• FDA cautions against antibiotics for heart patients

    By Rachael Rettner, MyHealthNewsDaily 

    An antibiotic commonly prescribed for bronchitis and sinus infections may increase the risk of death from heart problems, but only for people with certain risk factors, a new study suggests.

    The study involved more than a million cases of antibiotic treatment for young and middle-age adults living in Denmark.

    Use of the antibiotic azithromycin was linked with nearly a threefold increase in the risk of dying from heart problems over the five-day treatment, compared with not taking antibiotics. (Azithromycin is sold under the brand name Zithromax, and a treatment course is commonly referred to as a "Z pack.")

    However, the study found a similar increased risk of dying for people treated with the antibiotic penicillin. This suggests that there's something about people who are prescribed antibiotics — for instance, they may have health risks due to their bacterial infection — rather than the drugs themselves, that increases the risk of death from heart problems, the researchers said.

    In an editorial accompanying the study, researchers from the Food and Drug Administration said that doctors should consider the heart risks of azithromycin and other antibiotics when prescribing the drugs. Another antibiotic, called erythromycin, has also been linked with an increased risk of death from abnormal heartbeats.

    The new results are in contrast to those of a 2012 study that linked azithromycin with a higher risk of dying from heart problems than the antibiotic amoxicillin. That study and others prompted the FDA to warn the public in March that azithromycin may cause abnormal, and sometimes fatal, changes in heartbeat in people at risk for heart problems.

    Because the new study involved people in the general population, while the 2012 study involved people on Medicaid — a population with an above-average risk of dying over any given period — the researchers say the two studies are complementary, rather than conflicting. For the general population, the results are reassuring in that they suggest azithromycin "can be prescribed without concern about an increased risk of death from cardiovascular cause," the researchers said.

    "A lot of people got nervous when the FDA came out with their warning," saidDr. Tara Narula, associate director of the cardiac care unit at Lenox Hill Hospital in New York, who was not involved in the study. The new findings are helpful because they tell doctors which groups of patients may be at increased risk for heart problems with azithromycin, she said.

    No one knows the exact mechanism by which azithromycincauses heart problems, but it's thought to change the heart's electrical activity, Narulasaid.

    People with known problems in their hearts' electrical systems (such as arrhythmias), those with structural changes to the heart or heart damage (such as damage from a previous heart attack ), and those with underlying heart disease should be cautious when using the drug,Narulasaid.

    In 2011, about 40 million people in the United States received prescriptions for azithromycin, the FDA said.

    "This possibility should give clinicians pause when they’re considering prescribing antibacterial drugs, especially for patients with pre-existing cardiovascular risk factors, or clinical conditions in which antibacterial drug therapy has limited benefits," the FDA researchers wrote.

    The study and editorial will be published tomorrow (May 2) in the New England Journal of Medicine.

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  • Gene therapy to be tested in heart failure

    By Ben Hirschler, Reuters

    LONDON - British scientists are stepping up clinical tests of gene therapy in a bid to help people with advanced heart failure pump blood more efficiently.

    Researchers said on Tuesday they planned to enrol patients into two new clinical trials using Mydicar, a gene therapy treatment made by privately held U.S. biotech company Celladon.

    After more than 20 years of research, the ground-breaking method for fixing faulty genes is starting to deliver, with European authorities approving the first gene therapy for an rare metabolic disease last November.

    In the case of heart failure, the aim is to insert a gene called SERCA2a directly into heart cells using a modified virus, delivered via a catheter infusion. Lack of SERCA2a leads to ever weaker pumping in people with heart failure.

    Although drugs offer some relief, there is currently no way of restoring heart function and the prognosis for those with advanced disease is worse than for many cancers.

    One of the studies, led by scientists at Imperial College London, is part of a wider mid-stage Phase II project sponsored by Celladon that involves 200 patients worldwide, some of whom have already been treated in the United States and Denmark.

