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Health News Archive 3 - Heart
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Eating Fish Makes Heart Beat Slower

The more fish you eat each week, the slower your heart beats, new research suggests. This may help explain why eating fish seems to protect against sudden death--a problem that is often related to a fast heartbeat.

The results are based on a study of nearly 10,000 older men without evidence of heart disease. The men were divided into four groups based on weekly fish intake and their heart rate, and risk factors for heart disease were compared. Dr. Jean Dallongeville, from Institut Pasteur de Lille in France, and colleagues report the study findings in August 2003 issue of Circulation: Journal of the American Heart Association.

As weekly fish intake increased, heart rates fell, the researchers note. Furthermore, fish consumption remained a predictor of slower heart rates, even after accounting for other factors that can influence heart rate, such as age, smoking status, and physical activity.

In agreement with previous studies, fish intake was also associated with a rise in cell levels of omega-3 fatty acids, which are known to have many beneficial effects on the heart. Other effects of fish consumption included a drop in blood pressure, decreased triglyceride levels, and increased HDL ("good") cholesterol levels.

The new findings support the idea that fish should be a major dietary component, the authors conclude.

SOURCE: Circulation, August 12, 2003. 

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How Fish Oil Prevents Sudden Cardiac Death Explained

The May 2003 issue of Circulation: Journal of the American Heart Association published a review detailing the mechanism of fish oil in preventing sudden cardiac death. Last year the journal published the results of the GISSI-Prevenzione trial which found that taking a daily fish oil supplement for three months reduced sudden cardiac death by half compared to a placebo group. 

Following a trial conducted in 1989 that showed a reduction in mortality in subjects who consumed fish two times per week compared to those advised to consume fat or fiber, a series of observational studies and clinical trials provided similar results for omega-3 polyunsaturated fatty acids (n-3 PUFA) from fish. Because over half of the sudden cardiac deaths in heart disease patients are due to abnormal heart rhythms called ventricular arrhythmias, researchers believed that prevention of this dangerous condition may be responsible for the decrease in mortality observed.

Jackson Professor of Clinical Medicine Emeritus at Harvard Medical School, Alexander Leaf, MD, the review author, explained that studies of individual heart cells have shown that omega-3 fatty acids block excessive sodium and calcium currents in the heart, which cause erratic changes in heart rhythm. Dr Leaf commented, “Animal experiments show that fatty acids from n-3 fish oils are stored in the cell membranes of heart cells and can prevent sudden cardiac death or fatal arrhythmias.”

In an editorial in the same issue of Circulation, David S. Siscovick, MD, and colleagues wrote, “For clinicians, it is time to implement the current American Heart Association dietary guidelines . . . For policymakers, there is a need to consider a new indication for treatment with low-dose n-3 PUFA supplements – the prevention of sudden cardiac death in patients with a prior [heart attack]. For researchers, there is a need to continue both clinical studies and studies that explore the mechanism through which n-3 PUFAS influence the risk of sudden cardiac death.”

Source: Circulation: Journal of the American Heart Association, May 26, 2003

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Major Study Shows Fish Oil Supplements Reduce Sudden Cardiac Death

The outcome of the GISSI-Prevenzione trial, conducted by researchers in Italy on 11,323 patients, showed that one gram daily of fish oil derived fatty acid supplement taken for three months reduced the risk of sudden cardiac death from arrhythmia by one half compared to those who received a placebo. The research was published online in April 2002 in Circulation: Journal of the American Heart Association. 

Lead author Roberto Marchioli MD, of Consorzio Mario Negri Sud in Santa Maria Imbaro, Italy, stated, "That was a surprise. The risk of death, and sudden death, is higher in the first months after a heart attack. It is exactly in this period that the reduced effect on sudden death was noted.”

In an attempt to determine the timing of the benefits of omega-3 polyunsaturated fatty acid supplements, recent heart attack survivors were randomized to receive the fatty acids, vitamin E supplements, both supplements or a placebo. Total mortality was significantly lowered in the group receiving the fatty acids at three months, and the risk of sudden death was significantly lowered at four months. These trends continued to reveal a similar reduction in the risk of heart related deaths at six and eight months. The risk reductions were not associated with changes in cholesterol levels or by decreases in blood coagulation.

In an accompanying editorial, Alexander Leaf MD, of Harvard Medical School, discussed the ability of fatty acids to regulate the electrical activity of heart muscle cells, and stated that the findings of this study support the theory that an imbalance of omega-3 and omega-6 fatty acids promote arrhythmias. He commented, "This study is important because there is no really effective therapy for arrhythmias."

