Alcohol’s Effect on Heart Disease Risk

Alcohol’s Effect on Heart Disease Risk - Frequency of Light-to-Moderate Drinking Reduces Heart Disease Risk in Men.

A 12-year study of 38,077 male health professionals found that men who drank alcohol three or more days per week had a reduced risk of heart attack compared with men who drank less frequently. Men who drank less than one drink a day had similar risk reduction to those who drank three.

Many epidemiologic (population) studies have reported that moderate drinking — for men two drinks a day — is associated with a reduced risk of heart disease.

This study looked at the relationship between quantity and frequency and found that it was the frequency of drinking — not the amount, the type of alcohol, or whether or not it was consumed with a meal — that was the key factor in lowered heart disease risk.

Compared with men who drank less than once a week, men who consumed alcohol three or four days a week had approximately 2/3 (68 percent) the risk of heart attack, and men who consumed alcohol five to seven days per week had slightly less (63 percent) the risk. Study data suggested no additional cardiac benefit to drinking more than 2 drinks a day.

Also, the study authors point out that the small number of study participants who drank roughly three and a half or more drinks (50 or more grams of alcohol) per day limited their ability to study the harmful effects of heavy drinking. However, heavy drinking has well documented adverse health effects.

The study, published in this week’s New England Journal of Medicine, was based on an analysis of data from the Health Professionals Follow-up Study, which has followed a population of male dentists, veterinarians, optometrists, osteopathic physicians, and podiatrists, ages 40 to 75, for 12 years.

Kenneth J. Mukamal, M.D., M.P.H., at Beth Israel Deaconess Medical Center, was lead author for the project, which included scientists from the University of Sydney, Sydney, Australia; the Harvard School of Public Health, Boston; Brigham and Women’s Hospital, Harvard Medical School, Boston; and the Massachusetts General Hospital, Boston. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Heart, Lung, and Blood Institute (NHLBI), and the National Cancer Institute, all components of the federal government’s National Institutes of Health, supported the study.

NIAAA director Ting-Kai Li, M.D., said, "This rigorously conducted observational study adds to the epidemiologic evidence of a strong association between light-to-moderate alcohol consumption and reduced risk of heart disease. Only by research on the mechanisms of alcohol’s effects on the cardiovascular system, and perhaps the liver, and the genetic background of how individuals respond to alcohol, will we provide a scientifically informed means for assessing the risks and benefits of alcohol use on a person-to-person basis."

NHLBI director Claude Lenfant, M.D., said, "There are well-proven ways to prevent cardiovascular disease and reduce its risks, including lowering cholesterol levels and blood pressure, maintaining a healthy weight, being physically active, and stopping smoking. These preventive measures do not have the risks associated with alcohol consumption. Therefore, we do not advise the public to begin drinking alcohol to prevent heart disease. However, those who already drink alcohol should be aware that current evidence suggests that moderate drinking may reduce the risk of heart disease in some individuals."

At entry into this study, all participants had to be free of heart disease. Participants in the study completed questionnaires on diet every four years. Investigators confirmed the validity of the questionnaire responses by comparing them with seven-day dietary records in 127 participants.

The investigators controlled for numerous health and dietary factors, including smoking, exercise, diet, and family history of premature heart attack. Also, because alcohol use changes over time, and the effects of alcohol may be short-term, the study tracked the effect of recent versus baseline alcohol consumption, and found that the level of risk was more strongly related to recent, rather than past, consumption.

By the end of the 12-year follow-up, the investigators had documented 1,418 heart attacks. Men who consumed alcohol three or more times a week had a reduced risk of fatal or nonfatal heart attack, even when the amount consumed was only 10 grams of alcohol a day or less. A standard drink — a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits — has between 11 and 14 grams of alcohol. Dr. Mukamal, the study’s lead author, said, "We found little difference among different alcoholic beverage types in our study. This further emphasizes the role of frequent intake, rather than any specific beverage type, in the link between moderate drinking and heart attack risk."

In an accompanying editorial, Ira J. Goldberg, M.D., of the Columbia University College of Physicians and Surgeons, New York, points out that some studies show a reduction in cardiovascular disease, but not overall mortality, in patients who drink alcoholic beverages (this study did not report on overall mortality). He notes that alcohol has toxic effects that are well established and that additional research is needed to inform physicians on how to advise their patients.

The paper, "Roles of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease in Men," appears in the January 9, 2003 issue of The New England Journal of Medicine 348(2): 109-118. An accompanying editorial appears on pages 163-164.

