In Heart Disease, Women and Men Are Not Created Equal

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It may seem as if heart disease affects mostly men, but in fact it’s the No. 1 cause of death for both genders—more people die from heart disease than all cancers combined. Perhaps even more surprising is that more women than men will develop heart failure or die within a year of a heart attack.

Medical professionals don’t completely understand why women have worse outcomes than men when it comes to heart disease. One factor, however, is that heart attack symptoms are often very different in women and in some cases aren’t as obvious. Like men, women may experience classic chest pain, but they may also have a variety of more general symptoms, including:

  • nausea or vomiting,
  • indigestion,
  • shortness of breath,
  • pain in the upper back or arm,
  • neck and jaw pain, or
  • unusual fatigue.

Sometimes these symptoms may fade and reappear.

Men and women often have different types of artery disease. This may be a key to why symptoms are not the same. Men are more likely to have significant blockage of a major artery whereas many women have no evidence of arterial blockage. Women are more likely to have microvascular disease, which affects the heart’s smaller blood vessels.

Because many people believe that women are less likely to have a heart attack—combined with the differences in symptoms—may be why women don’t always realize they are having one. As a result, they may not seek treatment immediately. In one study, women did not get medical treatment for an average of 50 hours, compared to fewer than 16 hours for men. A delay in treatment contributes to a greater chance of dying from a heart attack.

In the emergency room, the lack of classic heart attack symptoms can lead to misdiagnosis, resulting in a delay in treatment. Studies show that women are less likely to receive appropriate treatment for heart attack compared to men. Even when they are treated appropriately, women often experience a higher risk of complications.

Although there have been tremendous improvements in the treatment of heart disease in women, more still needs to be done. Increased education and improved training will help the general public and medical professionals recognize the differences between men’s and women’s symptoms. In addition, more clinical research is needed to understand the reason for these gender-related differences and to better personalize the management of heart disease in women.

February is American Heart Month. Visit the American Heart Association’s website to learn more about heart disease in women.

 

John ChathamJohn Chatham, DPhil, is a professor of pathology and director of the Division of Molecular and Cellular Pathology at the University of Alabama at Birmingham.

 

Why Marriage Is Good for Your Heart

Loving tourists in Cartagena

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Valentine’s Day is a time when many of us reflect on the importance of our closest relationships. Whether they include family, friends or a significant other, science is not silent on the impact these relationships have on our health. A review of 148 studies reveals that strong social relationships are associated with a 50 percent increased likelihood of survival, regardless of medical condition. Other studies link low social support to an increased risk and incidence of heart disease. The newest research, however, explores the effect our most intimate relationships—with a romantic partner—have on heart health.

A study that looked at more than 6,000 people reports that being single is associated with heart disease. Specifically, people who were single had a 45 percent higher rate of death from heart disease than those who were married. A striking finding in this study was that even though the reason for being unmarried varied among the participants—some people had never married, others were divorced, separated or widowed—the risks were consistently lower in married people. From these results, the overall benefit of the spousal relationship on heart health seems clear.

Many factors may account for the positive effect of marriage on heart health, including:

  • improved social support,
  • a less sedentary lifestyle, and
  • increased motivation to make healthy lifestyle changes.

The quality of marital relationships over time also influences heart disease risk factors. Men who described their relationships as “improving” had a lowering of risk factors compared to those in marriages categorized as “consistently good” or “deteriorating.”

In other words, marriage is generally good for your heart health and even better when you work to improve that relationship over time. So as you think about those closest to your heart on Valentine’s Day, do your heart a favor and take your sweetheart on a date.

Shawn Bender, PhD

Shawn Bender, PhD, is an assistant professor at the University of Missouri and a research health scientist at the Harry S. Truman Memorial Veterans’ Hospital.

Keeping the Juices Flowing with Beets

Beetroot Juice

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With the new year upon us, many people are setting new goals for themselves related to improving their health or focusing on career-related goals. If establishing better exercise and nutrition habits are part of your quest to attain optimal health and productivity in 2018, you are not alone. New gym memberships are likely to rise in the coming months, and some may try nutritional products such as fruit and vegetable juice concoctions touted to enhance performance and overall health. The global juicing industry has gained a lot of traction in the last several years due to a wider health awareness among consumers. Emerging evidence suggests that casting beets in the starring role of your juice habit—along with aerobic exercise—may be one potential route to improving your cardiovascular health, and more recently shown, brain health.

