TIME medicine

Hormone Treatments Raise Cancer Risk Even After They’re Stopped

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Estrogen and progestin therapy to treat menopause has led to controversial and confusing recommendations. But in the latest and longest term look at the data, experts say the risks of the hormones may last long after women stop taking them

Researchers admit that when it comes to hormone therapy — estrogen and progestin — to treat the symptoms of menopause for women, they don’t have a lot of consistent or convincing answers. They thought the medications could not only help menopause symptoms but also protect against heart disease, although some studies showed the added hormones could also raise risk of breast cancer. The resulting advice to women seeking answers about whether hormone therapy is for them has been anything but satisfying.

Now the scientists involved in the first large trial of hormone therapy, the Women’s Health Initiative (WHI), have continued to study those women who participated in the 1990s and found some surprising results. Reporting in the journal JAMA Oncology, they say that the risk of breast cancer for women taking the combination of estrogen and progestin remains the same seven to eight years after they stop the drugs than while they were taking them.

MORE: Hormone Replacement Therapy After Menopause: What Women Need to Know

The estrogen helps to maintain levels of that hormone as natural amounts start to drop during menopause, and the progestin protects the uterus from potential tumors arising from excess amounts of estrogen. They also found that for the quarter or so post-menopausal women who have had a hysterectomy, and can take estrogen alone, the hormone can lower their risk of breast cancer.

The WHI was created to study the health effects of hormone therapy on the millions of women taking them. Some small studies had suggested that the hormones could protect women from heart disease; women tend to have heart attacks about a decade or so later than men on average, and researchers believed some of that protection came from estrogen. But doctors were concerned about the known connection between estrogen and breast cancer, since during puberty estrogen contributes to breast tissue growth, and wanted to understand how the benefits for the heart matched up against the risks to the breast, so they enrolled more than 26,600 women aged 50 to 79 years in the WHI.

MORE: Estrogen After Menopause Lowers Breast Cancer Risk for Some Women

They intended to study them until 2005, but in 2002, they stopped the trial when it became clear that there was a group of women experiencing higher heart disease rates. It turned out that these were the women taking hormones, either the combination or estrogen alone.

MORE: The Truth About Hormones

The results completely changed menopause treatment, and led to a precipitous drop in the use of the medications; in the U.S., where about 40% of women turned to the hormones, only 15% did after most experts agreed that they should only be used in the short term, for about a year or so during and just after menopause. The assumption was that the benefits in lowering breast cancer risk would be similar — if women stopped taking the hormones, then their risk would decline.

That seemed to be true, at least for the first year or so after discontinuing the therapy. But in 2013, Dr. Rowan Chlebowski, an oncologist at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, and one of the initial investigators on WHI, reported that the benefit didn’t hold for long. He found that if women who had previously been on estrogen and progestin therapy were studied for more than eight years, their risk of breast cancer started climbing back up, to levels that were on par with when they were taking the medications.

That finding, however, contradicted other results from studies. And to make matters more confusing, the women who had had a hysterectomy, and no longer had a uterus so could take estrogen alone, did not seem to experience the same increased risk of breast cancer. All of this data prompted Chlebowski to do a more detailed analysis of the WHI data on women who agreed to continue to participate years after they stopped taking the hormone therapy.

MORE: Making Sense of Hormone Therapy After Menopause

In the current study, it’s clear that the combination of estrogen and progestin increases breast cancer risk, he says. The drop in risk that occurs immediately after the therapy is stopped is likely due to the changing hormone environment. Any small or emerging tumors that were already present before hormone treatment started may eventually start growing again years later.

For women who have had a hysterectomy, taking estrogen alone does not increase breast cancer risk and may, according to the latest results, even provide some protection against the disease.

“It looks like hormones have longer term lingering effects,” says Chlebowski. “For estrogen and progestin together, we see an increase in risk even years after you stop. But for estrogen alone, it looks like the hormone may be more favorable in reducing breast cancer risk than we thought before. The estrogen alone findings are now quite compelling that we may had to call lit risk reduction.”

The results should stress the importance of defining what menopausal symptoms are, and how much they interfere with women’s daily lives. Most health groups now recommend short term hormone therapy, but it’s clear that the risks of breast cancer remain even after exposure. So doctors and patients need to weigh the relief of symptoms against the unhealthy legacy of taking these medications. “There is a little more risk than we thought with estrogen and progestin,” says Chlebowski. “But it’s always difficult to figure out how to categorize that risk. It’s different for each woman.”

