More Feathers in the Cap of Icosapent Ethyl

eicosapentanoic acid, Health & Wellness, heart disease, heart disease prevention, smoking

I am reminded of my late mentor, Dr. Peter O. Kwiterovich, Jr. who used to say when we published new research findings that “this is another feather in your cap”! Well, this expression could not be truer than what we have been witnessing with icosapent ethyl (IPE), the highly purified omega-3 fatty acid, EPA. First there was the landmark study, REDUCE-IT where IPE reduced the risk of cardiovascular death, heart attack, stroke, bypass/stent placement and rehospitalization for unstable by an astounding 25% in statin treated men and women with high triglycerides and cardiovascular risk. To date, IPE remains the best treatment for patients at similar underlying risk.

Last week, 2 new feathers were added to the IPE cap during presentations at the European Society of Cardiology (ESC), one of medicine’s premier international meetings. The first paper presented by my colleague, Dr. Deepak Bhatt found IPE to reduce the risk of the 2 types of heart attacks (ST and non-ST elevation) by 40% and 27%, respectively. The second feather was the result of another analysis showing that IPE eradicated the excess risk of cardiovascular events attributable to cigarette smoking; the manuscript is published in the European Heart Journal Cardiovascular Pharmacotherapy. For a comprehensive review of other IPE “feathers”, check out the excellent new review by Dr. Prakriti Gaba published in JCL.

During an ESC presentation, the prominent Danish Professor and Lipid Expert, Dr. Borge Nordestgaard, commented to me that every analysis performed for IPE has shown strikingly positive results. Could the reason for IPEs success be that the compound has unique characteristics that other fatty acids don’t? In fact, my colleague Dr. Preston Mason has performed a number of elegant studies demonstrating that to be the case. Specifically, IPE reduces inflammation and oxidative stress while improving endothelial function.

You certainly don’t have to convince me that IPE acts different fatty acids. Decades ago, we examined the role of purified EPA in human cells and found favorable effects that were not observed with other fatty acids- perhaps a presage of good things to come for IPE.

Michael Miller, MD is a cardiologist and Chief of Medicine at the Corporal Michael J Crescenz VA Medical Center and Vice Chair of Medicine at the Hospital of the University of Pennsylvania. Prior to his arrival in Philadelphia, he was Professor of Cardiovascular Medicine, Epidemiology and Public Health at the University of Maryland School of Medicine. He is the author of numerous scientific publications and several books, including Heal Your Heart published by Penguin Random House. Check him out on twitter: @mmillermd1

More Feathers in the Cap of Icosapent Ethyl

Uncategorized

I am reminded of my late mentor, Dr. Peter O. Kwiterovich, Jr. who used to say when we published new research findings that “this is another feather in your cap”! Well, this expression could not be truer than what we have been witnessing with icosapent ethyl (IPE), the highly purified omega-3 fatty acid, EPA. First there was the landmark study, REDUCE-IT where IPE reduced the risk of cardiovascular death, heart attack, stroke, bypass/stent placement and rehospitalization for unstable by an astounding 25% in statin treated men and women with high triglycerides and cardiovascular risk. To date, IPE remains the best treatment for patients at similar underlying risk.

Last week, 2 new feathers were added to the IPE cap during presentations at the European Society of Cardiology (ESC), one of medicine’s premier international meetings. The first paper presented by my colleague, Dr. Deepak Bhatt found IPE to reduce the risk of the 2 types of heart attacks (ST and non-ST elevation) by 40% and 27%, respectively. The second feather was the result of another analysis showing that IPE eradicated the excess risk of cardiovascular events attributable to cigarette smoking; the manuscript is published in the European Heart Journal Cardiovascular Pharmacotherapy. For a comprehensive review of other IPE “feathers”, check out the excellent new review by Dr. Prakriti Gaba published in JCL.

