Ultraprocessed Food Again Linked to Increased CVD, Death

High consumption of UPF in this Mediterranean cohort was associated with a 58% increased risk for CVD mortality and 52% higher risk of dying from ischemic heart disease (IHD) and cerebrovascular causes, independently of known risk factors for CVD, even among individuals who otherwise adhered to the Mediterranean diet.

The foods that contributed most to total UPF consumed were processed meat, which accounted for 19.8% of UPF intake; pizza (16.8%); and cakes and pies (13.4%).

The researchers found a direct linear dose-response relation between a 5% increase in the proportion of UPF in the diet and risk for all-cause and CVD mortality.

Cite this: Ultraprocessed Food Again Linked to Increased CVD, Death – Medscape – Dec 24, 2020. — https://www.medscape.com/viewarticle/943200?src=rss

After reading the full summary of the study I had some issues with the study findings on pizza. Apparently I’m not alone. From the comment section:

Pizzas were mentioned by the authors and Dr. Walter Willet (for whom I have always had great admiration and consider him among my 3 most valued nutrition resources) as a UPF. However, even as a consistent follower of Mediterranean diet for >40 years, I see nothing wrong with occasional enjoyment of two or three slices of Margherita pizza (which is not covered with any processed meats or extra cheeses).

Dr. Michael Mogadam

Like I’ve said many, many times pizza is a food group and should not be considered an ultraprocessed food. Without pizza life would not be possible. Pass on the chips, sugary drinks, restructured meat (see https://www.sciencedirect.com/topics/food-science/restructured-meat) and other types of junk food.

Don’t pass on the pizza!

Statins Can Save Lives

They examined the records of nearly 300,000 adults in the U.S. who had an initial atherosclerotic cardiovascular disease event between 2007 and 2016. These were divided into three groups: coronary heart disease, ischemic stroke or transient ischemic attack, or peripheral artery disease.

When people left the hospital or emergency department in 2007 following a first diagnosis in one of these categories, about half began taking statins within 30 days. By 2016, statin use increased to approximately 60%.

“Based on the guidelines, we hoped to see a much higher uptake among this entire group,” says Dr. Noseworthy. “Statin intolerance was only noted for 4%-5% of the patients, which means as many as 35% of patients are not receiving treatment according to the guidelines.”

Mayo Clinic. “Statins can save lives; are they being used?.” ScienceDaily. http://www.sciencedaily.com/releases/2020/12/201201144030.htm (accessed December 2, 2020) — https://www.sciencedaily.com/releases/2020/12/201201144030.htm

Journal Reference:

Xiaoxi Yao, Nilay D. Shah, Bernard J. Gersh, Francisco Lopez-Jimenez, Peter A. Noseworthy. Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016. JAMA Network Open, 2020; 3 (11): e2025505 DOI: 10.1001/jamanetworkopen.2020.25505

An Early-Onset Subgroup of Type 2 Diabetes: A Multigenerational, Prospective Analysis in the Framingham Heart Study

Abstract

OBJECTIVE To assess the relation of type 2 diabetes occurring earlier (age <55 years) versus later in life to the risk of cardiovascular death and to diabetes in offspring.

RESEARCH DESIGN AND METHODS In the Framingham Heart Study, a community-based prospective cohort study, glycemic status was ascertained at serial examinations over six decades among 5,571 first- and second-generation participants with mortality data and 2,123 second-generation participants who initially did not have diabetes with data on parental diabetes status. We assessed cause of death in a case (cardiovascular death)–control (noncardiovascular death) design and incident diabetes in offspring in relation to parental early-onset diabetes.

RESULTS Among the participants in two generations (N = 5,571), there were 1,822 cardiovascular deaths (including 961 coronary deaths). The odds of cardiovascular versus noncardiovascular death increased with decreasing age of diabetes onset (P < 0.001 trend). Compared with never developing diabetes, early-onset diabetes conferred a 1.81-fold odds (95% CI 1.10–2.97, P = 0.02) of cardiovascular death and 1.75-fold odds (0.96–3.21, P = 0.07) of coronary death, whereas later-onset diabetes was not associated with greater risk for either (P = 0.09 for cardiovascular death; P = 0.51 for coronary death). In second-generation participants, having a parent with early-onset diabetes increased diabetes risk by 3.24-fold (1.73–6.07), whereas having one or both parents with late-onset diabetes increased diabetes risk by 2.19-fold (1.50–3.19).

CONCLUSIONS Our findings provide evidence for a diabetes subgroup with an early onset, a stronger association with cardiovascular death, and higher transgenerational transmission.

Diabetes Care 2020 Dec; 43(12): 3086-3093. https://doi.org/10.2337/dc19-1758

Translation – The earlier you develop diabetes your risk of CVD and coronary death is higher. An if one or both of your parents developed either early onset or late onset diabetes you’re screwed.

Mothers’ Lifestyle Predicts When Offspring will have First Heart Attack or Stroke

Previous research has shown that parents pass on health to their offspring through both genes and shared environment/lifestyle. This was the first study to examine whether parents’ heart health was associated with the age at which offspring develop cardiovascular disease. In addition, it investigated the influence of each parent separately.

