Posted by on November 27, 2014 - 11:22am

Early results of the ELITE study find women who started hormone therapy early after menopause saw a significant slowing of atherosclerotic progression, whereas those who waited more than a decade saw no impact on vascular health, supporting the "timing hypothesis".

"ELITE results are consistent with the majority of the literature that shows that women who are young and/or in close proximity to menopause when starting hormone therapy have reduced coronary heart disease and overall mortality," according to study leader  Howard N. Hodis, MD, of the University of Southern California in Los Angeles, and colleagues.

The Women's Health Initiative, aiming for cardiovascular prevention with menopausal hormone therapy, had raised major concerns about stroke and myocardial infarction (MI) in its somewhat older, later menopause population.  The KEEPS study subsequently showed that for a younger (ages 42 to 58) population, this may not be true.

ELITE was designed to directly test the hypothesis that timing makes all the difference in safety of hormone therapy after menopause.

"I think it's important that clinicians not interpret this as you should start estrogen to try to prevent heart disease, but that the younger, newly menopausal woman who has menopausal symptoms should not be denied hormone therapy because of concerns about heart disease risk, as was seen in older women," JoAnn E. Manson, MD, of Brigham and Women's Hospital in Boston, told MedPage Today.

"There are other factors to take into consideration [such as risk of thrombosis]," she explained. "But because a newly menopausal woman is generally at low absolute risk of heart attack, stroke, thrombosis, all of those outcomes, it tends to be a favorable balance of benefit-to-risk."

While suggestive that early hormone therapy wouldn't have an impact on later heart disease risk, "this trial wasn't large enough to look at clinical events," Manson cautioned.

To learn more about this study, click HERE.   To learn more about Menopause, click HERE.

Primary source: American Heart Association
Source reference: Hodis HN, et al "Testing the menopausal hormone therapy timing hypothesis: The early versus late intervention trial with estradiol" AHA 2014; Abstract 13283.

Posted by on April 7, 2014 - 8:41pm

Drinking milk is not just for kids but also for post-menopausal women, new research shows. A new study from the Women's Health Initiative just published by the North American Menopause Society, reveals that calcium and vitamin D after menopause can improve women's cholesterol profiles.

Over 600 women took either a supplement containing 1,000 mg of calcium and 400 IU of vitamin D3, or a placebo, daily. Women who took the supplement, unsurprisingly, were two times more likely to have sufficient vitamin D levels (at least 30 ng/mL), in comparison to the women were taking placebo. Women who were taking supplements also had LDL (the "bad" cholesterol) numbers that were 4 to 5 points lower than the women taking placebo. The women on supplement also had higher levels of HDL (the "good" cholesterol) and lower levels of triglycerides.

Researchers agree that more work needs to be done to see whether or not supplementing one's diet with calcium and vitamin D can lower cholesterol levels and ultimately improve rates of cardiovascular disease in women after menopause. These results, however, show that there may potentially be extra benefits for those with calcium and vitamin D deficiencies to start supplements. Supplementing may be key for strengthening both the heart and bones after menopause. To learn more about healthy choices you can make after menopause, visit Northwestern's menopause website here.

“Calcium/vitamin D supplementation, serum 25-hydroxyvitamin D concentrations, and cholesterol profiles in the Women’s Health Initiative calcium/vitamin D randomized trial,” will be published in the August 2014 print edition of Menopause.


Posted by on November 14, 2013 - 4:19pm

The next time you see your primary care doctor, he or she will have access to updated guidelines and a new electronic tool that can better predict your chances of developing cardiovascular disease, including heart attack and stroke.

The guidelines -- released today from the American College of Cardiology and the American Heart Association -- were developed by a work group co-chaired by Donald M. Lloyd-Jones, M.D., senior associate dean, chair and professor of preventive medicine at Northwestern University Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital.

Past guidelines, which were last updated in 2004, only included data from Caucasians and focused on predicting one’s short-term (10-year) risk for coronary heart disease events such as a heart attack. Stroke risk was not a factor in the past guidelines. The new guidelines are based on a broader population sample, including African-Americans, and include stroke risk and both short-term and lifetime cardiovascular disease risk.

