Women at Work: Stress and its Impact on Cardiovascular Health
Posted by on November 23, 2015 - 4:17pm

As the holidays approach, we may be more aware of the stresses surounding our working lives. Perhaps you always have a stressful job, or perhaps projects become more stressful when attempting to complete projects before the new year deadline. Whatever the reason, our jobs can be stressful and it is important to know how this stress can impact our cardiovascular health. In fact, women who report having high job strain have a 40 percent increased risk of cardiovascular disease, including heart attacks and the need for procedures to open blocked arteries, compared to those with low job strain.

In addition, job insecurity -- fear of losing one's job -- was associated with risk factors for cardiovascular disease such as high blood pressure, increased cholesterol and excess body weight. However, it's not directly associated with heart attacks, stroke, invasive heart procedures or cardiovascular death, researchers said.  Job strain, a form of psychological stress, is defined as having a demanding job, but little to no decision-making authority or opportunities to use one's creative or individual skills.

"Our study indicates that there are both immediate and long-term clinically documented cardiovascular health effects of job strain in women," said Michelle A. Albert, M.D., M.P.H., the study's senior author and associate physician at Brigham and Women's Hospital, Boston, Mass. "Your job can positively and negatively affect health, making it important to pay attention to the stresses of your job as part of your total health package."

Researchers analyzed job strain in 17,415 healthy women who participated in the landmark Women's Health Study. The women were primarily health professionals, average age 57 who provided information about heart disease risk factors, job strain and job insecurity. They were followed for more than 10 years to track the development of cardiovascular disease. Researchers used a standard questionnaire to evaluate job strain and job insecurity with statements such as: "My job requires working very fast." "My job requires working very hard." "I am free from competing demands that others make."

The 40 percent higher risks for women who reported high job strain included heart attacks, ischemic strokes, coronary artery bypass surgery or balloon angioplasty and death. The increased risk of heart attack was about 88 percent, while the risk of bypass surgery or invasive procedure was about 43 percent.

"Women in jobs characterized by high demands and low control, as well as jobs with high demands but a high sense of control are at higher risk for heart disease long term," said Natalie Slopen, Sc.D., lead researcher and a postdoctoral research fellow at Harvard University Center on the Developing Child in Boston.

Previous research on the effects of job strain has focused on men and had a more restricted set of cardiovascular conditions. "From a public health perspective, it's crucial for employers, potential patients, as well as government and hospitals entities to monitor perceived employee job strain and initiate programs to alleviate job strain and perhaps positively impact prevention of heart disease," Albert said.

Source:   American Heart Association (2010, November 15). ScienceDaily.

Adopting healthy habits in your 30s can decrease heart disease risk.
Posted by on July 3, 2014 - 11:24am

The heart is more forgiving than you may think -- especially to adults who try to take charge of their health, a new Northwestern Medicine® study has found.

When adults in their 30s and 40s decide to drop unhealthy habits that are harmful to their heart and embrace healthy lifestyle changes, they can control and potentially even reverse the natural progression of coronary artery disease, scientists found.

“It’s not too late,” said Bonnie Spring lead investigator of the study and a professor of preventive medicine at Northwestern University Feinberg School of Medicine and a member of the WHRI Leadership Council.  “You’re not doomed if you’ve hit young adulthood and acquired some bad habits. You can still make a change and it will have a benefit for your heart.”

On the flip side, scientists also found that if people drop healthy habits or pick up more bad habits as they age, there is measurable, detrimental impact on their coronary arteries.“If you don’t keep up a healthy lifestyle, you’ll see the evidence in terms of your risk of heart disease,” Spring said.

“This finding is important because it helps to debunk two myths held by some health care professionals,” Spring said. “The first is that it’s nearly impossible to change patients’ behaviors. Yet, we found that 25 percent of adults made healthy lifestyle changes on their own. The second myth is that the damage has already been done -- adulthood is too late for healthy lifestyle changes to reduce the risk of developing coronary artery disease. Clearly, that’s incorrect. Adulthood is not too late for healthy behavior changes to help the heart.”