During an ESC presentation, the prominent Danish Professor and Lipid Expert, Dr. Borge Nordestgaard, commented to me that every analysis performed for IPE has shown strikingly positive results. Could the reason for IPEs success be that the compound has unique characteristics that other fatty acids don’t? In fact, my colleague Dr. Preston Mason has performed a number of elegant studies demonstrating that to be the case. Specifically, IPE reduces inflammation and oxidative stress while improving endothelial function.

You certainly don’t have to convince me that IPE acts different fatty acids. Decades ago, we examined the role of purified EPA in human cells and found favorable effects that were not observed with other fatty acids- perhaps a presage of good things to come for IPE.

Michael Miller, MD is a cardiologist and Chief of Medicine at the Corporal Michael J Crescenz VA Medical Center and Vice Chair of Medicine at the Hospital of the University of Pennsylvania. Prior to his arrival in Philadelphia, he was Professor of Cardiovascular Medicine, Epidemiology and Public Health at the University of Maryland School of Medicine. He is the author of numerous scientific publications and several books, including Heal Your Heart published by Penguin Random House. Check him out on twitter: @mmillermd1

When Athletes and Physicians Promoted Smoking!

Uncategorized

It’s hard to believe that not too long ago, revered athletes like Mickey Mantle and even our medical community promoted cigarette smoking! Yet despite the numerous bans, beginning with the cessation of Ads on TV (January 2, 1971), Billboard Ads (April, 1999) and most recently, the FDA’s process to ban JUUL cigarettes, smoking continues to be the #1 most preventable cause of heart disease.

Notwithstanding the cutback/elimination of advertising, nearly 8 million yearly deaths continue to be attributed to cigarettes worldwide; in the U.S., 500,000 tobacco related cardiovascular deaths are anticipated in 2022.

A recent review by the American Heart Association found that compared to non-smokers, tobacco use was associated with the development of heart disease at an earlier age in men and women aged 40-59 years, (5 and 4 years in men and women, respectively). In fact, middle-aged women without a history of heart disease who smoked, doubled their risk of sudden death; in middle-aged men, the risk was increased by 80%. Smoking also increased the risk of stroke in young men and women (less than 40 years of age) and heart failure in middle and older aged men and women.

Today, more than 34 million adults in the United States continue to smoke cigarettes. While these numbers are undoubtedly lower than during the era of incessant tobacco advertising campaigns, the ravaging, long-term health consequences attributable to daily tobacco use persists.

Unfortunately, in the absence of successful smoking cessation efforts, effective therapies to reduce tobacco related cardiac events are highly limited. I can think of 2 (statins and aspirin). Wouldn’t it be nice if there were other treatments available/associated with reduced risk?

Michael Miller, MD is a cardiologist and Chief of Medicine at the Corporal Michael J Crescenz VA Medical Center and Vice Chair of Medicine at the Hospital of the University of Pennsylvania. Prior to his arrival in Philadelphia, he was Professor of Cardiovascular Medicine, Epidemiology and Public Health at the University of Maryland School of Medicine. He is the author of numerous scientific publications and several books, including Heal Your Heart published by Penguin Random House. Check him out on twitter: @mmillermd1

30 Years of Heart-Related Discoveries/Advances at the University of Maryland School of Medicine

cholesterol, Diabetes, dietary fat, fish consumption, Health & Wellness, heart disease prevention, laughter, Uncategorized

As my 30-plus years as a faculty member at the University of Maryland School of Medicine and Medical Center has drawn to a close, I fondly recall 10 heart-related findings/discoveries and newsworthy events that gained worldwide attention, ending with the first genetically altered pig heart transplanted at UMMS last week.  Here they are in no special order.

1.         Poe likely died of rabies, doctor’s review shows: https://www.baltimoresun.com/news/bs-xpm-1996-09-11-1996255015-story.html

2.         Having high cholesterol levels early in life leads to heart problems by middle age: https://www.eurekalert.org/news-releases/823756

3.         Air Pollution and Diabetes: https://www.loe.org/shows/segments.html?programID=14-P13-00002&segmentID=5#:~:text=We’ve%20long%20known%20that,fatty%20diet%20can%20promote%20diabetes.