“We were tending to under treat women and African-Americans during important years in theirs 40s, 50s and 60s, because we weren’t fully capturing their risk,” Lloyd-Jones said. “We are now smarter about identifying risk and treating more people who will benefit.” The new recommended electronic assessment tool, which calculates a patient’s “cardiovascular risk score,” can be integrated into electronic health records or downloaded on a spreadsheet. The tool uses formulas to calculate a score based on factors such as age, race, gender, blood pressure, smoking, diabetes and cholesterol. The tool displays a percentage and a graphic that shows a patient’s individualized 10-year and lifetime risk versus someone his or her age with optimal risk levels.

The group charged with making these new recommendations also looked closely at existing literature on promising new technologies in the field of cardiology, which include CT scans and urine and blood tests to detect possible heart conditions. While the group does not support using these new risk measures routinely, if a doctor and patient are on the fence about treatment after the risk score has been calculated, there are four measures that show the most helpful assessment potential:

  • Family history of premature cardiovascular disease in first-degree relatives (before age 55 in your father or 65 in your mother)
  • Coronary artery calcium score, which can show the presence of plaque in artery walls
  • High-sensitivity C-reactive protein levels (higher levels have been associated with heart attack and stroke)
  • Ankle brachial index, the ratio of the blood pressure in the ankle compared to blood pressure in the arm

“These measure are reasonable for some situations, but we are not recommending them for routine assessment, and they should only be used after the risk equation exercise has been performed,” Lloyd-Jones said.

To read the full article and other comments, click here.

Source: Northwestern University News

Posted by on January 23, 2013 - 10:29am

Young and middle-age women whose diet included high levels of anthocyanins -- the flavonoids present in red and blue fruits such as strawberries and blueberries -- had a significantly reduced risk for myocardial infarction (MI), a large prospective study found.

Women whose anthocyanin intake was in the highest quintile had a 32% decrease in risk of MI during 18 years of follow-up, according to Eric B. Rimm, ScD, of Harvard University, and colleagues.

And in a food-based analysis, women who consumed more than three servings of strawberries or blueberries each week showed a trend towards a lower MI risk, with a 34% decrease compared with women who rarely included these fruits in their diet, the researchers reported online in Circulation.

"Growing evidence supports the beneficial effects of dietary flavonoids on endothelial function and blood pressure, suggesting that flavonoids might be more likely than other dietary factors to lower the risk of [coronary heart disease] in predominantly young women," they observed.

A number of preclinical experiments have demonstrated cardioprotective effects of anthocyanins, including anti-inflammatory effects, plaque stabilization, and inhibition of the expression of growth factors.   While studies have suggested that MI risk is increased in young and middle-age women who smoke or use oral contraceptives, little is known about the influence of diet in this population, whose risk may differ from that in older women.

The younger women may have a greater likelihood of endothelial dysfunction and coronary vasospasm and less obstructive disease.

Because dietary flavonoids -- found in vegetables, fruits, wine, and tea -- are recognized as benefiting endothelial function, the researchers looked at outcomes for 93,600 women enrolled in the Nurses' Health Study II who reported their consumption of various foods and their lifestyle factors every 4 years.

To read more visit:
Cassidy A, et al "High anthocyanin intake is associated with a reduced risk of myocardial infarction in young and middle-aged women" Circulation 2013; DOI:10.1161/CIRCULATIONAHA.112.122408.


Posted by on September 8, 2012 - 9:03am

According to a new study, vitamin D supplements may not reduce heart risks in older women as previously suggested. At total of 305 healthy postmenopausal women aged 60-70 yr were recruited and received a daily capsule of 400 or 1000 IU vitamin D3 or placebo.  Investigators found that the supplements did not have much of an impact on cholesterol, blood pressure and blood sugar.

Source:  Wood  J of Cl Endo & Metabolism, Aug 3, 2012.

