World Heart Day

This year on World Heart Day, as part of our mission to ensure heart health equity for all, we want to create a global community of Heart Heroes … people from all walks of life who are acting now to live longer, better, heart-healthy lives by making a promise:

• A promise to our families to cook and eat more healthily
• A promise to our children to  exercise more and help them to be more active, to say no to smoking and help our loved ones to stop
• A promise as a healthcare professional to help patients give up smoking and lower their cholesterol
• A promise as a policymaker to support policies that promote healthy hearts
• A promise as an employee to invest in heart-healthy workplaces

A simple promise … for MY HEART, for YOUR HEART, for ALL OUR HEARTS.

Cardiovascular disease is the world’s number one killer today. But it doesn’t need to be this way. By making just a few small changes to our lives, we can reduce our risk of heart disease and stroke, as well as improving our quality of life and setting a good example for the next generation. It’s about saying to yourself, the people you care about and individuals all around the world: “What can I do right now to look after my heart … and your heart?”

Because we believe every heartbeat matters.

17,900,000

 people die every year

from CVD, including heart disease and stroke

Everyone has the right to heart health

Looking after your heart means taking small but meaningful actions: eating a balanced diet, undertaking regular exercise, reducing your alcohol intake, quitting smoking … all the things that make you not only healthier but also able to enjoy your life to the fullest.

CVD is the leading cause of death and disability in the world, claiming 17.9 million lives a year. That’s a third of all deaths on the planet and half of all non-communicable-disease-related deaths. Around 85% of these deaths are due to heart disease and stroke.

World Heart Day plays a crucial role in changing all of this. It is a vital global platform that we, as well as our members, patient groups and supporters, can use to raise awareness and encourage individuals, families, communities and governments to take action now. To ensure that everyone has access to essential NCD medicines and those in need receive appropriate treatment, as well as secure basic health technologies can be found in all primary health care facilities. Together we have the power to reduce the burden of, and premature deaths from, CVD, helping people everywhere to live longer, better, heart-healthy lives.-

World Heart Federation

Green Tea molecule could Prevent Heart Attacks

Green tea could hold the key to preventing deaths from heart attacks and strokes caused by atherosclerosis, according to research funded by the British Heart Foundation and published in the Journal of Biological Chemistry.

Scientists from Lancaster University and the University of Leeds have discovered that a compound found in green tea, currently being studied for its ability to reduce amyloid plaques in the brain in Alzheimer's disease, also breaks up and dissolves potentially dangerous protein plaques found in the blood vessels.

Atherosclerosis is the build-up of fatty material inside our arteries that can reduce the flow of blood to the heart and brain. In advanced stages of the condition, a protein called apolipoprotein A-1 (apoA-1) can form amyloid deposits, which are similar in structure to those associated with Alzheimer's disease. These deposits build up within atherosclerotic plaques. Here, they increase the size of the plaques, further restricting blood flow, and may also make the plaques less stable, increasing the risk of a heart attack or stroke.

Researchers found that epigallocatechin-3-gallate (EGCG), most commonly associated with green tea, binds to the amyloid fibres of apoA-1. This converts the fibres to smaller soluble molecules that are less likely to be damaging to blood vessels.

Now, the team are working on finding ways of introducing effective amounts of EGCG into the bloodstream without it being necessary to drink large and potentially harmful quantities of green tea. This could involve modifying the chemical structure of EGCG, making it easier to be absorbed from the stomach and more resistant to metabolism, or developing new methods to deliver the molecule to the plaques -- such as via an injection.

David Middleton, Professor in Chemistry at Lancaster University, said:

"The health benefits of green tea have been widely promoted and it has been known for some time that EGCG can alter the structures of amyloid plaques associated with Alzheimer's disease.

"Our results show that this intriguing compound might also be effective against the types of plaques which can cause heart attacks and strokes."

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: "Our bodies are very good at breaking down EGCG so swapping your cuppa for green tea is unlikely to make a big difference with respect to your heart health. "But by engineering the molecule slightly, we might be able to make new medicines to treat heart attack and stroke."