TIME Heart Disease

What Divorce Does to Women’s Heart Health

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When it comes to the fallout from a divorce, one spouse is harmed more by it’s biological and psychological effects on the heart

Dissolving a marriage is hard on everyone, but researchers say the psychological stress of a divorce can have serious physical effects on the heart, especially for women.

Women who divorced at least once were 24% more likely to experience a heart attack compared to women who remained married, and those divorcing two or more times saw their risk jump to 77%. In the study published in the journal Circulation: Cardiovascular Quality and Outcomes, Matthew Dupre of Duke University and his colleagues found that men weren’t at similar risk. Men only saw their heart attack chances go up if they divorced two or more times compared to men who didn’t split with their spouses. If men remarried, their heart risk did not go up, while for women who remarried, their chances of having a heart attack remained slightly higher, at 35%, than that of divorced women.

MORE: Divorce More Likely When Wife Falls Ill

These findings remained strong even after Dupre’s team adjusted for other potential contributors to heart attack, including age, social factors such as changes in occupation and job status and health insurance coverage, and physiological factors including body mass index, hypertension and diabetes. Previous studies have found links between divorce or widowhood and heart disease that were explained, at least in part, by changes in people’s access to health care and their ability to keep up healthy eating and exercise habits.

But these are the first results from tracking people over a longer period of time—18 years—to capture the cumulative effects of changes in marital status, says Dupre. “We looked at lifetime exposure to not only current marital status, but how many times someone has been divorced in the past. What we found was that repeated exposure to divorce put men and women, but particularly women, at higher risk of having a heart attack compared to those who were married.”

MORE: Study: Marriage is Good For The Heart

And it wasn’t simply changes in health insurance coverage or financial status resulting from the divorce that explained the higher heart risk. Even after Dupre’s group accounted for these, the relationship held. While he admits that the trial did not investigate exactly how divorce is seeding more heart attacks, other studies hint at a possible explanation. Dramatic life changes such as divorce, which signal an end to not only a significant relationship but potentially to stable financial and social circumstances as well, can lead to spikes in the stress hormone cortisol, which in turn can push blood pressure, cholesterol and blood sugar to unhealthy heights.

The long term scope of the study revealed the impact that social and life events can have on the physical functioning of the body. “The health consequences of social stresses are real,” says Dupre. For women, the 77% higher risk of heart attack connected to multiple divorces was on par with well-established factors such as hypertension (which boosts risk by 73%) and diabetes (which elevates heart problems by 81%).

MORE: Do Married People Really Live Longer?

That’s doesn’t mean, of course, that women should avoid getting divorced to save their hearts. “Another way to put it is to say that women who are stably married are at an increased advantage of preventing heart attacks than women who may have had to go through transitions where they weren’t,” says Dupre.

It also makes a good case for doctors including discussion about potential stressors, including lifestyle and social circumstances, in their health assessment of patients. Recognizing that divorce may be a life event that can contribute to higher heart attack risk, for example, they can monitor patients experiencing divorce more carefully, and be alert to the first signs of potential problems with cholesterol, blood pressure or blood sugar. “Understanding all of the factors that lead to a physiological response are equally important,” says Dupre. And potentially life saving.

TIME

Shorter People More at Risk From Heart Disease Says Study

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"If you're 6ft 1in, you still need to stop smoking"

A study of nearly 200,000 men and women found that shorter people have a higher risk of heart disease than their taller counterparts.

Every 2.5 inches up reduce the risk of heart disease by 13.5 percent, according to the study published in the New England Journal of Medicine on Wednesday.

Scientists have long considered there to be a link between height and heart health, but the latest research found that genes controlling height were directly linked to heart disease risks.

To be sure, height is only one of many factors that affect the level of risk.

“In the context of major risk factors this is small – smoking increases the risk by 200-300% – but it is not trivial,” Nilesh Samani, a professor of cardiology at the University of Leicester and lead author of the study, told the BBC News website. “If you’re 6ft 1in, you still need to stop smoking.”

