TIME Heart Disease

This Makes Your Heart Attack Risk 8 Times Higher

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A new study links high levels of anger to an increased risk for heart attack

Getting very angry isn’t just off-putting to the people around you, it may also significantly increase your short-term risk for a heart attack, according to new findings.

Having an episode of intense anger was associated with an 8.5 times greater risk of having a heart attack during the following two hours, a new study published in The European Heart Journal Acute Cardiovascular Care showed. The new findings add to prior research that has suggested high levels of anger may spur a heart attack.

The study looked at 313 people who were being treated in a hospital for a heart attack. The men and women were asked to fill out a questionnaire about the level of anger they experienced in the last 48 hours based on a number scale:

  1. Calm.

  2. Busy, but not hassled.

  3. Mildly angry, irritated and hassled, but it does not show.

  4. Moderately angry, so hassled it shows in your voice.

  5. Very angry, body tense, maybe fists clenched, ready to burst.

  6. Furious, forced to show it physically, almost out of control.

  7. Enraged, out of control, throwing objects, hurting yourself or others.

An anger level greater than five was reported among seven of the people in the study in the two hours prior to their heart attack, and up to four hours prior for one person. An anger level of four was reported among two people within the the two hours before heart attack symptoms, and among four hours before for three people. According to the researchers, the results come to a 8.5-fold increase in relative risk of a heart attack in the two hours following severe anger. People who reported high levels of anxiety, also had a higher risk.

The study is small and therefore it’s still too early to know how great of a factor intense anger is in predicting heart attack onset. The anger levels are also self-reported and could differ person to person. But the study does provide experts with information about what emotional factors could trigger a heart attack. For instance, the researchers found that some of the greatest reported anger was due to arguments with family members followed by arguments with non-family members, work anger and driving anger. “Our findings highlight the need to consider strategies to protect individuals most at risk during times of acute anger,” the authors conclude.

Exactly how anger could trigger a heart attack still remains unknown, but the researchers speculate that the stress may stimulate activity in the heart like increased heart rate and blood pressure, blood vessel constriction, a plaque rupture, and clotting which could eventually lead to a heart attack.

“I think this study is very helpful in many ways because it’s validating to what we already know. Anger is not what we would call a traditional risk factor because it’s so hard to measure,” says Dr. Curtis Rimmerman a cardiologist at the Cleveland Clinic who was not involved in the study. “It highlights the importance of paying attention to a patient’s wellbeing.”

TIME heart

High Cholesterol Can Be Dangerous Even If You’re Young

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Lisa Bodvar—Getty Images

High cholesterol levels in older age are a familiar risk factor for heart attacks, and doctors warn that the danger can start much sooner for many. But how soon should you start worrying?

Most of us know that too much cholesterol in the blood can bring on dangerous clots that lead to heart attacks and stroke. And recent studies show that the build up of these fats in the blood vessels doesn’t happen overnight — it takes years of gradual deposits to narrow a vessel. So in 2013, when heart experts expanded the criteria for who over the age of 60 should consider taking cholesterol-lowering statins, Michael Pencina, a professor of biostatistics at the Duke University Clinical Research Institute, began wondering about those, including himself, who were younger. How long should they wait before taking the drugs?

In the latest study of healthy people who were followed for about 15 years on average, researchers report Monday in the journal Circulation that having even mildly elevated cholesterol levels can increase risk of having later heart problems by as much as 40%.

The researchers argue that having high cholesterol for many years—even if it starts when you’re young—should be a new risk factor that doctors and patients consider when discussing their risk of heart disease.

Even people with moderately high levels of lipids, who might not qualify for treatment for high cholesterol levels, could be at higher risk of heart attacks later in life simply because they harbor these elevated lipid levels for a long period of time.

MORE: Should I Take a Statin? What You Need to Know About the New Cholesterol Guidelines

Among a group of 1,478 people aged 55 years old from the Framingham Heart Study’s Offspring Cohort, those who had higher cholesterol levels for 11 to 20 years (beginning when they were about 35 years old) had a 16.5% higher risk of having a heart attack about 15 years later, compared to a 4.4% risk for those whose cholesterol levels never veered beyond the normal range during middle age. That’s an almost fourfold greater risk, and one that Pencina and his colleagues argue might be reason enough to be more aggressive in discussing ways to lower cholesterol with these patients so they can reduce their risk of heart trouble later on.

MORE: New Cholesterol Guidelines May Put 13 Million More on Statin Drugs

“We identified a patient population whom the guidelines might miss,” he says. It’s another dimension of cardiovascular health that needs to be looked at, and yes, I would say that it should be considered a risk factor.” In the study, the researchers considered LDL levels above 130 mg/dL as elevated, which falls into line with previous professional heart organization criteria.