4. U.S. Amish gene trait may inspire heart protection: https://www.reuters.com/article/us-heart-gene/u-s-amish-gene-trait-may-inspire-heart-protection-idUKTRE4BA6JQ20081211

5.         Want a McMuffin? Take your McVitamins: https://greensboro.com/want-a-mcmuffin-take-your-mcvitamins/article_20be3661-d342-549f-9118-a2e355f4175a.html

6.         UMMC Implants the World’s Smallest Pacemaker: https://www.umms.org/ummc/news/2017/ummc-implants-the-worlds-smallest-pacemaker

7.         University Of Maryland School of Medicine Study Shows Laughter Helps Blood Vessels Function Better: https://www.sciencedaily.com/releases/2005/03/050309111444.htm

8.         Study finds no value in heart supplement: CoQ10 not shown to relieve symptoms, UM cardiologist says: https://www.baltimoresun.com/news/bs-xpm-1999-09-27-9909270293-story.html

9.         Secondhand Smoke Ups Heart Disease in Unique Group of Female Nonsmokers – Amish Women: https://www.umms.org/ummc/news/2017/amish-secondhand-smoke

10.       In a First, Man Receives a Heart from a Genetically Altered Pig https://www.nytimes.com/2022/01/10/health/heart-transplant-pig-bennett.html?smtyp=cur&smid=tw-nytimes

Dr. Michael Miller is Chief of Medicine, Corporal Michael J Crescenz VAMC in Philadelphia, PA   Check him out on twitter: @mmillermd1

On Babe Ruth, Hobbies and the Heart

Uncategorized

As we get set to leave Baltimore for Philadelphia, I can’t help but reminisce of the great friendships and memories made in “Charm City”.   As a baseball enthusiast, moving to Baltimore in the mid-80s brought me an even greater appreciation of GH (Babe) Ruth, the hometown hero and legendary “Sultan of Swat”.  Over the past several decades, my hobby of collecting baseball memorabilia rose to a new depth as I pursued Ruth-related collectibles.  Of the 7 baseball cards illustrated, 5 are of the Bambino himself (from the 1933 Goudey and 1948 Leaf set), 1 is of his teammate, Lou Gehrig (1934 Goudey) and on the upper right, is the 1909 T-206 Ty Cobb (green background) acquired from the estate of Babe Ruth’s cousin shortly after my move to Baltimore from Cincinnati.   

It is no surprise that we commonly refer to Baltimore as “Small”-timore because there are so many interconnections…in the case of Babe Ruth, I pass by his birth home nearly every day as the University of Maryland Hospital is just a block away.  Ironically and many decades earlier, my wife’s family (generations of native Baltimoreans) at one time owned the pub where Babe Ruth’s father was employed (currently the centerfield area of Camden Yards).  Even our 13-year-old cockapoo is aptly named “George Herman”!

Listed below are reasons to engage in a hobby that is appealing to you.

  1. Hobbies have a positive impact on the heart by improving psychological health.  Studies have shown that psychological health is an important component of wellness/well-being for patients at risk of heart disease (CVD).
  2. A recent study in spouses who were caregivers of patients with Alzheimer’s disease found that participation in pleasant leisure activities was associated with improvement in cardiovascular risk factors such as blood pressure and emotional stress.
  3. Engagement in a variety of art forms (2 hours each week) such as the performing arts, visual arts and literature is associated with better emotional and heart health (improved heart rate variability).
  4. A study conducted in Pittsburgh found that engaging in enjoyable activities was associated with lower blood pressure, stress hormone (cortisol) levels, waist circumference, and body mass index as well as a better overall perception of physical function.
  5. A study of 4,200 Swedes aged 60 and over found that gardening and do-it-yourself projects to be associated with a 25-30% lower risk of heart attack, stroke or death from cardiovascular disease over a 12 year follow-up period.
  6. Enjoyment of a hobby is associated with an 8-fold lower risk of future cardiovascular events such as heart attack or stroke due to improvement in vascular health.
  7. A newly published study conducted in Japan over a 16-year follow-up period found that compared to those that have no hobbies, engaging in 1 or multiple hobbies was associated with a 10-20% lower risk of cardiovascular events.
  8. Engagement in activities such as jigsaw and crossword puzzles reduce stress hormone (cortisol) levels; a recent study found that elevated levels of urinary cortisol predates the development of hypertension.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Natural Foods to Combat Depression During the Holiday Season

