Being overweight may benefit older peopleThursday 27 March 2014 - 3am PST 

A new study from Australia finds that people aged 65 and over with a body mass index in the overweight range live longer and suggests perhaps the World Health Organization guidelines on BMI may not be suitable for older people.The World Health Organization (WHO) defines overweight as having a body mass index (BMI) greater than or equal to 25, and a BMI of 30 or over as obese. BMI is equal to a person's weight

in kilos divided by the square of their height in meters (kg/m2).

Caryl Nowson, professor of nutrition and aging at Deakin University in Melbourne, and

colleagues looked at links BMI and risk of death in people aged 65 and over, and found those

with the lowest risk of death had a BMI of around 27.5.

They also found those with a BMI between 22 and 23 - considered to be the normal weight range

- had a significantly higher risk of death.

They say their findings, which they report in the American Journal of Clinical Nutrition, question

whether the WHO guidelines are suitable for older adults. Prof. Nowson suggests it is time to

reassess them, and adds:"Our results showed that those over the age of 65 with a BMI of between 23 and 33 lived longer, indicating that the ideal body weight for older people is significantly higher than the recommended 18.5-25 'normal' healthy weight range."

For their study, the team pooled and re-analyzed results from studies published between 1990

and 2013 that had examined links between BMI and risk of death in people aged 65 and over.

Altogether, the analysis covered over 200,000 older people followed for an average of 12 years,

and revealed, with reference to BMI in the range 23.0 to 23.9, that there was no increased risk of

death for people in the overweight range, but:

Risk of death increased by 12% when BMI was between 21 and 22 (near the middle of the healthy weight range)

Risk of death increased by 19% when BMI was between 20 and 20.9 (still within the healthy weight range)

Risk of death increased by 8% when BMI was between 33 and 33.9 (in the obese range).

Prof. Nowson says for people aged 65 and over, by the WHO standards, being overweight is not

associated with an increased risk of death, and that "it is those sitting at the lower end of the

normal range that need to be monitored, as older people with BMIs less than 23 are at increased

risk of dying."

Advice on body weight for older people needs to look at more than just BMI

The study suggests that people aged 65 and over with a BMI in the overweight range live longer and may not

need to lose weight.

She suggests advice on ideal body weight for older people should take into account factors other

than BMI, and:

"Factors such as chronic diseases and the ability to move around need to be considered as there is no real issue with being in the overweight range unless it is preventing people from moving around freely."

She says older people need to get off the weight loss bandwagon and focus instead on getting a

balanced diet, eating when hungry and keeping active.

She says there is a real risk of malnutrition among older people from putting too much

emphasis on dietary restrictions.

"Malnutrition in older people is not well recognised as this can occur even when BMI is in the

overweight range," she adds.

Meanwhile, Medical News Today recently reported a study that found extreme loneliness is a risk factor for premature death in seniors. The University of Chicago research found

loneliness was tied to a 14% higher risk of death making it nearly as potent as disadvantaged

socioeconomic status, which carries a 19% increased risk of early death.

Written by Catharine Paddock PhD

New measures for curbing lifetime heart disease riskWednesday 26 March 2014 - 12am PST 

Heart DiseaseCardiovascular / CardiologyMedical Devices / DiagnosticsPublic Health

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Cardiovascular disease is the leading cause of death worldwide, and the World Health Organization estimates that by 2013, over 23 million people will die each year from the condition. In an effort to lower risks, new recommendations for preventing the disease have been drawn up by 11 professional societies and charitable organizations in the UK.These recommendations have been published in the journalHeart.

According to the Centers for Disease Control and Prevention (CDC), cardiovascular disease

(CVD) resulted in nearly 600,000 deaths in the US in 2010.

Likewise, in the UK, there are currently 7 million people living with the disease, approximately

160,000 of whom die each year.

A major global health problem, heart disease deaths have actually halved over the past 40-50

years, particularly in high-income countries where identification of common risk factors and

national public health initiatives have helped.

However, "despite impressive progress, there is much still to be achieved in the prevention and

management of cardiovascular care, with no room for complacency," the authors of the latest

study say.

The disease is of particular concern in low- and middle-income countries,

where obesity and diabetes are increasing.

To provide further recommendations, the Joint British Societies' consensus recommendations for the prevention of cardiovascular disease (JBS3) have drawn from the latest available scientific evidence.And their main recommendation involves putting patients at the heart of prevention by starting

defensive actions early, with the aid of a risk assessment tool, called the JBS3 risk calculator.Recommendations look at long-term risk and lifestyle factors from youth

CVD risks can be decreased by modifying certain lifestyle factors, such as quitting smoking and exercising

more.

