Being Tall: Good for Your Heart by Shashi K. Agarwal, MD

A strong link exists between stature and health. It has been associated with  imparied glucose tolerance, diabetes and complications of diabetes. It has also been linked with hypertension  and cardiovascular disease.

 The relationship between height and cardiovascular disease has been known for a long time. In a meta-analysis published in the European heart journal in 2010,  Paajanen and colleagues reported that shorter individuals were 50% more likely to develop or die from heart disease. They studied data from 52 studies comprising height and cardiovascular disease in a population totaling 3,012,747 individuals. The risk was higher if your height was under 5ft 4in or 165.4cm if you are a man or below 5ft or 153cm if you are a woman.

Cardiovascular risks associated with shorter stature include earlier and higher prevalence and greater severity of coronary artery disease, both in men and women. There is an increased risk for heart attacks, strokes and premature mortality. It is also associated with higher cardiovascular operative mortality.

 In the Physicians Health Study involving 1444 men being monitored for an average of 22 years, there was a 24% less incidence of heart failure in men over six feet when compared to men who were five feet, eight inches or shorter. This study from the Brigham and Women’s Hospital and Harvard Medical School in Boston was recently published online (January 2012) by the American Journal of Cardiology.

It has been suggested that a tendency for future cardiovascular morbidity and mortality may be influenced by factors affecting height and operating early in life. Also shorter people have smaller coronary arteries, which may allow them to get occluded earlier and predict a poorer operative mortality.

Are We Living Longer in the USA: CDC says YES! by Shashi K. Agarwal, MD

According to Wikepedia, “Life expectancy is the expected (in the statistical sense) number of years of life remaining at a given age.” It is generally quoted as the number of years a baby is expected to live at birth.  In 1900, global average life expectancy was just 31 years. By the mid mid-20th century, average life expectancy rose to 48 years.  In 2005, average life expectacy at birth reached 65.6 years. 

According to the CDC (CDC: “Deaths: Preliminary Data for 2010.”) the average life expectancy in America in 2010 has risen to 78.7 years, rising by about one month from 78.6 years in 2009. The death rate dropped to 746.2 deaths per 100,000 people, primarily due to a drop in deaths from cancer, heart disease, stroke, accidents, chronic lung disease, flu/pneumonia and blood infections. There has also been a drop in the infant mortality rates. 

Human life expectancy at birth has dramatically increased during the last century as the following data illustrates: 

Classical Greece: 28 years

Classical Rome: 28 years

Medieval Britain: 25-40 years

Early 20th century: 31 years

2010: 67.2 years 

Swaziland unfortunately still records an average of only 31.88 years in life expectancy while Japanese live to an average age of 82.6 years. 

Life expectancy differs from life span as calculation of life expectancy at birth includes all the babies that die before their first year of life as well as people that die from disease and war. The maximum life span for humans is said to be 122 years, referring to the oldest confirmed recorded age for any human (Jeanne Calment). 

According to the World Health Organization, global disease burden in 2030 worldwide will be ranked as follows:

1. HIV/AIDS

2. Unipolar depressive disorders

3. Ischemic heart disease

4. Chronic obstructive pulmonary disease

5. Perinatal conditions

6. Cerebro-vascular disease

7. Road traffic injuries

8. Cataracts

9. Lower respiratory infections

10. Tuberculosis

11. Hearing loss, adult onset

12. Diabetes mellitus

13. Diarrheal diseases

14. Violence

15. Malaria

Aspirin for Cardiovascular Protection: Only if You have Established Obstructive Vascular Disease! by Shashi K. Agarwal, MD

Cardiovascular disease is now the leading cause of morbidity and mortality worldwide. Over the last decade or so, prophylactic aspirin use has become a common practice to prevent cardiovascular events. Low dose aspirin is taken by millions of patients worldwide to prevent cardiovascular disease. However, recent reports have questioned its routine use in healthy adults as being cardio-beneficial.

A recent meta-analysis published online January 9, 2012 in the Archives of Internal Medicine revealed that although there is a modest benefit in taking aspirin for primary prevention, these advantages are offset by a higher incidence of non-trivial bleeding. In this analysis of nine randomized placebo controlled studies with 100,000 patients followed for six years, there was a 10% reduction in cardiovascular events but there was a 30% increased risk of significant bleeding events. (Seshasai SRK, Wijesuriya S, Sivakumaran R, et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012; DOI:10.1001/archinternmed.2011.628. Available at: http://archinte.ama-assn.org.)