Posted by on August 26, 2012 - 8:41am

For years we criticized heart researchers for not including women in the early studies that recommended aspirin to prevent heart disease.  We asked:  How can you recommend aspirin in women when all the studies took place in males!  In 2007, after additional studies that included females, the American Heart Association released guidelines for the CVD preventive care in women including aspirin. Their recommendations:

  • Primary prevention (other at-risk or healthy women):   Consider aspirin therapy in women >65 years if blood pressure is well-controlled and benefit for ischemic stroke and myocardial infarction prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke.
  • Secondary prevention (high risk):  Aspirin therapy should be used in high-risk women (established coronary heart disease, cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm, end-stage or chronic renal disease, diabetes, and 10-year Framingham risk>20%) unless contraindicated.

A recent study, using a web-based risk assessment tool found that the majority of women for whom aspirin is recommended were not following national guidelines.  The authors led by Cathleen Rivera, MD at Scott and White Healthcare in Texas concluded that there is a need for more education about aspirin among clinicians and women for increased prevention of heart disease.  Given the rising direct and indirect costs of cardiovascular disease, it makes sense that health care providers take a closer, serious look at the increased use of low cost aspirin in lieu of designer heart meds.!

Source:  Rivera C, Song J, Copeland L et al.  Journal of Women's Health, Vol. 21, 2012.

Posted by on July 3, 2012 - 12:15pm

 Consuming a low carbohydrate-high protein diet -- like the Atkins diet -- may be associated with a greater risk of cardiovascular disease in women.   Decreases in carbohydrate intake and increases in protein intake  were all associated with significantly greater risks of incident cardiovascular disease events in young Swedish women, according to Pagona Lagiou, MD, PhD, of the University of Athens in Greece, and colleagues.

The findings, which were reported online in BMJ, "do not answer questions concerning possible beneficial short-term effects of low carbohydrate or high protein diets in the control of body weight or insulin resistance," the authors wrote.   "Instead, they draw attention to the potential for considerable adverse effects on cardiovascular health of these diets when they are used on a regular basis," they wrote.

Low carb-high protein diets have become popular because of the short-term effects on weight control, but concerns have been raised about the potential cardiovascular effects over the long term. Studies exploring the issue have given mixed results, with a U.S. study showing no relationship between such a diet and rates of ischemic heart disease.   But three European studies showed a greater risk of cardiovascular mortality with such a diet.

The current analysis included 43,396 women, ages 30 to 49 at baseline, who completed a comprehensive questionnaire on lifestyle and dietary factors, as well as medical history. They were followed for an average of 15.7 years.   During follow-up, there were 1,270 incident cardiovascular events, which included ischemic heart disease, ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, and peripheral arterial disease.

After adjustment for energy intake, saturated and unsaturated fat intake, and numerous cardiovascular risk factors, each one-point decrease in carb intake was associated with a relative 4% increase in cardiovascular events (95% CI 0% to 8%). There was a suggestion that the associations were stronger for women whose protein came mostly from animal sources, but the test for interaction did not reach statistical significance for nearly all of the individual outcomes.

"Although these results are based on an observational study, their biological plausibility seems self evident," according to Anna Floegel, MPH, of the German Institute of Human Nutrition Potsdam-Rehbruecke, and Tobias Pischon, MD, MPH, of the Max Delbrück Center for Molecular Medicine Berlin-Buch.

"A low carbohydrate diet implies low consumption of whole-grain foods, fruits, and starchy vegetables and consequently reduced intake of fiber, vitamins, and minerals. A high protein diet may indicate higher intake of red and processed meat and thus higher intake of iron, cholesterol, and saturated fat," they explained in an accompanying editorial.

"These single factors have previously been linked to a higher risk of major chronic diseases, including cardiovascular disease, in observational studies, so it is not surprising that this combination of risk factors is linked to a higher incidence of disease and mortality," they said.