Professor Sheena Radford, Director of the Astbury Centre for Structural Molecular Biology at the University of Leeds and co-author of the research, said: "The findings of this round of studies are very encouraging. We now need to apply the best scientific techniques to find how we can take the molecular EGCG element from green tea, and turn it into a functioning tool to combat life-limiting health issues."

HEART FACTS

        24 fun facts about the Heart

1. The average heart is the size of a fist in an adult.
2. Your heart will beat about 115,000 times each day.
3. Your heart pumps about 2,000 gallons of blood every day.
4. An electrical system controls the rhythm of your heart. It’s called the cardiac conduction system.
5. The heart can continue beating even when it’s disconnected from the body.
6. The first open-heart surgery occurred in 1893. It was performed by Daniel Hale Williams, who was one of the few black cardiologists in the United States at the time.
7. The first implantable pacemaker was used in 1958. Arne Larsson, who received the pacemaker, lived longer than the surgeon who implanted it. Larsson died at 86 of a disease that was unrelated to his heart.
8. The youngest person to receive heart surgery was only a minute old. She had a heart defect that many babies don’t survive. Her surgery was successful, but she’ll eventually need a heart transplant.
9. The earliest known case of heart disease was identified in the remains of a 3,500-year-old Egyptian mummy.
10. The fairy fly, which is a kind of wasp, has the smallest heart of any living creature.
11. The American pygmy shrew is the smallest mammal, but it has the fastest heartbeat at 1,200 beats per minute.
12. Whales have the largest heart of any mammal.
13. The giraffe has a lopsided heart, with their left ventricle being thicker than the right. This is because the left side has to get blood up the giraffe’s long neck to reach their brain.
14. Most heart attacks happen on a Monday.
15. Christmas day is the most common day of the year for heart attacks to happen.
16. The human heart weighs less than 1 pound. However, a man’s heart, on average, is 2 ounces heavier than a woman’s heart.
17. A woman’s heart beats slightly faster than a man’s heart.
18. The beating sound of your heart is caused by the valves of the heart opening and closing.
19. It’s possible to have a broken heart. It’s called broken heart syndrome and can have similar symptoms as a heart attack. The difference is that a heart attack is from heart disease and broken heart syndrome is caused by a rush of stress hormones from an emotional or physical stress event.
20. Death from a broken heart, or broken heart syndrome, is possible but extremely rare.
21. The iconic heart shape as a symbol of love is traditionally thought to come from the silphium plant, which was used as an ancient form of birth control.
22. If you were to stretch out your blood vessel system, it would extend over 60,000 miles.
23. Heart cells stop dividing, which means heart cancer is extremely rare.
24. Laughing is good for your heart. It reduces stress and gives a boost to your immune system.

How stress may increase risk of heart disease

Heightened activity in the amygdala -- a region of the brain involved in stress -- is associated with a greater risk of heart disease and stroke, according to a study published in The Lancet that provides new insights into the possible mechanism by which stress can lead to cardiovascular disease in humans.

While more research and larger studies are needed to confirm the mechanism, the researchers suggest that these findings could eventually lead to new ways to target and treat stress-related cardiovascular risk.

Smoking, high blood pressure and diabetes are well-known risk factors for cardiovascular disease and chronic psychosocial stress could also be a risk factor.

Previously, animal studies identified a link between stress and higher activity in the bone marrow and arteries, but it has remained unclear whether this also applies to humans. Other research has also shown that the amygdala is more active in people with post-traumatic stress disorder (PTSD), anxiety and depression, but before this study no research had identified the region of the brain that links stress to the risk of heart attack and stroke.

In this study, 293 patients were given a combined PET/CT scan to record their brain, bone marrow and spleen activity and inflammation of their arteries. The patients were then tracked for an average of 3.7 years to see if they developed cardiovascular disease. In this time 22 patients had cardiovascular events including heart attack, angina, heart failure, stroke and peripheral arterial disease.

Those with higher amygdala activity had a greater risk of subsequent cardiovascular disease and developed problems sooner than those with lower activity.