The investigators note that people could live healthier, longer lives if doctors assess patient risk

of CVD over the long term.

Currently, strategies for preventing and treating the disease are based on estimating a person's risk of CVD in the next 10 years. But the new recommendations extend this focus from targeting only those at short-term risk to those whose family and lifestyle factors from a younger age indicate a high lifetime risk.The researchers say their approach is based on the growing evidence that suggests there is a

long pre-clinical phase to CVD and that most heart attacks or strokes occur in individuals in the

"intermediate" risk category.

They note that, despite evidence to the contrary, most of the public underestimate their lifetime

risk of developing and dying of CVD, regarding cancer as a greater threat instead.

As such, the JBS3 risk calculator aims to better educate individuals about their lifetime CVD risk

by revealing the "true age of the heart."

Using family and lifestyle risk factors, the calculator predicts how many more years an individual

will likely live before he or she has a heart attack or stroke, compared with an individual without

those risk factors.

The authors say the risk calculator "is a novel and exciting tool that can be used to motivate both

physicians and patients to tackle the potential scourge of CVD, at a time when overt disease is

not present and prevention may exert its greatest impact."

Emphasis on lifestyle changes rather than prescription drugs

The team is hopeful that the risk calculator will empower patients and help them understand why

they need to start reducing their risk of CVD, when they should start and exactly what they

should do.

Fast facts about CVD Over 80% of CVD deaths occur in low- and middle-income countries.

Worldwide in 2008, an estimated 17.3 million people died from CVDs.

By 2030, over 23 million people are estimated to die each year from CVDs.

"It is important to emphasize that, for the majority, the strong message will be the potential gains

from an early and sustained change to a healthier lifestyle rather than prescription of drugs," they

say.

Modifiable lifestyle factors include adopting a healthy diet, quitting smoking and increasing the

amount of regular exercise while decreasing sedentary activity.

The researchers note that acute cardiovascular care is quite expensive. With life expectancy

increasing, prevalence of CVD likewise rises.

"The lifesaving gains made through national investment in acute cardiovascular care over more

than a decade now need to be complemented by a modern and integrated approach to

cardiovascular prevention," they say.

Medical News Today recently reported on a new 3D-printed membrane that is implanted onto

the outer layer of the heart wall to predict occurrence of heart attacks, transforming patient

treatment.

Written by Marie Ellis

Study Questions Fat and Heart Disease LinkBy ANAHAD O'CONNOR MARCH 17, 2014, 5:00 PM 

Smokey Bones Bar & Fire Grill/PRNewsFotoA new study questions the relationship between heart disease and saturated fat.

Many of us have long been told that saturated fat, the type found in meat, butter and cheese, causes heart disease. But a large and exhaustive new analysis by a team of international scientists found no evidence that eating saturated fat increased heart attacks and other cardiac events.

The new findings are part of a growing body of research that has challenged the accepted wisdom that saturated fat is inherently bad for you and will continue the debate about what foods are best to eat.

For decades, health officials have urged the public to avoid saturated fat as much as possible, saying it should be replaced with the unsaturated fats in foods like nuts, fish, seeds and vegetable oils.

But the new research, published on Monday in the journal Annals of Internal Medicine, did not find that people who ate higher levels of saturated fat had more heart disease than those who ate less. Nor did it find less disease in those eating higher amounts of unsaturated fat, including monounsaturated fat like olive oil or polyunsaturated fat like corn oil.

“My take on this would be that it’s not saturated fat that we should worry about” in our diets, said Dr. Rajiv Chowdhury, the lead author of the new study and a cardiovascular epidemiologist in the department of public health and primary care at Cambridge University.

But Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health, said the findings should not be taken as “a green light” to eat more steak, butter and other foods rich in saturated fat. He said that looking at individual fats and other nutrient groups in isolation could be misleading, because when people cut down on fats they tend to eat more bread, cold cereal and other refined carbohydrates that can also be bad for cardiovascular health.

“The single macronutrient approach is outdated,” said Dr. Hu, who was not involved in the study. “I think future dietary guidelines will put more and more emphasis on real food rather than giving an absolute upper limit or cutoff point for certain macronutrients.”

He said people should try to eat foods that are typical of the Mediterranean diet, like nuts, fish, avocado, high-fiber grains and olive oil. A large clinical trial last year, which was not included in the current analysis, found that a Mediterranean diet with more nuts and extra virgin olive oil reduced heart attacks and strokes when compared with a lower fat diet with more starches.