    The second trial, which is due to start in the summer, will test the same treatment in 24 British patients already fitted with mechanical heart pumps to see how the approach may help in this particular setting.

    It promises to be a long haul, with extensive Phase III studies still needed once results of the current mid-stage tests are received, which Celladon expects in the first half of 2015.

    Gene therapy has experienced a series of advances and setbacks over the decades. The most notable blow came in 1999 when an Arizona teenager died in a gene therapy experiment. More recent results, however, have been promising in fields ranging from immune system diseases to blindness.

    "It is a great example of the slow burn of good laboratory science translating into a potential clinical treatment," said Peter Weissberg, medical director of the British Heart Foundation, which is co-funding the second trial.

    Because gene therapy replaces or boosts the activity of a faulty gene, it offers the possibility of a one-time "fix" - and that creates an economic challenge.

    Any gene therapy is bound to be expensive, since a single dose could last a lifetime and the manufacturer will have just one shot at recouping its investment.

    But Alexander Lyon of Imperial College, lead investigator on both studies, said it could be a cost-effective solution in heart failure if it avoided the need for interventions such as heart transplants at 200,000 pounds ($300,000) each. 

  • 12 school football players die each year, study finds

    By Genevra Pittman
    Reuters
    Each year in the U.S. an average of a dozen high school and college football players die during practices and games, according to a new study that finds heart conditions, heat and other non-traumatic causes of death are twice as common as injury-related ones. 

    Researchers reviewed data from the National Center for Catastrophic Sports Injury Research and found 243 football deaths recorded between July 1990 and June 2010.

    One hundred of the fatalities resulted from an underlying heart condition, 62 were due to a brain injury - typically a subdural hematoma - and 38 were from heat-related causes, according to findings published in The American Journal of Sports Medicine.

    Kelly Dougherty, an assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine, said she found the number of heat-related deaths in particular "quite alarming."

    Many of those deaths happened in the South during preseason play, including at two-a-day practices.

    "These are preventable deaths," said Dougherty, who has studied heat acclimation but wasn't involved in the new study.

    "This article highlights the urgent need for future research studies that would investigate children's and especially football players' body temperature responses during practice (and) during games," she told Reuters Health.

    "We have so few data to guide policy, to guide recommendations, and we really don't have a good idea of body temperature responses in the field."

    Current recommendations from the American Academy of Pediatrics call for making sure kids and teens gradually adapt to exercising in the heat during the preseason and for teams to take more water breaks, and play with less intensity, on very hot and humid days. 

    Some deaths on the rise
    Some tests can pick up on the abnormalities that may cause sudden heart-related deaths in young athletes; however widespread screening programs are controversial, in part because of a high rate of false positives.

    After heart, brain and heat-related conditions, 11 players - all African Americans with sickle cell trait - died from sickle cell crises during intense conditioning. People with sickle cell trait carry one copy of the gene for sickle cell disease, rather than two, but they can be especially vulnerable to dehydration and low oxygen, for example. 

    Seven players died from asthma, seven from a sudden blow to the chest, five from a blood clot and the rest from broken necks, abdominal injuries, infections and lightning, Frederick Mueller from the University of North Carolina at Chapel Hill and his colleagues found.

    The 243 deaths in total over 20 years work out to one for every 100,000 high school and college football players during that period.

    High school athletes accounted for 203 of those deaths; but because there are so many more high school players, a college player was statistically almost three times more likely to die playing football than a high school player during the study period.

    A representative from the National Collegiate Athletic Association (NCAA) said its health and safety committee planned to review the new study. The NCAA funds the National Center for Catastrophic Sports Injury Research.

    "Through this data the NCAA has made recent policy changes in several important areas, including football preseason practice, medical examinations, safety training for coaches, concussion management plans and sickle cell trait," the representative wrote in an email to Reuters Health.

    The rate of deaths related to sickle cell trait, heart conditions and heat all increased during the second decade of the study, the researchers found.

    "These conditions require a greater emphasis on diagnosis, treatment, and prevention," Mueller's team wrote.

