Is Comprehensive Screening Good Enough to Detect Sudden Cardiac Death?

Is comprehensive heart screening sufficient for young people who are engaging in aggressive exercises such as Marathon running, military training, etc? Should they also undergo additional testing with treadmill exercise and echocardiography (cardiac ultrasound)?

What is sudden cardiac death? As defined by American Heart Association, sudden cardiac death (SCD) or cardiac arrest is the sudden, abrupt loss of heart function in a person who may or may not have diagnosed heart disease. It just occurs immediately or shortly after the symptoms appear.

Every year, sudden cardiac death causes about 166,200 deaths among adults in the United States before reaching a hospital or emergency room.

For people below the age of 35, SCD has many causes. Not all of these causes are due to cardiac problems and only some of these can be detected by screening. Patients who die suddenly are commonly caused by cardiovascular disease, in particular, coronary heart disease (CAD), but it rarely happens to younger age group.

No doubt treadmill ECG stress testing can be used to detect CAD. Nevertheless, it does have its own limitations. For example, it has a false positive result of 10 to 20 percent. In other words, if CAD occurs in 1 per 1,000 people screened, out of 25,000 persons tested, 25 might have CAD. This means that 2,500 to 5,000 might have false positive stress results, and these people have to undergo further testing, such as nuclear imaging and coronary angiography, which may have other risks such as radiation exposure.

It is unjustified to place such a big percentage of people to these risks, as this would certainly outweigh the benefit of detecting a few with CAD. Obviously, stress testing should only be used for those at higher risk such as older men or those with significant risk factors for heart disease.

For youngsters, a more common cause of SCD is hypertrophic cardiomyopathy (HCM). It is an inherited condition with abnormal thickening of the heart muscle. People with HCM will show ECG abnormalities.

In fact, adding ECG to a history and physical examination in athletes, and referring only those with ECG abnormalities for more tests was proved to be an effective mean to minimize the risk of SCD due to HCM. Such approach has also been shown by studies in Italy and endorsed by the International Olympic Committee and European Society of Cardiology.

Meanwhile, prevention and control of risk factors like diabetes, high cholesterol, hypertension (high blood pressure), obesity, and smoking through healthy lifestyles should be encouraged to reduce SCD.

Heart Damage May Be Reduced By Folate!

When the blood flow is cut off, the damage to the heart muscle could be reduced with the help of high doses of folate, as suggested by an animal study carried out by researchers from Johns Hopkins Medical Institutions in Baltimore. The findings were published in the April 2008’s addition of “Circulation”.

What is folate? It is a water-soluble B vitamin obtainable from food. The synthetic form of folate that is found in supplements and added to fortified foods is known as folic acid. Folate helps produce and maintain new cells. It can be found in natural foods like leafy vegetables (such as spinach and turnip greens), fruits (for example, citrus fruits and juices), and dried beans and peas.

In the animal study, rats were treated with folate or placebo. After 1 week, their left coronary arteries were blocked for 30 minutes. As we know, blood normally carries oxygen to the heart muscle. Any sudden and severe blockage could just trigger a heart attack or an abnormal heart rhythm, which is considered as fatal conditions.

The researchers performed a 90-minute of reperfusion to some rates and do nothing to the others. Reperfusion is the restoration of the coronary blood flow to the heart muscle. Preserving or restoring heart function is a necessary procedure, but it can well cause a disturbance in the function of the cells in the heart muscle known as reperfusion injury.

Rats that were treated with folate had significantly less functional damage of the heart than those that were treated with placebo. When the researchers looked at reperfusion, smaller areas of dead heart muscle were found among rats pretreated with folate.

Further analysis also indicated that folate might have achieved these beneficial effects, in part, by maintaining levels of the high-energy phosphates ATP and ADP in the heart.

Despite of the positive findings, the researchers felt that it is still premature for people to start taking high doses of folate. However, if future studies on human beings can prove equally effective, then high-dose folate could be given to those people with high-risk factors (diabetes, heart disease, high blood pressure, high cholesterol, etc.) for preventing possible heart attack or to people who have suffered heart attack.

Can Aromatherapy Products Help Relieve Stress?

People spend a fortune on aromatherapy products marketed by health and beauty companies believing that this would help them relieve their stress and improve their health conditions. Stress is known to be a risk factor for heart disease, high blood pressure, cancer, and many other medical disorders.

However, a recent study by a group of researchers at Ohio State University might just make them disappointed. The researchers reported in April 2008 in the Journal “Psychoneuroendocrinology” that these expensive scented oils may help people’s mood but would not do much on their health. Just like many home remedies, there is no hard evidence to support that these so-called ‘good smell’ would be good for the body.