Alice H. Lichtenstein, a nutritional biochemist at Tufts University, agreed that “it would be unfortunate if these results were interpreted to suggest that people can go back to eating butter and cheese with abandon,” citing evidence that replacing saturated fat with foods that are high in polyunsaturated fats – instead of simply eating more carbohydrates – reduces cardiovascular risk.

Dr. Lichtenstein, who was not involved in the latest study, was the lead author of the American Heart Association’s dietary guidelines, which recommend that people restrict saturated fat to as little as 5 percent of their daily calories, or roughly two tablespoons of butter or two ounces of Cheddar cheese for the typical person eating about 2,000 calories a day. The heart association states that restricting saturated fat and eating more unsaturated fat, beans and vegetablescan protect against heart disease by lowering low-density lipoprotein or so-called bad cholesterol.

In the new research, Dr. Chowdhury and his colleagues sought to evaluate the best evidence to date, drawing on nearly 80 studies involving more than a half million people. They looked not only at what people reportedly ate, but at more objective measures such as the composition of fatty acids in their bloodstreams and in their fat tissue. The scientists also reviewed evidence from 27 randomized controlled trials – the gold standard in scientific research – that assessed whether taking polyunsaturated fat supplements like fish oil promoted heart health.

The researchers did find a link between trans fats, the now widely maligned partially hydrogenated oils that had long been added to processed foods, and heart disease. But they found no evidence of dangers from saturated fat, or benefits from other kinds of fats.

The primary reason saturated fat has historically had a bad reputation is that it increases low-density lipoprotein cholesterol, or LDL, the kind that raises the risk for heart attacks. But the relationship between saturated fat and LDL is complex, said Dr. Chowdhury. In addition to raising LDL cholesterol, saturated fat also increases high-density lipoprotein, or HDL, the so-called good cholesterol. And the LDL that it raises is a subtype of big, fluffy particles that are generally benign. Doctors refer to a preponderance of these particles as LDL pattern A.

The smallest and densest form of LDL is more dangerous. These particles are easily oxidized and are more likely to set off inflammation and contribute to the buildup of artery-narrowing plaque. An LDL profile that consists mostly of these particles, known as pattern B, usually coincides with high triglycerides and low levels of HDL, both risk factors for heart attacks and stroke.

The smaller, more artery-clogging particles are increased not by saturated fat, but by sugary foods and an excess of carbohydrates, Dr. Chowdhury said. “It’s the high carbohydrate or sugary diet that should be the focus of dietary guidelines,” he said. “If anything is driving your low-density lipoproteins in a more adverse way, it’s carbohydrates.”

While the new research showed no relationship overall between saturated or polyunsaturated fat intake and cardiac events, there are numerous unique fatty acids within these two groups, and there was some indication that they are not all equal.

When the researchers looked at fatty acids in the bloodstream, for example, they found that margaric acid, a saturated fat in milk and dairy products, was associated with lower cardiovascular risk. Two types of omega-3 fatty acids, the polyunsaturated fats found in fish, were also protective. But a number of the omega-6 polyunsaturated fatty acids, commonly found in vegetable oils and processed foods, may pose risks, the findings suggested.

The researchers then looked at data from the randomized trials to see if taking supplements like fish oil produced any cardiovascular benefits. It did not.

But Dr. Chowdhury said there might be a good explanation for this discrepancy. The supplement trials mostly involved people who had pre-existing heart disease or were at high risk of developing it, while the other studies involved generally healthy populations.

So it is possible that the benefits of omega-3 fatty acids lie in preventing heart disease, rather than treating or reversing it. At least two large clinical trials designed to see if this is the case are currently underway.

A heart attack is a serious medical emergency in which the supply of blood to the heart is suddenly blocked, usually by a blood clot. Lack of blood to the heart can seriously damage the heart muscle.A heart attack is known medically as a myocardial infarction or MI.Symptoms can include:

chest pain: the chest can feel like it is being pressed or squeezed by a heavy object,

and pain can radiate from the chest to the jaw, neck, arms and back

shortness of breath

feeling weak and/or lightheaded

overwhelming feeling of anxiety

It is important to stress that not everyone experiences severe chest pain; often the pain can be mild and mistaken for indigestion.It is the combination of symptoms that is important in determining whether a person is having a heart attack, and not the severity of chest pain.Read more about the symptoms of a heart attack.Treating heart attacks

A heart attack is a medical emergency. Dial 999 and ask for an ambulance if you suspect that you or someone you know is having a heart attack.