    "The problem of football fatalities is real and needs to be addressed by continued surveillance and rule changes when applicable to further reduce the incidence."

  • FDA proposes tightening rules for heart defibrillators

    The FDA is setting new rules for defibrillators: Those portable machines that deliver an electric shock to the heart: they can mean the difference between life and death when someone is having a heart attack. NBC's Robert Bazell reports.

    By Toni Clarke
    The U.S. Food and Drug Administration is proposing new rules aimed at improving the reliability of emergency defibrillators following some 45,000 reports of device failures over the past seven years.

     

    The defibrillators, found in hundreds of airports, shopping malls and restaurants across the country, are designed to jump-start the heart after it has suddenly stopped.

    The FDA said its proposal would require manufacturers to provide clinical data or other evidence proving their devices are safe and effective in order to be approved or remain on the market.

    The proposals would also require manufacturers to provide inspection reports and submit to the FDA details of any changes made to the device. Companies will have 15 months to submit the information to the FDA once the proposals are final.

    Dr. William Maisel, deputy director of the FDA's center for devices and radiological health, said there were 88 recalls of automated emergency defibrillators in the seven years from 2005 to 2012 as well as thousands of malfunctions.

    He said it was not possible to estimate how many deaths occurred due to the malfunctions since death may have occurred anyway, but there have been enough cases of device malfunctions to warrant concern.

    Most problems involved the design or manufacture of the device, or inadequate control of components purchased from other suppliers, Maisel said, adding that the agency would focus on these areas when reviewing the new marketing applications.

    Makers of emergency defibrillators include Physio-Control Inc, Zoll Medical Corp and Royal Philips Electronics NV.

    Rachel Bloom-Baglin of Philips said the company has not yet seen the written version of the proposal. However, based on previous discussions with the FDA, the company believes that more scrutiny would not result in an interruption of supply of the defibrillators or accessories.

    Physi-Control's chief executive, Brian Webster, said the increase in device failures can partly be attributed to the fact that they are more prevalent.

    "While it is the FDA's position that defibrillator failures have risen over the past several years, the number of devices in the market has grown dramatically over that same time period," he said. "An evaluation of the number of defibrillator malfunctions must include the number of devices deployed to accurately assess whether the failure rate is increasing or actually decreasing."

    Maisel said it was not possible to give a precise number of times emergency defibrillators were used and therefore what the failure rate is, but he said "our perception is that the failure rate is quite small."

    Officials at Zoll were not immediately reachable for comment. 

     

  • Sugary drinks tied to 180,000 deaths worldwide

    By Rachael Rettner
    MyHealthNewsDaily

    Consumption of soda and other sugar-sweetened beverages may contribute to hundreds of thousands of deaths around the world, mainly due to type 2 diabetes, a new study says. 

    The results show sugar-sweetened beverage consumption is linked to 180,000 deaths a year worldwide, including 25,000 deaths a year in the United States, the researchers say. The study is being presented at a meeting of the American Heart Association.

    Of the 15 most populated countries, Mexico had the highest rate of death linked to the beverages at 318 yearly deaths per million adults, and Japan had the lowest at 10 yearly deaths per million adults.

    Earlier studies show drinking sugar-sweetened beverages increases the risk of chronic diseases such as diabetes, heart disease and cancer, and the new study provides an estimate just how big this problem is, the researchers said.

    "Our findings should push policy makers world-wide to make effective policies to reduce consumption of sugary beverages, such as taxation, mass-media campaigns, and reducing availability of these drinks," said study researcher Gitanjali M. Singh, a postdoctoral research fellow at the Harvard School of Public Health in Boston, Mass.

    However, experts cautioned the study found only an association, and cannot prove that sugar-sweetened beverage consumption caused these deaths. Sugar-sweetened beverages (SSBs) are often just part of a bad diet that contributes to poor health.

