An unusual medical brawl erupted on Tuesday when the influential Institute of Medicine issued a report questioning the basis of years of advice for Americans to cut their salt intake in half.

The Institute, which advises the federal government on medical issues, concluded that the studies have answered the question poorly.  A panel of experts looked at studies showing the medical effects of eating too much salt, as well as at studies that have been used to suggest that some people may suffer form eating too little salt.

Its finding: There’s enough evidence to support advising Americans to keep sodium to 2,300 milligrams a day or less, but there’s not enough to support the current, lower target of 1,500 milligrams a day.

“There is evidence to lower excessive salt intake,” Dr. Brian Strom, a professor of medicine, epidemiology and biostatistics at the University of Pennsylvania, who chaired the panel, told reporters.

There is also good evidence that lowering intake to around 2,300 milligrams a day decreased the risk of heart disease,” Strom said. But he said that the evidence was absent to support recommendations of taking it as low as 1,500 milligrams a day. And, he said, there were some studies suggesting this could harm some people -- although those studies are also flawed.

This infuriated the American Heart Association.

“While the American Heart Association commends the IOM for taking on the challenging topic of sodium consumption, we disagree with key conclusions,” Heart Association CEO Nancy Brown said in a statement.

“The report is missing a critical component -- a comprehensive review of well-established evidence which links too much sodium to high blood pressure and heart disease.”

The Institute agrees that Americans eat far too much salt -- more than 3,400 milligrams a day on average. Most is “hidden” salt, in processed foods such as bread and cereal, restaurant meals and especially fast food.

And studies clearly show that salt raises blood pressure and that cutting salt can lower blood pressure. High blood pressure damages blood vessels and can lead to stroke, kidney failure and heart failure.

“We knew about all this data and it didn’t change our thinking,” said Dr. Elliott Antman of Brigham and Women’s Hospital and Harvard  Medical School . “We have to take the evidence that we have -- which is strong,” added Antman, a spokesman for the American Heart Association.

Several studies have suggested that about a quarter of Americans are salt-sensitive -- that their blood pressure is directly and immediately affected by how much salt they eat. But this doesn’t mean that the other 75 percent can pile on the salt with impunity, Antman said.

“About 90 percent of the population will ultimately develop hypertension as they age,” he said. “Part of this is almost certainly from years of eating too much salt, he added. Eating too much salt can also affect kidney function, he said.

“An aggressive reduction in sodium is the way to go,” he said.

Strom would not be drawn into an argument. “What we are saying is the available data is not consistent on outcomes,” he said. “We are not saying that one shouldn’t be lowering excessive salt intake in the general population,” he added.  “There is simply a lack of data showing it is beneficial.”

And, he said, it is not up to the panel to set a target. “It’s not that we are against (a target intake of) 1,500 milligrams,” he said. “The data are not consistent.”

The trouble with trying to measure salt intake is that it’s very hard to separate out salt from the rest of the  ingredients in food, said Antman.

A truly scientifically rigorous study would randomly assign people to eat diffferent amounts of salt daily and watch to see what kind of diseases they develop -- something that would be difficult to set up, police and also difficult to defend, ethically.

Antman says most Americans get their salt from prepared foods and from restaurants, not from at-home, scratch cooking. What’s needed, he said, is more encouragement for restaurants and food companies to lower sodium content of food.

The food industry argues that Americans have a taste for salt and they won’t buy products that are salt-free.  Antman agrees that it’s hard.  “We are used to a high sodium content in our food,” he said.

“But the data say that in just two to three weeks you can train person’s taste buds to become accustomed to a lower sodium content in food.”

The Center for Science in the Public Interest piled on, too.

"What the committee failed to emphasize is that most Americans are deep in the red zone, consuming 3,500 to 4,000 milligrams of sodium a day,' the group, which publicizes calorie counts and other food risks, said in a statement.

"It's clear that those excessive levels increase the risk of high blood pressure, heart attacks, and strokes. Whether we aim for 2,300 or 1,500 milligrams a day is irrelevant until we move down out of the red zone. At restaurants, you can get roughly 2,000 milligrams of sodium from just one burrito, a single-serve pizza, or an order of kung pao chicken, and at least 1,000 milligrams from a typical sandwich or burger."

The Centers for Disease Control and Prevention has a widget on salt intake here.

Related:

• Too much salt may trigger autoimmune disease
• US advises Americans to eat less salt
• Most teens well down the road to heart disease

Cases of heart failure – a chronic and expensive condition – are set to spike 46 percent by 2030, the American Heart Association projected on Wednesday.

As Americans get older, and more of us develop various heart conditions, the number of those with heart failure will rise from 5 million now to 8 million in 2030, the group says.

It’s a pricey condition to treat, and every American will end up paying $244 a year to care for people with the condition, through higher insurance rates and taxes, the Heart Association says.

“If we don’t improve or reduce the incidence of heart failure by preventing and treating the underlying conditions, there will be a large monetary and health burden on the country,” said Dr. Paul Heidenreich of the Stanford University School of Medicine, who led the analysis published in the journal Circulation: Heart Failure.

“Direct and indirect costs to treat heart failure could more than double from $31 billion in 2012 to $70 billion in 2030,” the Heart Association, which publishes the journal, said in a statement.

“The costs will be paid for by every adult in this country, not just every adult with heart failure,” Heidenreich said.