TIME Exercise/Fitness

This Study Busts Your Work Out Excuse

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Air quality may not be the best in cities, but the benefits of physical activity can outweigh the harms of breathing in pollutants

Exercising outdoors is certainly preferable to being cooped up in a stuffy gym, but if you live in an urban area, the pollution from cars and buses may give you pause. It shouldn’t. Zorana Andersen from the center for epidemiology and screening at the University of Copenhagen and her colleagues report in the journal Environmental Health Perspectives that being active trumps some of the negative health effects that breathing in polluted air might have.

MORE: Pollution: Dangerous to Joggers

In a study involving 52,061 people who were followed for around 13 years, Andersen found that those who were more active were less likely to die during the study than those who were more sedentary, regardless of the pollutant levels where they lived. The researchers asked the participants to detail their physical activities, including their leisure sports, how much they walked, whether they biked or walked to work, and whether they spent time gardening. They compared these responses to the levels of nitrogen dioxide near their homes; NO2 is a gas produced from the burning of fossil fuels in cars, and is an ingredient for other harmful pollutants such as ozone and particulate matter, which can cause respiratory illnesses. Previous studies found that walking along a busy London street, for example, caused a drop in lung function and that cycling or running near high traffic roadways also compromised people’s respiratory functions slightly.

In Andersen’s study, however, people who participated in sports showed a 22% lower risk of dying from any cause during the 13-year followup, while those who cycled regularly showed a 17% lower risk and people who spent time gardening showed a 16% lower risk compared to those who didn’t do either of those activities — and regardless of the pollution levels where they lived.

MORE: Ozone Can Harm the Heart in as Little as Two Hours

“We found an even more positive message around physical activity than we even hoped for,” says Andersen. “Physiologically it’s plausible that you inhale more particles [of pollution] when you exercise in polluted areas, and we thought maybe the accumulated lifetime effect of this would reduce the benefit of exercise. But we don’t see that.”

Essentially, the benefits of being active were strong enough to overcome some of the negative effects of breathing in pollutants. That makes sense, she says, because even if people aren’t exercising to avoid inhaling pollutants, they are still exposed to them, and Andersen’s study shows that even if exercises might be exposed to slightly higher levels of compounds like NO2, that still doesn’t negate the positive effects of physical activity on their heart, blood sugar levels and more. In fact, for specific conditions, the benefits of exercising remained quite high; active people even in highly polluted areas had a 66% lower chance of dying early from diabetes compared to those who didn’t exercise.

She notes, however, that some cities may have significantly higher pollution levels than Copenhagen, where the participants lived, and it’s not clear yet how greater concentrations can affect the exercise-pollution-mortality balance. So if you have a choice for working out, biking or walking in a less polluted area, however, such as a park or a quieter side street, that might be a good idea. But don’t worry too much if you don’t. “Being active prolongs life more than staying away from air pollution,” says Andersen. “So pollution shouldn’t be a barrier to exercise.”

TIME Diet/Nutrition

Eating Eggs With Raw Veggies Boosts Nutritional Benefits, Study Says

Fern salad made from fern with quail eggs.
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Cooked eggs increase carotenoid absorption in salads

Next time you’re eating a raw-vegetable salad, consider adding cooked eggs to the mix. A new study suggests that mixing eggs with raw vegetables increases carotenoid absorption almost ninefold, entailing a range of benefits including a longer life span, fewer chronic illnesses and a reduced cancer risk.

Researchers at Purdue University in Indiana served 16 subjects three different varieties of the dish: an eggless salad, a salad with 1½ scrambled eggs and a salad with three scrambled eggs. There was a threefold to ninefold increase in carotenoid absorption from the salad containing the most eggs, according to Science Daily.

The salubrious ingredients — from beta-carotene to lycopene — serve as antioxidants protecting against cancer and heart disease.

“Americans underconsume vegetables, and here we have a way to increase the nutritive value of veggies while also receiving the nutritional benefits of egg yolks,” said the study’s researcher Wayne Campbell.

“Next time you visit a salad bar, consider adding the cooked egg to your raw veggies,” added Campbell. “Not only are lutein and zeaxanthin available through whole eggs, but now the value of the vegetables is enhanced.”