But he stresses that this factor won’t fall easily into a threshold below which patients won’t need to worry about their cholesterol and above which they will. “There are so many components like family history and other factors that go into the decision of what kind of intervention people may need, such as lifestyle, diet or pharmacologic,” says Pencina. “But if you are measuring your cholesterol, even if it’s fine at an early age, it lets you build that history.”

TIME Diet/Nutrition

Older Adults May Be OK to Eat More Salt Than Previously Thought

New study takes a look at sodium recommendations

It’s currently recommended that adults aged 51 and older consume less than 1,500 mg of sodium a day for better heart health. Since that’s less than one teaspoon of salt, it can be hard to achieve if fast or processed food is part of their diets. But now a new study shows that consuming up to 2,300 mg of salt isn’t associated with greater mortality, cardiovascular disease, or heart failure in older adults.

The study, published in the journal JAMA Internal Medicine, doesn’t refute Centers for Disease Control and Prevention (CDC) recommendations that older people should consume less than 1,500 mg of sodium a day, but it shows there also isn’t harm if people consume up to 2,300 mg (which is the CDC’s recommendation for the general population).

The authors note that a limitation of the study is that the amount of sodium consumed was self-reported, and people generally tend to underestimate their sodium consumption.

There did seem to be a greater risk for heart-related health problems among people who consumed more than 2,300 mg, but the numbers were not statistically significant.

To reach these findings, the researchers looked at the self-reported diets of 2,642 adults between ages 71 to 80, and followed-up 10 years later. The researchers found that 10-year mortality rates were 33.8% among people consuming less than 1,500 mg a day, 30.7% among people consuming 1,500 to 2,300 mg, and 35.2% among people consuming more than 2,300.

The CDC recommendations offer a bit more leeway for people two and older who are supposed to consume 2,300 mg of sodium or less. But the American Heart Association has a 1,500 mg a day recommendation for all ages. Both recommendations have been disputed, with some experts arguing there’s a lack of evidence that people really need to be aiming for that little sodium, and that it’s a goal that most people cannot realistically meet.

“In older adults it’s probably ok if you stick with the general recommendations of one teaspoon (2,300 mg),” said study author Dr. Andreas P. Kalogeropoulos of Emory University. “If you reach 70 and are free of cardiovascular disease or heart failure, these people are probably going to do ok with the standard recommendations. But know that anything over one teaspoon is bad for your health.”

TIME health

Plastic and Permanent: The Artificial Heart’s Debut

First Artificial Heart Implantation
Ravell Call—Getty Images Barney Clark receives the first artificial heart implant Dec. 2, 1982, in Salt Lake City

Dec. 2, 1982: Doctors implant the first permanent artificial heart in a human, Barney Clark, who lives 112 days with it

Barney Clark’s heart was made of plastic — and instead of beating, it whooshed.

The 61-year-old retired dentist was in an advanced stage of cardiomyopathy, a progressive weakening of the heart muscle, when he became the first recipient of a permanent artificial heart on this day, Dec. 2, in 1982.

Heart transplants were already being done to prolong lives, but in a limited, last-resort way. Surgeons accomplished the first human-to-human transplant in South Africa in 1967, when a man with severe heart damage received the heart of a 25-year-old woman who had died in a car crash. He survived 18 days. In 1977, after new immunosuppressant drugs dramatically increased the odds of survival, the first recipient of a heart transplant at Columbia University’s Medical Center — one of only three institutions in the country performing the surgery at the time — survived 14 months.

But Clark was 11 years too old to be a candidate for a heart transplant, according to the criteria U.S. surgeons had by then agreed on. His only shot at survival was Dr. Robert Jarvik’s pneumatically-powered heart. The Jarvik 7, as it was called, comprised two plastic pumps powered by compressed air, which required the patient to be hooked up at all times to a rolling console the size and weight of a refrigerator. The artificial heart could pump blood through the body at 40 to 120 pulses per minute, but it replaced the telltale heartbeat with a soft clicking sound followed by a whoosh.

Clark knew what he was in for: before agreeing to the operation, he first toured a facility where Jarvik’s hearts were keeping several sheep and calves alive, including a calf named Tennyson who set the survival record of 268 days, according to TIME.

He met the requirements for the surgery by having a fatal heart condition, with no other treatment alternatives, as well as a strong will to live. By the time of the surgery, he was nearly dead already: his heart was pumping a liter of blood per minute, or a fifth the normal rate.

The surgery was considered a success, since Clark went on to live another 112 days. A surgeon told TIME that his color had changed, from blue to pink, after more oxygen infused his blood. There were hitches, however. A week after the surgery, he suffered a series of seizures his doctors blamed on an imbalance of fluids and salts. Following the seizures, he was often disoriented, and sometimes believed he was still a dentist in Seattle.