The researchers also found that the heightened activity in the amygdala was linked to increased bone marrow activity and inflammation in the arteries, and suggest that this may cause the increased cardiovascular risk. The authors suggest a possible biological mechanism, whereby the amygdala signals to the bone marrow to produce extra white blood cells, which in turn act on the arteries causing them to develop plaques and become inflamed, which can cause heart attack and stroke.

In a small sub-study, 13 patients who had a history of PTSD also had their stress levels assessed by a psychologist, underwent a PET scan and had their levels of C-reactive protein -- a protein that indicates levels of inflammation in the body -- measured. Those who reported the highest levels of stress had the highest levels of amygdala activity along with more signs of inflammation in their blood and the walls of their arteries.

"Our results provide a unique insight into how stress may lead to cardiovascular disease. This raises the possibility that reducing stress could produce benefits that extend beyond an improved sense of psychological wellbeing," said lead author Dr Ahmed Tawakol, Massachusetts General Hospital and Harvard Medical School, USA. "Eventually, chronic stress could be treated as an important risk factor for cardiovascular disease, which is routinely screened for and effectively managed like other major cardiovascular disease risk factors."

The researchers note that the activity seen in the amygdala may contribute to heart disease through additional mechanisms, since the extra white blood cell production and inflammation in the arteries do not account for the full link. They also say that more research is needed to confirm that stress causes this chain of events as the study was relatively small.

Writing in a linked Comment, Dr Ilze Bot, Leiden Academic Centre for Drug Research, Leiden University, The Netherlands, said: "In the past decade, more and more individuals experience psychosocial stress on a daily basis. Heavy workloads, job insecurity, or living in poverty are circumstances that can result in chronically increased stress, which in turn can lead to chronic psychological disorders such as depression." She says that more research is needed to confirm the mechanism but concludes: "These clinical data establish a connection between stress and cardiovascular disease, thus identifying chronic stress as a true risk factor for acute cardiovascular syndromes, which could, given the increasing number of individuals with chronic stress, be included in risk assessments of cardiovascular disease in daily clinical practice."

Story Source: The Lancet. 

Potential RNA Markers of abnormal heart rhythms identified in circulating blood

Atrial fibrillation (AF) is a heart condition that causes an irregular, and often rapid, heart rate. It increases the risk of developing strokes, heart failure, and even dementia. Although it can be associated with aging, high blood pressure, diabetes, heart valve problems, etc, about one-third of patients with AF have no symptoms until they suffer a stroke. Therefore, a means of identifying or predicting AF with the aim of starting preventative therapy is highly desirable.

AF is associated with several factors that maintain its progression, including inflammation, electrical disturbances, and structural changes in the heart's upper chambers (the atria). Moreover, several different short sequences of RNA known as microRNAs (miRNAs) have been linked with AF pathology. miRNAs control gene expression after the transcription stage, and have been suggested as possible markers for some cardiovascular diseases because of their stability in the bloodstream. However, it remains unknown whether the miRNAs shown to be related to AF are suitable as predictive biomarkers of disease.

A team of researchers from Tokyo Medical and Dental University (TMDU) addressed this issue by comparing miRNA expression in AF patients and healthy controls, and between control mice and those with a similar abnormal heart rhythm to AF. They showed that four miRNAs not previously associated with AF were significantly upregulated in the serum of AF patients and diseased mice, indicating their potential use as AF biomarkers. The study results were recently published in Circulation Journal.

Initially, human serum and mouse atrial tissue were screened for 733 and 672 miRNAs, respectively. These were eventually narrowed down to four by excluding non-detectable and non-specific miRNAs, and focusing on the quantification of their expression.

"One of the miRNAs, miR-214-3p, is implicated in inflammation, so we wondered whether this might be the underlying mechanism of miRNA-induced AF pathology," first author Yu Natsume says. "We compared miRNA expression with levels of a serum inflammatory factor but found no correlation suggestive of an association."

Statistical analysis of diagnostic ability showed that miR-214-3p and miR-342-5p had the highest accuracy as individual biomarkers at predicting AF, but that a combined analysis of all four miRNAs slightly improved this accuracy.