If the casualty is not allergic to aspirin and it’s easily available, give them a tablet (ideally 300mg) to slowly chew and then swallow while waiting for the ambulance to arrive.The aspirin will help to thin the blood and restore blood supply to the heart.Treatment for a heart attack will depend on how serious it is. Two main treatments are:

using medication to dissolve blood clots – this is known as thrombolysis

surgery to help restore blood to the heart

Read more about treating heart attacks.What causes a heart attack?

Coronary heart disease (CHD) is the leading cause of heart attacks. CHD is a condition in which coronary arteries (the major blood vessels that supply the heart with blood) get clogged up with deposits of cholesterol. These deposits are called plaques.During a heart attack, one of the plaques ruptures (bursts), causing a blood clot to develop at the site of the rupture. The clot may then block the supply of blood running through the coronary artery, triggering a heart attack.Smoking, a high-fat diet, diabetes and being overweight or obese all increase your risk of developing CHD.Read more about the causes of heart attacks.Recovery

The time it takes to recover from a heart attack will depend on the amount of damage to the heart muscle. Some people are well enough to return to work after two weeks. Other people may take several months to recover. The recovery process aims to:

reduce your risk of another heart attack by a combination of lifestyle changes, such

as eating a healthy diet, and medications such as statins (which help lower blood

cholesterol levels)

gradually restore your physical fitness so you can resume normal activities (this is

known as cardiac rehabilitation)

Most people can return to work after having a heart attack, but how quickly will depend on, your health, the state of your heart and the kind of work you do.Read more about recovering from a heart attack.

Who is affected

Heart attacks are one of the most common reasons why a person requires emergency medical treatment.There were just over 92,000 heart attacks in England between April 2010 and April 2011.Most heart attacks occur in older people over 45 years of age. Men are two to three times more likely to have a heart attack than women.Complications

Complications of heart attack can be serious and possibly life-threatening, and include:

cardiogenic shock – this is where the muscles of the heart are severely damaged,

meaning the heart can no longer supply enough blood to maintain many body

functions

heart rupture – is where the heart’s muscles, walls or valves split apart (rupture)

arrhythmia – is an abnormal heartbeat, such as a ventricular arrhythmia, where the

heart begins beating faster and faster before going into a kind of spasm and then

stops beating (cardiac arrest)

These complications can occur quickly after a heart attack and are a leading cause of death.Many people will die suddenly from a complication of a heart attack before reaching hospital.Read more about the complications of a heart attack.Outlook

The outlook for people who have had a heart attack can be highly variable depending on:

their age – the older you are the more likely you are to experience serious

complications

the severity of the heart attack – specifically how much of the muscle of the heart has

been damaged during the attack

how long it took before a person received treatment – the longer the delay the worse

the outlook tends to be

In general around one third of people who have a heart attack die as a result. These deaths often occur before a person reaches

hospital, or alternatively, within the first 28 days after the heart attack.If a person survives for 28 days after having a heart attack, their outlook improves dramatically and most people will go on to live for many years.

More Young Adults at Risk for High Blood PressurePast Issues / Fall 2011 Table of Contents

Fast Facts Nearly one in three adults—more than 65 million Americans—suffers from high blood pressure, also

called hypertension.

A growing number of young adults are now at risk for the disease.

High blood pressure leads to more than half of all heart attacks, strokes, and heart failure cases in

the United States. It also increases the risk of kidney failure, blindness, and other serious health

consequences.

High blood pressure is a silent killer, often with no obvious or visible symptoms.

For African Americans, the disease tends to begin at an earlier age and be more severe than among

whites, Asians, and Hispanics.

Study shows 19 percent of young adults have high blood pressure. NIH-funded analysis indicates higher risk for young adults than previously believed.With more than 65 million Americans suffering from the effects of high blood pressure (HBP), it is

critical to understand the basics in order to be able to better control the disease. This is even more

urgent, since recent research shows that young adults have HBP in increasing numbers.

The new study—which took blood pressure readings of more than 14,000 men and women between

24 and 32 years of age—revealed a higher percentage of high blood pressure readings than results

from a previous major study, according to Steven Hirschfeld, Associate Director for Clinical Research

for the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development

(NICHD). The previous study (NHANES) reported high blood pressure in 4 percent of adults 20 to 39

years of age.

“Investigations into the reasons underlying the reported differences between the [two studies] will no

doubt yield additional insight into the measurement of high blood pressure in the young adult

populations,” he says.

The study authors wrote that they were unable to pinpoint any reasons for the differences. In addition,

they said that many young people are unaware that they have HBP.