The bad news is that 40 percent of this sample lost healthy lifestyle factors and acquired more bad habits as they aged.“That loss of healthy habits had a measurable negative impact on their coronary arteries,” Spring said. “Each decrease in healthy lifestyle factors led to greater odds of detectable coronary artery calcification and higher intima-media thickness. Adulthood isn’t a ‘safe period’ when one can abandon healthy habits without doing damage to the heart. A healthy lifestyle requires upkeep to be maintained.”

Spring said the healthy changes people in the study made are attainable and sustainable. She offers some tips for those who want to embrace a healthy lifestyle at any age:

  • Keep a healthy body weight
  • Don’t smoke
  • Engage in at least 30 minutes of moderate to vigorous activity five times a week
  • No more than one alcoholic drink a day for women, no more than two for men
  • Eat a healthy diet, high in fiber, low in sodium with lots of fruit and vegetables

The study was published June 30 in the journal Circulation.

Source:  Northwestern News Center.  By Erin White

-

Calcium and vitamin D may help with Cholesterol
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.

 

NEW GUIDELINES FOR PREDICTING CARDIOVASCULAR DISEASE
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

Some Women At Greater Risk Post-Heart Attack
Posted by on August 23, 2013 - 2:41pm

When patients undergo an acute myocardial infarction, lifestyle changes are necessary to reduce the risk of relapse.   Yet research shows that women and minority patients have a more difficult time with risk factor modification efforts.  A recent study published in the Journal of Women’s Health revealed that 93% of the patients examined had at least one of the five cardiac risk factors evaluated, and of that 93%, black female patients had the greatest risk factor burden of any other subgroup.

The study examined 2,369 patients who were hospitalized for acute myocardial infarction.  The cardiac risk factors evaluated were hypertension, hypercholesterolemia, smoking, diabetes, and obesity. These are well established and potentially manageable risk factors that, when mitigated properly, may decrease the development of coronary heart disease, adverse cardiac events, and even mortality.  Why, then, are 93% of patients showing at least one risk factor post-heart attack?

The answer may lie in the disparities in educating and discharging patients after an acute myocardial infarction episode.  For instance, the research revealed that black female patients were less likely than white patients to receive lipid-lowering medications and smoking-cessation counseling, and this is merely one example of the inconsistencies associated with patient care.  While this study postulates other possible reasons for the high number of at-risk patients, the purpose of the research is to help target intervention strategies to those groups most affected.  Improving post-AMI preventative strategies will decrease the risk of recurrent events while improving patient health outcomes.  Susan G. Kornstein, MD stated “These findings indicate missed opportunities for both prevention and management of cardiac risk factors, particularly for women and minority patients.”  Perhaps with this surfacing research, patient risk factors will no longer be a “missed opportunity,” but rather a preventative priority for clinicians across the globe.

Read more about this research study here.

Scientists journey to US Environmental Protection Agency to advocate for women's health
Posted by on October 17, 2012 - 1:18pm

Our success as researchers is measured by our ability to translate our findings, according to the often-used phrase, from bench to bedside.  In other words, if we can apply our basic science findings to clinical care, we have the ability to impact countless lives.  This pipeline is a national priority, and in fact, many Academic Medical Centers have established programs to facilitate rapid clinical translation.  However, equally as important, and perhaps less appreciated is the need to translate basic science findings into relevant policies that protect and influence the general public.

Reproductive science and medicine are greatly impacted by the environment. Trends in reproductive health demonstrate that reproductive function has declined since the mid-20th century in certain populations and locations [1].  Coincident with this decline in reproductive function is the large and ever-increasing number of natural and synthetic chemicals to which humans are exposed [2, 3].  Basic, clinical, and epidemiological research has demonstrated that exposure to certain compounds and contaminants, such as Endocrine Disrupting Chemicals (EDC), can have negative impacts on reproductive health. These compounds interfere with the production, transport, activity, and metabolism of natural hormones in the body. As we, as basic scientists and clinical researchers, understand the mechanisms by which these environmental exposures to such compounds affect developmental, reproductive, and neuroendocrine functions, we must also be able to inform and educate the implications of these specific reproductive health findings to the decision makers in Washington, DC.  The question is: How?

