Yo-yo dieting hikes death, heart risks in overweight heart disease patients

UNTV News   •   April 6, 2017   •   2825

FILE: Reuters

(Reuters Health) —  For overweight people with heart disease, trying and failing to lose weight may be more dangerous than not losing weight at all.

A new retrospective study has concluded that patients whose weight fluctuates the most die twice as quickly or have twice the risk of heart attack or stroke compared to people who maintain a stable body weight.

And their risk of developing diabetes grows by 78 percent.

The findings, which need to be confirmed by further research, suggest a life-and-death conundrum. Being overweight is already known to pose serious health risks. The new research says dropping the pounds and putting them back on again poses additional dangers.

If you are an overweight person with heart disease who lost 20 pounds “you are worse off if you drop your weight and gain it back” than if you didn’t lose it in the first place, chief author Dr. Sripal Bangalore, an interventional cardiologist and associate professor of medicine at New York University’s Langone Medical Center told Reuters Health by phone.

The study is saying, “If you’re going to lose weight, do it right and you need to take it seriously,” said Dr. Ira Ockene, a professor of medicine at the University of Massachusetts Medical School in Worcester, who was not connected with the research.

If people use the results as an excuse not to drop unhealthy pounds, “that would be unfortunate,” Ockene told Reuters Health. “There’s a lot of data that says if you lose weight and keep it off, you do better.”

“Hopefully this will be used as a motivation to lose weight and maintain weight,” Bangalore said.

Such yo-yo dieting, where a person’s weight fluctuates repeatedly, is already known to be unhealthy in people without heart disease.

The new study in the New England Journal of Medicine explored whether that was specifically true for people with coronary artery disease, where fatty deposits have built up in the blood vessels feeding the heart muscle. The researchers recycled data from 9,509 volunteers who were part of a Lipitor study published in 2005 and sponsored by Pfizer.

Another important limitation of the study: It did not examine whether patients lost weight because they tried to, or if their weight fluctuated because they were battling illness.

After adjusting for various factors such as high blood pressure, smoking, race, gender, diabetes, cholesterol levels and treatment with Lipitor, the Bangalore team found that people whose weights fluctuated the most were 2.24 times more likely to die from any cause within about five years, 2.17 times more likely to have a heart attack and 2.36 times more likely to be hit with a stroke than people whose weights were the most stable.

For every 3- or 4-pound change in body weight, their risk of heart attack, cardiac arrest, chest pain, death from heart disease or the need for surgery to open a clogged artery rose by 4 percent.

The dangers posed by shifting weight were least pronounced in people who had a normal weight to begin with.

Ockene said people need to put weight loss in perspective.

“Studies show people set unattainable goals. Heavy people say, ‘I need to lose 40 pounds’ and they set a goal that is largely unattainable. And when they lose 10 pounds they’re disappointed. And they say, ‘What the hell’ and they just gain it back,” he said.

“But if you lose 10 pounds and keep it off, your diabetes will be better, your blood pressure will be better, your lipids will be better, a lot of things will be better. You don’t need to lose 30 or 40 pounds,” he said. “That’s an important issue for people to understand.”

As a typical example of patients in the study whose weights fluctuated significantly, the researchers cited the case of a 53-year-old man whose weight went from 231 pounds to 244 pounds three months later, then dropped to 211 pounds eighteen months later before going up to 253 pounds after another 18 months had passed. — The dangers posed by shifting weight were least pronounced in people who had a normal weight to begin with.

Ockene said people need to put weight loss in perspective.

“Studies show people set unattainable goals. Heavy people say, ‘I need to lose 40 pounds’ and they set a goal that is largely unattainable. And when they lose 10 pounds they’re disappointed. And they say, ‘What the hell’ and they just gain it back,” he said.

“But if you lose 10 pounds and keep it off, your diabetes will be better, your blood pressure will be better, your lipids will be better, a lot of things will be better. You don’t need to lose 30 or 40 pounds,” he said. “That’s an important issue for people to understand.”

As a typical example of patients in the study whose weights fluctuated significantly, the researchers cited the case of a 53-year-old man whose weight went from 231 pounds to 244 pounds three months later, then dropped to 211 pounds eighteen months later before going up to 253 pounds after another 18 months had passed. — By Gene Emery

SOURCE: bit.ly/2nognpI New England Journal of Medicine, online April 5, 2017.

College student viral for graduating in a wheel chair passes away

Aileen Cerrudo   •   March 28, 2019

QUEZON CITY, Philippines — Smart, humble, and a good friend. That is how Joemar Kenik Mangkok’s friends describe him.

Joemar’s story became viral after his sister, Lyn Mangkok-Ayob, posted his graduation ceremony on Facebook .