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Omega 3 Fish Oil Cuts Risk of Heart Attack And Sudden Death

People who eat several servings of fish each week may lower their risk of heart disease and death, two new studies report.

A study published in the April 11th issue of the New England Journal of Medicine found that long chain omega-3 fatty acids might help prevent sudden death from heart attacks. The study was conducted on 94 physicians and 184 controls and found that those who had omega-3 blood levels in the top quartile were 81% less likely to die in a heart attack. 

The results show that the risk of sudden death decreased as the amount of omega-3 fatty acids in the blood rose. Men in the second-lowest quartile had a 45% lower risk of sudden cardiac death compared with those in the lowest quartile, and those in the second highest quartile had a 72% lower risk of death.

The findings support a growing body of research indicating that omega-3 fatty acids may reduce the risk of heart disease and death.

Omega-3 fatty acids, which are found in fatty fish such as salmon and mackerel, may lower the risk of developing an irregular heart rhythm and reduce blood cholesterol and clotting--all risk factors for heart disease.

The findings point to a way for individuals to lower their risk of sudden death from heart attack, according to Dr. Christine M. Albert and colleagues from Brigham and Women's Hospital and Massachusetts General Hospital, both based in Boston.

"The results suggest that increasing intake of omega-3 fatty acids by either supplements or by diet may substantially reduce the risk of sudden death, even among those without a history of heart disease," Albert said.

Another new study, published in the April 10th issue of The Journal of the American Medical Association, reports that women who consumed at least five servings of fish a week lowered their risk of coronary heart disease by more than one third and cut their risk of fatal heart attack by half over a 16-year period.

Even women in the study who ate fewer weekly servings of fish benefited. Those who ate fish one to three times a month cut their risk of developing heart disease by more than 20% and those who ate fish two to four times a week lowered their risk by more than 30%, the study of nearly 85,000 women found.

"Mounting evidence suggests that there is an inverse association between fish intake and heart disease in women and men," Dr. JoAnn E. Manson, a study author from Brigham and Women's Hospital in Boston, said. "We would recommend that people eat more fish as part of a healthy diet."

SOURCES: The New England Journal of Medicine 2002;346:1113-1118; The Journal of the American Medical Association 2002;287:1815-1821.

Reprinted with permission of 
Medline plus Health Information: a service of the National Library of Medicine

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Fish May Cut Inflammation And Heart Disease Risk

A diet rich in fatty fish may protect the heart and blood vessels by reducing inflammation, according to researchers.

The investigators found that individuals with the highest cell levels of docosahexaenoic acid (DHA), a type of omega-3 fatty acid found in fish such as salmon and mackerel, had lower levels of C-reactive protein in their blood. C-reactive protein (CRP), a marker of blood vessel inflammation, is associated with risk of heart disease.

The findings "suggest a novel mechanism by which fish consumption may decrease the risk of coronary artery disease," Dr. Trine Madsen from Aalborg University in Denmark, and colleagues reported in the November 2001 issue of the American Journal of Cardiology.

Omega-3 fatty acids may protect against inflammation, which is thought to contribute to the build-up of plaque inside arteries, by inhibiting the formation of inflammation-promoting proteins, the researchers noted.

Previous studies have found an association between high blood levels of CRP and increased heart attack risk in otherwise healthy individuals. Elevated CRP may also signal the risk of additional heart attacks in people who already suffer from heart disease.

The study included 269 patients aged 39 to 77 who were undergoing angiography, a modified x-ray scan of the heart's arteries. Study volunteers answered questions about their diet, particularly in regards to fish intake. Researchers measured omega-3 polyunsaturated fatty acid levels in cell membranes, which reflect a person's dietary intake in the previous days to weeks. Researchers also measured CRP levels in blood.

Individuals whose CRP levels were in the lowest quartile had significantly higher levels of DHA in cell membranes. There was no difference in CRP levels between people who had suffered a heart attack and those who did not, results indicated, but individuals whose arteries had narrowed from a build-up of plaque had significantly higher CRP levels than individuals with no arterial narrowing.

"The inverse correlation between CRP and DHA may reflect an anti-inflammatory effect of DHA in patients with stable coronary artery disease," Madsen's team concluded.

SOURCE: American Journal of Cardiology 2001;88:1139-1142.