chocolate, Coffee, depression, dietary fat, fish consumption, Gut Health, gut microbes, heart disease prevention, mental illness, Nutrition, omega 3's, stress

While the holiday season is jovial and celebratory for the majority of Americans, it can also be a source of despondency and despair for others. This is especially true for those afflicted with seasonal affective disorder or have great fear and anxiety leading to self-imposed travel restrictions in the midst of the COVID pandemic.

Fortunately, as of this writing, the most recent evidence suggests that if you’ve been vaccinated and “boosted”, the latter should be less of an overriding concern.

Nevertheless, as compared to the pre-COVID pandemic era, levels of depression and anxiety have also risen to unforseen heights.  With the Holiday Season upon us, presented below is a heart healthy selection of foods/drinks proven to enhance mood and combat/limit depression and make your holiday season a more enjoyable one.

  1. Mushrooms: A new study of nearly 25,000 men and women found that compared to non-consumers, those who ate mushrooms on a regular basis were less likely to experience signs of depression.  Mushrooms are an excellent source of ergothioneine (ERGO), an amino acid with antioxidant properties shown (in rodent studies) to alleviate symptoms of depression.  Other good food sources of ERGO are beans (black, kidney) and oat bran.
  2. Cranberries:  Cranberries are also rich in antioxidants and in the brain protective and anti-inflammatory compound ursolic acid.  Ursolic acid not only reduces growth of certain tumors but has also been shown to improve memory and reduce mood disorders, especially anxiety and depression. Try a handful of cranberries or 4 ounces of pure cranberry juice each day to reap the benefits.
  3. Prebiotics: Non-digestible carbohydrate foods (prebiotics) such as garlic, Jerusalem artichokes, leeks and onions, promote the growth of healthy gut bacteria to reduce neuroinflammation and improve symptoms of anxiety and depression.
  4. Dark chocolate: A study of ~13,600 adults found that compared to non-consumers, daily consumption of dark chocolate (3.5 ounces) was associated with ~60% lower risk of depression.
  5. Coffee: Compared to minimal or no consumption, coffee drinkers have a 25% lower risk of depression. The most favorable results were observed with an average amount of 13.5 ounces consumed daily.
  6. Mediterranean Style Diet: A Mediterranean style diet (vegetables, fruits, legumes, nuts, whole grains, fish) is associated with improved mental health in men and women with depression.
  7. Kiwi: A recent study found that consuming a kiwifruit daily was associated with improved mood and overall well-being that was attributable to more than the high Vitamin C content.
  8. Bivalves: Mussels, oysters, clams and scallops are good/excellent sources of selenium associated with reduced depression and improved mood.
  9. Bananas: Bananas are an excellent source of Vitamin B6 with anti-anxiety, antidepressant properties. A banana a day may keep the psychiatrist away!
  10. Pumpkin Seeds: Try a small handful of pumpkin seeds daily. The rich content of tryptophan, zinc and magnesium may reduce anxiety and combat depression.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Increasing Awareness of Disparities in Cardiovascular Health Care

heart disease, Heart Health, hypertension, racial disparity

It is well established that cardiovascular disease is disproportionately higher in blacks than in whites, Asians and Hispanics.  In fact, death from heart disease is 1.7 to 2-fold higher in black men compared to white men 45 years and older.  Similarly in women, cardiovascular events are also elevated in blacks compared to whites with an approximate 2.5-fold risk beginning in middle-age (45+ years).

