Tag Archives: cardiovascular disease

Women and Heart Disease

Heart image

Image: Depositphotos

Traditionally perceived as a predominantly male problem, cardiovascular diseases (CVDs) are in fact the number one killer of women.1 Cardiovascular diseases cause approximately 46% of older women’s deaths globally, with the additional 14% of deaths caused by cancers – most commonly lung, breast, colon and stomach cancers.

More than 400,000 American women die each year from CVDs, at a rate that is close to one death per minute. 2,3 Adding to the poor prognosis is the finding that nearly two-thirds of women with fatal outcomes never experienced any warning symptoms.3 The situation with CVDs in younger women also warrants attention.  The mortality from coronary heart disease among women age 35 to 44 years showed an average annual increase of 1.3% between 1997 and 2002.4 The projected increase in coronary heart disease deaths in 2020, compared to 2006, is 9% for women age 35-44 and 15.9% for women age 45-54.5

A complicating factor in developing a tailored treatment approach for women lies in the fact that they have been largely underrepresented in clinical trials. In addition, approximately three-fourths of clinical trials conducted in CVD subjects do not report gender-specific results.6 Researchers are now making an effort to close this information gap by including female subjects and comparing CVD outcomes between the two genders.

A recent study examined the association between multiple cardiac risk factors and the presence of obstructive coronary artery disease in men and women.7 The study found that women with diabetes, hypertension, and smoking had significantly greater odds ratios for obstructive coronary artery disease than men with identical risk factors. The differences between genders were even more pronounced in patients with multiple risk factors. Women with four cardiac risk factors had almost double the risk for obstructive coronary artery disease compared with men.

Another relevant study reviewed 64 cohort studies published between January 1st, 1966 and February 13th, 2013 in Medline and focused on identifying any sex differences in the effect of diabetes on the risk of CVD. 8 The study reported that diabetes increases the risk of incident coronary heart disease in women by more than 40% compared with men with diabetes. The reason behind such a difference in diabetes-related risk of coronary heart diseases in men and women is poorly understood. Higher levels of CVD risk factors and relative undertreatment in women do not account for all of the excess risk observed. Elucidating the causes behind gender differences in risk factors would have important implications in management and treatment of CVD in women.

It is an unfortunate fact that the increasing body of knowledge available on heart disease, associated risk factors and prevention measures often goes underutilized. The American Heart Association is working on raising awareness through education and advocacy.2 The FDA has joined in these efforts by identifying four important guidelines for women: eating a heart healthy diet, managing existing health conditions, learning the facts about aspirin, and recognizing the signs of a heart attack. NIH’s The Heart Truth program sponsored by the National Heart, Lung, and Blood Institute aims ‘’to raise awareness about heart disease and its risk factors among women and educate and motivate them to take action to prevent the disease and control its risk factors.’’

Through targeted research, education, and close communication between the healthcare providers and patients, CVD outcomes in women will likely improve. Heart disease rarely develops in the absence of the major risk factors, such as: elevated levels of blood cholesterol, high blood pressure, smoking, obesity, and diabetes. February is American Heart Month – a perfect time to re-evaluate your own risks for CVD and prompt the women in your life to be proactive about their health. It is time to speak loudly about the silent killer.

 References

  1. Women’s health. WHO Fact sheet no. 334. September 2013. Geneva, World Health Organization, 2011.
  2. Cardiovascular Disease: Women’s No. 1 Health Threat. Fact sheet. American Heart Association. 2013.
  3. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics – 2013 update: a report from the American Heart Association. Circulation. 2013; 127:e6-e245.
  4. Ford, Earl S. and Capewell, Simon. Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 through 2002: Concealed Leveling of Mortality Rates. J Am Coll Cardiol. 2007; 50(22):2128-32.
  5. Huffman MD, Lloyd-Jones DM, Ning H, et al. Quantifying options for reducing coronary heart disease mortality by 2020. Circulation. 2013; 127:2477–84.
  6. Blauwet LA, Hayes SN, McManus D, et. al. Low rate of sex-specific result reporting in cardiovascular trials. Mayo Clin Proc. 2007; 82:166-170.
  7. Ko DT, Wijeysundera HC, Udell JA, et al. Traditional cardiovascular risk factors and the presence of obstructive coronary artery disease in men and women. Can J Cardiol. 2014; 30(7):820-6.
  8. Peters SAE, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systemic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia. 2014; 57:1542-1551.

Jasenka Piljac Zegarac is a scientist and freelance writer. She holds a PhD in biology and a BS degree in biochemistry, and contributes on a regular basis to several health and science blogs. Her scientific publications have gathered more than 1100 citations. She may be contacted for assistance with a variety of science and medical writing projects.

Heart Health: The Mediterranean Diet Revisited

Mediter foods1Cardiovascular diseases (CVDs) are the number one cause of death globally.1 The World Health Organization (WHO) predicts that the number of CVD-associated deaths will increase to reach a staggering 23.3 million by 2030, and that CVDs will remain the single leading cause of death worldwide.2 Due to such a profound impact of CVDs on population health, numerous research studies have focused on identifying effective heart disease prevention measures. It has been postulated that behavioral risk factors account for about 80% of coronary heart disease and cerebrovascular disease,1 indicating that dietary and lifestyle patterns play a pivotal role in their prevention. In the sea of bad news surrounding CVDs, this, in fact, is a piece of good news.