Heart failure developes when the heart has been weakened from heart disease, high blood pressure, diabetes or other conditions. As the heart struggles to pump, it can enlarge but it gets weaker. Fluid can build up around the heart, leaving patients tired and out of breath.

Half of all Medicare patients hospitalized for heart failure die within three years.

Treatments start out with cheap diuretics to get rid of the excess fluid, but it can quickly become expensive.  Heart failure is the leading cause of hospitalization for Americans over age 65. More effective dissemination and use of guideline-recommended therapy to prevent heart failure and improve survival.

Patients and medical professionals alike need better information about how to treat the condition, the Heart Association said. Nurses, doctors, pharmacists and other professionals need specialized training, and certain ethnic groups, such as African-Americans, need targeted outreach.

Related:

• Younger adults don't do well with heart failure
• Breast cancer survivors face heart failure
• Americans get too many heart pills

Getty Images, stock

Pizza is not all bad, but fewer than 1 percent of American teens have ideal diets, plus they don't exercise enough, according to new research.

A stunning 80 percent of U.S. teenagers are eating diets that put them on a clear path to heart disease, researchers reported on Monday.

They’re eating too much fat, salt and sugar and not eating enough fruits and vegetables, the American Heart Association study found. Just 1 percent ate what the Heart Association considers a perfectly healthy diet.

Plus they don’t exercise enough, says Christina Shay of the the University of Oklahoma Health Sciences Center, who led the study.

“The far less-than-optimal physical activity levels and dietary intake of current U.S. teenagers, is translating into obesity and overweight that, in turn, is likely influencing worsening rates of high blood pressure, high cholesterol and blood glucose at these young ages,” Shay said in a statement.

It’s no secret that Americans, and especially teens, eat poor diets. What concerns the Heart Association and doctors is that people may not realize how little slack there is for teenagers to get away with this. The seeds of heart disease are sown in childhood, these experts advise.

“Autopsy findings reported more than a century ago identified fatty streaks in the large arteries of children as young as 6 years of age,” Shay’s team wrote in their report, published in the journal Circulation.

More recent studies have found evidence of early heart disease in children.

The researchers surveyed 4,600 teenagers taking part in a large national study. The teens answered detailed questions about their eating and exercise habits and also underwent medical exams. The team looked for their blood pressure, cholesterol and blood sugar levels, as well as weight and diet and exercise.

Fewer than 80 percent scored well on diet. Just 1 percent met the ideal guidelines of 4.5 or more cups a day of fruits and vegetables, two servings of fish a week, 3 ounces a day of whole grains, less than 1,500 mg of salt a day and no more than 450 calories worth of sugar-sweetened drinks a week.

Only 45 percent scored acceptably on five or more of the factors. Only 44 percent of girls and 67 percent of boys reported idea physicial activity levels. Just two-thirds had ideal weights.

A third already had unhealth cholesterol levels or were on the way there, the report found. The good news came on blood pressure – 90 percent of the girls and 78 percent of the boys had healthy blood pressure.  And 66 to 70 percent had never tried smoking.

Heart disease is the No. 1 killer in the United States. The Heart Association says 80 percent of cases can be prevented with healthy habits.

Related:

• Group: 97 percent of restaurant meals for kids flunk nutrition
• Junk food may not be addictive, after all

Jeff Chiu / AP

Atlanta cardiologist Dr. Spencer King demonstrates how a catheter is used to repair a diseased heart valve. Many problems that used to require open-heart surgery now can be treated with minimally invasive procedures.

Have a heart problem? If it's fixable, there's a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels.

Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube.

These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects — without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches.

All rely on catheters — hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes into blood vessels.

"This is the replacement for the surgeon's knife. Instead of opening the chest, we're able to put catheters in through the leg, sometimes through the arm," said Dr. Spencer King of St. Joseph's Heart and Vascular Institute in Atlanta. He is former president of the American College of Cardiology. Its conference earlier this month featured research on these novel devices.

"Many patients after having this kind of procedure in a day or two can go home" rather than staying in the hospital while a big wound heals, he said. It may lead to cheaper treatment, although the initial cost of the novel devices often offsets the savings from shorter hospital stays.

Not everyone can have catheter treatment, and some promising devices have hit snags in testing. Others on the market now are so new that it will take several years to see if their results last as long as the benefits from surgery do.

But already, these procedures have allowed many people too old or frail for an operation to get help for problems that otherwise would likely kill them.

"You can do these on 90-year-old patients," King said.

These methods also offer an option for people who cannot tolerate long-term use of blood thinners or other drugs to manage their conditions, or who don't get enough help from these medicines and are getting worse.

"It's opened up a whole new field," said Dr. Hadley Wilson, cardiology chief at Carolinas HealthCare System in Charlotte. "We can hopefully treat more patients more definitively, with better results."

For patients, this is crucial: Make sure you are evaluated by a "heart team" that includes a surgeon as well as other specialists who do less invasive treatments. Many patients now get whatever treatment is offered by whatever specialist they are sent to, and those specialists sometimes are rivals.

"We want to get away from that" and do whatever is best for the patient, said Dr. Timothy Gardner, a surgeon at Christiana Care Health System in Newark, Del., and an American Heart Association spokesman. "There shouldn't be a rivalry in the field."