According to the American Heart Association, 7 core health behaviors/risk factors shape the likelihood of developing a heart attack or stroke. They include: blood pressure (BP), body mass index (BMI), cholesterol level, dietary habits, glucose control, physical activity and smoking history.  In an otherwise healthy individual, “ideal” cardiovascular health would be defined as optimal core health behaviors/risk factors such as 1) BP less than 120/70; 2) BMI between 18-24.9 kg/m2, 3) LDL cholesterol levels less than 100 mg/dL, 4) a diet low in animal based saturated and trans fats, 5) fasting blood glucose less than 100 mg/dL, 6) being physically active (at least 150 minutes of mild-moderate activity [such as brisk walking at 3-5 mph] per week) and 7) not smoking cigarettes.  Unfortunately, less than 1 in 3 adult men/women exhibit ideal cardiovascular health led by Asians (29%) and Whites (19%) while Hispanics and Blacks (14% and 10%) lag well. behind this milestone.   For a more comprehensive review on this topic, check out our recent paper led by my colleague, Dr. Penny-Kris Etherton.

Listed below are further insights into the barriers, challenges and opportunities for implementing change to reduce disparities in diet-related heart disease based upon the publication in the Journal of the American Heart Association.

  1. Food deserts are areas that lack access to affordable foods that comprise a healthy diet (e.g., fruits, vegetables, low‐fat milk, whole grains). In Baltimore, high availability of healthy foods was only present in 19% of predominately black neighborhoods compared to 68% of white neighborhoods.
  2. A study conducted in Atlanta found that individuals in food deserts were more likely to be black, less likely to be college graduates, and had lower income compared with individuals in nonfood deserts.
  3. Access to supermarkets stocking affordable healthy foods is associated with greater likelihood of fulfilling healthy dietary recommendations. For each supermarket present in a census tract, the intake of fruits and vegetables rose by 32%.
  4. Large disparities exist in supermarket access in predominately black communities. There are 5 times more supermarkets in census tracts where whites live compared to where blacks reside.
  5. Approximately 3.5% of the US population live in a food swamp, defined by the ratio of fast-food outlets and convenience stores to supermarkets and grocery stores in a given area.
  6. Financial incentives to encourage purchasing of healthy foods and/or disincentives or restrictions on purchasing of unhealthy foods improves diet quality, especially in low‐income groups. A 10% reduction in the price of healthy foods increased consumption by 12%.
  7. An increase in the cost (tax) of unhealthy foods decreased consumption by 6%. This approach reduced intake of sugar‐sweetened beverages (9%), fast food (3%), and other unhealthy beverages (5%).

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Top Nutrition Controversies in 2021

Health & Wellness, heart disease, Heart Health, Nutrition, plant based meat, soy protein

In our 3rd installment on “Trending Nutrition Controversies” by the American College of Cardiology’s Nutrition Workgroup and led by Dr. Monica Aggarwal, we describe some of the popular dietary-related controversies in 2021.  For a link to this publication, press here.

Below are highlights of this review and the evidence for or against the use of these products and development/progression of cardiovascular disease.