The Dietary Guidelines for Americans, issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, defines moderate drinking for men as no more than 2 drinks per day. The Guidelines can be viewed on-line at the website http://www.nutrition.gov.

Reference: NHLBI National Heart, Lung, and Blood Institute and NIAAA.

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Diabetes Health News 16 May 2008

Not All Fat Created Equal
It has long been known that type 2 diabetes is linked to obesity, particularly fat inside the belly. Now, researchers at the Joslin Diabetes Center have found that fat from other areas of the body can actually reduce insulin resistance and improve insulin sensitivity.

In a study published in the May issue of Cell Metabolism, a team lead by C. Ronald Kahn, M.D. found that subcutaneous fat -- fat found below the skin, usually in the hips and thighs -- is associated with reduced insulin levels and improved insulin sensitivity.



Understanding Red Wine's Potential Benefit For Diabetes
New research suggests that resveratrol, a chemical commonly found in red wine, has the ability to lower blood sugar levels, but might have certain untoward side effects. This research will be presented at the American Association of Clinical Endocrinologists (AACE) 17th Annual Meeting & Clinical Congress by Kimberly Martin, MD, and mentor, Dr. F. Ismail-Beigi, on Friday, May 16th, at the Walt Disney World Dolphin Resort in Orlando.

Resveratrol is a naturally occurring chemical found in grapes that has been reported to have cardioprotective, anti-inflammatory, anti-viral, and glucose-lowering properties. The effect of resveratrol on lowering blood glucose in diabetic rats has been reported by several investigators in the past.



High Beta-Glucan Barley Helps Manage Diabetes And Heart Health
Governor Brian Schweitzer appeared at Montana State University to celebrate Montana's scientific contribution to the development of barley varieties that serve as a natural way to help manage diabetes, heart disease and obesity.

The Governor congratulated MSU-trained researchers for their development of BGLife™ Barley, a new strain of barley that promotes healthy blood sugar, is proven to reduce cholesterol, promotes healthy blood pressure and helps control weight, all conditions associated with diabetes and heart disease. These patented barley varieties are the result of almost 30 years of agricultural research.



Diabetes And Alzheimer's Disease Linked By Salk Institute Study
Diabetic individuals have a significantly higher risk of developing Alzheimer's disease but the molecular connection between the two remains unexplained. Now, researchers at the Salk Institute for Biological Studies identified the probable molecular basis for the diabetes - Alzheimer's interaction.

In a study published in the current online issue of Neurobiology of Aging, investigators led by David R. Schubert, Ph.D., professor in the Cellular Neurobiology Laboratory, report that the blood vessels in the brain of young diabetic mice are damaged by the interaction of elevated blood glucose levels characteristic of diabetes and low levels of beta amyloid, a peptide that clumps to form the senile plaques that riddle the brains of Alzheimer's patients.



New Study Finds California Neighborhoods "Designed For Disease"
Californians face an added challenge as they battle expanding waistlines and obesity-related diseases - their address. A landmark study released shows the state's first direct correlation between where you live and your risk for obesity or diabetes.

The groundbreaking study, Designed for Disease: the Link Between Local Food Environments and Obesity and Diabetes, examines the correlation between the health of nearly 40,000 Californians and the mix of retail food outlets near their homes. The key finding: people living in neighborhoods crowded with fast-food and convenience stores but relatively few grocery or produce outlets are at significantly higher risk of suffering from obesity and diabetes.


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Causes of Memory Loss – Low Folate Levels

High homocysteine levels and low folate levels cause memory loss. The B vitamin folate may help reduce memory loss according to data from a recent nationwide health and nutrition survey, NHANES III.

Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Mass., were looking for a relationship between blood homocysteine levels and memory loss.

Earlier, their research had established that homocysteine levels were higher in elderly people with low intakes of B vitamins, especially folate.

They had also validated reports that homocysteine - a byproduct of our own amino acid metabolism - increases risk of stroke, which is a major player in the loss of cognitive function.

But they wanted to see if high homocysteine levels or low B vitamin status had a more subtle influence in memory loss among people over age 60.

That’s because B vitamins are involved in the synthesis of chemicals crucial to brain function, according to nutritional epidemiologist Martha Morris, who led the study. Or, homocysteine itself might be toxic to nerve cells.

Morris collaborated with Paul Jacques, Irwin Rosenberg and Jacob Selhub at the Boston center, which is funded by the Agricultural Research Service, USDA’s chief scientific research agency.

Luckily, the NHANES III included a sensitive test of recall after a short delay, one that can identify individuals with a milder loss of recall.