Here are some common problems and newer treatments for them:

Heart valves
Millions of people have leaky heart valves. Each year, more than 100,000 people in the United States alone have surgery for them. A common one is the aortic valve, the heart's main gate. It can stiffen and narrow, making the heart strain to push blood through it. Without a valve replacement operation, half of these patients die within two years, yet many are too weak to have one.

"Essentially, this was a death sentence," said Dr. John Harold, a Los Angeles heart specialist who is president of the College of Cardiology.

That changed just over a year ago, when Edwards Lifesciences Corp. won approval to sell an artificial aortic valve flexible and small enough to fit into a catheter and wedged inside the bad one. At first it was just for inoperable patients. Last fall, use was expanded to include people able to have surgery but at high risk of complications.

Gary Verwer, 76, of Napa, Calif., had a bypass operation in 1988 that made surgery too risky when he later developed trouble with his aortic valve.

"It was getting worse every day. I couldn't walk from my bed to my bathroom without having to sit down and rest," he said. After getting a new valve through a catheter last April at Stanford University, "everything changed; it was almost immediate," he said. "Now I can walk almost three miles a day and enjoy it. I'm not tired at all."

"The chest cracking part is not the most fun," he said of his earlier bypass surgery. "It was a great relief not to have to go through that recovery again."

Catheter-based treatments for other valves also are in testing. One for the mitral valve — Abbott Laboratories' MitraClip — had a mixed review by federal Food and Drug Administration advisers this week; whether it will win FDA approval is unclear. It is already sold in Europe.

Heart rhythm problems
Catheters can contain tools to vaporize or "ablate" bits of heart tissue that cause abnormal signals that control the heartbeat. This used to be done only for some serious or relatively rare problems, or surgically if a patient was having an operation for another heart issue.

Now catheter ablation is being used for the most common rhythm problem — atrial fibrillation, which plagues about 3 million Americans and 15 million people worldwide. The upper chambers of the heart quiver or beat too fast or too slow. That lets blood pool in a small pouch off one of these chambers. Clots can form in the pouch and travel to the brain, causing a stroke.

Ablation addresses the underlying rhythm problem. To address the stroke risk from pooled blood, several novel devices aim to plug or seal off the pouch. Only one has approval in the U.S. now — SentreHeart Inc.'s Lariat, a tiny lasso to cinch the pouch shut. It uses two catheters that act like chopsticks. One goes through a blood vessel and into the pouch to help guide placement of the device, which is contained in a second catheter poked under the ribs to the outside of the heart. A loop is released to circle the top of the pouch where it meets the heart, sealing off the pouch.

A different kind of device — Boston Scientific Corp.'s Watchman — is sold in Europe and parts of Asia, but is pending before the FDA in the U.S. It's like a tiny umbrella pushed through a vein and then opened inside the heart to plug the troublesome pouch. Early results from a pivotal study released by the company suggested it would miss a key goal, making its future in the U.S. uncertain.

Heart defects
Some people have a hole in a heart wall called an atrial septal defect that causes abnormal blood flow. St. Jude Medical Inc.'s Amplatzer is a fabric-mesh patch threaded through catheters to plug the hole.

The patch is also being tested for a more common defect — PFO, a hole that results when the heart wall doesn't seal the way it should after birth. This can raise the risk of stroke. In two new studies, the device did not meet the main goal of lowering the risk of repeat strokes in people who had already suffered one, but some doctors were encouraged by other results.

Clogged arteries
The original catheter-based treatment — balloon angioplasty — is still used hundreds of thousands of times each year in the U.S. alone. A Japanese company, Terumo Corp., is one of the leaders of a new way to do it that is easier on patients — through a catheter in the arm rather than the groin.

Newer stents that prop arteries open and then dissolve over time, aimed at reducing the risk of blood clots, also are in late-stage testing.

High blood pressure
About 75 million Americans and 1 billion people worldwide have high blood pressure, a major risk factor for heart attacks. Researchers are testing a possible long-term fix for dangerously high pressure that can't be controlled with multiple medications.

It uses a catheter and radio waves to zap nerves, located near the kidneys, which fuel high blood pressure. At least one device is approved in Europe and several companies are testing devices in the United States.

"We're very excited about this," said Harold, the cardiology college's president. It offers hope to "essentially cure high blood pressure."

The Lancet

Researchers conduct an MRI on a mummy from Egypt, in search of evidence of clogged arteries.

From the Andes to Alaska and ancient Egypt, people suffered from hardening of the arteries even 4,000 years ago, researchers reported on Sunday, suggesting heart disease may not be the fault of modern living, after all.

The team looked at mummies preserved in the cold or dry heat and found fully a third had clear evidence of clogged arteries. The findings, presented at a meeting of the American College of Cardiology and also published in the Lancet medical journal, build on earlier studies that looked at ancient Egyptian mummies.

Signs of artery disease in Egyptian mummies was believed to support the idea that a life of leisure, with plenty of rich food, is the main cause of heart disease. This broader study, however, found signs of heart disease in the remains of people who would have been far from wealthy or idle.

“The fact that we found similar levels of atherosclerosis in all of the different cultures we studied, all of whom had very different lifestyles and diets, suggests that atherosclerosis may have been far more common in the ancient world than previously thought,” says cardiologist Randall Thompson of of Saint Luke’s Mid America Heart Institute in Kansas City, who led the study.