"The same two miRNAs showed increased expression in a subset of patients with intermittent AF and another subset with chronic AF," corresponding author Tetsuo Sasano says. "The increases were in comparison both with healthy controls of the same age and young healthy controls, suggesting these miRNAs may predict AF regardless of the age of the individual."

The researchers propose additional studies to determine the functional role of the identified miRNAs with respect to AF.

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Story Source:Tokyo Medical and Dental University. 

Can Aspirin Lower Your Risk for Heart Attack and Stroke?

How Does Aspirin Prevent a Heart Attack or Stroke?

Aspirin may help lower your risk for a heart attack or stroke by preventing dangerous blood clots from forming. When you damage a blood vessel, usually by a cut or bruise, your body sends small cell fragments called platelets to the site of the injury. The platelets stick together, or clot, to stop the bleeding allow the injury to heal.

Plaque buildup in your arteries can put you at risk for dangerous blood clots because plaque can rupture. If a blood clot forms at the site of the rupture, it can block blood flow and lead to a heart attack or stroke.

Aspirin can help keep platelets from sticking together, thus lowering your risk for dangerous blood clots.

Who Should Take Aspirin for Heart Attack and Stroke Prevention?

Your doctor may recommend daily aspirin to lower your risk for heart attack and stroke if you have:

• Had a heart attack or stroke in the past, or are at risk for one
• Undergone angioplasty or coronary artery bypass surgery
• Peripheral artery disease, or blocked blood vessels in your legs
• Atrial fibrillation, a heart rhythm problem that raises your risk for blood clots
• Coronary artery disease, or blocked blood vessels in your heart

You should only take aspirin for heart health if your doctor recommends it. Your doctor may also suggest taking aspirin with other medicines that can help prevent dangerous blood clots.

If you have a high risk for bleeding or are allergic to aspirin, you shouldn’t take it. Because aspirin affects your blood’s ability to clot, you might bleed easier. It’s important to alert your doctor, dentist, and other health care providers that you’re taking aspirin before undergoing any medical procedures.

Will I Need to Make Other Lifestyle Changes?

In addition to taking aspirin to lower your risk for heart attack and stroke, your doctor might recommend the following lifestyle changes:

• Eat heart-healthy foods, like salmon, berries, and leafy greens
• Quit or avoid smoking
• Get regular physical activity
• Control your blood pressure
• Maintain a healthy weight
• Take your medicines as prescribed

BUT DO NOT TAKE ASPIRIN IN REGULAR OR FREQUENT USE....

By Heart and Vascular Institute...

BLOOD PRESSURE AND HEART RATE

Blood Pressure vs. Heart Rate

Blood pressure

Blood pressure is a two-part measurement, expressed in a fraction, like 120/80 mm Hg.

The first number is the systolic pressure, which measures pressure against your artery walls when your heart contracts and pumps blood out. The second number, called the diastolic pressure, measures the blood’s pressure against the artery wall as your heart rests between pumps.

Hypertension, or high blood pressure, means your heart is working too hard which can weaken your heart and damage your blood vessels. If your blood vessels can’t move blood through your body effectively, your heart and other important organs such as the eyes, brain, and kidneys may not get the oxygen and nutrients they need. High blood pressure raises your risk of heart, disease, heart attack, heart failure, stroke, and kidney disease.

Hypotension, or low blood pressure, means your heart pumps more slowly than normal. That’s not always a problem — athletes sometimes have low blood pressure. However, hypotension can cause symptoms like fatigue, dizziness, weakness, and blurry vision.

Heart rate

A high heart rate or pulse, on the other hand, can indicate stress, excess weight, medicine usage, a poor fitness level, or body position. Your heart rate is the number of times your heart beats per minute, and it can change gradually as you age. The difference between pulse and blood pressure is both in what they measure and what they affect.

How Blood Pressure and Heart Rate Are Related

Interestingly, your heart rate and blood pressure won’t always rise and fall in sync. Even if they both rise, it doesn’t mean they’ll rise at the same rate. When exercising, your heart rate will increase, but your blood pressure may stay the same or increase to a lesser extent. That’s because the blood vessels increase in size to allow for faster and easier flow. The blood flow may not impact the blood pressure reading to the same degree as it does your heart rate.