Others had reported that homocysteine was related to Alzheimer’s disease, as well as to poor cognitive function in elderly both with and without dementia.

Perhaps 75 percent of dementia is due to stroke or Alzheimer’s disease, which is now thought to develop from minor strokes. So the researchers excluded data from people who had suffered a stroke.

Their analysis showed elevated homocysteine levels were associated with memory loss. But the survey subjects whose blood folate levels were in the upper half appeared to be protected from memory loss even if their homocysteine levels were high.

Reference:
Judy McBride, USDA, Agricultural Research Service.

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ADHD Stimulant Medications - Heart Attack, Strokes and Mental Problems

ADHD Stimulant medications increase stroke and heart attack risks and risks of adverse mental symptoms. On February 21, 2007, the FDA directed the manufacturers of all ADHD stimulant medications approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) to develop Patient Medication Guides to alert patients to possible cardiovascular risks and risks of adverse psychiatric symptoms associated with the medicines, and to advise them of precautions that can be taken.

An FDA review of reports of serious cardiovascular adverse events in patients taking usual doses of ADHD products revealed reports of sudden death in patients with underlying serious heart problems or defects, and reports of stroke and heart attack in adults with certain risk factors.

Another FDA review of ADHD medicines revealed a slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems.

The FDA recommends that children, adolescents, or adults who are being considered for treatment with ADHD drug products work with their physician or other health care professional to develop a treatment plan that includes a careful health history and evaluation of current status, particularly for cardiovascular and psychiatric problems (including assessment for a family history of such problems).

As part of the Agency’s ongoing regulatory activity, in May 2006 the FDA directed manufacturers of these products to revise product labeling for doctors to reflect concerns about adverse cardiovascular and psychiatric events.

These changes were based on recommendations from the FDA Pediatric Advisory Committee and the Drug Safety and Risk Management Advisory Committee. To help patients understand these risks, an additional part of this revised labeling process is the creation of a Patient Medication Guide for each individual product.

The medicines that are the focus of the revised labeling and new Patient Medication Guides include the following 15 products:

• Adderall (mixed salts of a single entity amphetamine product) Tablets

• Adderall XR (mixed salts of a single entity amphetamine product) Extended-Release Capsules

• Concerta (methylphenidate hydrochloride) Extended-Release Tablets

• Daytrana (methylphenidate) Transdermal System

• Desoxyn (methamphetamine HCl) Tablets

• Dexedrine (dextroamphetamine sulfate) Spansule Capsules and Tablets

• Focalin (dexmethylphenidate hydrochloride) Tablets

• Focalin XR (dexmethylphenidate hydrochloride) Extended-Release Capsules

• Metadate CD (methylphenidate hydrochloride) Extended-Release Capsules

• Methylin (methylphenidate hydrochloride) Oral Solution

• Methylin (methylphenidate hydrochloride) Chewable Tablets

• Ritalin (methylphenidate hydrochloride) Tablets

• Ritalin SR (methylphenidate hydrochloride) Sustained-Release Tablets

• Ritalin LA (methylphenidate hydrochloride) Extended-Release Capsules

• Strattera (atomoxetine HCl) Capsules

Reference:
FDA News - ADHD Medications and Cardiovascular, Psychiatric Adverse Events - Accessed 1 March 2008.

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Trans Fats Increase LDL Cholesterol Levels

Research conducted by scientists at the Beltsville (Maryland) Human Nutrition Research Center (BHNRC) contributed to the 2005 Dietary Guidelines for Americans including recommendations that people in the United States limit their intake of fats and oils that are high in trans fatty acids.

Joseph Judd (now retired), and nutritionist Beverly A. Clevidence, and colleagues fed 58 male and female volunteers, aged 26 to 64, four controlled diets, characterized as moderately high trans fat, high trans fat, high saturated fat, and high “heart healthy” oleic acid.

LDL cholesterol levels were measured each time the volunteers completed one of the diets for a 6-week period. The study showed that after they consumed any of the trans-fat or saturated-fat diets, as opposed to the oleic-acid diet, their LDL cholesterol levels were significantly increased.

Trans fats cause changes in metabolism that increase the amount of circulating LDL cholesterol, which in turn can get deposited in blood vessel walls.

The scientists also reported that it’s important not to replace dietary trans fats with saturated fats. In fact, the 2005 Dietary Guidelines recommend consuming less than 10 percent of daily calories from saturated fatty acids. That’s 22 grams or less for a 2,000-calorie diet.