“A common assumption is that the rise in levels of atherosclerosis is predominantly lifestyle-related, and that if modern humans could emulate pre-industrial or even pre-agricultural lifestyles, that atherosclerosis, or at least its clinical manifestations, would be avoided,” Thompson added.

The Lancet/Randall Thompson

This mummy shows signs of heart disease, researchers, found

“Our findings seem to cast doubt on that assumption, and at the very least, we think they suggest that our understanding of the causes of atherosclerosis is incomplete, and that it might be somehow inherent to the process of human aging.”

Thompson’s team looked at 137 different mummies, using MRI scans to find the signs of calcification that mark artery disease. Calcium builds up in the “plaques” that clog arteries, making them hard and also making it easy to spot them on scans.

The mummies came from Peru, where bodies often mummified naturally when left in cold, dry caves high in the mountains; from the southwestern U.S, where dry air can mummify bodies; from the Aleutian Islands of Alaska, where the cold can mummify remains; and from Egypt.

The Lancet/Randall Thompson

Randall Thompson of Saint Luke's Mid America Heart Institute in Kansas City and colleagues found clear signs of heart disease in a third of 137 mummies they studied from around the world.

About 38 percent of the mummies from Egypt had signs of atherosclerosis. A quarter of the mummies from Peru did, 40 percent of ancestors of Pueblo Indians from the U.S. Southwest and three out of the five Unangans from the Aleutian Islands.

“None of the cultures were known to be vegetarian. Physical activity was probably prominent in all these of civilizations without animal or vehicle transport,” the researchers wrote.

But they would have eaten very different diets. “Indigenous food plants varied greatly over the wide geographical distance between these regions of the world. Fish and game were present in all of the cultures, but protein sources varied from domesticated cattle among the Egyptians to an almost entirely marine diet among the Unangans,” the researchers wrote.

The Aleutian Islanders would have led a hard life, venturing out on kayaks to hunt seal and to fish, and they lived in underground homes to escape the extreme cold weather. Andean peoples would have been fit, and also unlikely to have lived easy lives.

What did they have in common? Probably a lot of untreated infections, the researchers said.

“All four populations lived at a time when infections would have been a common aspect of daily life and the major cause of death. Antibiotics had yet to be developed and the environment was non­hygienic.”

Doctors know that infection can be linked to heart and artery disease. One marker of heart disease is inflammation, as measured by a compound called C-reactive protein. Could infection have somehow kept arteries inflamed and prone to clogging?

“This would be consistent with the accelerated atherosclerosis experienced by modern-day patients with rheumatoid arthritis and systemic lupus erythematosus (commonly known as lupus),” the researchers wrote.

A study published in the new England Journal of Medicine in 2003 found about 37 percent of patients with lupus had atherosclerosis.

Heart disease is the No. 1 killer of Americans, causing about a quarter of all deaths. And half of these are linked to cardiovascular disease, much of it so-called hardening of the arteries, according to the Centers for Disease Control and Prevention.

It's hard to say how common atherosclerosis is in the population as compared to the mummies, because few Americans get full-body scans that would show it, but a study last year of Afghanistan and Iraq veterans who died or were killed showed 8.5 percent had atherosclerosis in or around the heart, compared to 77 percent of Korean war veterans and 45 percent of Vietnam War veterans. Doctors believe widely used medications to lower cholesterol may have been a factor in the different rates.

Related links:

• Mummies show that even rich Egyptians were in poor health  
• Egyptian mummy's curse was blocked arteries  
• Heart disease found in Egyptian mummies
• Egyptian mummy shows signs of a rare, painful disease  
• 'Maiden' Inca mummy had a lung infection  
• Hallucinogens found in Andean mummy's hair  

Stress does bad things to the heart. New studies have found higher rates of cardiac problems in veterans with PTSD, New Orleans residents six years after Hurricane Katrina and Greeks struggling through that country's financial turmoil.

Disasters and prolonged stress can raise "fight or flight" hormones that affect blood pressure, blood sugar and other things in ways that make heart trouble more likely, doctors say. They also provoke anger and helplessness and spur heart-harming behaviors like eating or drinking too much.

"We're starting to connect emotions with cardiovascular risk markers" and the new research adds evidence of a link, said Dr. Nieca Goldberg, a cardiologist at NYU Langone Medical Center and an American Heart Association spokeswoman.

She had no role in the studies, which were discussed Sunday at an American College of Cardiology conference in San Francisco.

The largest, involving 207,954 veterans in California and Nevada ages 46 to 74, compared those with PTSD, or post-traumatic stress disorder, to those without it. They were free of major heart disease and diabetes when researchers checked their Veterans Administration medical records from 2009 and 2010.

Checked again about two years later, 35 percent of those with PTSD but only 19 percent of those without it had developed insulin resistance, which can lead to diabetes and hardening of the arteries.

Doctors also saw higher rates of metabolic syndrome — a collection of heart disease risk factors that include high body fat, cholesterol, blood pressure and blood sugar levels. About 53 percent of veterans with PTSD but only 37 percent of those without it had several of these symptoms.

The numbers are estimates and are not as important as the trend — more heart risk with more stress, said one study leader, Dr. Ramin Ebrahimi, a cardiologist at the Greater Los Angeles VA Medical Center and a professor at UCLA. It shows that PTSD can cause physical symptoms, not just the mental ones commonly associated with it.