    "Diets with more calories from SSBs are poorer diets overall," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine, who was not involved in the study. "They may also have more starch, or sodium, or trans fat, or chemicals, and almost certainly do," Katz said.

    The new study included information from 114 countries, looking at dietary surveys to assess sugar-sweetened beverage consumption, as well the number of deaths from certain diseases. The researchers used information from earlier studies to estimate the effect of sugary drink consumption on weight gain, and, in turn, the effect of weight gain on the risk of death from cardiovascular disease, diabetes and cancer.

    Related story: Nutrition experts: Despite ruling, soda ban is still a great idea

    Overall, sugar-sweetened beverage consumption was linked to 133,000 deaths from diabetes, 44,000 deaths from cardiovascular diseases and 6,000 deaths from cancer.

    Of nine world regions, Latin America/Caribbean had the most diabetes deaths at 38,000, and East/Central Eurasia had the most cardiovascular deaths at 11,000, in 2010.

    Katz warned against becoming too preoccupied with any particular nutrient, as an earlier study found that excess salt intake was linked to 150,000 premature deaths worldwide. Instead, it's important to focus on overall diet, he said.

    "If we improve the quality of diets, we improve both sugar intake, and salt intake and everything else, and will certainly have better health to show for it," Katz said. Cutting down on sugar-sweetened beverages, but eating more of other junk foods, could worsen health, he said. 

    In a statement, the American Beverage Association said, "The researchers make a huge leap when they take beverage intake calculations from around the globe and allege that those beverages are the cause of deaths which the authors themselves acknowledge are due to chronic disease."

    The American Heart Association recommends adults consume no more than 450 calories per week from sugar-sweetened beverages, based on a 2,000 calorie per day diet. 

  • Post-smoking weight gain doesn't harm heart

    By Catherine Winters
    MyHealthNewsDaily

    Plenty of smokers swear they’ll quit. But nagging concerns about post-smoking weight gain, and perhaps the effect it'll have on their risk for cardiovascular disease, may prompt some to put their plans to quit on the back burner. Now, a new study suggests that post-smoking weight gain won't raise people's risk for cardiovascular disease or death even if they have diabetes. 

    Researchers found that people without diabetes who stopped smoking reduced their risk for heart attack, stroke or cardiovascular death by about 50 percent. Gaining weight didn’t change that reduction in risk. People with diabetes — a group that has to be especially careful about weight gain — had the same reduction in risk regardless of how much weight they gained.

    During the study, researchers analyzed data on 3,251 people enrolled in the Offspring Cohort of the landmark Framingham Heart Study. That study was desgined to identify the causes of heart disease. People in the Offspring Cohort, which began in 1971, underwent regular physical examinations. During these visits, study participants were weighed; their body mass index, or BMI, was calculated; their cholesterol and blood glucose levels were measured; and their smoking habits were recorded.

    The researchers found that on average, smokers, nonsmokers and long-term quitters —those who had been smoke-free for four or more years — gained an average of one to two pounds between study visits, which occurred every four years. Recent quitters — those who had quit within the previous four years — gained much more weight, about five to 10 pounds. At their first examination, 31 percent of people in the study smoked. By the fourth examination, about 20 years later, just 13 percent did.

    Among people without diabetes, recent quitters gained much more weight —nearly six pounds — than long-term quitters and smokers, who each gained about a pound, and nonsmokers who gained about three pounds. Among people with diabetes, recent quitters gained nearly eight pounds on average; smokers, nearly two pounds; long-term quitters, zero; and nonsmokers one pound.

    Typically, people who quit smoking gain between about seven and 13 pounds within the first six months, a gain that lingers over time. Death from cardiovascular disease increases by 40 percent for each five-unit increase in body mass index, or BMI. In a person who is 5 feet 7 inches tall and weighs 180 pounds, that's the equivalent of a 30-pound gain, according to the researchers.

    During about 25 years of follow-up, the researchers found that 631 cardiovascular events had occurred. Of these, 337 (53.4 percent) were heart attacks and 147 (23.3 percent) were strokes.