He never left the hospital after his transplant, and ultimately died of “circulatory collapse and secondary multi-organ system failure” triggered by an infection that was likely the result of a blood transfusion, according to his obituary in the New York Times.

Later recipients fared somewhat better with the Jarvik 7. William Schroeder lived a record 620 days with one, although his quality of life was poor after he suffered serious strokes within the first three weeks. Another recipient, Leif Stenberg, made remarkable progress with his new heart, and lived 229 days before suffering a fatal stroke.

Stenberg’s renewed vigor was a triumph fraught with unexpected philosophical considerations. Long suspected of being a powerful Swedish crime boss, he was never convicted of any crime, partly because his health problems delayed a trial on charges of tax evasion. But the transplant led to a new delay, since Swedish law defined death as the moment when one’s heart stopped beating. Stenberg’s attorneys, therefore, argued that he should not have to stand trial, since he was already dead.

Read the full report on Barney Clark’s operation from 1982, here in the TIME Vault: Living on Borrowed Time

TIME Diet/Nutrition

Energy Drinks Are Hurting Young Kids

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AFP/Getty Images Cans of energy drinks are displayed in a store in San Diego on November 10, 2006.

Poison centers are fielding calls about adverse health events from energy drinks for kids as young as six

Over 40% of calls to U.S. poison centers concerning energy drinks are for kids under age 6, some of whom reported experiencing symptoms like serious cardiac and neurological problems.

In a new study that examined the American Association of Poison Control Centers’ National Poison Data System, looking at reports from Oct. 2010 to Sept. 2013, researchers found that of the 5,156 reported cases of energy drink exposure, 40% where unintentional exposures by kids. Symptoms related to the heart, like abnormal rhythms, were noted in 57% of the reported cases. Neurological issues were reported in 55% of the cases.

American Heart Association

Prior data has shown that young kids are passing up caffeinated beverages like soda, but are instead consuming more energy drinks and coffee. The FDA is currently investigating the risks of added caffeine in products consumed by young people.

The trouble with energy drinks is that they are not always regulated the same way as other beverages. For instance, some are considered dietary supplements, and don’t need FDA safety approval. The FDA considers caffeine to be safe, but some energy drinks can contain up to 400 milligrams (mg) of caffeine per can, as compared to 100-150 mg in a coffee, the study’s authors say.

Researchers are unsure what part of energy drinks can cause adverse health problems. It’s possible other ingredients besides caffeine can result in medical issues.

The American Beverage Association responded to the study, which is not yet published but was presented recently at the American Heart Association’s Scientific Sessions:

“This abstract has not been published and therefore the authors’ full methodology and analysis is not available for review. In the past, various experts have raised concerns regarding misinterpretation and inherent limitations of data from National Poison Data System when it comes to Energy Drinks. Based on the most recent government data reported in the journal Pediatrics, children under 12 have virtually no caffeine consumption from energy drinks.

Even so, leading energy drink makers voluntarily place advisory statements on energy drink packaging stating that energy drinks are not recommended for children. They also have voluntarily pledged not to market these products to children or sell them in K-12 schools. These guidelines and more are noted in the ABA Guidance on the Responsible Labeling and Marketing of Energy Drinks.

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

Eating Fruit Cuts Heart Disease Risk by 40%

Heart with coronary vessels
Pasieka—Getty Images

An extra helping of leafy-greens is good for your heart

Eating fruit every day can lower risk of heart disease by up to 40%, new research suggests.

A new study that looked at more than 451,680 participants over seven years asked the group to report their fruit consumption, whether it be never, monthly, 1-3 days per week, 4-6 days per week, or daily.

The researchers found that compared to people who never eat fruit, those who eat fruit every day cut their heart disease risk by 25% to 40%. Those who ate the most amount of fruit also had much lower blood pressure compared to the participants who never ate fruit.

The study is not the first to find a connection between eating fruit and having better heart health. One study of about 110,000 men and women over 14 years found that people who eat fruit and vegetables every day had a lower risk of developing cardiovascular disease, and some studies have found that citrus fruits like oranges, lemons and grapefruits have especially protective benefits.

Next time you’re in need of a snack, grab an apple over a bag of chips. It’s surely not the last time science will say it.

TIME Heart Disease

New Heart Drug Saves More Lives Than Standard Treatment

A new drug may replace the current standard of treatment for heart failure

Drug maker Novartis released highly anticipated results from its clinical trial, PARADIGM-HF, showing its new heart failure drug cut cardiovascular deaths by 20%. The results were announced at the European Society of Cardiology meeting on Saturday.

Novartis has been testing a drug called LCZ696 for chronic heart failure in hopes of replacing ACE inhibitors, one of the mainstays of heart failure treatment. In March, an ethics council that was monitoring the trial data simultaneously requested the company end the trial since it was clear that participants using LCZ696 lived longer without being hospitalized for heart failure compared to those using the standard-care ACE inhibitor, enalapril.