In  2010, the Program on Reproductive Health and the Environment at the University of California, San Francisco developed the Reach the Decision Makers Fellowship with the exact intent of providing interested individuals and teams with the resources to advance science-based policy solutions.  Specifically the Reach Program serves to provide individuals with a distinct interest in reproductive health and the environment, with mechanisms to interact with the United States Environmental Protection Agency (US-EPA).  Over the past two years, the Reach program directed by Tracey Woodruff, PhD, MPH, an esteemed leader in the field, has trained over 75 individuals nationwide based on the principles of participatory democracy, social justice, and taking action to prevent harm (for more recent news about the Reach Program, check out the following blog written for the Physicians for Social Responsibility).

Table 1. Our interdisciplinary team

To take advantage of this unique program, we assembled an interdisciplinary team of six individuals committed to reproductive health and the environment (Table 1).  Our team is comprised of professionals from academia, health care, government, and the community, and collectively we have experience in research, policy, advocacy, teaching, and communication (Table 2).   Prior to joining the Reach Program, our team has worked together at Northwestern University and Northwestern Memorial Hospital in various settings including the Women’s Health Research Institute, the laboratory of Teresa K. Woodruff, PhD, the Oncofertility Consortium, the National Physicians Cooperative, the Oncofertility Saturday Academy, and the proposed Northwestern University Superfund Research Center in Reproductive Health Hazards. We joined the Reach Program with the goal of ensuring that the manner in which the US-EPA evaluates reproductive health and toxicity is in line with the current state of scientific knowledge.

Table 2. Team backgrounds

As Reach Program fellows, we have participated in a rigorous training program to define a reasonable “ask” in relation to our goal, to perform research on the topic, and to learn how to identify the key decision makers within the US-EPA who will listen to our request and affect change.   Over the past six months, we have engaged in a first trip to Washington, DC where we attended presentations from policy experts regarding the US-EPA hazard evaluation procedures and how scientists can inform the agency on emerging research regarding the effects of environmental toxins on reproductive health. Meetings at the US-EPA gave the team a greater understanding of the overall institution and current initiatives of the agency. We have also participated in nine webinars covering topics spanning from the effects of environmental toxins on reproductive health to identifying policies and policy makers at the US-EPA.

We also developed our policy project by systematically gaining an understanding of the US-EPA as an agency and the documents and guidelines that inform its staff. Members of the US-EPA helped us identify a principle document in reproductive health and the environment, the Guidelines for Reproductive Toxicity Risk Assessment. This document was written in 1996 and has not been revised since that time so our group decided to focus on some of the significant opportunities to improve upon the guidelines. Since 1996, the state of reproductive research has advanced and we identified three specific areas of research that could be prioritized during the updating of the Guidelines for Reproductive Toxicity Risk Assessment, as follows:

  • While the Guidelines acknowledged the importance of non-reproductive consequences of an impaired reproductive system, such as osteoporosis and increased risk of stroke, they did not include these outcomes as endpoint measures for further research study.
  • Model organisms are necessary for advancing research in reproductive and environmental health. In the Guidelines, the authors state that effects seen in one organism may be assumed to occur in another. While this is meant to be protective for unstudied species, it is also true that certain species are ideal to investigate different aspects of science and health. Thus, we encourage the study of multiple model organisms in reproductive health and the environment.
  • Research advances over the past decade have shown that significant sex differences are seen in the way males and females respond to different drugs and environmental toxins. This warrants the need to include both sexes in reproductive research, a consideration that could strengthen the updated Guidelines.

Our team developed these ideas into a position statement to inform US-EPA staff and interested parties of the need to advance reproductive health and the environment. This project culminates tomorrow, Thursday, October 18, 2012 when the team will fly to Washington, D.C. to meet with Nica Louie (Environmental Health Scientist at the National Center for Environmental Research), Brenda Foos (Director, Regulatory Support and Science Policy Division, Office of Children's Health Protection), and Daniel Axelrad (Environmental Scientist, Office of Policy) at the US-EPA. We hope to gain a greater understanding of the procedures of the agency at these meetings and advocate for the need to update Guidelines for Reproductive Toxicity Risk Assessment.