Exercising regularly, avoiding tobacco use, and following a healthy diet are effective measures aimed at warding off heart disease. But what exactly falls under the broad definition of a healthy diet, what are its key ingredients, and what is their mechanism of action? While other plant-based diets may exert similar protective effects, this article will present a brief overview of several important studies correlating the Mediterranean diet with heart health.

The main ingredients of the Mediterranean diet are fruits and vegetables, legumes, nuts and cereals, olive oil and fish. Low-to-moderate intake of dairy products and red meat, and moderate intake of wine with meals, are also typical for the Mediterranean diet.3 A study published in 2003 in the New England Journal of Medicine followed 22,043 adults in Greece during a median period of 44 months.4 The study found that a high degree of adherence to the Mediterranean diet, assessed on a scale of 0 to 9, was associated with an overall reduction in total mortality during the 44 month follow-up period. In addition, greater adherence to this diet was inversely associated with death due to coronary disease and death due to cancer.

Another large, multicenter, nutritional intervention study, termed the PREDIMED study, was launched in Spain in 2003. This randomized trial followed 7447 persons in the age range 55-80 years, from 2003 to 2011, with the aim of investigating the effects of the Mediterranean diet on prevention of major cardiovascular events in high-risk persons. Study participants were divided into three dietary intervention groups: a low-fat diet group, a Mediterranean diet group supplemented with extra-virgin olive oil, and a Mediterranean diet group supplemented with tree nuts (walnuts, almonds, hazelnuts). The main finding of this large trial was that the Mediterranean diet supplemented with extra-virgin olive oil or tree nuts reduced the risk of suffering from CVD-related death, myocardial infarction or stroke by approximately 30 percent.5

Although a positive correlation between the Mediterranean diet and heart health has been established, less information is available on the mechanism by which this diet exerts its effects.  In which segment of the long cascade of events leading to CVD does the Mediterranean diet exert protection? Atherosclerosis is a slow, progressive, inflammatory disease that starts with injury to the arterial wall and, over time, leads to the build-up of cholesterol-filled plaques in the inner lining of the artery. Arterial hardening and narrowing follows, causing obstructed blood flow. Accumulation of inflammatory cells at the site of injury is an important step in this process, thus, assessment of the biomarkers of inflammation can indicate disease progression and plaque instability.

A recent study investigated the effects of the Mediterranean diet on biomarkers of inflammation and plaque instability in persons with high risk for CVD.6 One hundred sixty four subjects were included in the study and randomized into three diet groups as follows: a low-fat diet group, a Mediterranean diet group supplemented with extra-virgin olive oil, and a Mediterranean diet group supplemented with tree nuts. After 12 months of intervention, changes in inflammatory biomarkers and plaque vulnerability were measured.  A significant decrease in inflammatory biomarkers was observed in subjects adhering to the Mediterranean diet supplemented with extra virgin olive oil or nuts, in addition to a reduction in cardiovascular risk factors such as blood pressure, and LDL- and total cholesterol levels. It appears that the Mediterranean diet exerts its effect at least at two levels, although additional mechanistic studies are necessary to draw any final conclusions.

The peoples occupying the Mediterranean region, such as Sicilians, have been known for their good health and longevity, and although the Mediterranean diet is not the only influencing factor, it is likely one of the more significant ones. 7 The good news is that it may never be too late to make in change in one’s dietary habits. Positive effects in the main cardiovascular risk factors have been observed only three months after implementing a supplemented Mediterranean diet in persons at high cardiovascular risk, aged 55 to 80 years.8 With this in mind, you just might discover new appreciation for the distinct flavor and aroma of olive oil.

References

  1. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011.
  2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030.PLoS Med. 2006; 3(11):e442.
  3. Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995; 61:Suppl 6:S1402-S1406.
  4. Trichopoulou A, Costacou T, Bamia C, et al. Adherence to a Mediterranean Diet and Survival in a Greek Population. N Engl J Med. 2003; 348(26):2599-2608.
  5. Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with Mediterranean Diet. N Engl J Med. 2013; 368(14):1270-90.
  6. Casas R, Sacanella E, Urpi-Sarda M, et al. The Effects of the Mediterranean Diet on Biomarkers of Vascular Wall Inflammation and Plaque Vulnerability in Subjects with High Risk for Cardiovascular Disease. A Randomized Trial. Plos One. 2014; 9(6):1-11.
  7. Vasto S, Scapagnini G, Rizzo C, et al. Mediterranean diet and longevity in Sicily: survey in a Sicani Mountains population. Rejuvenation Res. 2012;15(2):184-8.
  8. Estruch R, Martínez-González MA, Corella D, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145(1):1–11.

Jasenka Piljac Zegarac is a scientist and freelance writer. She holds a PhD in biology and a BS degree in biochemistry, and contributes on a regular basis to several health and science blogs. Her scientific publications have gathered more than 1100 citations. She may be contacted for assistance with a variety of science and medical writing projects.