgeons and founder and director of the Foundation for Gender-Specific Medicine. Here’s why:

Females are tougher in utero

Two and a half as many boys are conceived as girls, Dr. Legato says, but they’re so much more likely to succumb to prenatal infection or other issues in the womb that by the time they’re born, the ratio is close to one to one. “They’re also slower to develop physically than girls prenatally, which means they’re more likely to die if they are preemies due to underdeveloped lung or brain development,” Dr. Legato explains.

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Women are less likely to be daredevils

Unintentional injuries are the third leading cause of death in men, according to the CDC; for women it’s only the sixth. Again, you can blame it on biology: The frontal lobes of the brain—which deal with responsibility and risk calculation—develop much more slowly in males than females, Dr. Legato says.

The result: Guys often take many more risks (which you probably already realize if your small son has taken one too many spins off his bike handlebars). “Almost inevitably, a male will take risks that a woman of his same age wouldn’t take,” Dr. Legato says.

Women succumb to heart disease later

Heart disease is the leading killer of both men and women, but men are more likely to develop it—and die from it—as early as their 30s and 40s. Women, on the other hand, typically develop heart disease 10 years later than men. They’re protected from it until menopause, since their bodies churn out estrogen, which helps keep arteries strong and flexible, says Dr. Legato.

HEALTH.COM: 15 Weird Things Linked to Heart Attacks

Women have stronger social networks

Friends make good medicine: People with strong social connections have a 50% lower chance of dying than those with few social ties, according to a 2010 study at Brigham Young University. “Most men tend to hold their stress and worries close to their chest, while women tend to reach out and talk to others,” Dr. Legato explains. The one exception: married men, which also explains why so many studies show that they’re likely to be healthier and live longer.

HEALTH.COM: How Friends Make You Healthier

Women take better care of their health

Men are 24% less likely than women to have visited a doctor within the past year and are 22% more likely to skip out on cholesterol testing, according to the Agency for Healthcare Research and Quality. In fact more than a quarter (28%) of men don’t have a regular physician and about one in five didn’t have health insurance in 2012, according to the Kaiser Family Foundation.

You can blame it on the so-called John Wayne syndrome: “Men often deny illness; they minimize symptoms because they don’t want to go to a doctor and find out something is wrong,” Dr. Legato notes.

HEALTH.COM: 10 Worst States for Women’s Health

This article originally appeared on Health.com

TIME Heart Disease

People Without Friends Have Worse Outcomes After Heart Attack

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The importance of friends for heart health

Without the support of friends and family, you’re less likely to emerge from a heart attack healthy.

A study in the Journal of the American Heart Association analyzed the responses of 3,432 heart attack patients on their levels of social support one month and then a year after a heart attack. One-fifth of them had low social support—meaning they felt that they didn’t have friends or family they could confide in or lean on for emotional or financial support—and during their recovery this group showed lower mental functioning, worse quality of life and more depressive symptoms. The effect affected men and women equally.

MORE: A Happy, Optimistic Outlook May Protect Your Heart

Encouraging social support isn’t usually seen as a top priority for heart attack recovery, but this is just one more piece of evidence that it should be: one study showed that within six months of having a heart attack, depression increased the risk of death from 3% to 17%.

MORE: A Link Between Anxiety and Heart Attacks

“We shouldn’t just be concerning ourselves with pills and procedures,” said Harlan Krumholz, MD, the study’s senior author and director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, in a statement. “We have to pay attention to things like love and friendship and the context of people’s lives. It may be that these efforts to help people connect better with others, particularly after an illness, may have very powerful effects on their recovery and the quality of their lives afterwards.”

TIME Heart Disease

Fat In Olive Oil Repairs Failing Hearts, Study Finds

Olive oil.
Josa Manuel Ferra—Getty Images

Yup, the Mediterranean diet seriously starts today

For broken rat hearts, nothing beats a healthy glug of olive oil.

That’s what new research published in the journal Circulation found when it looked at beating rat hearts riddled with heart failure, a condition that manifests itself in humans over time when chronic high blood pressure makes it harder for the heart to pump blood, making the heart grow bigger, thicker, and less effective. The heart becomes unable to metabolize and store the fat it needs to keep pumping—like an engine out of fuel, the study author says—and the fat it does manage to metabolize breaks down into toxic by-products that exacerbate heart disease.