[Science Daily]

TIME medicine

Who Should—And Who Shouldn’t—Take Vitamin D

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Here's what experts say, based on the latest evidence

Does your diet need a little extra D? For researchers, it’s one of nutrition’s most vexing questions. “It’s the wild, wild west,” says Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. “The issue has become murkier over time rather than clearer.” Research is mixed about whether doctors should routinely test for vitamin D levels, like they do for cholesterol, and whether people should be supplementing their diets with vitamin D pills.

Case in point: a study just released in JAMA Internal Medicine showed that vitamin D did not lower the risk of falls among an elderly population in Finland. The study, which compared the effects of exercise against vitamin D supplements on falls and resulting injuries, did find, however, that exercise cut the chances of more severe injury from falls in half compared to those who didn’t exercise.

MORE Want to Stay Healthy? Don’t Rely on Vitamins

But that doesn’t mean that vitamin D isn’t worth taking at all. The Institute of Medicine (IOM), and the U.S. Preventive Services Task Force (USPSTF) both recently reviewed all of the evidence on vitamin D and its health effects and concluded that in many cases, D supplementation is beneficial—with some important caveats. The two groups say that 600 international units (IU) are generally enough for most healthy adults and that higher doses of vitamin D don’t necessarily produce more health benefits. They also stress that those benefits are limited to bone health; there isn’t enough evidence to support the idea that taking the vitamin can protect against heart disease, cancer, diabetes or cognitive decline, all benefits suggested by some smaller studies.

“More isn’t necessarily better,” says Manson, who served on the IOM committee. “In some cases, it can be worse.”

Overdoing vitamin D can lead to calcium in the urine, which can cause kidney stones. Extremely high doses—around 10,000 IU a day—can trigger calcium deposits in the blood vessels, which can lead to clots that cause heart attacks. The IOM panel recommended no more than 4,000 IU of vitamin D daily to avoid these potential problems.

MORE Want to Build Endurance? Cut Back on Vitamin C and E Supplements

When people are tested for vitamin D deficiency and come up short, some researchers caution against treatment. In addition to the dosage risks, there’s also evidence that the lab tests for the type of vitamin D circulating in the blood, 25-hydroxyvitamin D, may not be the most reliable measure of a person’s D levels. Plus, not all labs use the same standard test for picking up 25 hydroxy D, and they set different standards for what are considered normal levels. “Clinicians are often left chasing a number, and trying to get patients’ blood levels up to a certain point,” says Manson. “But when you think about how many people are screened for vitamin D, and the concerns about the reliability in how it’s measured, and the differences in what is considered normal ranges across laboratories, it’s really concerning.”

Better data may be coming soon, however. Several large trials are underway in which people are randomly assigned to take different levels of vitamin D supplements so researchers can study their health outcomes, from bone problems to heart disease, cancer, diabetes and more. Manson is overseeing the largest of these, called VITAL, which has 26,000 participants. The results from these studies, which are being conducted in the U.S., Europe, Australia and New Zealand, should be available in 2017. “We should have conclusive answers in about three years,” Manson says.

The studies will also look specifically at whether vitamin D levels and metabolism differ across racial and ethnic groups. Some studies have hinted that disparities by race in heart disease and certain cancer risks may be due to vitamin D, and the randomized trials will hopefully provide more information on whether that’s true.

In the meantime, Manson says doctors and patients should follow the IOM and USPSTF guidelines: doctors should not order vitamin D blood tests for all of their patients, and people shouldn’t take more than 600 IU of the vitamin if they are otherwise healthy. The only people who may need regular testing for vitamin D deficiency, and possible supplementation, are those with malabsorption problems like Celiac disease, those who have had bypass surgery, or people who have already had fractures and have been diagnosed with osteoporosis. People taking certain medications, including treatment for tuberculosis, may also need to consider vitamin D pills.

For everyone else, however, universal screening isn’t necessary—and there isn’t any reason to take more than the recommended daily allowance of vitamin D.

Read next: The 4 Most Confusing Things About Sugar

Listen to the most important stories of the day.

TIME Innovation

Five Best Ideas of the Day: March 26

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Al Qaeda and ISIS are locked in an ideological war, and for once, it’s good to be their mutual enemy.

By Daniel Byman and Jennifer Williams in Lawfare

2. For the millions left behind by America’s new economy, disability claims — legitimate or otherwise — are skyrocketing.