By UPMC health care......

TOMATOES AND HEART HEALTH

Tomatoes have two key nutrients that have a big impact on heart health: lycopene and potassium.

Lycopene is a chemical that gives a tomato its red color and is also a powerful antioxidant, a type of substance that helps keep cells from becoming damaged. Some research shows that lycopene may lower LDL, or “bad” cholesterol, and keep blood from clotting, which lowers stroke risk.

Potassium is a mineral that can help lower blood pressure by taking some of the sodium out of your body, and by relaxing the walls of your blood vessels.

Link between flu and heart attack confirmed in new research

Chances of a heart attack are increased six-fold during the first seven days after detection of laboratory-confirmed influenza infection, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and Public Health Ontario (PHO).

"Our findings are important because an association between influenza and acute myocardial infarction reinforces the importance of vaccination," says Dr. Jeff Kwong, a scientist at ICES and PHO and lead author of the study.

In the study published in the New England Journal of Medicine, the researchers found a significant association between acute respiratory infections, particularly influenza, and acute myocardial infarction.

The risk may be higher for older adults, patients with influenza B infections, and patients experiencing their first heart attack. The researchers also found elevated risk -- albeit not as high as for influenza -- with infection from other respiratory viruses.

"People at risk of heart disease should take precautions to prevent respiratory infections, and especially influenza, through measures including vaccinations and handwashing," says Kwong.

The researchers add that patients should not delay medical evaluation for heart symptoms particularly within the first week of an acute respiratory infection.

provided by Public Health Ontario..........

Macrophages conduct electricity, help heart to beat

"This work opens up a completely new view on electrophysiology; now, we have a new cell type on the map that is involved in conduction," says senior author Matthias Nahrendorf, a systems biologist at Massachusetts General Hospital, Harvard Medical School. "Macrophages are famous for sensing their environment and changing their phenotype very drastically, so you can think about a situation where there is inflammation in the heart that may alter conduction, and we now need to look at whether these cells are causally involved in conduction abnormalities."

Nahrendorf showed the results to his colleagues, David Milan and Patrick Ellinor, both electrophysiologists at Massachusetts General Hospital, who responded by opening the doors to their labs. Together, the teams found that macrophages extend their cell membranes between cardiac cells and create pores, also called gap junctions, for the electrical current to flow through. The macrophages contribute by preparing the conducting heart cells for the next burst of electricity so conducting cells are able to keep up with a fast contraction rhythm.

The group will follow up by looking at whether macrophages are involved in common conduction abnormalities. There are also potential connections between macrophages and anti-inflammatory drugs, which are widely reported to help with heart disease. If macrophages do play a role in disease, the researchers say it can open up a new line of therapeutics, as these immune cells naturally consume foreign molecules in their presence and are easy to target as a result.

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Revealed by Cell Press.

Cardiac macrophages found to contribute to a currently untreatable type of heart failure

The concept of heart failure traditionally referred to a loss of the organ's pumping capacity, which is called systolic heart failure. But in HFpEF the heart retains the ability to pump or eject blood into the circulation. What is compromised is the ability of the heart muscle to relax and allow blood to flow into the left ventricle, reducing the amount of blood available to pump into the aorta. Symptoms of HFpEF are similar to those of heart failure in general, but since factors contributing to the condition are not well understood, it has been difficult to find promising therapies.

Interactions among cells within the heart -- including macrophages -- are essential to normal cardiac function but can also contribute to problems. For example, after the heart muscle is damaged by a heart attack, macrophages induce the cells called fibroblasts to generate the connective tissues that help reinforce damaged tissue. But excessive fibroblast activation can lead to the distortion and stiffening of tissues, further reducing cardiac function.

"Not only were numbers of inflammatory cardiac macrophages increased in both the mice and in humans with HFpEF, but their characteristics and functions were also different from those in a healthy heart," says Hulsmans. "Through their participation in the remodeling of heart tissue, these macrophages increase the production of extracellular matrix, which reduces diastolic relaxation. Our findings regarding the cell-specific knockout of IL-10 are the first to support the contribution of macrophages to HFpEF."