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American Heart Assn Updates Omega-3 Recommendations

The American Heart Association (AHA) has updated its recommendation for omega-3 fatty acids.  According to the updated recommendations published in the November 2002 issue of Circulation: Journal of the American Heart Association, “People who have high triglycerides may benefit from a supplement of 2-4 grams per day of EPA and DHA (omega-3 fatty acids).  Even the 1-gram per day dose recommended for patients with existing cardiovascular disease (CVD) may be more than they can easily get from diet alone.  These people should talk to their doctor about taking supplements to reduce heart disease risk.”  

The AHA also recommended eating fish (particularly fatty fish such as salmon or tuna) at least two times a week.  The updated recommendations noted that fish is a good source of protein without the high saturated fat found in fatty meat products. 

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Lycopene from Tomatoes Protects Women's Heart Health

Results presented at the March 2002 annual meeting of the American College of Cardiology in Atlanta, suggest that high blood levels of Lycopene, a carotenoid-antioxidant, can reduce heart disease risk in middle-aged women by one third. The study involved tracking 1000 post-menopausal women with cardiovascular disease enrolled in the ongoing Women's Health Study. Researchers looked at data from blood levels of lycopene collected in 1992, as well as examined their diets, physical activity and cholesterol levels.  However, the researchers behind the findings are treading cautiously for now, trying first to figure out whether dietary lycopene consumption directly correlates with higher blood levels of lycopene.

Several studies to date have indicated that consuming lycopene-rich tomato products reduces the risk of cardiovascular disease. In a multicenter, case-controlled study of heart attack patients in 10 European countries, biopsied adipose tissue samples, used as a marker of long-term antioxidant exposure instead of blood levels, revealed that lycopene was the only protective antioxidant.1

In other research using dietary intake as a measure, University of Toronto investigators found that consuming one to two servings per day of tomato juice, spaghetti sauce and concentrated lycopene for one week doubled blood levels of lycopene, while notably lowering oxidized LDL levels.2  Lycopene is believed to slow the progression of atherosclerosis by inhibiting the oxidation of low-density lipoproteins (LDL), or the "bad" cholesterol. Meanwhile, low blood levels of carotenoids have been found to increase the risk of a second heart attack in smokers,3 as well the risk of developing and dying from coronary artery disease.4

  1. Am J Epidemiol 1997 Oct 15;146(8):618-26
  2. Lipids 1998 Oct;33(10):981-4
  3. Am J Clin Nutr 1996;63:559-65
  4. BMJ 1997;314:629-33

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Pycnogenol® Reduces Chronic Venous Insufficiency and LDL Cholesterol

Indication: Chronic venous insufficiency (CVI) and LDL cholesterol

Research: In an open controlled comparative study 40 patients aged 34 to 71 diagnosed with Chronic venous insufficiency (CVI) were treated with either 600 mg of Venostatin® (horse chestnut seed extract) per day or 360 mg of Pycnogenol® per day over a period of four weeks. Low density lipoproteins (LDL) and high density lipoproteins (HDL) were measured before and at the end of treatment. During the study, each leg was separately evaluated to determine the effects of the supplements as well as to determine the progression of CVI through symptoms characterized by the condition including pain, cramps, nighttime swelling, feeling of heaviness and reddening of the skin.

Three tests were used to score the statistical significance of the study. The first was the Friedman test, which determined the improvement of symptoms before and after two and four weeks of treatment. The second was the Wilcoxon signed rank test, which was used to evaluate the statistical significance of serum level reduction in LDL and HDL cholesterol levels. Finally, the Mann-Whitney rank sum test was used to compare differences in the parameters of Pycnogenol® versus Venostatin.

Results: Researchers made several observations. The circumference of the lower legs, indicative of swelling, was significantly reduced in patients after two weeks of treatment with Pycnogenol® and was further reduced after four weeks of Pycnogenol® treatment. The treatment with Venostatin only produced a moderate reduction of lower leg circumference, which was not found to be statistically significant. The study also found that Pycnogenol® significantly reduced the combined average of CVI symptoms (reddening of the skin, pain, cramps, etc.), while Venostatin showed slight improvement in the feeling of heaviness in both legs and reddening of the skin of the left legs, however, these changes were not statistically significant. Finally, patients treated with Pycnogenol® had significantly reduced blood levels of cholesterol and LDL, while patients treated with Venostatin had no changes in their blood status.