  1. Artificial and Non-Nutritive Sweeteners: Whether they contain aspartame (Equal), saccharin (Sweet & Low), sucralose (Splenda) or stevia (Truvia), the artificial sweetener franchise has been stirred into a frenzy as several large studies have linked the frequency of these sweeteners to weight gain, increased risk of Type 2 diabetes and cardiovascular disease. Consequently and until new studies suggest otherwise, we recommend limiting the use of artificial sweeteners.  Instead, consider adding unsweetened vanilla/ cocoa extract and/or a cinnamon stick to your morning Java.
  2. Cocoa/Cacao:  As a rich source of antioxidants, studies have shown that 1-2 tablespoons of cocoa/cacao daily is associated with 10-15% lower risk of heart disease compared to non-consumers.  Minimize use of  chocolate-containing products that are highly processed (e.g., sugar and corn syrup) to maintain the benefits.
  3. Soy:  Isoflavones (e.g., genistein, daidzein) present in soy are powerful antioxidant and anti-inflammatory mediators.  Substitution of soy in place of animal based protein has been associated with reductions in LDL cholesterol (3-5%), systolic blood pressure (5-7 mmHg) and overall improved survival from heart disease and cancer.
  4. Plant-based Meats and Substitutes:  Despite the recent hoopla surrounding the alternative meat craze for the plant-based Beyond Burger (mung bean/pea) and Impossible Burger (soy), both products also add saturated fat (coconut oil) and sodium to enhance flavor and texture. While these substitutes may be viewed as “healthier” compared with animal sources of protein, they are viewed as less healthy choices  when compared to minimally processed proteins, such as lentils, peas and beans.
  5. Dietary Nitrates: Foods such as beet root, celery and dark green vegetables are high in dietary nitrates. Plant based nitrates promote the production of nitric oxide that in turn improves vascular health, reduces insulin resistance and improves exercise capacity. Supplementation with beetroot juice (high in dietary nitrates) was shown to reduce systolic blood pressure by 8 mmHg (the near equivalence to a single BP medication). After nitrates are converted to nitrites, the antioxidants contained within plant but not animal based products also protect against the formation of carcinogenic nitrite (N-nitroso) compounds.
  6. Grass-Fed versus Grain-Fed Meats:  Grass-fed beef has a lower fat content with a more favorable saturated fat profile than consumption of grain-fed meat.  However, both grass-fed and grain-fed meats contain trans-fats that promote heart disease and studies to date have not shown differences between the two in cholesterol levels, triglycerides, blood pressure or insulin sensitivity.                                                                                                                                                                                                                                   In case you missed highlights of our 2nd Nutrition Controversy paper press here and see below:
  7. Added Sugars: Individuals should limit added sugar to less than 10% of calories and preferably less than 100 calories daily for women and less than 150 calories daily for men.
  8. Legumes: Consuming 3.5 ounces of legumes (such as beans, chickpeas, lentils and peas) at least 4 times each week is associated with ~15% reduction in the risk of heart disease.
  9. Tea consumption: Daily consumption of any tea is associated with an 8-10% reduced risk of heart attack or stroke.
  10. Kimchi: In a 2-week study in overweight/obese men and women consumed 3 servings (3.5 ounces) of kimchi daily, significant decreases in weight (3.3 lbs), fasting glucose (100to 94 mg/dl), and systolic BP (126 to 121 mm Hg) were observed.
  11. Folic Acid & Vitamin B12: Although folic acid and vitamin B12 supplements lower homocysteine levels, results from large clinical trials studies have failed to demonstrate reduction in cardiovascular events.
  12. Probiotic yogurt: Diabetic patients randomized to probiotic yogurt containing Lactobacillus acidophilus (300 g daily) for 8 weeks experienced a 23% reduction in LDL-C and 15% increase in HDL-C compared with baseline.                                                                                                                                                                                                                                                                                                                                             And for some of the highlights of our 1st Nutrition Controversy paper press here and see below:
  13. Green Leafy Vegetables: For each oz of green leafy vegetables consumed daily, there is a 13% lower risk of developing T2DM.
  14. Southern Foods: A Southern pattern of eating consisting of fried foods, egg dishes, processed meats, and sugar-sweetened drinks is associated with a 50-60% increase in cardiac events over a 6-year period compared to a primarily plant-based pattern.
  15. Cholesterol: For each 300-mg increment in dietary cholesterol (~2 egg yolks), blood cholesterol levels rise 6-7 mg/dL
  16. Blueberries: Consuming ~1 cup of blueberries per day is associated with blood pressure reduction of 7 mm Hg systolic and 5 mm Hg diastolic.
  17. Anthocyanins: A 32% lower risk of a heart attack was observed in those with the highest compared to the lowest quintile of anthocyanin intake (e.g., blueberries and strawberries).
  18. Mixed Nuts: A Mediterranean diet supplemented with  a 1 ounce serving of mixed nuts daily for 5 yrs was associated with a 30% lower risk of cardiac events compared with a lower-fat control diet.
  19. Plant-based diet: A study conducted in Tarahumara Indians consuming a plant-based diet (e.g. corn and beans) did not identify a single overweight or hypertensive man during the 4-yr follow-up period.
  20. Vegetable Oils:  A study conducted in Costa Rica found that the saturated fat, palm oil used for cooking was associated with 25-30% higher risk of heart disease compared to use of less saturated vegetable oils (soybean and sunflower).