Senior author Mathias Nahrendorf, MD, PhD , of the Center for Systems Biology, adds, "Heart muscle cells and fibroblasts have been considered the major contributors to HFpEF. Our identification of the central involvement of macrophages should give us a new focus for drug development. And since macrophages naturally take up materials for disposal, inducing them to ingest drugs carried in by nanoparticles could limit their contributions to the development of HFpEF." Nahrendorf is a professor of Radiology at Harvard Medical School.

Revealed by  Massachusetts General Hospital.

Red wine proves good for the heart (again).........

Antioxidants found in wine have advanced stents

Antioxidant compounds found in red wine are advancing the treatment of heart disease -- the leading cause of death for both men and women in the U.S.

Heart disease occurs when plaque builds up within artery walls blocking the blood flow through tissues in the body, increasing the risk of a heart attack or stroke. About 630,000 people die each year from heart disease, according to the Centers for Disease Control and Prevention.

While there is no singular cure for heart disease, there are numerous forms of treatment including lifestyle changes and surgical procedures. In one procedure called a coronary angioplasty, a surgeon inserts and inflates a tiny balloon inside a blocked or narrow artery to widen it and allow blood to flow through to the heart thereby decreasing the risk of a heart attack or stroke. This procedure often includes inserting a permanent small mesh tube to support the blood vessel called a stent.

Commercial stents can release chemotherapy agents that are toxic and can cause the blood vessel to narrow again. LSU Department of Comparative Biomedical Sciences Professor Tammy Dugas is developing a new stent that releases red wine antioxidants slowly over time that promotes healing and prevents blood clotting and inflammation. The two antioxidant compounds are resveratrol and quercetin.

"By delivering red wine antioxidants during conventional angioplasty, it may be possible to prevent excess tissue from building up and the blood vessel from narrowing again as it heals," Dr. Dugas said.

In addition to the stent, Dugas and colleagues are developing a balloon coated with the same compounds to treat blood flow blockages throughout the body called peripheral artery disease. This disease which can limit the blood flow to kidneys, the stomach, arms or legs affects about 8 to 12 million Americans. However, less than 20 percent are diagnosed by a physician. Drug-coated balloons are a relatively new product, and are being developed to help interventional cardiologists treat arteries that are difficult to target with traditional angioplasty and stent treatments.
Revealed by Louisiana State University......

Diagnostic test helps primary care docs rule out pathologic heart murmur in kids

Although heart murmur in children is usually harmless (referred to as innocent murmur), in a small number of cases it is symptomatic of cardiac disease (referred to as pathologic murmur). A new study finds that disappearance of heart murmur while standing reliably rules out pathologic heart murmurs. Using an acoustic-based, non-electronic stethoscope, researchers at two French universities noted heart sound characteristics of 194 consecutive children referred to pediatric cardiologists for heart murmur, first with patients in the supine (flat on their back) position, and then for at least one minute in the standing position.

After observational data were collected, an echocardiogram was performed to assess the presence or absence of cardiac anomalies that could explain the murmur. Eight-five percent of children (n=164) referred to a cardiologist for heart murmur did not have cardiac disease. Thirty children (15 percent) had an abnormal echocardiogram that explained the heart murmur. Of 100 children (51 percent) who had heart murmur while supine but not standing, two had an organic murmur and only one required follow up. The disappearance of heart murmur while standing, therefore, excluded a pathologic murmur with a high predictive positive value of 98 percent and a specificity of 93 percent, but with a poor sensitivity of 60 percent. In an era of highly technical medicine, physical examination should remain the first step in diagnosis, according to the authors. They conclude that the disappearance of heart murmur in children upon standing is a valuable clinical test to exclude a pathologic cardiac murmur and avoid costly referral to a cardiologist.

This was revealed by American Academy of Family Physicians....

DEEP INSIGHT INTO THE HEART.......