    Among people without diabetes, recent quitters were 37 percent less likely to have a heart attack; long-term quitters were 68 percent less likely; and nonsmokers were 81 percent less likely. Among people with diabetes, recent and long-term quitters were 60 percent less likely than smokers to suffer a heart attack; and nonsmokers were 85 percent less likely.

    "We knew people gained weight after they stopped smoking," said senior study author researcher Dr. James B. Meigs of the general medicine unit at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School. "We didn't know if that would impact the size of the benefit of stopping smoking."

    The findings suggest that the benefits of quitting trump weight gain. "From a public health perspective, people who stop smoking will gain a little weight, but it doesn't mitigate the benefits," added Meigs. "This study allows doctor to say to patients, 'If you stop smoking, within a few years, you'll have the same chance of dying from a heart attack as you would if you hadn’t smoked.' Stopping smoking is really beneficial and again, we can say this with certitude."

    Of the major risk factors for cardiovascular disease — namely diabetes, smoking, high blood pressure, high cholesterol and age — weight gain usually influences only three of those,  Meigs said. "In people who gain weight, their blood pressure tends to go up and their cholesterol and blood sugar levels tend to get a little worse."

    As it turns out, "in our study, the weight gain wasn't so big that people were going from Twiggy to Jumbo," Meigs said. "They were gaining a few pounds in the middle distribution of weight from kind of heavy to a little heavier." 

    Indeed, the most overwhelming risk factor for having a heart attack or stroke is cigarette smoking. "A little weight gain that raises blood pressure, blood glucose or cholesterol isn’t nearly harmful enough to overcome the benefits of not smoking," Meigs said.

    The study is published today (March 12) in the Journal of the American Medical Association.

  • Fewer heart blockages showing up on stress tests

    By Genevra Pittman
    Reuters
    The proportion of patients who have blocked arteries show up during a stress test has dropped "enormously" over the past two decades, according to a new study. 

    However, researchers disagreed about why that might be the case - whether the tests are getting worse, people's heart problems are becoming less severe, or simply too many healthy people are being referred for testing they don't need.

    On a stress test, doctors monitor a person's heart and blood vessels during exercise or after administering a combination of drugs that similarly stress the heart. The exams are used to make a more definitive diagnosis among patients who have some signs of a blockage but not enough to warrant treatment, such as with artery-opening stents.

    For the new study, researchers tracked close to 40,000 people who underwent stress testing to look for blocked arteries at Cedars-Sinai Medical Center in Los Angeles between 1991 and 2009.

    During that period, the proportion of referred patients with an abnormal test fell from about 41 percent to less than nine percent. Similarly, the proportion with moderate to severe blockage dropped from 21 percent to five percent, according to findings published Monday in the Journal of the American College of Cardiology.

    In the study's later years, more patients undergoing testing were obese or had diabetes, the research team found, but fewer smoked.

    The researchers, led by Dr. Alan Rozanski from St. Luke's Roosevelt Hospital in New York City, suggest the findings may mean fewer people with heart-related symptoms, such as chest pain, now have blockages. Or it could be that doctors need a better test to diagnose those patients.

    Dr. Patrick O'Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, had a different interpretation.

    "The fact that the results are changing over time can only mean one thing, and that's that we're overusing this test," O'Malley, who wasn't involved in the new research, told Reuters Health.

    "I think it represents a culture of testing that has been sort of an epidemic in this country."

    It could be that more people with mild or non-traditional heart disease symptoms - such as shortness of breath - are being sent to stress testing when it's unlikely to reveal any problems, O'Malley said.

    The majority of tests performed in the most recent years used medication rather than exercise to stress a patient's heart, Rozanski's team found. Rozanski did not respond to requests for comment before deadline.

    So-called pharmacologic stress tests are typically three to four times more expensive than an exercise stress test, according to O'Malley. He thinks they should largely be limited to people who aren't able to walk on a treadmill.