Saturated fats and trans fats tend to be solid at room temperature. The thick, yellow grease that forms in a cool pan after cooking meat is saturated fat. Both types of fats can collect in the body and clog arteries, leading to heart disease.

A 2007 Agricultural Research Service data analysis shows that U.S. consumers aren’t winning the battle on staving off fats.

The analysis, which was based on nationally representative dietary-intake survey data from What We Eat in America/NHANES 2003-2004, was led by nutritionist Alanna J. Moshfegh who heads the Food Surveys Research Group at BHNRC.

The researchers studied the levels and sources of saturated and unsaturated fats in the American diet and found that about 64 percent of adults in the United States exceed the dietary recommendation for consuming saturated fat.

New labelling laws require foods to be labelled for their trans fat as well as their saturated fat content, therefore people can keep an eye on their fat intake by reading food labels.

For example, a croissant has about the same number of calories as a bagel. But a croissant, which is a buttery puff pastry, has 32 times as much saturated fat (6.6 grams compared to an oat-bran bagel’s 0.2 grams).

Reference:
Rosalie Marion Bliss, Agricultural Research Service Information Staff, USDA, ARS (28/2/2008).

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When Weight Loss Diets Don’t Work, Adopt a Healthy Lifestyle Instead

The “Every Size” strategy, a health-centered rather than weight-centered program, may help chronic dieters reshape their thinking, shed unhealthy habits, adopt new patterns of eating, become more physically active, and increase their self-esteem. That’s according to Nancy L. Keim, a chemist with ARS.

“Chronic dieters are those who either have failed at a sequence of diets, or, after successfully losing weight, gain back the pounds and start the dieting cycle all over again,” explains ARS physiologist Marta D. Van Loan. “For obese folks who can’t find a healthful weight loss regimen that gives them lasting results, this alternative to conventional dieting may offer greater and more sustainable improvements to several key indicators of their health.”

Keim and Van Loan are with the ARS Western Human Nutrition Research Center at Davis, California. The two scientists collaborated with Judith L. Stern and Linda Bacon of the University of California, Davis, in a study of the “Health at Every Size” approach.

Van Loan says the novel experiment rates as “one of the most rigorous comparisons of conventional dieting versus the Every Size lifestyle.” The results? Remarkable improvements for the obese, chronic dieters assigned to the Every Size cohort, one of two teams for the study.

Seventy-eight obese women, ages 30 to 45, participated in either the health-centered Every Size team or the weight-centered traditional diet team. The teams met for specialized, 90-minute educational sessions every week for the first 6 months of the year-long study, then met for six once-a-month sessions.

Both groups were instructed in nutrition basics. Women on the conventional diet track were schooled in topics that are typically covered in many popular weight-loss programs, such as how to monitor their weight, control their eating, and exercise briskly.

Meanwhile, their Every Size colleagues learned how to build their self-esteem; recognize and follow the body’s natural, internal cues to hunger and satiety (a feeling of fullness); make healthy choices at mealtimes and in between; and enjoy some form of physical activity—an approach that’s different from exercising mainly to lose weight.

Two Years Later: The Results

A total of 38 women, 19 from each team, participated in a panel of follow-up exams - lab tests and questionnaires - 2 years after the study’s start.

Every Size volunteers had kept their weight stable, neither gaining nor losing a significant number of pounds. In contrast, the dieters had lost weight by the sixth month, but regained it by the 2-year checkpoint. Their beginning weights and their weights 2 years later weren’t significantly different.

The Every Size women held onto the progress that they had made in several health risk factors such as cholesterol levels and systolic blood pressure - the amount of pressure in blood vessels when the heart pumps blood through them.

At the start and end of the study, total cholesterol and systolic blood pressure were in the normal range for all the women. Within this range, however, the Every Size women lowered their total cholesterol and their systolic blood pressure and were able to maintain those reductions for the entire course of the study.

In contrast, the dieters didn’t lower their total cholesterol at any point in the study. And they weren’t able to maintain the healthful decrease in systolic blood pressure that they’d achieved just after the 6-month reducing-diet phase.

What about physical activity?

At the 2-year point, Every Size team members had nearly quadrupled the amount of time they spent in moderate, hard, or very hard physical activity, compared to what they had reported at the study’s outset.

The dieters didn’t fare as well. At the 1-year point, they were exercising more than at the start, but they didn’t sustain their improved level to the 2-year checkpoint.

Although all the dieters made a lasting improvement in at least one of the food-related habits called “eating behaviors,” the Every Size volunteers improved in more of the categories.