Phytotherapy Research, Phytotherapy Research 2002 Mar;165up­p11:1-5

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Hawthorn for Heart Failure

Researchers treated 209 patients who had suffered from severe heart failure for at least six months.  Treatments consisted of one of three regimens: 1800 mg of hawthorn extract, 900 mg of hawthorn or placebo.  The treatments lasted for 16 weeks, and the patients’ exercise capacity was carefully measured by their performance on stationary exercise bicycles. 

Results: After 16 weeks, patients taking the higher dosage of hawthorn extract (1800 mg) had significant improvements in exercise tolerance, compared with patients taking either the lower dose of hawthorn or the placebo.  Only 1.4% of the patients taking the 1800 mg dosage of hawthorn (1 patient) had side effects (dizziness and vertigo) compared with 10% of those taking placebo. 

American Heart Journal, 2002;143:910-915.

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Study Provides Evidence That Cranberry Juice May Help Fight Heart Disease

Based on human studies, researchers have found that drinking three glasses a day of cranberry juice significantly raises levels of "good cholesterol" in the blood and increases plasma antioxidant levels, reducing the risk of heart disease.

Although researchers have long suspected, based on laboratory tests, that the antioxidant-rich juice may help lower risk factors for heart disease, no human studies had established such a link until now. Their findings, the first long-term study of the effect of cranberry juice on cholesterol levels, were described at the 225th national meeting of the American Chemical Society in March 2003, the world's largest scientific society.

"This study gives consumers another reason to consider drinking cranberry juice, which has more health benefits than previously believed. People should consider drinking it with their meals, perhaps as an alternative to soda," says Joe Vinson, Ph.D., the study's lead author and a professor of chemistry at the University of Scranton in Scranton, Penn.

Besides heart benefits, previous studies have shown that cranberries can help prevent urinary tract infections and may reduce the risk of gum disease, stomach ulcers and cancer.

Study Procedure
In the current study, Vinson measured cholesterol levels in nineteen subjects with high cholesterol after a fasting, baseline blood sampling, followed by monthly samplings. Ten of the subjects were given cranberry juice with artificial sweetener but without high fructose corn syrup, while the other subjects drank cranberry juice with no added sugars. The drinks all contained approximately 27 percent pure cranberry juice by volume, like the common supermarket variety.

Each subject was fed one glass (8 ounces) of juice a day for the first month, then two glasses a day for the next month, and three glasses a day during the third month of the study. Subjects were not monitored with respect to exercise, diet and alcohol consumption, the researcher says.

Research Findings
While there were no changes in overall cholesterol levels, good cholesterol (high density lipoprotein, or HDL) appeared to significantly increase by an average of 10 percent after three servings of juice per day. Based on known epidemiological data on heart disease, this increase corresponds to an approximate 40 percent reduction in heart disease risk, says Vinson.

Plasma antioxidant capacity, a measure of the total amount of antioxidants available for the body, was significantly increased — by as much as 121 percent — after 2 or 3 servings of juice per day, he says. Like elevated levels of good cholesterol, increased antioxidant levels are also associated with a decreased risk of heart disease.

The mechanism by which cranberry juice changes cholesterol levels has not been clearly established. Vinson suspects that the effect may have to do with the fruit's high levels of polyphenols, a type of potent antioxidant. Previous studies by the researcher have shown that cranberries have among the highest levels of phenols in comparison to 20 of the most commonly consumed fruits.

The current study underscores government health recommendations that people should eat more fruits and vegetables to help maintain a healthy diet and lifestyle. The Cranberry Institute provided funding for this study.

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Lycopene May Help Prevent Atherosclerosis

Low levels of the carotenoid and antioxidant Lycopene may be linked to early atherosclerosis, a new study reports. Lycopene is naturally found in tomatoes and other red-hued foods.  

Previous research has shown that eating lots of food rich in lycopene may reduce the risk of certain diseases including cancer, particularly prostate cancer.

In this study, researchers studied 520 middle-aged men and women in southeastern Finland. They used ultrasound imaging to measure the intima-media thickness of the carotid artery, since gradual thickening is a marker for the progression of atherosclerosis. On average, intima-media thickness was greater in men with low levels of lycopene.  After accounting for all other factors, low lycopene levels were linked to a nearly 18% increase in artery thickness. The researchers suggest that low levels of lycopene may play a role in the development of artery disease.

Atherosclerosis, Thrombosis, and Vascular Biology, December 2000; 20: 2677-2681

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