Many other studies have shown that aspirin has a favorable risk/benefit ratio when taken for secondary prevention. Its regular use provides added protection in patients with an acute or previous  myocardial infarction or ischemic stroke, unstable or stable angina, stroke or cerebral ischemia, peripheral arterial disease, or atrial fibrillation.

Aspirin remains an important emergency treatment in suspected heart attacks. Given as chewable ‘baby’ aspirin in a dose of 160 mg to 325 mg, it is very effective in slowing platelet aggregation in patients with  an acute coronary syndrome. (recommended by the American Heart Association and the American College of Cardiology)  Its emergent use helps  prevent further occlusion or reocclusion of the coronary artery, thereby reducing myocardial damage and death. Previous studies have demonstrated  a 23% reduction in death in patients with suspected heart attack, and a 49% reduction in non-fatal heart attacks and strokes. An even more impressive 53% reduction is seen with its use in the incidence of myocardial infarction, stroke of vascular death following coronary angioplasty. 

Final recommendations: Do not use aspirin for primary prevention of cardiovascular disease. However aspirin 62-150 mg has evidence based benefits in the secondary prevention of cardiovascular disease. It also has dramatic beneficial effects if used in the chewable form in suspected heart attacks.

Nuts about Nuts? The Best Nuts for Cardiovascular Protection by Shashi K. Agarwal, MD

Cardiovascular disease is now the leading cause of morbidity and mortality worldwide. Dietary indiscretion is emerging as an important villain in its development. Besides a diet rich in fruits, vegetables and whole grains, regular nut consumption has shown to impart significant beneficial effects in reducing cardiovascular risk.

Nuts contain healthy mono and polyunsaturated fatty acids, alpha linolinic acid, fiber and beneficial bioactive compounds such as phytosterols. Ingestion results in a decrease in low density lipoprotein, prevention of LDL oxidation, reduction in inflammatory markers of cardiovascular disease and improved endothelial function. These beneficial effects translate into a lower atherosclerotic disease risk and thereby reduced coronary artery disease. Other benefits include increased insulin sensitivity and improved weight management.

A recent study looked at various raw nuts and rated them according to their polyphenol content and potency. The descending ranking from the best raw nuts: walnuts, brazil nuts, pistachios, pecans, peanuts, almonds, macadamia nuts, cashews and hazelnuts. Among roasted nuts, the descending order was: walnuts, brazil nuts, hazelnuts, peanuts, pecans, cashews, macadamia nuts, almonds and finally pistachios.

To summarize, regular consumption of nuts, especially walnuts and brazil nuts, can help minimize cardiovascular risk and also decrease the risk of developing type 2 diabetes mellitus.

Bereavement: Cardiotoxic to Close Survivors by Shashi Agarwal, MD

Fear, anxiety and depression are often implicated in the increased vulnerability to cardiac events. A recent report has shown that bereavement following the death of someone close is by far the most stressful state experienced by humans and increases the risk of a heart attack by a staggering 21-fold in the first 24 hours. This data was recently reported: Mostofsky E, Maclure M, Sherwood JB, et al. Risk of acute myocardial infarction after the death of a significant person on one’s life. The determinants of myocardial infarction onset study. Circulation 2012; DOI: 10.1161/CIRCULATIONAHA.111.061770. Available at: http://circ.ahajournals.org/.

Researchers conducted a study of 1985 patients hospitalized for a heart attack during the years of 1989 thru 1994. Of these patients, 270 or 13.6% had lost a special person during the preceding six months. 19 had lost someone within one day of their heart attack. This worked out to an elevated risk of 21.1 times of getting a heart attack within 24 hours of the death of a significant person. Although the risk declined gradually on each subsequent day, it remained almost 6 times higher at the end of the first week. The study found that after 4 weeks, the risk was still mildly elevated.

Profound bereavement triggers heart attacks in many ways. An acute surge in sympathetic activity results in a fast heart rate, increased blood pressure, decreased blood flow to the heart muscle and heightened cardiac electrical instability. There is an associated increase in tendency to form blood clots. Other contributing factors experienced during the intense grief period include lack of sleep, abnormal eating patterns and non-compliance with regular medications.

The greatly increased risk of heart attack following the death of someone close lingers on for at least four weeks. Close emotional and medical support is necessary for these individuals during this period. Family and friends need to be aware of this need, and may help prevent further tragedy.