Knowing that the placebo effect could have a very strong impact on one’s health, the researchers hope to test the claimed stress-relieving and healing properties of 2 of the most popular aromatherapy scents, lavender and lemon, in a measurable way.

In the study, 56 healthy male and female volunteers underwent a series of tests over 3 half-day sessions. Each of them was tested in advance to make sure that each had a normal sense of smell.

To test the impact of the smells, the nostrils of the participants were taped with cotton balls laced with essential oils and distilled water.

To see if the smells could help manage pain responses, the subjects’ feet were dunked in ice-cold water.

To see if it would improve healing, a standard test was performed in such a way that tape was applied and removed repeatedly on the same spot of skin.

To test the impact on the mood, the subjects were asked to complete 3 standard psychological tests during each session.

To test the impact on stress levels, the subjects’ period blood tests were taken and their blood pressure and heart rates monitored.

The series of experiments conducted on lemon or lavender oils did not show any positive health effect on the immune system or on the body’s ability to mitigate pain or stress. Nevertheless, the lemon oil did show a clear mood enhancement

The researchers claimed that the current study is probably the most comprehensive study ever done in the area, but they admitted that they still failed to discover any quantitative results on whether these oils provide any physiological effect for people in general.

The human body is infinitely complex. Therefore, if one uses these oils and feels better, there is no way for scientists to prove that it does not improve that individual’s health.

In conclusion, good smells may make people feel better but one should not rely on them to change the physiology.

What Is the Link Between Sleep Duration and Stroke?

I used to hear from friends or relatives that one should sleep at least 8 hours per night to stay healthy. Is this a justified statement? Does it mean that we should sleep as long as we can?

In reality, “the more is better” may not be true, at least not for the sleep duration.

A report published in July 2008 in the medical journal “Stroke” indicated that middle-aged women who slept 9 hours or more per night would have their risk of stroke increased by 70 percent. This is the finding obtained by United States researchers from the University of North Carolina in Chapel Hill.

Although a number of studies have established a link between sleep duration and mortality, there is still a lack of evidence to associate sleep patterns and cardiovascular disease.

Of the 93,175 women of age between 50 and 79, who were enrolled in the Women’s Health Initiative Study, 8.3 per cent normally slept no more than 5 hours per night, while 4.6 percent slept at least 9 hours per night.

At the end of the study (span over a period of average of 7.5 years), it was found that 1,166 women got ischemic stroke. This is the most common type of stroke, which occurs when blood vessels in the brain block. When this happens, oxygen will be prevented from reaching the brain and will thus cause the brain's tissue to die.

When comparing with women sleeping 7 hours, those slept 6 hours or less, 8 hours, or 9 hours or more increased the risk of stroke by 14 percent, 24 percent, and 70 percent, respectively.

For women who slept 6 hours or less and had cardiovascular disease at the beginning of the study, their chance of getting stroke was increased by 22 percent. Furthermore, women who slept longer hours during the night were not associated with frequent snore or sleepiness. Therefore, sleep during, either shorter or longer than the norm (7 hours), could be independent risk factors for stroke.

Women sleeping long hours during the night is not so common than those who slept less than 6 hours, therefore, the overall health impact of a short sleep is probably greater than long sleep.

However, the researchers caution that their data do not imply that women of long sleep duration would cut their risk of stroke if they reduce their sleep duration. Further studies are still required to help understand the possible mechanisms behind the associations found in this study.

Will Weight Loss Drugs Benefit Obese Patients?

While some doctors do agree upon the difficulty to help overweight or obese patients lose weight successfully by taking weight loss drugs alone, others would think that the few kilos loss would make a significant difference for patients suffering from heart disease or diabetes problems. Nevertheless, those people who take the drugs for cosmetic reasons may not see much benefit.

A study carried out by researchers from the University of Alberta in Canada revealed that patients on weight loss drugs might lose little more than their money, and yet face many unpleasant side effects. The report, which was published in the “British Medical Journal” on November 16, 2007, indicated that close to 20,000 patients, weighing an average of 100 kilos lost less than 5 kilos because of these weight loss drugs. These patients had been on one of 3 weight loss drugs, Xenical, Reductil and Accomplia for one to 4 years.

The meta-analysis using data from 30 clinical trials found that up to 30 percent of the patients on Xenical had unpleasant digestive and intestinal side effects, such as incontinence. On average, they lost 3 kilos.

Patients who took Reductil lost 4 kilos and had improved cholesterol levels, but up to 20 percent of the patients suffered from high blood pressure, raised pulse rates, insomnia and nausea.