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Does a High Fat Diet Promote Memory Loss and Cognitive Decline?

Brain Health, dietary fat, Health & Wellness, heart disease, heart disease prevention, Heart Health, insomnia, metabolic syndrome, Nutrition

A new study out this week and published in iScience found that fat cells play a major role in advancing brain aging and cognitive decline through Na,K+ATPase signaling.  Recent studies have suggested that this pathway is also responsible for conditions that accelerate cardiovascular disease risk including, metabolic syndrome and fatty liver (nonalcoholic steatohepatitis).

The new study was conducted in mice that were genetically modified to release the peptide, NaKtide, in fat cells.  NaKtide is a direct inhibitor of Na,K+ATPase signaling.  The authors found that compared to a control diet, a Western diet (greater than 40% of calories derived from fat) resulted in Na,K+ATPase -mediated cellular inflammation and altered levels of brain biomarkers that affect memory and cognition. These proinflammatory effects were abolished when NaKtide was activated, thereby resulting in improved function of regions that include the brain’s memory center (hippocampus).

The bottom line is that in a mouse model, Na,K+ATPase signaling in fat cells promotes memory loss and neurodegenerative changes.  They raise the possibility that a similarly operative signaling -pathway in humans might lead to adverse long-term neurologic consequences under certain conditions (such as repeated exposure to a high fat diet).  Finally, they suggest that effective therapies directed against this proinflammatory signaling pathway could offset cognitive decline.

Of course, the most effective and currently available approach to reduce cognitive decline as related to this pathway would consist of reducing daily intake of highly saturated, processed and deep-fried foods!

Listed below are additional features related to diet, physical activity, obesity and brain health.

  1. Obesity promotes inflammation within the brain leading to cognitive decline and progression of neurodegenerative disorders.
  2. Significant and rapid weight loss as a consequence of bariatric surgery has been associated with improvements in cognitive function including memory and executive function.
  3. Adherence to the Mediterranean diet – high in vegetables, whole grains, fish, and olive oil – correlates with higher cognitive function.
  4. Compared to a high fat, Atkins Diet, a low fat Ornish Diet is associated with low levels of TMAO, a gut metabolite predictive of increased cardiovascular disease risk and reduced cognitive function.
  5. Replacement of saturated fat by polyunsaturated or monounsaturated fat is associated with lower rates of neurodegenerative disease.
  6. Higher levels of physical activity are associated with a 35% reduced risk of cognitive decline and 14% reduced risk of dementia.
  7. A diet containing at least one serving of green leafy vegetables each day is associated with slower age-related cognitive decline by approximately 10 years.
  8. Metabolic Syndrome is associated with increased risk of developing cognitive impairment and premature dementia.
  9. Chronic exposure to stress confers a higher risk of developing neurodegenerative disorders including Alzheimer’s disease.
  10. Chronic insomnia is associated with a 30-35% increased risk of progressive dementia.
  11. Musicians are 64% less likely to develop mild cognitive impairment or dementia, even after adjusting for physical activity and education.
  12. Drinking 3-5 cups of coffee per day at midlife was associated with a decreased risk of dementia and Alzheimer’s Disease by about 65% at late-life.
  13. Speaking at least 2 languages has been shown to delay the onset of dementia by 4-5 years.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Early Onset Hypertension= Early Onset Dementia

acromegaly, blood pressure, coarctation of the aorta, Heart Health, hypertension, sleep apnea, supplements

 

 

A new study out this week has found that being diagnosed with elevated blood pressure at a young age, is associated with risk of early dementia.