Virginia Neale, the Associate Director of Government Relations for Northwestern University, will also join the team and bring her expertise in bridging academia and the government to the project. Neale also facilitated a meeting between team members and legislative assistants to the House of Representatives congresswoman Jan Schakowsky (D-IL), who resides over Northwestern University’s Evanston campus. As congressional requests to the US-EPA are often needed to gather teams of experts and update guidelines, we will ask Schakowsky’s office to make such a request to gather the National Academy of Sciences and revise the Guidelines for Reproductive Toxicity Risk Assessment.

The work done this week, and over the past six months, by this interdisciplinary group, will build the foundation for the team to continue communicating evidence-based reproductive health findings to the policy makers in Washington D.C. who have the ability to affect change on a federal level. The relationships we develop this week will be fostered in the coming months and years to ensure that reproductive health is promoted at the highest level within the EPA and advocate that US-EPA guidelines are updated to include the most recent advances in reproductive research

This blog was Contributed by Francesca Elizabeth Duncan, PhD and Kate Waimey Timmerman, PhD    Read more about the team here in a Northwestern University press release.

1.         Woodruff, T.J., J. Schwartz, and L.C. Giudice, Research agenda for environmental reproductive health in the 21st century. Journal of epidemiology and community health, 2010. 64(4): p. 307-10.

2.         Sutton, P., L.C. Giudice, and T.J. Woodruff, Reproductive environmental health. Current opinion in obstetrics & gynecology, 2010. 22(6): p. 517-24.

3.         Woodruff, T.J., et al., Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility: executive summary. Fertility and sterility, 2008. 89(2 Suppl): p. e1-e20.

Women's Access To Health Care: 2012 State Analysis
Posted by on September 1, 2012 - 1:15pm

Each year the Kaiser Family Foundation and the National Women’s Law Center release a Women’s Access To Care: State By State Analysis. This report highlights many of the key issues pertaining to women’s health and health policy. Given the vast amount of decision-making and funding that take place at the state level, this analysis is a yearly must read.

Here are the highlights for 2012:

General Notes of Importance

  • A total of 13 states have Offices of Women’s Health that develop agendas on women’s health issues and provide policy guidance to the governor’s office, state legislature and the state department of health.
  • Few states require special training and service protocols for health care providers and law enforcement personnel that serve victims of violence. Most states do, however, have laws prohibiting discrimination against victims of violence seeking health insurance.
  • Women now account for 30% of new HIV infections in the United States. To prevent vertical transmission of HIV, the majority of states have implemented the Centers for Disease Control and Prevention’s 1995 guidelines for HIV testing of pregnant women, which call for voluntary testing for all pregnant women.

Private Insurance Coverage

  • Most states mandate that insurers cover some screening tests important to women’s health. 49 states and DC have mammography mandates, while only 25 states and DC have cervical cancer screening mandates.
  • Some states have taken major steps in increasing access to reproductive health care for women by mandating insurance coverage for key services. Half the states have adopted contraceptive coverage mandates, which require insurers to cover contraceptives to the same extent as other prescription medications, although 14 states include an exemption for employers and/or insurers with moral or religious objections to contraception.
  • About two-thirds of states have addressed mental health parity in an attempt to increase access to mental health services. Access to mental health care is particularly important for women, who are twice as likely as men to suffer from certain mental health conditions.

Medicaid

  • Most states have made significant expansions in Medicaid eligibility. Women comprise the majority of adult Medicaid recipients and nearly one in five women ages 18 to 64 living below 200% of the federal poverty level are enrolled in Medicaid.
  • States have taken steps to expand Medicaid coverage and income protections for low-income seniors and people with disabilities. Medicaid is an important source of coverage for low-income seniors (who disproportionately tend to be women) and people with disabilities.
A simple reason to exercise
Posted by on August 10, 2011 - 8:28am

A healthy heart is like a rubber band. The more elastic it is, the better it works. A new study by Benjamin Levine at the Texas Health Presbyterian hospital in Dallas shows lifelong exercise can help your heart stay that way.