    According to the Healthcare Blue Book, an exercise stress test costs about $200, depending on the hospital.

    The use of more expensive tests - in likely less appropriate patients - reflects how "obsessed" heart doctors have become with finding and treating any small abnormalities, O'Malley said.

    "If the prevalence of (positive test) results are going down, it just means we're doing too many, and we're doing them on people we shouldn't be doing them on," he said. 

  • Uninsured less likely to get heart meds

    By Andrew M. Seaman, Reuters

    New York - Uninsured Americans were less likely to get the best treatment for heart troubles than those with insurance in a new study that hints the blame may lie with the quality of physicians who typically treat the uninsured. 

    In a group of about 61,000 Americans, researchers found that those without any health insurance were between 6 percent and 12 percent less likely than people with either public or private insurance to be prescribed drugs that are considered standard care for heart disease.

    "There is some difference of treatment. It only applies - interestingly enough - to uninsured patients," said the study's senior author Dr. Paul Chan, of Saint Luke's Mid America Heart Institute in Kansas City, Missouri.

    In the past, studies found uninsured Americans have worse health outcomes, compared to the insured. They're also less likely to get screenings and preventive care - possibly because they don't often go to a doctor.

    Less is known, though, about uninsured people who do go to doctors and whether they receive worse care than insured people.

    For the new study, Chan and his colleagues used data from 2009 on 60,814 heart patients at 30 doctors' offices around the U.S.

    Of those patients, about 9 percent were uninsured, 71 percent had private insurance, and 20 percent had public insurance, such as Medicare or Medicaid.

    The researchers, who published their findings in the Journal of the American College of Cardiology, looked to see which patients received the recommended medications for their heart conditions and whether the treatment they got was linked to their insurance status.

    Overall, patients with public or private insurance received about the same number of prescriptions, but the uninsured patients were less likely to be prescribed drugs, compared to the insured patients.

    For example, about 73 percent of uninsured patients were prescribed beta-blockers after a heart attack, compared to about 81 percent of privately insured patients. And about 89 percent of uninsured patients received medication for high cholesterol, compared to about 95 percent of privately insured patients.

    But those differences seemed to disappear when the researchers took into account where the patients were being treated.

    "That seems to suggest that at lot of this is being mediated by the clinics that are seeing lots of uninsured patients. They're underperforming compared to clinics that are seeing insured patients," said Chan.

    "It speaks to the idea that the higher the number of uninsured patients in your practice, the more financially unstable it is... and quality goes down," said Dr. Ed Havranek, a cardiologist at the Denver Health Medical Center in Colorado.

    Havranek, who wrote a commentary accompanying the new study, told Reuters Health, "If it's just the lack of insurance, it should not affect the physicians' decisions to sit down and prescribe (a drug)." It could be driven by doctors' perceptions of their patients, he said.

    Chan added that uninsured people tend to be sicker and their other conditions may take priority over their heart problems.

    "Truth be told, when many of these patients come in it's not just cardiovascular disease. It's diabetes, obesity and smoking too," Chan said.

    Havranek said the first step to solving the problem is doing what Chan and his colleagues did by shining a light on it, and then finding a practical solution.

    "You have to be open to the possibility that you're not doing things accurately or fairly across patient populations," he said.

  • New stroke guidelines expand use of clot-busting drugs

    By Rachael Rettner, MyHealthNewsDaily
    Some people who've had a stroke can receive a clot-busting drug up to 4.5 hours after their symptoms begin, according to new guidelines from the American Heart Association. 

    Previously, the guidelines said the drug must be delivered within three hours of the onset of symptoms.

    The drug, called tissue plasminogen activator, or tPA, breaks down blood clots in the brain, and can improve stroke symptoms and reduce the risk of disability. It is used only for strokes caused by blood clots, and not those caused by bleeding in the brain. The sooner the treatment is given, the better a patient's chances for recovery, said Dr. Edward Jauch, lead author of the guidelines and director of the Division of Emergency Medicine at the Medical University of South Carolina.