The study was conducted in offspring-mother-father trios from the Framingham Heart Study — a total of 1,989 offspring, 1,989 mothers, and 1,989 fathers. Offspring were enrolled at an average age of 32 years and followed over 46 years (1971-2017) for the development of cardiovascular events. “Crucially, the study followed offspring into most of their adult life when heart attacks and strokes actually occur,” explained Dr. Muchira

European Society of Cardiology. “Mothers’ lifestyle predicts when offspring will have first heart attack or stroke.” ScienceDaily, 4 November 2020. www.sciencedaily.com/releases/2020/11/201104194708.htm.

Journal Reference: Muchira JM, Gona PN, Mogos MF, et al. Parental cardiovascular health predicts time to onset of cardiovascular disease in offspring. Eur J Prev Cardiol., 2020 DOI: 10.1093/eurjpc/zwaa072

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium

RESULTS Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor–adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01).

CONCLUSIONS CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium — Diabetes Care 2020 Oct; 43(10): 2597-2606. https://doi.org/10.2337/dc20-0166

Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association

Abstract

Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome. Some drug-induced arrhythmias (bradyarrhythmias, atrial tachycardia, atrioventricular node reentrant tachycardia) are significant predominantly because of their symptoms; others (monomorphic ventricular tachycardia, Brugada syndrome, torsades de pointes) may result in serious consequences, including sudden cardiac death. Mechanisms of arrhythmias are well known for some medications but, in other instances, remain poorly understood. For some drug-induced arrhythmias, particularly torsades de pointes, risk factors are well defined. Modification of risk factors, when possible, is important for prevention and risk reduction. In patients with nonmodifiable risk factors who require a potentially arrhythmia-inducing drug, enhanced electrocardiographic and other monitoring strategies may be beneficial for early detection and treatment. Management of drug-induced arrhythmias includes discontinuation of the offending medication and following treatment guidelines for the specific arrhythmia. In overdose situations, targeted detoxification strategies may be needed. Awareness of drugs that may cause arrhythmias and knowledge of distinct arrhythmias that may be drug-induced are essential for clinicians. Consideration of the possibility that a patient’s arrythmia could be drug-induced is important.

Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association — https://www.ahajournals.org/doi/10.1161/CIR.0000000000000905

If you go to the original article page you’ll find a link to the full statement in PDF format that includes several lists of the medications that can either cause or exacerbate arrhythmias.

Cardiac Testing Post COVID-19: Of Echos and MRIs — The Skeptical Cardiologist

CVCT CardioBrief published online earlier this week a letter from a group of “clinicians, researchers and imaging specialists” who are concerned about the “presentation, interpretation and media coverage of the role of cardiac magnetic resonance imaging in the management of asymptomatic patients recovered from COVID-19.” It’s short and sweet but makes many excellent points. Let’s…

Cardiac Testing Post COVID-19: Of Echos and MRIs — The Skeptical Cardiologist

Excellent post. Thanks for sharing your expertise Dr. Pearson.

Statins Are Your COVID-19 Friend: Keep Taking Them — The Skeptical Cardiologist – Updated 09.24.20

Statins remain our safest and most effective drug for primary and secondary prevention of coronary artery disease. However, a cult of statin deniers has taken hold on the internet and their efforts often result in patients inappropriately stopping statins, an outcome which can have lethal consequences. Early in the pandemic a patient of mine in…

Statins Are Your COVID-19 Friend: Keep Taking Them — The Skeptical Cardiologist

Thank you doctor.

Note to my readers: I encourage you to follow the link and read the entire post and the comments to fully understand Dr. Pearson’s message.
And if you’re a statin denier don’t bother reading the full post because we’re not here to engage in an argument or to change your opinion on this medication.

Update

University of California – San Diego. “Statins reduce COVID-19 severity, likely by removing cholesterol that virus uses to infect.” ScienceDaily. http://www.sciencedaily.com/releases/2020/09/200923164603.htm (accessed September 24, 2020).

https://www.sciencedaily.com/releases/2020/09/200923164603.htm

Eat More Broccoli

Published in the British Journal of Nutrition the research has found higher consumption of cruciferous vegetables, such as broccoli, Brussels sprouts and cabbage, is associated with less extensive blood vessel disease in older women.

Using data from a cohort of 684 older Western Australian women recruited in 1998, researchers from ECU’s School of Medical and Health Sciences and The University of Western Australia found those with a diet comprising more cruciferous vegetables had a lower chance of having extensive build-up of calcium on their aorta, a key marker for structural blood vessel disease.

Dr Blekkenhorst said women in this study who consumed more than 45g of cruciferous vegetables every day (e.g. ¼ cup of steamed broccoli or ½ cup of raw cabbage) were 46 percent less likely to have extensive build-up of calcium on their aorta in comparison to those consuming little to no cruciferous vegetables every day.

Edith Cowan University. “Broccoli and Brussels sprouts a cut above for blood vessel health.” ScienceDaily. http://www.sciencedaily.com/releases/2020/08/200820102434.htm (accessed August 20, 2020).

https://www.sciencedaily.com/releases/2020/08/200820102434.htm

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