Categories for Blood Pressure Levels in Adults(in mmHg, or millimeters of mercury)

Category Systolic (top number)

Diastolic (bottom number)

Normal Less than 120 And Less than 80

Prehypertension 120–139 Or 80–89

High blood pressure

Stage 1 140–159 Or 90–99

Stage 2 160 or higher Or 100 or higher

The ranges in the table apply to most adults (aged 18 and older) who don't have short-term serious

illnesses.

All levels above 120/80 mmHg raise your risk, and the risk grows as blood pressure levels rise.

"Prehypertension" means you're likely to end up with HBP, unless you take steps to prevent it. —

National Heart, Lung, and Blood Institute

What Is High Blood Pressure?Simply put, blood pressure is the force exerted by blood on the walls of the arteries and veins as it

courses through the body. Like the ocean tide, it is normal for blood pressure to rise and fall

throughout the day. Blood pressure is lowest when you are sleeping and rises when you awaken. But

when the pressure stays elevated over time, it causes the heart to pump harder and work overtime,

possibly leading to various, serious health problems, ranging from hardening of the arteries, stroke,

and brain hemorrhage to kidney malfunction and blindness.

Blood pressure is recorded as two numbers, the systolic (pressure during a heartbeat) over the

diastolic (pressure between heartbeats). For example, a measurement of 120/80 millimeters of

mercury (mmHg) is expressed as “120 over 80.” Normal blood pressure is less than 120/80. People

with pressures between 120/80 and 139/89 are considered to have pre-hypertension and are likely to

develop high blood pressure without preventative measures.

Today, clinical guidelines recommend that physicians work with patients to keep their blood pressures

below 140/90 mmHg, and even lower for people with diabetes or kidney ailments. In all cases,

patients are encouraged to lose excess weight, exercise regularly, not smoke, limit intake of alcoholic

beverages, and follow heart-healthy eating plans, including cutting back on salt and other forms of

sodium.

Assessing Your RiskWhile many Americans develop high blood pressure as they get older, it is not a hallmark of healthy

aging. This is especially critical for African Americans, in whom the disease tends to begin at an

earlier age and be more severe. In addition to being at increased risk, they also experience higher

rates of death from stroke and kidney disease than does the general population.

While an individual’s blood pressure may be normal now, 90 percent of Americans over 50 years of

age have a lifetime risk of high blood pressure, Americans should take action before being diagnosed

with high blood pressure.

An Ounce of PreventionBecause blood pressure rises as body weight increases (and obesity is a known risk factor for

developing high cholesterol and diabetes, which in turn can lead to heart disease), a loss of as little as

10 pounds can help to lower blood pressure.

Two recent studies confirm the blood pressure benefits of maintaining a healthy diet. First is the

Dietary Approaches to Stop Hypertension (DASH) clinical study, which tested the effects of food

nutrients on blood pressure. It emphasizes consumption of fruits, vegetables, and lowfat dairy foods,

whole grains, poultry, fish, and nuts, and stresses reduction of fats, red meats, sweets, and sugared

beverages.

Second is the DASH-sodium study, which demonstrates the importance of lowering sodium (salt)

intake. Most Americans consume far more than the current, daily recommendation of 2,400 milligrams

(mg) of sodium—about a teaspoon of table salt—or less. This includes all salt and sodium consumed,

not just at the table, but also in cooking. For those with high blood pressure, consuming even less

may be advisable, since the DASH-sodium study revealed that diets containing no more than 1,500

mg of sodium per day had still greater pressure-lowering effects.

Regular physical activity is another good step toward controlling or even preventing high blood

pressure. Start with 30 minutes of moderate-level activity, such as brisk walking, bicycling or

gardening on most—preferably all—days of the week. The activity even may be divided into three, 10-

minute periods each. For added benefit, these moderate half-hours may be increased or supplanted

by regular, vigorous exercise. Of course, prior to upping the activity level, people should check with

their physicians, especially if they have had heart trouble or a previous heart attack, a family history of

heart disease at an early age, or other serious health problems.

Another healthy move is to limit alcohol intake. Excess alcohol can raise blood pressure as well as

damage the liver, heart, and brain. Drinks should be kept to a maximum of one per day for women,

and two for men. (One drink equals 12 ounces of beer or five ounces of wine.)

Finally, quit smoking. Among other things, smoking damages blood vessel walls and speeds

hardening of the arteries. Ceasing smoking reduces the risk of heart attack in just one year.

Taking ControlHigh blood pressure is a silent killer, often with no obvious or visible symptoms. The only way to find

out if you have hypertension is through testing by your physician, who will make the diagnosis on the

basis of two or more readings taken on different visits.http://www.nlm.nih.gov/medlineplus/magazine/issues/fall11/articles/fall11pg10-11.html