By no means are only elderly people at risk from heart diseases. Physically active individuals can also be affected, for example if a seemingly harmless flu bug spreads to the heart muscle. Should this remain undetected and if, for example, a builder continues with his strenuous job or an athlete carries on training, this can lead to chronic inflammation and in the worst case even to sudden death. The latest issue of the Forschung Frankfurt journal describes how modern non-invasive examinations using state-of-the-art imaging technology can reduce such risks.

Professor Eike Nagel and his 12 coworkers at the Institute for Experimental and Translational Cardio Vascular Imaging of Goethe University Frankfurt are developing better ways to predict and diagnose heart diseases. In recent years, the researchers have taken the lead in the development of a procedure that is still very new in heart scans. Nagel explains the advantages: "With the help of magnetic resonance imaging, we can look right inside the heart muscle." Blood flow to the heart muscle is visualized and shows whether there are any constrictions of the arteries supplying the heart. Experts can also spot whether the heart muscle is scarred, inflamed or displays any other anomalies.

The comparatively fast method makes it possible to examine patients at an early stage and may prevent cardiac insufficiency or even a heart attack. "Diseases such as HIV, kidney damage, rheumatic diseases or tumours often affect the heart either directly or as a side effect of therapy," says Nagel, describing groups potentially at risk. The cardiologist is convinced: "Nowadays we can treat or even cure so many diseases, but the heart suffers too and this should be carefully monitored as it mostly remains undetected."

It is concluded  that these rapid advances in imaging over the last decades fascinating: "Nowadays we can spot the slightest changes and literally get a clear picture of the heart's condition."  

Cardiorespiratory fitness is essential to reduce risk of coronary heart disease

Coronary heart disease (CHD) is a leading cause of death for men in the U.S. Both cardiorespiratory fitness (CRF) and the blood triglyceride/high-density lipoprotein ratio (TG:HDL ratio) are strong predictors of death from CHD. In the current issue of Mayo Clinic Proceedings, two new studies highlight the importance of CRF on subsequent CVD and mortality risk. These articles contribute substantive evidence on the importance of achieving moderate to high levels of CRF in both adults and children.

In an investigation led by Stephen W. Farrell, PhD, of The Cooper Institute, Dallas, TX, researchers found strong evidence that moderate-to-high level of fitness counteracted some of the negative effects of a high TG:HDL ratio.

"While it is still extremely important to measure traditional risk factors such as resting blood pressure, blood cholesterol, triglyceride, and glucose levels, having a measure or estimate of the patient's cardiorespiratory fitness level gives us additional information regarding cardiovascular disease risk," explained Dr. Farrell. "The results of this study support this recommendation. Regardless of whether the blood TG:HDL ratio was low or high, having at least a moderate level of fitness provided some protection from CHD death when compared to having a low level of fitness."

A total of 40,269 men received a comprehensive physical examination between January 1, 1978 and December 31, 2010. The exam included a maximal treadmill exercise test to measure cardiorespiratory fitness level, and also included measurement of the blood TG:HDL ratio. This ratio is easily calculated by taking the fasting blood triglyceride level and dividing it by the blood HDL cholesterol level. A lower ratio is an indicator that insulin is working well, while a higher ratio indicates resistance to insulin. Higher ratios also indicate an increased risk of future prediabetes, type 2 diabetes, and cardiovascular disease.

The participants, categorized into low, moderate, and high CRF groups, were followed for an average period of 16.6 years, during which time 556 deaths due to coronary heart disease (CHD) occurred. Moderate to high levels of fitness provided significant protection from CHD death. Lower values for the TG:HDL ratio also provided significant protection. The lowest risk of CHD death was seen among high fit men in the lowest category of TG:HDL ratio, while the highest risk of CHD death was seen among low fit men in the highest category of TG:HDL ratio. Within each of the four categories of TG:HDL ratio, having a moderate to high level of fitness provided significant protection against CHD death when compared to having a low level of fitness. Therefore, knowing the patient's fitness level as well as their TG:HDL ratio provides much more information about CHD risk status than just knowing one or the other. When used in combination with other risk factors, such as the patient's blood pressure, bloodwork, family history, etc., measuring or estimating the patient's level of CRF can result in a much more accurate determination of their cardiovascular disease risk status.