Beets are a good source of antioxidants, minerals and nitrates. The nitrate-rich properties of beets have caught the attention of researchers, particularly those in the field of vascular medicine. Nitrates in food are converted to nitric oxide in the body. Nitric oxide relaxes the walls of the arteries, lowering blood pressure and increasing blood flow to muscles. That is one of the reasons why the nitrates in beetroot juice have been shown to enhance exercise performance in high-performing athletes, as well as in less elite exercisers.

In addition to the cardiovascular and performance benefits of consuming beets, recent studies suggest that the root vegetable may also be linked to brain health. One study found that older adults who performed aerobic exercise for six weeks and drank beetroot juice daily had greater improvements in brain activity related to movement than the participants who exercised without drinking beetroot juice. The brain networks of the juicing group more closely resembled the brains of younger adults, suggesting that when combined with exercise, beets can enhance the brain’s ability to make new connections between brain cells. Another study showed that young adults who drank a single dose of beetroot juice had increased blood flow to the area of the brain involved in higher-order thinking. The study participants also fared better in cognitive tasks such as basic math.

So, before you lace up your running shoes or settle back into your office chair, consider topping off with a dose of beetroot to keep the juices flowing.

 

Yasina Somani cropYasina Somani, MS, is a PhD student in the Cardiovascular Aging and Exercise Lab at Penn State. She is interested in studying the effects of novel exercise and nutritional therapies on cardiovascular outcomes in both healthy and clinical populations.

 

Look on the Bright Side—It May Improve Your Health

half full

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If you tend to see the proverbial glass as half empty instead of half full, you may want to rethink your position. Looking on the bright side and expecting good things to happen may have a positive effect on your physical health. An optimistic outlook on life may reduce your cardiovascular disease risk, lower blood pressure and improve overall health and longevity. It can also reduce sensitivity to pain and may help people manage chronic pain more easily.

You may be skeptical or cautiously optimistic about this. How can simple optimism lead to good health? The answer is still not entirely clear, but scientists are slowly uncovering the biological details. They’ve learned that the body’s response to stress may be an important factor.

When the body is stressed, it sends biological messengers called stress hormones into the bloodstream to tell different organs to respond in various ways. One of the major stress hormones is cortisol. When cortisol is high, the body responds by making unhealthy amounts of certain substances (such as cholesterol) that can harm the heart. These substances may damage and cause inflammation in the blood vessels. Inflammation may also lead to more damage in the circulatory system. This unfavorable chain of events may increase the risk of heart disease.

People who look on the bright side may be more likely to have markers of good health—including lower stress hormone levels—even when they face stressful situations. One study found rats with pessimistic behavior traits had more inflammation than their optimistic counterparts. Lower cortisol and inflammation levels may be due to decreased activity of the fight-or-flight nervous response, although more research is needed.

Motivation may also play a role in boosting the health of optimists. People who think positively may be more motivated and tend to make more of an effort in social interactions than those who are pessimistic. This can lead to healthier social connections and an increase in beneficial behaviors such as exercising regularly and following a healthy diet. The motivational aspects of optimism (or pessimism) may also affect a person’s behavioral response to stress.

December 21 is “Look on the bright side” day. Try a visualization exercise to boost your optimism. It may have a positive effect on your overall health.

Audrey Vasauskas

Putting Out Fires Hurts Firefighters’ Hearts

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As the temperature outside rises, our bodies make adjustments to keep our internal temperature constant to prevent us from overheating through a process called thermoregulation. This includes bodily functions such as sweating and widening of the blood vessels (vasodilation). When we sweat, perspiration evaporates from our skin to cool us down. When the blood vessels under our skin widen, our heart pumps more blood to our skin, which releases more heat from our inner body.

Our bodies are constantly working to hold a steady core temperature around 98-100 degrees Fahrenheit (F). This allows our organs to function properly. But when the temperature outside is extremely hot, our temperature can start to rise. A person with a body temperature above 104 degrees can develop heat stroke. This can cause dizziness, difficulty breathing, confusion, seizures or loss of consciousness. Brain and heart damage—sometimes permanent—can occur when body temperature climbs above 107 degrees F.

Too much summer heat can be unhealthy for everyone, but it can be especially dangerous to firefighters. The incidence of fires increases in the U. S. during the summer months. Firefighters fight almost twice as many fires in the summer compared to the rest of the year. On top of dealing with the extreme heat (sometimes over 700 degrees F!), these first responders face extreme physical exertion, mental stress and smoke inhalation on the job. All of these factors together can place firefighters in immediate danger of heat exhaustion, heatstroke and heart problems. In fact, firefighters are up to 136 times more likely to die from coronary artery or heart disease during or soon after they suppress a fire.