"Twenty or 30 years ago PTSD was a term reserved for combat veterans. We have come to realize now that PTSD is actually a much more common disorder and it can happen in veterans who did not undergo combat but had a very traumatic experience" such as losing a friend, he said.

That goes for others who suffer trauma such as being raped, robbed at gunpoint or in a serious accident, he said. Nearly 8 million Americans have PTSD, the National Institute of Mental Health estimates.

They include survivors of Hurricane Katrina. Tulane Medical Center doctors led a study of their hospital's patients that suggests heart attack incidence is three times higher in New Orleans than it was in the two years before the 2005 storm.

Heart attacks made up 2.4 percent of admissions in the six years after the storm compared to just 0.7 percent before it. The post-storm patients were more likely to be unemployed or uninsured, to smoke, and to have depression, anxiety or high cholesterol, resarchers found.

 A third study found that heart attacks rose sharply in the Messinia area of southwestern Greece since January 2008, the start of that country's financial crisis. Researchers compared medical records of more than 22,000 patients admitted to the General Hospital of Kalamata — the only hospital with a cardiology department in the region.

There were 1,084 heart attacks in the four years after the crisis began compared to 841 in the four years before it, even though the population and its demographics remained the same.

Heart attack incidence rose 40 percent among women, who have higher unemployment rates than men and tend to be more responsible for child care — a double burden of stress, said the lead researcher, Dr. Emmanouil Makaris.

Kathryn Doyle
Reuters
U.S. researchers found better levels of "good cholesterol" and other markers of heart health in the blood of middle-aged study subjects with a sunny outlook on life. 

At least some of the connection between optimism and blood lipids in the new study appeared to result from the optimists' tendency to have a healthy body weight and a "prudent" diet, according to the researchers.

"It is one additional piece of evidence suggesting that our psychological health and physical health are intertwined, and that viewing the world optimistically may have some tangible benefits for our health," said lead author Julia Boehm, a research fellow at the Harvard School of Public Health in Boston.

Previous research by Boehm and her colleagues had shown a link between optimism and lowered heart attack risk. So they decided to look at whether there was an independent connection between optimistic or pessimistic outlooks and cholesterol, which is known to play a role in heart attack risk.

The group analyzed data from the Midlife in the United States study, which included phone interviews and lab tests for 990 people aged 40 to 70.

Based on the interviews, participants' levels of optimism were rated on a scale from 6 to 30 depending on their agreement or disagreement with statements like, "In uncertain times I usually expect the best."

According to results published in The American Journal of Cardiology, people with higher optimism scores also had more high-density lipoproteins (HDL), the desirable form of cholesterol that is believed to protect against heart disease. They also had lower levels of triglycerides, the fatty molecules involved in hardening of the arteries.

There was no connection between optimism and total cholesterol levels, or to low-density lipoproteins (LDL), the "bad cholesterol."

For every increase of 5 points on the optimism scale, however, HDL in the blood increased by 1 milligram per deciliter.

That same HDL increase would translate to a three percent reduction in the risk for heart disease, experts said. For comparison, regular exercise can decrease heart disease risk by six percent.

"Honestly I'm not surprised, this is what I expect," said Dr. Franz Messerli, a cardiologist at St. Luke's-Roosevelt Hospital in New York, who was not involved in the study.

It's still impossible to say whether optimism causes a change in cholesterol, or cholesterol influences outlook, or both are subject to some third variable, according to Messerli.

"In the case we have here, we really don't know what is the chicken and what is the egg," he told Reuters Health.

Boehm's group did try to account for other influences, and when they factored-in lifestyles - including diet and alcohol consumption, and body weight - the link between optimism and blood fats became weaker.

That suggests the optimists' tendency to have healthier lifestyles and weight may explain "in part" the differences in their blood lipids, the researchers conclude. 

"If you're a forward looking, positive individual, that attitude appears to have broad, far reaching consequences in areas of your life," said Dr. Hilary Tindle, who studies mind-body medicine at the University of Pittsburgh but wasn't involved with the new research.

Conversely, risk of heart attack and stroke goes up in depressed people, Messerli points out. "But nobody has shown the opposite, that all of a sudden if you go from a pessimist to an optimist your risk goes down."

Because the current study only found a link to blood lipids, but not to heart disease or cardiovascular "events," more research is needed, the experts agreed.

The time when attitude adjustments could be used in pursuit of physical health is still a long way off, Messerli said. 

A Mediterranean diet rich in fruits, vegetables, olive oil and a little wine can cut the risk of heart attacks and strokes by 30 percent, researchers reported on Monday in a study that shows the real-life benefits of a diet long encouraged by doctors.

The results were so startling that the study was cut short after less than five years, and the results rushed to publication in the New England Journal of Medicine.

“A Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events,” the researchers, led by Dr. Ramon Estruch of the Carlos III Health Institute in Barcelona, wrote.

The study was done in Spain, where people already supposedly eat the Mediterranean diet -- which is characterized by lots of salad, fruit, vegetables, nuts, a little fish, a little lean meat, a small amount of cheese and olive oil.  Wine is also served at meals. But the 7,400 volunteers in the trial got extra counseling, and either a weekly supply of extra-virgin olive oil or mixed nuts.