The study published in the American Heart Association journal, Hypertension analyzed 11,399 Chinese adults who were diagnosed with hypertension at 3 age groups: 1)when they were younger than age 35; 2) between ages 35 to 44 and 3) aged 45 to 54 years. Another 11,399 men and women without a history of high blood pressure served as the control group.  Brain MRI scans were performed in all participants. The results of the study indicated that in all 3 comparator age groups, those with hypertension exhibited smaller brain (volume) sizes with the largest difference observed in the group under age 35.

Among the subjects who developed any type of dementia during the study period, the risk was 61% higher in men and women 35-44 years of age who had been diagnosed with hypertension compared to similar aged normotensive controls. In addition, vascular dementia was increased 45-69% when hypertension was diagnosed between ages 35-54 years. To review this paper, click here.

The study supports early identification and treatment of high blood pressure – it stands to reason that control of hypertension at a young age would reduce development of dementia.

High blood pressure can occur under a variety of circumstances and may be associated with the following:

  1. Exercise induced hypertension (systolic pressure greater than 210 mmHg in men and 190 mmHg in women with exercise) is associated with a 35-40% increased risk of cardiovascular events and mortality.
  2. Hypertension of the eyes (ocular hypertension) raises the risk of glaucoma.  Risk factors for ocular hypertension include diabetes, hypertension, extreme nearsightedness and chronic steroid use.
  3. Black licorice can raise blood pressure and cause palpitations when 2 or more ounces are consumed per day.
  4. Herbal supplements that may raise blood pressure include ginseng, guarana, ma-huang and St. John’s Wort.
  5. Examples of commonly used drugs that may raise blood pressure include NSAIDs (ibuprofen), steroids (prednisone), decongestants (pseudoephedrine), antidepressants (fluoxetine) and anti-infectives (ketoconazole).
  6. The 4 “classic H signs” of Pheochromocytoma, Hyperhydrosis (excessive sweating), Hypertension, Heart palpitations and Headache are only observed in 40% of cases.
  7. Hypertension with disproportionate pulses (reduced in lower compared to upper extremities) could be due to narrowing of the aorta (coarctation). Coarctation is associated with exercise induced hypertension.
  8. Recent onset of high blood pressure associated with kidney stones, bone pain and abdominal pain (also known as “stones, bones and groans”) may be the result of high calcium levels due to an overactive parathyroid gland.
  9. Hypertension is observed in up to 70% of those affected with obstructive sleep apnea. Treatment of sleep apnea and its underlying causes, may effectively reduce blood pressure.
  10. Up to 30% of patients with hypertension do not respond effectively to 3 blood pressure medications. The most common condition associated with “resistant hypertension” is obstructive sleep apnea.
  11. A recently diagnosed elevation in blood pressure that exceeds 150/100 mmHg on 3 different days should be screened for the rare medical condition, primary aldosteronism (Conn’s Syndrome).
  12. A young woman with recent onset hypertension in association with tinnitus (ringing in the ears), dizziness, neck pain and poor kidney function may be due to another rare medical condition, fibromuscular dysplasia, recently been linked to spontaneous coronary artery dissection (SCAD).
  13. Consider a workup for acromegaly in someone who has recently developed hypertension along with an increase in shoe (and glove) size. Complications of acromegaly include resistant hypertension, diabetes, and an enlarged heart, thereby raising  the risk of arrhythmia (abnormal heart rhythm) and sudden death.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1