While starting to exercise late in life has its benefits, Dr. Levine says:  “You don’t want to wait too long if you want to try to make these major structural changes.”

Between the ages of 45 and 60 is when the heart typically starts to stiffen. To reduce those effects, exercise should be a conscious part of your daily routine. “Four to five days a week we think is the right dose to make sure that you have the maximum benefits.”

The study, supported by the National Institutes of Health, was presented at the annual scientific meeting of the American College of Cardiology.
Source;  HHS HealthBeat

An Apple a Day May Keep Bad Cholesterol Away!
Posted by on May 13, 2011 - 7:55am

A new study discovered that apples promoted good cholesterol levels in the participating women.   Researchers from Florida State University were surprised at the results of their study that included 160 females aged 45-85 randomly selected to received either 75 grams of dried apples or dried prunes for a whole year.  The apple consumption group significantly reduced the blood levels of total cholesterol and low density cholesterol (LDL- bad cholesterol) by 14% and 23%, respectively. Good cholesterol (HDL) increased in the study group by 4%.  The atherogenic  (plaque building) risk ratios of lipid  and C-reactive protein levels were also improved in the apple group.

The women in the study group also lost an average of 3.3 pounds even though the apples added another 240 calories to the usual daily diet.  Dr. Bahram Arjmandi who led the study, suggested that weight loss may be due to the pectin in apples which satisfies hunger.   Early animal studies had already suggested that apple and its components, e.g. apple pectin and polyphenols, improve lipid metabolism and lower the production of proinflammatory molecules. The authors believed that this study was the first  to look at the cardioprotective effects of daily consumption of apple for one year in postmenopausal women.

Of course, more studies will need to be done to reconfirm these results and look at the cellular interactions but we already know that apples are a good source of fiber, so why not have "an apple a day!"

 

Add Fiber Now, Avoid Heart Disease Later
Posted by on April 4, 2011 - 8:45am

High-fiber diets during early adult years may lower lifetime cardiovascular disease risk

A new study from Northwestern Medicine shows a high-fiber diet could be a critical heart-healthy lifestyle change young and middle-aged adults can make. The study found adults between 20 and 59 years old with the highest fiber intake had a significantly lower estimated lifetime risk for cardiovascular disease compared to those with the lowest fiber intake.  This is the first known study to show the influence of fiber consumption on the lifetime risk for cardiovascular disease.

“It’s long been known that high-fiber diets can help people lose weight, lower cholesterol and improve hypertension,” said Donald M. Lloyd-Jones, M.D., corresponding author of the study and chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine. “The results of this study make a lot of sense because weight, cholesterol and hypertension are major determinants of your long-term risk for cardiovascular disease.”

A high-fiber diet falls into the American Heart Association’s recommendation of 25 grams of dietary fiber or more a day.  Lloyd-Jones said you should strive to get this daily fiber intake from whole foods, not processed fiber bars, supplements and drinks.

“A processed food may be high in fiber, but it also tends to be pretty high in sodium and likely higher in calories than an apple, for example, which provides the same amount of fiber,” Lloyd-Jones said.

For the study, Hongyan Ning, M.D., lead author and a statistical analyst in the department of preventive medicine at Feinberg, examined data from the National Health and Nutrition Examination Survey, a nationally representative sample of about 11,000 adults.  Ning considered diet, blood pressure, total cholesterol, smoking status and history of diabetes in survey participants and then used a formula to predict lifetime risk for cardiovascular disease.

“The results are pretty amazing,” Ning said. “Younger (20 to 39 years) and middle-aged (40 to 59 years) adults with the highest fiber intake, compared to those with the lowest fiber intake, showed a statistically significant lower lifetime risk for cardiovascular disease.”  In adults 60 to 79 years, dietary fiber intake was not significantly associated with a reduction in lifetime risk of cardiovascular disease. It’s possible that the beneficial effect of dietary fiber may require a long period of time to achieve, and older adults may have already developed significant risk for heart disease before starting a high-fiber diet, Ning said.

As for young and middle-aged adults, now is the time to start making fiber a big part of your daily diet, Ning said.

Erin White is the broadcast editor. Contact her at ewhite@northwestern.edu

Pages