Many studies have shown that people who eat a Mediterranean diet are less likely to die of heart disease. This one was powerful because it randomly assigned people to eat such a diet as part of their normal lives over several years.

The 7,400 patients aged 55 to 80 were all high risk of heart disease because of diabetes, a family history of heart disease, high blood pressure, unhealthy cholesterol levels or they were overweight or smokers.

They were randomly assigned to one of three groups: a Mediterranean diet with extra-virgin olive oil added; the same diet but with mixed nuts; or just a standard diet with advice to cut fat. They were given either a liter of olive oil per week (for the olive oil group), 30 grams of walnuts, hazelnuts and almonds (for the nut group), or little non-food presents for the control group.

They all got individual and group counseling.

After nearly five years, 58 people who simply followed a low-fat diet had strokes, but just 32 people did if they ate a Mediterranean diet with nuts, and 49 who followed the Mediterranean diet with extra olive oil. The Mediterranean diet also cut the risk of heart attack.

Thirty people died from heart disease in the control group, compared to 31 who ate the Mediterranean diet with nuts and 26 who at the Mediterranean diet with olive oil.

But the people who ate a Mediterranean diet were less likely to die overall in the five years, compared to those in the control group. Overall, the Mediterranean diets cut the risk of heart disease death, heart attacks and strokes by 30 percent, the researchers calculated.

"This is another piece of evidence for the benefits of diets containing 'good' fats such as those in olive oil and nuts," said nutrition expert Marion Nestle of New York University. 

"I wonder whether they plan to continue the trial for a longer time—I didn’t see any comment on that—because a few more years might give greater clarity," Nestle added in an e-mail.

There are lots of reasons why a Mediterranean-style diet might reduce heart disease. Researchers had noticed that people in Northern Europe, who eat butter and lard more than olive oil, were more likely to die of heart disease than their Southern European neighbors, even if they were just as overweight and exercised the same amount.  A study of the diet’s benefits published back in the 1960s showed the diet cut the rate of strokes and heart attacks, probably because it lowered cholesterol levels.

Olive oil and nuts contain monounsaturated fats, which are better for artery health than the saturated fats found in butter, meat and lard. The diet is also high in fiber and vitamins such as A, C and E, as well as minerals.  Walnuts and fish are rich in omega-3 fatty acids, which have been shown to benefit heart health. And reducing meat has been shown to cut the risk of both heart disease and cancer.

Related:

• Mediterranean diet cuts heart disease, diabetes
• Mediterranean diet cuts deaths
• Mediterranean diet lowers Alzheimer’s risk
• 1 in 4 indulges bizarre late-night food craving
• Why snacking at night is bad for you

By Genevra Pittman
Reuters
Black men and women are more likely to die of a heart attack or heart failure than whites in the United States, according to a new study.

Researchers said those disparities could be explained by black adults' higher rates of smoking, diabetes and high blood pressure, and the finding that they tend to be heavier than whites.

The study's lead author said the result is "distressingly similar" to racial differences seen in data from the 1990s, despite public health efforts to address them.

"The sad fact is, we really don't see an awful lot of movement in terms of that long-standing disparity. It's pretty much where we were the last time we looked at it," Dr. Monika Safford, from the University of Alabama at Birmingham, told Reuters Health.

Her team's findings are based on close to 25,000 middle-aged and older adults who had blood and urine tests and a general health check in 2003 through 2007. At that point, none of them had heart disease.

Over the next four-plus years, 659 people in the study developed any kind of heart disease, including heart attacks and heart failure. About one-third of those "events" were fatal.

Every year during the study, 4 in 1,000 black men died from heart disease, on average, compared to 1.9 of 1,000 white men, the researchers found. Among women, 2 in 1,000 blacks died of heart disease each year, compared to 1 in 1,000 whites.

Safford and her colleagues found the extra deaths in blacks could be explained by their higher heart risks to begin with. For example, close to one in three black men and women had diabetes at the study's onset, versus one in six white participants.

"There are no surprises here," Safford said.

She said genetics may put black adults at higher risk for uncontrolled high blood pressure. When it comes to high cholesterol, fewer of them are on statins. And blacks may not be accessing quit-smoking programs - or other preventive care - as often as whites.

"The question is, did they have problems before (dying of heart disease) that weren't picked up? And maybe it's because they're not getting the same quality healthcare," said Dr. Carl "Chip" Lavie, from the John Ochsner Heart and Vascular Institute in New Orleans, who wasn't involved in the new research.

"The obvious implications are, we need to do a better job in African Americans of getting their risk factors treated, and probably getting them to recognize symptoms of cardiovascular disease."

More ethnic disparities
Another report published alongside Safford's found heart-disease differences aren't limited to blacks and whites: among Latinos in the United States, cardiac risks were common but varied widely.

Of more than 15,000 Cubans, Dominicans, Mexicans, Puerto Ricans, and Central and South Americans living in four U.S. cities, researchers found 80 percent of men and 71 percent of women had at least one "risk factor" for heart disease. Those included diabetes, high cholesterol, high blood pressure, smoking and obesity.

Heart disease and related risks were more common among people who'd lived in the U.S. for longer, or were second- or third-generation immigrants.

Risks also varied by study participants' country of origin. Obesity and smoking, in particular, were most common among Puerto Ricans, Dr. Martha Daviglus from the University of Illinois at Chicago and her colleagues reported in the Journal of the American Medical Association.