By Chana Joffe-Walt in Planet Money by National Public Radio

3. Maybe universities shouldn’t measure prestige by the number of applicants they turn away.

By Jon Marcus in the Hechinger Report

4. When younger women have heart attacks, they’re twice as likely to die as their male counterparts. Is medicine’s gender bias to blame?

By Maya Dusenbery in Pacific Standard

5. Can the triumph and tragedy of soccer help Harvard students appreciate the humanities?

By Colleen Walsh in the Harvard Gazette

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Heart Disease

New Class of Cholesterol Drugs Shows Promise For Heart Disease

The experimental drugs show promise, but medical experts remain cautious

Experimental drugs intended to lower cholesterol may also significantly reduce the risk of heart attacks and strokes, according to two new studies.

New research published in The New England Journal of Medicine show that a new class of cholesterol drugs, called PCSK9 inhibitors, may not just lower levels of bad cholesterol, but may also reduce the likelihood of adverse heart events.

The two drugs, evolocumab (under development by Amgen) and alirocumab (under development by Sanofi and Regeneron) appeared to reduce the risk of cardiac events like heart attack by around half, according to new studies.

PCSK9 inhibitors keep levels of low-density lipoprotein (LDL) cholesterol in the blood in check. In some cases they’ve shown to be even more effective than statins, one of the most prescribed drug categories. The experimental drugs are given by injection.

As the New York Times reports, it’s still too early to tell whether the drugs could be used to prevent adverse heart disease events, and the initial studies were only meant to assess the safety of the drugs as cholesterol moderators. Many in the medical community want to see more data.

The drugs have long been shown to be effective at lowering cholesterol, but there may be more widespread use if they also significantly lower heart attack and death risk. Reuters reports that both companies have already submitted their drugs for approval by the U.S. Food and Drug Administration (FDA).

Both studies were presented at the American College of Cardiology annual meeting.

TIME Heart Disease

Depression and Stress Could Be ‘Perfect Storm’ for Heart Disease Patients

The combination of depression and stress may increase the chance of a patient dying of heart disease

Intense stress and depression in people with coronary heart disease creates a “perfect storm” that can increase the risk of death, according to a new study in the journal Circulation: Cardiovascular Quality and Outcomes.

Overall, patients with both conditions are nearly 50% more likely to die or experience a heart attack as a result of heart disease than those with low stress or depression. The results were most apparent in the first two and a half years after observation began.

“The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use and health-risk behaviors,” said lead study author Carmela Alcántara, a researcher at Columbia University Medical Center.

The study, which looked at nearly 4,500 adults, expanded on previous research that found that both depression and stress can independently increase the risk of heart disease. The study suggested that some previous research may have misattributed the cause of heart-disease death to stress or depression independently. In reality, the study suggests, the interaction between stress and depression may have led to death rather than either independent factor.

The study traced participants for an average of nearly six years and asked patients to self-report symptoms of depression and stress. Overall, 6.1% of study participants had both high stress and intense symptoms of depression. Only 5.6% of the total sample had high stress alone, and 7.7% had intense symptoms of depression alone.

Researchers said the results suggest that doctors may want to consider additional methods to treat heart disease that include interventions to treat stress and depression.

TIME Heart Disease

7 Weird Things That Can Mess With Your Heartbeat

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Heart symptoms should never be taken lightly, but factors as innocent as caffeine and thirst may be the cause

A few weeks ago I thought I was having a heart attack. My morning started out normal: I woke up at my usual hour, feeling what I thought was a little bit of tiredness. But as I went about my morning routine, things grew scary. I broke out in a cold sweat as I brushed my teeth. My skin turned white as paper. And then, scariest of all: my heart was pounding like crazy. As a health writer I know these aren’t textbook signs of a heart attack, but I also know that dangerous cardiovascular events in women can be more subtle than those in men.

Later that day I went to urgent care, but an EKG and blood tests showed nothing out of the ordinary. Turns out my heartbeat went haywire as a result of a side effect from a medication. The technical term for this: heart palpitations, which can be brought on by many things.

“When a person says they’re having heart palpitations they’re referring to a sensation of their heart beating differently. Or they may simply have an awareness of their heart beating,” explains Shephal Doshi, MD, director of cardiac electrophysiology at Providence Saint John’s Health Center in Santa Monica, California.