    Currently, just 3 to 5 percent of stroke patients reach the hospital in time to be considered for the treatment, the AHA says. Researchers hope the new guidelines will increase the number of patients who receive the treatment, Jauch said.

    Patients are eligible to receive tPA in the extended time window — 3 to 4.5 hours after stroke symptoms appear — if they are younger than age 80, if their stroke is mild to moderate in severity, if they are not taking anticoagulants (blood thinners), and if they do not have a history of stroke or diabetes, Jauch said.

    Another new recommendation says stroke patients eligible for tPA should receive it within one hour of arriving at the hospital.

    A 2007 European study showed the benefits of using tPA in the extended time window. In 2009, the AHA issued an advisory to doctors about the benefits of using tPA in the extended window, but this is the first time the recommendation has appeared in the organization's official stroke management guidelines. 

    The new guidelines also recommend that hospitals offering specialized stroke treatment should collaborate with facilities that don't have such specialized treatments. For instance, the hospitals might set up a network for "telemedicine," which would allow doctors at special treatment centers to assess a patient remotely via a computer monitor or TV screen. Hospitals also should set up efficient systems that allow stroke patients to be quickly transferred from one hospital to another if needed, Jauch said

    Symptoms of stroke include difficulty speaking (slurred speech) or understanding others, arm weakness or numbness, face numbness or drooping, and blurred vision. If you experience these symptoms, you should call 911 right away, the AHA says.

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  • Few Americans have 'healthy' hearts

    By Rachael Rettner, MyHealthNewsDaily 

     

    Just 3 percent of Americans have optimal heart health, while 10 percent have poor heart health, according to a new report from the American Heart Association.

    The District of Columbia has the highest percentage of people with ideal heart health, at 6.9 percent, followed by Vermont, at 5.5 percent, and Virginia, at 5 percent. The states with the lowest percentage of people in ideal heart health are Oklahoma, at 1.2 percent, and West Virginia and Mississippi, both at 1.5 percent.

    The findings are based on a 2009 survey of more than 350,000 Americans that collected information on seven indicators of heart health.

    People were considered to have optimal heart health if they met the following criteria: They did not have high blood pressure, high cholesterol or diabetes; they were not overweight, underweight or obese; they did not smoke; they did at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity a week; and they ate five or more servings of fruits and vegetables a day.

    The maximum score was 7, and the average was 4.4. [See 7 Ways to Lower Your Risk of Heart Disease.]

    In general, people living in New England and western states had higher percentages of people with ideal heart health than did people hailing from southern states.

    The findings show that the heart health of Americans varies dramatically by state, the researchers said. The study estimates could be used to help states set goals for improving heart health in their areas, they said.

    The study excluded people with coronary heart disease (CHD) and stroke because risk factors for heart disease in this population differ from those in people who don’t have a history of CHD or stroke.  The findings were based on people's self-reports. As a result, the study could have overestimated the percentage of people in ideal heart health if individuals didn't know they had a certain condition.

    The study is published today (Dec. 19) in the Journal of the American Heart Association.

    You can find out your heart health score by visiting the AHA's website.

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  • Heart disease progress could be ruined by your bad habits

    MyHealthNewsDaily

    America's progress in the fight against heart disease could be slowed by unhealthy habits, according to a new report.

    The American Heart Association's current goal is to reduce the rate of death from heart disease by 20 percent by 2020, but if current trends continue, the rate may improve only by 6 percent, the AHA said in its report.

    Between 1999 and 2009, the rate fell about 33 percent, the AHA noted.

    Although rates of smoking, high cholesterol and high blood pressure are expected to decline, these improvements may be offset by increases in obesity and diabetes, coupled with only small changes in diet and exercise, the report said.