She said some groups of Latinos, such as Puerto Ricans, appear to have more heart-related problems than white and black Americans, while others, like South Americans, tend to have fewer.

"They can't all just be considered one generic population," said Dr. Patrick O'Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland who didn't participate in the new studies.

"What we knew until now was based on a group of Hispanics, mainly Mexican-Americans, and as you can see, risk factors vary among all of the other Hispanic/Latino groups," Daviglus told Reuters Health.

That's because people from different countries eat and exercise in different ways, have different degrees of cultural acceptance when it comes to smoking, and adapt to living in the U.S. differently, she said.

Addressing disparities
Across the board, the average 45-year-old man has a 60 percent chance of having a stroke, heart attack or heart disease sometime in his life, according to another analysis of multiple long-term studies. A 45-year-old woman has a 56 percent risk.

Even middle-aged adults who are non-smokers, normal weight and have no other heart risks have a more than 30 percent chance of eventually developing heart disease, a team led by Dr. John Wilkins of Northwestern University in Chicago concluded.

Safford and Daviglus both emphasized the importance of targeting health and education programs to people in communities that need them, whatever their race or ethnicity.

"We need to educate these communities, we need to provide them means to improve their lifestyle," according to Daviglus - such as with free quit-smoking programs and exercise classes.

"The good news is that we know what the fixes are - now we just have to buckle down and do them," Safford said.

O'Malley told Reuters Health that although doctors should be more aware of higher risks for blacks and some Latinos - and possibly treat those patients more aggressively - issues such as economic and educational disparities will have to be addressed to create significant changes in health trends.

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Do you look old for your age? You may be at increased risk of heart disease.

By Joseph Brownstein
MyHealthNewsDaily

A bald patch on the top of your head or a small vertical crease in your earlobe may seem like relatively harmless signs of aging, but a new study says signs like these may signal an increased risk of heart disease.

Danish researchers found that people were 39 percent more likely to have heart disease, and 57 percent more likely to have a heart attack, if they had at least three of these four signs: baldness on top of the head, receded hairline, a crease in the earlobe, and fatty deposits on the eyelids known as xanthelasmata.

The researchers accounted for people's ages in their results.

Therefore, the study shows "looking old for your age, by [having] these aging signs, marks poor cardiovascular health," said study researcher Dr. Anne Tybjaerg-Hansen, a professor and chief physician in the department of clinical biochemistry at Copenhagen University Hospital.

While the exact reason for the links between these signs and heart disease risk remains unclear, the study "validates the common clinical practice that the clinician examines the patient, and often looks at whether a person looks older or younger for her age," Tybjaerg-Hansen said.

The researchers used data from the Copenhagen Heart Study, which included10,885 people who were over the age of 40. Over the 35-year study, 3,401 participants developed heart disease, and 1,708 had a heart attack. Researchers examined six physical features associated with aging, but found that two — gray hair and wrinkles — did not appear to be linked with increased risk of heart problems.

The study included 5,828 men and 5,057 women. When the researchers considered the genders separately, they found that hair loss in women was not linked with an increased risk of heart disease. However, among the 737 men who had a receding hairline, 82 suffered a heart attack, meaning there a 40 percent higher risk in men with hair loss than those without.

Previous research has looked at whether hair loss may be a warning sign of heart disease, but results have been conflicting. Some studies have linked the severity and type of baldness with the risks of heart disease or heart attacks to varying degrees, but others have found no connection. Because the risk of both heart disease and baldness rise with age, it can be difficult for researchers to separate the two in studies.

Tybjaerg-Hansen said the four signs identified in the new study should give clinicians greater incentive to treat patients who have them. "The suggestion is that lifestyle changes and lipid-lowering therapies should be intensified, because their risk is higher," she said.

However, the area needs more research, because "it would be nice to know why these [varying factors] would be associated with increased risk," she said.

Tybjaerg-Hansen said, for example, that hair loss is linked with levels of  testosterone in the blood, so the new study suggests the hormone also plays a role in heart disease, but there's "no hard data there at all, [it's] only speculative."

She said the group for whom the new results would raise the greatest concern is men between ages 70 and 79. In this group, 45 percent of those with all four aging signs developed heart disease, versus 31 percent of those with none of the four.

"This study underscores the importance of doing a good physical exam, in addition to any testing we're going to do for risk for heart disease," said Dr. Nieca Goldberg, director of the NYU Center for Women's Health and American Heart Association spokesperson, in a statement in response to the study.

While the researchers adjusted their results to account for other risk factors for heart disease, Goldberg noted that, for example, xanthelasmata is a sign of high cholesterol levels, a traditional risk factor for heart disease.

Goldberg concluded that while the length of the study made the results compelling, doctors "need to continue to monitor our standard testing for heart disease risk, such as measuring cholesterol, blood pressure, glucose for diabetes."

The researchers are presenting their findings today (Nov. 6) at an American Heart Association research conference. The findings have not been published in a scientific journal.

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Brr! You're more likely to die of a heart-related problem in the winter, but it's not because of the cold, researchers say.

Winter can kill you. But it’s not the cold or the snow shoveling that will do you in. Whether you live in a typically hot climate like Arizona, or a chillier area like Massachusetts, you’re more likely to succumb to some form of cardiovascular disease during the winter months, researchers reported at the annual meeting of the American Heart Association Tuesday.