#LABANPUSO…datu congrats🎓 dahil e2 na ang pangarap natin lahat na maabot mo ang araw na e2😭😭😭.sana gumaling kana at kc…

Posted by Lyn Mangkok Ayob on Saturday, 23 March 2019

Noor Galmak Mopak, one Joemar’s friends, said they have been together since first year college. They were even co-interns. Noor, Joemar and the rest of their friends made a promise to one another.

“First year pa lang po kami may pangako kami sa isa’t isa na kahit anong mangyari, sabay-sabay kami ga-graduate (Ever since first year, we promised that all of us will graduate together, no matter what ) she said.

Joemar graduated on March 22, Friday, at Southern Mindanao Institute of Technology Inc. in Sultan Kudarat. He graduated with a degree of Bachelor of Arts in Secondary Education, major in Mathematics.

He had been suffering from rheumatic heart disease for five years and no matter what happened, he kept his promise.

Despite being unable to walk and despite the heaviness of his oxygen tank, he went up the stage and accepted his diploma.

No illness could stop him.

After receiving his diploma, Joemar was rushed to the hospital and went into a coma on March 25.

On Tuesday, his sister Lyn announced his passing.

Lyn expressed her heartfelt thanks to everyone who sent their support. In her previous post, she expressed her wish for her brother after he graduated in college.

“Sana maging inspirasyon ka sa mga kabataan. We love you so much datu (I hope you become an inspiration to the youth)—Aileen Cerrudo

Air quality linked to cardiac ‘events,’ heart disease patients unaware

UNTV News   •   April 18, 2018

FILE PHOTO: A cyclist wears a mask as he cycles near Buckingham Palace in London April 2, 2014. REUTERS/Luke MacGregor

Poor air quality with high levels of tiny pollution particles known as PM 2.5 are tied to a spike in emergency department visits for heart- and lung-related illnesses and stroke, a California study suggests, but a nationwide U.S. survey finds that few heart patients are aware of air quality risks.

Based on analysis of areas affected by the intense 2015 California wildfire season, researchers found that within a day of residents being exposed to dense smoke, emergency room visits for heart attacks and other cardiac events and symptoms rose by 15 percent overall, and 42 percent among people over age 65.

Stroke and other cerebrovascular emergencies rose 17 percent overall, and 22 percent for older adults, the study team reports in the Journal of the American Heart Association.

“Unlike places that have chronic exposure to poor air quality where we can educate people about the health risks, wildfires happen at unexpected times,” said senior study author Ana Rappold of the U.S. Environmental Protection Agency’s National Health and Environmental Effects Research Lab in Durham, North Carolina.

“Wildfires have become a leading cause of short-term exposure to polluted air,” she said in a telephone interview. “It’s important to talk to people about how exposure to wildfire can impact their health.”

Large-scale wildfires are projected to increase through the end of the century in many areas, particularly in California, Rappold and her colleagues note in their report. Wildfire smoke contains several pollutants, including carbon monoxide, nitrogen dioxide and ash particles that have been associated with lung and heart problems.

It also contains tiny particles, smaller than 2.5 micrometers, that are produced by burning, such as in wildfires, indoor cooking fires and motor vehicle exhaust.

These particles are small enough to enter the bloodstream from the lungs and are linked to inflammation, heart rhythm disturbances and clotting issues, the authors write.

Rappold and colleagues analyzed emergency room visits between May 1 and September 30, 2015 in eight northern and central California basins where fires covered more than 800,000 acres of land.

Based on data from the National Oceanic and Atmospheric Administration, the research team followed smoke plumes and particulate matter concentrations as they moved across the state. They also looked at emergency room data for diagnoses such as heart attack, angina, cardiac dysrhythmia, pulmonary embolism, stroke, asthma, COPD and pneumonia.

The researchers found 361,000 cardiovascular, 15,500 cerebrovascular and 230,000 respiratory diagnoses. Emergency room visits for heart issues were associated with wildfire smoke density for all adults and were more pronounced for those over age 65. Brain and lung issues were also more severe among older adults, especially on medium- and dense-smoke days.

“We have an aging population in this country with increasing obesity, diabetes and associated heart and lung diseases, and we have an increasing number of acres that burn every year,” said one of the study’s coauthors, Dr. Wayne Cascio, who directs the EPA National Health and Environmental Effects Research Lab.

“We also have an increasing number of people encroaching on acres that have a high likelihood of burning,” Cascio said in a telephone interview. “That’s the perfect storm of increasing the number of people who are at risk for wildfire exposure.”

In future studies, the EPA team plans to look at how long wildfire smoke and particulate matter lingers in the air and causes health problems, as well as how these air pollution exposures affect healthcare expenses through programs such as Medicare.

They’ve also launched Smoke Sense (bit.ly/2gFdHTV), a mobile app that encourages people to submit information about wildfire exposures and their health and productivity.

“I tell my patients that if they have heart or lung disease, they need to be mindful about poor air quality and smoke from wildfires,” Cascio said. “Avoid them to the extent that you can and look at EPA resources or others to plan what else you should do.”