    "Americans need to move a lot more, eat healthier and less, and manage risk factors as soon as they develop,” said Dr. Alan Go, chairman of the report's writing committee. “If not, we’ll quickly lose the momentum we’ve gained in reducing heart attack and stroke rates and improving survival over the last few decades." In 2009, cardiovascular disease accounted for about one in three deaths in the U.S.

    Currently, 68.2 percent of adults are overweight, and more adults are obese than are either normal weight or underweight (34.6 percent compared with 31.8 percent), the report said. Twenty-two percent of adults do not exercise at all. Among high school students, 17 percent of girls and 10 percent of boys said they exercised for less than an hour during the past week.

    The AHA said it is working to help build healthier communities by improving access to healthy foods and parks.

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  • Losing your job increases heart attack risk

    By Linda Carroll

    Losing your job can give you a heart attack – quite literally.

    Duke University researchers have found that unemployment significantly raises the risk of a heart attack. And that risk goes up with each job loss and with increasing time spent unemployed, according to a study published in the Archives of Internal Medicine.

    In fact, one job loss raised the risk of a heart attack by 35 percent, while four job losses raised the risk by 63 percent. The unemployed were at greatest risk of a heart attack within the year following a layoff or firing.

    “Looking at a lifetime of exposure to a social stressor such as unemployment – the number of times a person has lost a job or the amount of time they’re without a job – there’s an independent association with heart attacks,” says the study’s lead author Matthew E. Dupre, an assistant professor of at Duke and a senior fellow at the university’s Center for the Study of Aging.

    Dupre says he and his colleagues were somewhat surprised by their results, since they took into account known  and suspected risk factors, like high blood pressure and loss of health insurance.

    “The fact that the associations remained largely unchanged despite accounting for more than a dozen suspected risk factors was somewhat unexpected,” he says. “Changes in income, health insurance, health behaviors, physical health status, and the like had little impact on the risks related to unemployment. Instead, we found that the risks associated with multiple job losses were of the magnitude of other established risk factors, such as smoking, hypertension, and diabetes.”

    For the new study, the researchers scrutinized the health and work histories of 13,451 adults aged 51 to 64. Detailed histories covered a full 18 years, during which study volunteers suffered a total of 1061 heart attacks.

    At the outset, 14 percent of the volunteers were unemployed. During the course of the study 69.7 percent lost one or more jobs.

    Heart experts said that the study adds to the mounting evidence that certain kinds of stressors can ramp up the risk of a cardiovascular event.

    “This is adding to what we know with regards to the triggers of cardiovascular events,” says Dr. John Schindler, an assistant professor of medicine at the University of Pittsburgh Medical Center. “Many years ago we thought of this as a random process. Now we see there are real triggers, whether environmental or perceived stress.”

    Recent studies have turned up numerous emotional triggers, including frustration, depression, and anxiety, Schindler says. “And all of those go along with unemployment,” he adds.

    So, what is it about job loss that might raise the risk of a heart attack?

    “There are likely multiple mechanisms which link significant socioeconomic stress, including becoming unemployed, to an increased risk of cardiovascular events,” says Dr. Eliot Corday Professor of Cardiovascular Medicine and Science at the University of California, Los Angeles, Eliot Corday Professor of Cardiovascular Medicine and Science at the University of California, Los Angeles, and co-director of the UCLA preventive cardiology program. “These include sustained activation of the part of the nervous system involved with stress and stress-related hormones, decrements in heart healthy behaviors, avoiding preventive health visits and measures, and not seeking prompt medical attention when there are early warning signs.”

    What the study shows, experts say, is that you need to pay extra attention to your heart in times of stress, such as job loss.

    “My conclusion is that we should always be focused on our hearts since cardiovascular disease is potentially such a potentially deadly disease,” Schindler says. “But since we’re at greater risk the first year we lose a job, at that time we should be even more diligent about cardiovascular health.”

    Future research could examine whether emotional support could help reduce risk.

    “Whether the cardiovascular risk related to unemployment and multiple job losses could also be reduced by psychological support or enhanced social resources will require further study,” Fonarow says.

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