For example, both groups did a better job of regaining control of their eating after they’d broken some eating-related rule that they had imposed on themselves. But the Every Size women made more progress, and sustained it, in other facets of eating behavior.

The Every Size team members, for instance, had apparently come to terms with issues such as bulimia (binge eating followed by purging), a “drive for thinness,” and dissatisfaction with their body size.

Dieters made initial improvements in handling bulimia, dealing with body size, and learning to follow the body’s natural signals of hunger and fullness, but they didn’t maintain the progress they’d achieved in these areas.

The researchers also monitored depression, a common problem among large-sized women whose low self-esteem may be related to their body image. Both groups made significant strides in lessening depression, but only the Every Size women were able to preserve a more optimistic outlook.

At the 2-year point, volunteers answered questions about how helpful the program was to them. When asked whether they’d continued to implement some of the tools they’d learned, 89 percent of the Every Size women answered “regularly” or “often.” Only 11 percent of the dieters did so.

Focusing on health and on changing behavior, instead of on weight loss, apparently acted as “keys to the successes of the Every Size team,” Van Loan points out. The scientists discuss these and other conclusions in an article in a 2005 issue of the Journal of the American Dietetic Association. The National Institutes of Health and National Science Foundation provided some of the funding for the study.

For many people, weight-loss diets “simply don’t work,” says Van Loan. The Health at Every Size strategy “may break the cycle of unsuccessful dieting” and open the door to happier, healthier lives.

Reference:
Marcia Wood, Agricultural Research Service Information Staff. USDA, ARS.

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High Homocysteine Levels and Heart Disease

High levels of homocysteine are strongly associated with heart disease. Cholesterol isn't the only blood component associated with the risk of heart disease and stroke. Since the early 1990s, the amino acid homocysteine-a byproduct of amino acid metabolism-has emerged as another important risk factor.

Researchers believe that when body cells dump too much homocysteine into the blood, artery linings become irritated, encouraging the formation of plaque—fatty deposits that cling to artery walls.

One cause of this dumping is a low intake of folate, vitamin B6, or vitamin B12, according to earlier findings by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts.

Body cells need these three B vitamins to convert the amino acid methionine to cysteine. When any one is lacking, the intermediate product in the conversion, homocysteine, builds up.

In 1993, the Boston researchers were first to report homocysteine levels in any population-more than 1,100 elderly in the original Framingham (Massachusetts) Heart Study.

Even in this relatively narrow age range-67 to 96 years-homocysteine levels increased with age. Men had higher levels than women, but the difference narrowed at the upper ages.

Two years later, Norwegian researchers reported similar age and gender differences among the middle-aged population in their country. Smaller population samples in the United States and Europe generally support these findings.

"We wanted to describe serum homocysteine concentrations across our population and test for differences among sex, age, race, and ethnicity," says Paul F. Jacques, an epidemiologist at the USDA center involved in the earlier study.

But the studies covered specific age groups and were not representative of the U.S. population as a whole.

In the current study, Jacques and his Boston colleagues collaborated with scientists affiliated with the Centers for Disease Control and Prevention in Atlanta, Georgia, and Hyattsville, Maryland.

Using blood serum samples from the latest National Health and Nutrition Examination Survey, they measured homocysteine levels for 3,766 males and 4,819 females from age 12 up.

The results "confirm the age and sex differences reported in non-representative samples," says Jacques. Homocysteine levels increased with age. They were also significantly higher in males than females, regardless of whether the subjects were white or black with no Hispanic or Mexican-American background.

Levels were closest between the two genders in the young and old, diverging around puberty and converging after menopause.

The researchers suspect that impaired kidney function may contribute to the higher levels in older people. Body size, estrogen, and vitamin status may explain the difference between genders, they say.

Larger people have more creatinine-a protein breakdown product-circulating in their blood. And studies show a strong correlation between circulating creatinine and homocysteine levels.

Also, "estrogen seems to protect against high homocysteine," says Jacques, judging by the lower levels in premenopausal women. Further, women are more conscious about nutrition. The women in the study had a higher folate status than the men.

Mexican-American females had the study's lowest homocysteine levels-significantly lower than non-Hispanic black and white subjects. Jacques says nutrition may explain part, but not all, of the difference. He has not yet analyzed the data to look for other factors.

"It's crucial we understand the basis for these age and gender differences," he adds, "because fairly modest increases in homocysteine are strongly associated with higher risk of vascular disease."

Reference:
Judy McBride, Agricultural Research Service Information Staff.

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