Learn about some top triggers of palpitations, plus what to do about them.

Read more: 9 Subtle Signs You Could Have a Heart Problem

Panic attacks

If you feel as if your heart is racing like it’s going to beat out of your chest, it could be a panic attack, Dr. Doshi says. Shaking, sweats, and an overwhelming feeling of impending doom are also common symptoms. Panic attacks are generally not dangerous, though they can feel absolutely terrifying. “Sometimes you may have an arrhythmia [an abnormal heart rhythm caused by a disruption in the heart’s electrical signaling] that’s actually causing the panic attacks, so see a doctor to rule out something more serious,” Dr. Doshi adds. Otherwise, recurring panic attacks can be treated with talk therapy to identify triggers and anti-anxiety medications.

Read more: 12 Signs You May Have an Anxiety Disorder

Caffeine

So your heart’s beating faster than normal. Before you start worrying, did you just have a big cup of Joe? “Caffeine is a stimulant,” says Brian Kolski, MD, an interventional cardiologist with St. Joseph Hospital in Orange, California. This means that it “stimulates the autonomic nervous system (the involuntary nervous system which controls heart rate and more), which can cause an increase in palpitations.” Dr. Kolski recommends seeing your doctor if palpitations become excessive or are accompanied by dizziness, lightheadedness, or chest pain—even if you suspect it’s caused by caffeine.

Read more: 12 Surprising Sources of Caffeine

Decongestants

Decongestants such as pseudoephedrine (the active ingredient in Sudafed) are also stimulants. “Some people who may be sensitive to these drugs can experience heart palpitations,” adds Dr. Doshi. Over-the-counter meds are usually safe, but you should talk to your doctor or pharmacist if you have any other medical conditions. If you have a heart arrhythmia, for example, your doctor may advise against taking certain decongestants, Dr. Doshi says.

Read more: 10 Products to Help You Find Sinus Relief

Dehydration

Losing too much fluid, not drinking enough, or a combination of the two can quickly lead to dehydration, which, when severe, can lead to heart palpitations along with dry mouth, dark urine, and muscle cramping. “Dehydration can cause changes in your body’s electrolytes and also lowers blood pressure,” Dr. Doshi says. “This puts stress on the body and, as a result, could cause an abnormal heartbeat.” Prevent it with regular trips to the water cooleryour body needs 2.2 liters (or about nine cups of fluid) every day to function properly, per the Institute of Medicine.

Read more: 7 Easy Ways to Drink More Water

Prescription meds

Many prescription medications, including those for asthma or thyroid problems, can cause palpitations, says Dr. Kolski. “Some medications affect how other medications are metabolized, while others cause changes in the electrical conduction system of the heart.” These heartbeat changes aren’t normally a cause for alarm, but they can be bothersome. Make sure your doctor knows about every drug or supplement you’re taking before you start any new medications. Also, pay close attention to the possible side effects listed on the drug information that comes with your medicine when you pick it up from the pharmacy, so you won’t freak out if it happens. If your regular medicines are messing with your heartbeat day-to-day, talk to your doctor to see if there’s a different drug that might work better for you.

Read more: 19 Signs Your Thyroid Isn’t Working Right

Anemia

Most commonly caused by iron deficiency, anemia means your body isn’t making enough healthy red blood cells to carry adequate oxygen to your tissues. Although it doesn’t always cause heart palpitations, people with anemia may sometimes feel their heart beating harder, says Kolski. “Since you have fewer red blood cells, a faster heart beat increases oxygen delivery when you’re anemic.” Other symptoms include fatigue and hair loss.

Read more: 15 Signs You May Have an Iron Deficiency

Heavy metals

People who work in construction, as metal workers, or in other industrial settings can be exposed to mercury, cadmium, and other heavy metals regularly. Long-term exposure can lead to inflammation, blood clots (thrombosis), and other heart-related problems. “Heavy metal exposure can be directly toxic to heart muscle,” Dr. Kolski says. “[It] can also cause problems with electrolytes. Anything that causes a derangement in electrolytes can cause heart palpitations.”

Read more: 10 Best Foods for Your Heart

In general, heart symptoms should never be taken lightly; if you ever feel like something’s up with your heart, see a doctor ASAP (in the ER or an urgent care center) for a full evaluation.

This article originally appeared on Health.com.

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