Compared to the summer season, people are 26 to 36 percent more likely to die in winter from a heart attack, a stroke, heart failure or some other circulatory disease, says the study’s lead author Dr. Bryan Schwartz, a cardiovascular research fellow at the Heart Institute at Good Samaritan Hospital in Los Angeles.

Schwartz and his co-author, Dr. Robert Kloner, director of research at the hospital, examined approximately 1.7 million death certificates from 2005 to 2008 from seven U.S. locations that ranged from hot to cold: Texas, Arizona’s Maricopa County, Georgia, California’s Los Angeles County, Washington, Pennsylvania and Massachusetts.

The researchers were surprised at what they found. No matter where the data were from, the pattern was the same: Many more deaths in the winter than in the summer.

Because low temperatures have often been linked with increased death rates, “we thought the winter peak would be more prominent in cold climates like Massachusetts,” says Schwartz, now a researcher at the University of New Mexico. “But the death rates were similar. That means that temperature is a small factor -- or not a factor at all.”

Then why is winter so deadly? The researchers are uncertain, but influenza and depression are possible causes. Flu season peaks in the winter, Schwartz points out, and during winter’s shorter days, people tend to feel more down and discouraged. They may exercise less and not be as careful about what they eat.

For example, “a patient who already has congestive heart failure might not be as adherent to a low-salt diet. That can be enough to promote fluid retention and worsening heart failure and eventually death.”

That makes sense to Dr. Lee Goldberg, medical director of the heart failure and cardiac transplant center at the University of Pennsylvania.

“People who are depressed are less likely to exercise and take their medications,” he says. “And they’re also more likely to cheat a bit on their diets. “

Depression doesn’t just impact lifestyle, Goldberg says. “When people are depressed there are chemical changes that can increase stress on the cardiovascular system.”

In other words, when it comes to your heart, winter is not the time to be careless.

“You need to take care of your heart 365 days a year,” Goldberg says. “You have to make time for it, regardless of what else is going on.”

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Multivitamins might help lower the risk for cancer in healthy older men but do not affect their chances of developing heart disease, new research suggests.

Two other studies found fish oil didn't work for an irregular heartbeat condition called atrial fibrillation, even though it is thought to help certain people with heart disease or high levels of fats called triglycerides in their blood.

The bottom line: Dietary supplements have varied effects and whether one is right for you may depend on your personal health profile, diet and lifestyle.

"Many people take vitamin supplements as a crutch," said study leader Dr. Howard Sesso of Brigham and Women's Hospital in Boston. "They're no substitute for a heart-healthy diet, exercising, not smoking, keeping your weight down," especially for lowering heart risks.

Sesso said patients who view multivitamins as a "quick fix" might neglect other efforts to improve their health.

"The danger of taking multivitamins is that it will lead you to think you can forgo other lifestyle changes," such as not smoking and maintaining a healthy diet, said Dr. Dariush Mozaffarian, associate professor in the department of epidemiology at Harvard School of Public Health.

The U.S. Physicians Health Study II monitored nearly 15,000 healthy male doctors aged 50 and older for more than 10 years. Participants were randomly assigned to take either monthly packets of Centrum Silver or fake multivitamins. After about 11 years, there were no differences between the groups in heart attacks, strokes, chest pain, heart failure or heart-related deaths.

"We found that after more than a decade, there is neither benefit nor risk," in terms of cardiovascular disease, said Dr. Howard Sesso, study author and associate epidemiologist at Brigham and Women's Hospital in Boston.

Researchers reported last month that the same trial showed that a daily multivitamin reduced the men's overall risk of cancer by 8 percent.

"We still feel very comfortable with the conclusions for the cancer findings," Dr. Sesso said. "The lack of effect for cardiovascular disease versus cancer benefit isn't necessarily inconsistent. There could be a difference in mechanism of effect."

The studies were presented Monday at an American Heart Association conference in Los Angeles and the vitamin research and one fish oil study were published in the Journal of the American Medical Association.

Multivitamins are America's favorite dietary supplement — about one-third of adults take them. Yet no government agency recommends their routine use for preventing chronic diseases, and few studies have tested them to see if they can. A leading preventive medicine task force even recommends against beta-carotene supplements, alone or with other vitamins, to prevent cancer or heart disease because some studies have found them harmful. And vitamin K can affect bleeding and interfere with some commonly used heart drugs. 

Side effects were fairly similar except for more rashes among vitamin users. The National Institutes of Health paid for most of the study. Pfizer Inc. supplied the pills and other companies supplied the packaging.

The same study a few weeks ago found that multivitamins cut the chance of developing cancer by 8 percent — a modest amount and less than what can be achieved from a good diet, exercise and not smoking.

Multivitamins also may have different results in women or people less healthy than those in this study — only 4 percent smoked, for example.

The fish oil studies tested prescription-strength omega-3 capsules from several companies in two different groups of people for preventing atrial fibrillation, a fluttering, irregular heartbeat.

One from South America aimed to prevent recurrent episodes in 600 participants who already had the condition. The other sought to prevent it from developing in 1,500 people from the U.S., Italy and Argentina having various types of heart surgery, such as valve replacement. About one third of heart surgery patients develop atrial fibrillation as a complication.

Both studies found fish oil ineffective.

The Associated Press and Reuters contributed to this report

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