In a separate study by a team at the Centers for Disease Control and Prevention in Atlanta, researchers found that people with lung disease are more likely than those with heart diseases to be aware of the risks they face during poor air quality alerts.

The research team analyzed surveys of more than 12,000 U.S. adults between 2014 and 2016. About half of participants were aware of air quality alerts, 27 percent said they avoided busy roads to reduce their exposure and 3 percent said they had talked with a health professional about ways to avoid exposure to air pollution. Compared to the other survey participants, awareness of air quality alerts was 11 percent more common among people with asthma and avoidance of busy roads was 13 percent more common. People with asthma were also five times more likely to have spoken with a doctor about avoiding pollution exposure.

“Targeted public health messages about air quality might raise awareness about alerts and motivate changes in behavior among those at risk during periods of unhealthy air quality,” said lead study author Maria Mirabelli of the CDC’s Asthma and Community Health Branch.

“Be aware of air quality alerts and discuss with a health professional the strategies to reduce air pollution exposure,” Mirabelli advised in an email. “Avoid busy roads to reduce exposure when walking, biking or exercising outdoors.”

SOURCES: bit.ly/2HGf8hz Journal of the American Heart Association; online April 11, 2018; and bit.ly/2HpUapo American Journal of Preventive Medicine, online March 15, 2018.

Many breast cancer survivors may die of heart disease, doctors warn

UNTV News   •   February 8, 2018

FILE PHOTO: A breast cancer patient listens to her doctor after a radiological exam in a file photo. REUTERS/Yannis Behrakis

(Reuters Health) – The same advances in breast cancer treatment that have dramatically improved survival in recent years have also left a growing number of women vulnerable to potentially fatal cardiovascular problems, the American Heart Association warns.

Chemotherapy can weaken the heart muscle, some newer targeted medicines can increase the risk of heart failure, and radiation can cause heart rhythm disorders and structural damage in the arteries and heart valves, the AHA emphasizes in its scientific statement on the link between breast cancer and heart disease.

Cardiovascular disease is the number one cause of death in women, and this risk increases with age, noted Dr. Laxmi Mehta, lead author of the statement and section director of preventive cardiology and women’s cardiovascular health at the Ohio State University Medical center in Columbus.

“So as breast cancer survivors are living longer, their risks of cardiovascular disease increase,” Mehta said by email.

Breast cancer survivors, especially women over age 65, are more likely to die from cardiovascular disease than tumors, the AHA statement stresses.

This doesn’t mean women should skip lifesaving cancer therapies, but it does mean they should be aware of the cardiac side effects and be monitored for cardiovascular disease during treatment and afterwards, Mehta added.

“Any patient who is going to undergo breast cancer treatment, whether they have heart disease at the beginning or not, should be aware of the potential effects on their heart,” Mehta advised.

Several cancer treatments have long been linked to an increased risk of heart problems in the future.

For example, anthracyclines, such as doxorubicin, are a type of chemotherapy that has been used since the 1970s and can cause irreversible damage to the left ventricle, the heart’s main pumping chamber.

And taxanes, such as paclitaxel, have been linked to irregular heart rates and rhythm disorders.

Trastuzumab and pertuzumab, targeted therapies for an aggressive type of malignancy known as HER-2 positive breast cancer, can also damage the left ventricle but this damage may be reversible after treatment stops. Women who develop heart failure while taking these drugs may be able to alter treatment to help prevent worsening or permanent cardiac damage.

Another chemotherapy – doxorubicin – can damage heart cells, but the risk of heart failure may be reduced when the medicine is administered slowly, rather than all at once. Women taking this medicine may also reduce their risk of heart failure by pairing it with another drug, dexrazoxane.

Radiation can damage arteries and cause blockages, but newer techniques can deliver lower and more targeted doses of radiation that are less toxic to the heart than standard regimens a generation ago.

Heart disease and breast cancer share many of the same risk factors, including obesity, inactivity, smoking, and poor eating habits, according to the AHA statement published in Circulation. Lifestyle changes designed to avoid these risk factors may help women minimize their risk of cancer and heart problems.

“Women have a higher risk for heart disease if they go untreated for existing cardiovascular risk factors or develop risk factors such as obesity or low fitness during breast cancer treatment,” said Dr. Susan Gilchrist, a cardiology professor at the University of Texas MD Anderson Cancer Center in Houston.

Even when women don’t have any risk factors for heart disease when they’re diagnosed with breast cancer, they should still adopt a heart-healthy lifestyle to lower the chances of developing heart problems associated with cancer treatments, the AHA recommends.

“The key message is to be proactive and focus on prevention,” Gilchrist, who wasn’t involved in the AHA statement, said by email. “Stay active during treatment, avoid smoking and weight gain, get to goal with blood pressure and cholesterol, and do appropriate cardiovascular screening as determined by your oncologist.”

SOURCE: bit.ly/2C3JVjM Circulation, online February 1, 2018.

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