For more informations about preventing heart disease, visit:   2011 Guidelines for CVD Prevention in Women

Primary source: BMJ
Lagiou P, et al "Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study" BMJ 2012; DOI:10.1136/bmj.e4026.


Posted by on May 23, 2012 - 4:28pm

Heart disease and stroke deaths drop significantly for people with diabetes!
According to the Centers for Disease Control and Prevention (CDC) healthier lifestyles, better disease management are helping people with diabetes live longer.   Death rates for people with diabetes dropped substantially from 1997 to 2006, according to a study published May 22 in the journal Diabetes Care. Among the most promising findings,

  • Deaths from all causes declined by 23%.
  • Deaths related to heart disease and stroke dropped by 40%.
  • Although an adult with diabetes is likely to die at a younger age than one who does not have diabetes, the difference is getting smaller.

These findings parallel other surveillance reports showing improved medical treatment for cardiovascular disease, better management of diabetes, and some healthy lifestyle changes contributed to the decline. On average, people with diabetes were less likely to smoke and more likely to be physically active than in the past. Better control of high blood pressure and high cholesterol also may have contributed to improved health among diabetics.  However, obesity levels among people with diabetes continued to increase ☹.

Posted by on May 21, 2012 - 7:12am

Ireland, a land of "happy wars and sad love songs," is also a nation that  is adopting some of the bad eating habits found in the U.S.  and is trying to break those habits.

That assessment comes from Ian Graham, MD, of Dublin's Trinity College, who chairs the Irish Heart Foundation Cardiovascular Prevention Council and is co-chair of the program committee at EuroPRevent 2012, which opened with "Ireland Day," a series of presentations focusing on efforts to tame cardiovascular disease among the Irish.

To illustrate his point, he introduced Robbie Walsh, a 39-year-old Dublin postman who had an MI at age 37.    Walsh, a ruddy-faced man who seemed pleased to share his story with a room full of journalists, said he regularly walked 5 to 6 hours a day delivering mail so he had always considered himself healthy.   But Walsh also smoked about 25 cigarettes a day, "more on the weekends or if I went out for drink," regularly ate red meat, and limited vegetables to "about once or twice a week." And both his father and his brother had heart disease.

Following coronary artery bypass graft surgery for single vessel disease, Walsh entered a standard 12-week long cardio-rehab program that taught him the value of fruits, vegetables, and a life without cigarettes.   Perhaps most importantly, Walsh said, is that he knows that preventing a second heart attack is a lifelong job for him.

Graham, who pointed to Walsh as a success story, said expanding prevention efforts in Ireland, as well as the whole of the European Union and North America, will depend largely upon the buy-in from the primary care community, since all of primary prevention and much of secondary prevention is a "GP job."

Posted by on April 22, 2012 - 6:29am

Heart disease is the leading cause of death among women, and evidence-based national guidelines promote the use of daily aspirin for women at increased risk for cardiovascular disease. However, less than half of the women who could benefit from aspirin are taking it, according to an article  available free online at the Journal of Women's Health website*.

"Based on this survey, it is evident that the majority of women for whom aspirin is recommended for prevention of cardiovascular disease are not following national guidelines," says Susan G. Kornstein, MD,  Executive Director of the Virginia Commonwealth University Institute for Women's Health.

Among more than 200,000 women participating in a web-based survey to assess their risk for cardiovascular disease, only 41%-48% of women for whom aspirin is recommended reported that they took an aspirin daily, according to the study authors, Cathleen Rivera, MD and Texas-based colleagues. The women were more likely to use aspirin if they had a family history of cardiovascular disease or had high cholesterol, as reported in the article "Underuse of Aspirin for Primary and Secondary Prevention of Cardiovascular Disease Events in Women." The authors conclude that improved educational programs are needed to increase awareness of the benefits of aspirin use to prevent heart disease among women.

Mary Ann Liebert, Inc./Genetic Engineering News  "Should More Women Take A Daily Aspirin To Prevent Heart Disease?." Medical News Today. MediLexicon, Intl., 9 Apr. 2012. Web.
12 Apr. 2012.