MORE: Ending the War on Fat

It’s a complicated problem without an obvious quick fix, which is why researchers were surprised by what came next. To see exactly how fat moves around in the cells of these impaired hearts, they removed hearts from rats, kept them beating normally and put them in a strong magnetic field through a process called nuclear magnetic resonance spectroscopy. They delivered two types of fat directly to the hearts—either oleate, the kind of fat found in olive oil and canola oil, or palmitate, which is in dairy products, palm oil and animal fat. When the scientists followed the fat around, they found drastic differences in how the hearts reacted to the two fats.

MORE: The Worst Times to Be Treated for a Heart Condition

“If we gave hearts that were failing palmitate, they basically looked like failing hearts,” says E. Douglas Lewandowski, study author and director of the University of Illinois at Chicago Center for Cardiovascular Research. Their fat metabolism and storage remained depressed and the hearts weren’t producing enzymes that would help metabolize fat. But when they gave the hearts oleate, they vastly improved. The presence of oleate completely restored the fat content in the cell back to normal, Lewandowski says, and the hearts contracted better and showed normalized genes that help in fat metabolism.

“We didn’t think it would have such profound effects,” Lewandowski says. “When we think about normalizing the metabolism, it’s so far upstream of so many disease processes that it’s very exciting.” In just half an hour, the fat induced all of these positive changes.

MORE: Can Olive Oil Help Prevent Stroke?

More research—especially on humans—is needed before imagining that oleate could help the failing hearts of people, but Lewandowski admits his study shows the potential for actual dietary therapeutic regimens. And the results might help partly explain why the Mediterranean diet is so heart-healthy. People who follow it have long shown lower rates of heart disease death and heart problems, and the good monounsaturated fats, like the kind in oleate, raises the good kind of cholesterol and lowers the less desirable kind. We’ll have to wait for the olive oil heart infusions, but in the meantime, here’s your latest excuse for heavy-handed drizzling.

TIME Heart Disease

Cardiac Arrest Patients Need CPR, Not Hospitals, Doctor Says

Blurred motion shot of speeding ambulance
Manuel Sulzer—Getty Images

Physicians debate whether taking cardiac arrest patients to the hospital is worth the time lost

Patients undergoing cardiac arrest are better off being treated right away by ambulatory teams instead of being taken to hospitals, a physician argued in The BMJ on Wednesday.

Cardiac arrest–not to be confused with a heart attack–is an instantaneous loss of heart function. A heart attack is caused by a blockage, whereas cardiac arrest is a malfunction in the heart’s systems. Typically, immediate cardiopulmonary resuscitation (CPR) is the best treatment, but in his editorial, Jonathan Benger, a professor of emergency care at the University of the West of England, argues that there’s not a lot more a hospital can do, and that preparing a patient for transport only leads to delays in care.

In his opinion, that should stop.

In the U.K. less than 10% of patients with cardiac arrest survive and leave the hospital. In Benger’s argument, first responders should instead do what they can at the scene of the incident—including CPR and early defibrillation—without worrying about taking the patient to the hospital. “If spontaneous circulation does not return then the patient’s death should be accepted and made as dignified as possible,” he writes.

Rates of survival for out-of-hospital cardiac arrest in the U.S. are only about 9.5%, according to the American Heart Association (AHA). But the type of strategy Benger suggests probably won’t change clinical practice soon, other experts say.

“Although overall survival to discharge of patients who are neurologically intact is quite low, the concept of abandoning all resuscitation efforts at the scene after cardiac arrest is not a practice that is ready for prime time in the U.S.,” says Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York. According to Glatter, the ability to conduct a high-level, tech-enabled resuscitation is still limited in the field. In some cases, Glatter says a reversible cause for the cardiac arrest can be identified in the hospital.

One of the greatest arguments against not bringing cardiac arrest patients to the hospital is that it could hinder organ donor supplies. “The potential loss of patients who are not resuscitated in the hospital setting from ambulance transport could lead to a loss of vital organs for transplant,” says Glatter. “That would have a ripple effect to those who need organs the most.”

Given the low survival rates of cardiac arrest, skipping the transport time is a valid argument, but missing out on some of the technologies and expertise at a hospital will likely be very hard for the medical community to justify at this point.

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