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.