In a study published in Circulation last month, researchers may have uncovered several reasons why putting out fires puts firefighters at risk for heart disease. They discovered that a single, 20-minute session of fire simulation training—where healthy firefighters were exposed to physical activity in the extreme heat (about 755 degrees F)—was enough to injure their blood vessels, even though the firefighters’ core body temperature never reached above 101 degrees F. The problem: Although the firefighters’ bodies did keep their core temperature within a healthy range, their blood vessels did not relax properly immediately after the training. Also, as a result of the training, the firefighters’ blood clotted more easily. Damaged blood vessels and increased clotting of the blood can be very harmful to the heart and sometimes can lead to a heart attack.

This research shows us that even when we are able to keep our body temperature from getting too high, there are hidden dangers of being physically active in extremely hot temperatures. So keep your heart healthy this summer and don’t overexert yourself while outdoors!

Dao Ho, PhD

Dao H. Ho, PhD, is a biomedical research physiologist at Tripler Army Medical Center. The views expressed in this blog post are those of the author and do not reflect the official policy or position of the U.S. Department of the Army, U.S. Department of Defense or the U.S. government.

When’s the Best Time to Eat? Your Body Clock Knows

 

Two teenager girls, sisters, eats fastfood on the street

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The American Heart Association recently released a statement suggesting that when and how often you eat could affect your risk for developing heart disease and stroke. Until now, the focus on diet has been primarily about how much and what you eat. This news—that the time of day you eat may also be important—could change the way people are able to manage their health.

Our bodies have natural daily patterns called circadian rhythms that occur roughly over a 24-hour cycle. Many biological processes are driven by circadian rhythms, including when you go to sleep and wake up, your body temperature, heart rate, blood pressure and the release of various hormones. A “master clock,” a tiny group of cells called the suprachiasmatic nucleus (SCN), located in the hypothalamus area of the brain manages circadian rhythms. This master clock is mostly controlled by changes in light.

Every cell in the body also has its own internal clock called a “peripheral clock.” Peripheral clocks make sure all of the cells’ functions are coordinated with the master clock. Animal studies show us the importance of keeping peripheral clocks in sync with the brain’s master clock. For example, when the peripheral clock in a mouse’s heart is disrupted, the mouse develops heart failure and dies at a much younger age than normal mice.

Unlike the master clock, peripheral clocks are more responsive to the availability of food than changes in light. As a result, eating at the “wrong” time of day could shift the rhythms of the peripheral clocks so they are out of sync with the master clock. For example, shift workers who work in the middle of the night are active when they would normally be asleep and eat at times when their body doesn’t expect food. They are at much greater risk for being overweight, becoming insulin resistant and developing cardiovascular disease because their master and peripheral clocks are likely to be out of sync.

Research in mice has shown that if they consume a high-fat meal at the end of their active period (the equivalent of a high-fat dinner for humans) they gain more weight, develop insulin resistance and have impaired cardiac function compared to mice that eat the same high-fat meal at the beginning of their active phase (breakfast).

Studies in people suggest that eating meals late in the day is linked to negative health effects, but a direct relationship has not been shown. Nevertheless, if when you eat is just as important as what you eat, it might not hurt to eat your larger meals earlier in the day if you can.

 

John Chatham

John Chatham, DPhil, is a professor of pathology and director of the Division of Molecular and Cellular Pathology at the University of Alabama at Birmingham.

Go Ahead, Wear Your Heart on Your Sleeve!

Jousting Competition

A jousting knight wears his heart on his sleeve. Credit: iStock

In medieval times, a jousting knight would wear the colors of the lady he was courting tied around his arm. Hence, the phrase “Wear your heart on your sleeve” was born. Today, we use this romantic phrase to describe someone who expresses their emotions openly. How applicable that ancient phrase really is to maintaining a healthy heart!

In a landmark paper, a group of scientists discussed how stress and social interactions with others affected the health of the heart. It is well-known that stress is a major factor in the development of heart disease. This is because stress is a double whammy: It activates the “fight-or-flight” nervous response, and it causes inflammation in the cells that line blood vessels. Both of these events can damage blood vessels in the heart.

Research shows that positive social interaction expressing emotion is important for heart health. Support from a spouse or partner, friends or other groups can reduce stress and help you stick to a healthy diet and exercise program to minimize your risks.