Accomplia was most effective as patients taking this drug lost the most weight, 5 kilos on average along with improved blood pressure and cholesterol levels. Nevertheless, the 6 percent of the patients had an increased risk of mood disorders.

In fact, another study reported also on November 16, 2007 in medical journal “The Lancet that patients who were prescribed Accomplia were very likely to suffer from depression, anxiety and even suicidal tendencies.

The worldwide annual sales of these 3 medicines is closed to US$1.2 billion. These drugs are meant for severely obese people, and many of them suffer from or are at higher risk of heart disease and diabetes.

Despite the side effects, which were explicitly listed by the drug manufacturers, many doctors do prescribed them to selected patients. According to their argument, fat people who lose 4 kilos could cut their risk of getting diabetes by 30 to 40 percent, and for those already suffer from diabetes, 4 kilos loss in weight would cut their blood sugar level and their risk of getting heart disease.

Would Fruit Juice Benefit Women with Type-2 Diabetes?

Eat more vegetables and fruits to stay healthy! You would probably hear this very common statement frequently. How about fruit juice, is it good for health?

A recent study published in July 2008 by Tulane University School of Public Health and Tropical Medicine, New Orleans indicated that “women with Type-2 diabetes” should stay away from fruit juice. They should eat green leafy vegetables and whole fruits, instead, if they wish to ward off Type-2 diabetes.

The researchers found that with an additional 3 servings of whole fruit daily, or one more serving of spinach, kale or similar leafy green vegetable, the risk of developing diabetes over an 18-year-period was reduced among the 71,346 women enrolled in the Nurses’ Health Study.

The decrease was only modest, so if one with many other risk factors, for example, unhealthy diet, smoking, emotional stress, overweight, etc., then this may not be able to prevent one from diabetes, the researchers added.

Diabetes is a very common disease that affects some 150 million people worldwide. A person with diabetes will have high levels of sugar in their blood. This will lead to heart disease, heart attack, stroke, blindness, kidney failure, etc. if it is not managed appropriately.

In the study, 4,529 women, who developed Type-2 diabetes, were being followed and their data on the diets were analyzed. These women were divided into 5 groups based on fruit and vegetable intake, and on fruit juice consumption.

It was found that an additional of 3 servings a day of whole fruit would reduce the risk of Type-2 diabetes by 18 percent, while a single additional serving of leafy green vegetables only cut the risk by 9 percent. When an additional daily serving of fruit juice was introduced, the likelihood of developing diabetes was increased by 18 percent. A possible reason for such an increase in risk could be the big sugar load coming in liquid form that is absorbed rapidly.

The new findings seem to be contradicting with the current national dietary guidelines in United States, which recommend using 100 percent fruit juice to replace a serving of fruit. While the findings must be replicated, the researchers still warn people who wish to replace some beverages with fruit juices as healthier options to implement with caution.

Are There Gender Differences In Metabolizing Fructose?

Fructose is a simple sugar commonly used for sweetening drinks and foods. Short-term high fructose intake among young people is rather common. However, it appears that men and women have their own way of metabolizing high levels of fructose.

For men, such pattern of consumption will cause their blood triglycerides (fats) to increase and insulin resistance to decrease. This will also raise their risk for cardiovascular disease and Type-2 diabetes. On the other hand, women seem to get rid of the excess sugar load in a less harmful way.

In a study to evaluate the relationship between nutrition and metabolic disorders, researchers from Lausanne University School of Biology and Medicine in Switzerland enlisted 8 each of healthy, non-smoking men and women of normal weight and about 23 years of age to participate in 2 different 6-day diets separated by a 4-week wash-out period. The findings of the study were published in “Diabetes Care”

Not participated in sports or exercise, these men and women followed either the 'control' diet or the diet that included a lemon-flavored drink containing 3.5 grams of fructose.

The fructose load used for the study corresponded to several liters of sodas per day, which was considered quite large. 12 fasting metabolic parameters of the participants were tested the day after they completed each diet.

Fructose supplementation caused the men a significant increase in 11 of the 12 factors, including a 5 percent increase in fasting glucose and 71 percent increase in triglyceride levels. However, women had a significant increase in only 4 out of the 12 factors tested, and showed a 4 percent increase in fasting glucose and 16 percent increase in triglyceride levels.

As the current study only involved a very small number of participants, the researchers felt that further studies should be carried out to include a larger population so that gender differences in metabolic pathways could be accurately be identified and confirmed.

Meanwhile, the researchers also wonder if fructose may have effects that are more deleterious in individuals who are at high risk of metabolic disorders.