Anticipation over the drug’s results has been mounting since the recommended closure of the trial; results were so impressive that the treatment showed potential to become the next standard of care. The latest trial showed significantly more patients on LCZ696 were alive, and they had 21% fewer hospitalizations compared to people on enalapril. They also found that the drug doubled the effect enalapril had on all-cause mortality, which is the holy grail of trial end points.

About 20 to 26 million people live with heart failure across Europe and the U.S., and even with treatment it has a poor prognosis and costs $100 billion to treat globally. The majority of those costs come from hospitalizations.

“We thought, what if we could replace the cornerstone of heart failure treatment, ACE inhibitors,” says Patrice Matchaba, development head for Novartis’ critical care franchise. “That’s why we designed PARADIGM and it was a bold decision to make.”

LCZ696 is a pill taken twice a day and is part of a new class of drugs that blocks receptors exerting harmful effects on the heart. The treatment protects the heart by reducing muscle strain, which allows the heart muscle to recover.

Fewer patients using LCZ696 discontinued the trial for adverse events, but the group did have more hypotension and non-serious angioedema compared to patients on enalapril. They had less renal impairment, hyperkalemia and cough.

Matchaba says Novartis will be submitting to the FDA by the end of 2014 and that they’ve already received fast-track status. They will submit in Europe the first quarter of 2015.

TIME heart

Pigs Can Grow Their Own Pacemakers

And the scientists say that the technique, which involves cutting edge reprogramming of cells, may be tested in people soon

Pacemakers are remarkable devices that save the lives of 300,000 people in the U.S. each year. They essentially take over for failing hearts, but since the devices require invasive surgery to implant in the heart, researchers have been looking for less invasive approaches to keeping the heart ticking. And now, reporting in the journal Science Translational Medicine, Dr. Eduardo Marban, director of the Cedars-Sinai Heart Institute, has a lead—thanks to pigs.

“We were able for the first time to create a biological pacemaker using minimally invasive methods, and show that the new pacemaker cells suffice to support the demands of daily life,” he said. “When the pigs exercised, the hearts beat faster. When they were at rest, their hearts slowed down.”

He and his colleagues say that a single gene can transform existing heart cells to take over the function of ailing pacemaker cells in the heart, The group tested their theory in mice, and were encouraged enough by the results to predict that human trials may be as close as three years away.

MORE: A ‘Vaccine’ for Heart Disease Could Mean No Pills, Lettuce or a Gym

Marban has been working for more than a decade to find a better way to keep pacemaker patients’ hearts pumping at the right rate. In particular, he was focused on the 2% of them who need to go on antibiotics to treat an infection—because the devices are foreign objects implanted into the body, infections are possible—and in the interim have their pacemakers removed to be cleaned. During that time, these patients receive a temporary pacing device connected to a catheter, but the catheter itself may be an additional source of infection and make the antibiotic treatment less effective.

MORE: Single Gene Responsible for Group of Heart Disease Risk Factors

In Marban’s experiment, he simply loaded deactivated cold viruses, which are able to easily infect cells, with a gene—called TBX18—that is active during fetal development but later shuts off. Earlier studies showed that simply bathing cells in TBX triggered normal heart cells to start morphing into the ones that keep hearts working. That’s exactly what happened in the seven pigs whose hearts were injected with the gene. A small proportion of their normal heart cells, the size of a peppercorn, were transformed into electrically pulsing cells and essentially took over the pacemaker function of the pigs’ hearts.

Dr. Eugenio Cingolani, director of the cardiogenetics-familial arrhythmia clinic at Cedars Sinai and a co-author of the paper, said that while encouraging, more studies on the efficacy of the genetic reprogramming process, as well as a more in-depth analysis of the potential adverse effects are needed.

But the findings represent a promising first step toward a potentially new technique for treating certain life-threatening conditions.

“This development heralds a new era in gene therapy, where genes are used not only to correct deficiency disorders but to convert one cell to another to treat disease,” said Marban. “Now that we and others are hot on the trail of developing therapeutics based on this principle of cell reprogramming, I anticipate that the flood gates will open and people will look for genes of interest to do whatever they want in particular organs or tissues of interest.”

At the very least, he believes that a hardware-free, biological pacemaker based on the technique could become reality.

TIME heart

VIDEO: Here’s How Your Heart Actually Works

In a short video, Edmond Hui explains how the human hearts actually pumps blood

The heart has baffled scientists for centuries, and its inner workings still confuse a lot of people. So Dr. Edmond Hui set out to make a video that would explain it in clear terms once and for all.

In the video above, Edmond Hui retraces how scientists used to think the heart worked compared to how it actually works.

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