Heart disease is the leading cause of death worldwide, with annual deaths creeping up to 24 million. Reducing stress and anxiety is an important aspect of keeping your heart healthy. Exercise, yoga, meditation and even deep breathing can promote a sense of calm when tensions mount. Try running or yoga with a friend or join an exercise class to keep you on track for a healthy heart. Go ahead, wear your heart on your sleeve—it’s good for you!

February is American Heart Month. You can find more information about keeping your ticker ticking on the American Heart Association’s website.

Audrey Vasauskas

Bring on Winter! (But Stay Safe and Healthy)

 

girl playing on a winter walk

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Winter officially begins next week with the winter solstice—the day of the year with the fewest hours of sunlight—on Dec. 21. With the cold weather and shorter days, you might be tempted to curl up under a blanket until the spring thaw. Whether you plan to hibernate or get outside to enjoy the chill, we’ve got some good reads about how our physiology responds to the cold weather.

Check out these throwback posts featuring cold weather tips to help you stay safe and healthy during the coldest months:

Have fun, be safe and take note of how your body adapts to the season!

Stacy Brooks and Erica Roth

 

 

Can Alcohol Cause Irregular Heartbeat?

red wine

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Alcohol and heart health have a complicated relationship. Recent research suggests that moderate drinking may reduce your risk of stroke. But for some people, even one or two drinks a day may increase the risk of a form of heart disease called atrial fibrillation (AFib).

AFib is an irregular heartbeat of the two upper chambers of the heart (atria). During an episode of AFib, the atria beat quickly and out of synch with the lower chambers of the heart (ventricles). This irregular pattern can cause blood to clot in the heart, which also increases the risk of stroke.

A recent study published in the Journal of the American Heart Association suggests that over time, moderate alcohol consumption may cause the left atrium to become larger. The enlargement of the heart chamber can lead to AFib in some cases. This is one of the first studies to show in a large population of humans that structural changes in the heart can cause AFib. Previously, AFib had been thought to arise as a result of problems with the electrical impulses in the heart.

For most people who follow a heart-healthy diet, exercise and don’t have high cholesterol or high blood pressure, the occasional drink probably won’t hurt or lead to AFib. However, it’s a good idea to be aware of the alcohol-related heart disease risk as office parties and family gatherings get into full swing this holiday season.

Learn more about atrial fibrillation from the Mayo Clinic.

Erica Roth

Looking for a New Physical Challenge? Try a Mountain Ultra-Marathon

Idyllic Alps Valley

The Aosta Valley in Italy where the Tor des Geants is held. Credit: iStock

Of all the extreme endurance races out there—such as the Ironman triathlon or 50- or 100-mile marathons—the Tor des Géants ultra-mountain marathon may be the most extreme. The course is 205 miles long on the rugged terrain of the Italian Alps with a cumulative elevation gain of 24,000 feet. Participants have 150 hours, little more than six days, to complete the course. These feats of ultra-endurance are fascinating for scientists because they showcase how the heart adapts when pushed to the limit. Previous studies have found that after 3- to 15-hour races like marathons and the Ironman triathlon, the heart doesn’t pump as well, a condition referred to as exercise-induced cardiac fatigue. A group of French researchers looked at what happened to the heart after running for over 100 hours in the Tor des Géants. They were surprised to find that unlike with marathons and triathlons, heart function improved after the ultra-mountain marathon race.

During a heartbeat, the heart fills with blood and then squeezes together to push out the blood. In situations in which the body constantly needs more oxygen, such as with exercise, the amount of blood filling the heart is one signal that tells the heart to keep beating harder. The more the heart fills, the stronger the heart contracts.

This study found that the runners’ hearts filled more during each heartbeat. The researchers think it’s because the amount of plasma, which is the liquid portion of blood, increased, raising the overall amount of blood in the body. But why it increased is not clear. Fluid intake could be one factor, says Michael Joyner, MD, an exercise physiologist not involved in the study, in a podcast. Runners in ultra-long races pay extra attention to staying hydrated and often maintain or gain weight from the extra fluids, he says. Stéphane Nottin, PhD, the lead investigator of the study, wonders if inflammation from the extreme physical stress or greater retention of sodium (the kidneys use sodium to absorb water) is also involved.

“Physiology has a long history of expedition-led investigations—whether it’s high altitude, desert—and this paper follows in that wonderful tradition,” Joyner says. Other current ongoing studies in this spirit include a Mount Everest climb to examine cognitive decline at low oxygen levels and a study on the heart of a swimmer swimming across the Pacific.

 

Maggie KuoMaggie Kuo, PhD, is the former Communications and Social Media Coordinator for APS. Catch more of her writing in the Careers Section of Science Magazine.