Measuring BP the right way: the AHA issues a scientific statement


Takeaway

  • The American Heart Association (AHA) has issued a scientific statement on the measurement of BP, with a wide range of information on everything from technique, timing, and devices to best approaches in specific patient populations.

Why this matters

  • The statement is a timely update of a 2005 scientific statement and follows on the 2017 guidelines from the AHA and partner organizations.
  • The authors take a close look at oscillometric devices.

Key highlights

  • The statement takes a close look at appropriate cuff size, correct body position, and competence of the person doing the measurement.
  • It offers a table that breaks proper measurement technique into 6 steps:
    • Patient preparation: 3-5 minutes seated without talking, feet flat on floor, back supported; exam table is not appropriate.
    • Proper technique: validated device, correct cuff size and position.
    • Proper measurement: first record in both arms, use the arm with higher reading for future; separate repeats by 1-2 minutes.
    • Proper documentation: record systolic/diastolic values to nearest even number.
    • Average: average ≥2 readings on ≥2 occasions for proper BP estimation.
    • Tell the patient their readings.
  • Algorithms for distinguishing white-coat vs masked hypertension also provided.
  • Addresses specific populations, such as pediatrics, pregnancy, and technology (e.g., smartphone measurement).

Is Omega-3 Pointless for Preventing Heart Disease?


Meta-analysis showed no significant link to coronary disease, any major vascular events

Omega-3 fatty acids have gotten a heart-healthy reputation without good evidence that they actually prevent major cardiovascular disease events, according to a meta-analysis.

Across 10 large randomized trials lasting at least 1 year, taking the supplements was not associated with significantly reduced risk of:

  • Death from coronary heart disease: rate ratio 0.93 (99% CI 0.83-1.03)
  • Nonfatal myocardial infarction: RR 0.97 (99% CI 0.87-1.08)
  • Any coronary heart disease events: RR 0.96 (95% CI 0.90-1.01)
  • Major vascular events: RR 0.97 (95% CI 0.93-1.01)

Benefits also weren’t seen in subgroups with prior coronary heart disease, diabetes, elevated lipid levels, or statin use, Robert Clarke, MD, of the University of Oxford in England, and colleagues reported in JAMA Cardiology.

While the European Society of Cardiology has called a protective effect of omega-3s debatable at best, the American Heart Association has recommended use as “reasonable” for secondary prevention of coronary heart disease in patients with recent events and “might also be considered” in people with heart failure and reduced ejection fraction.

“However, the results of the present meta-analysis provide no support for the recommendations to use approximately 1 g/d of omega-3 FAs in individuals with a history of CHD for the prevention of fatal CHD, nonfatal MI, or any other vascular events,” Clarke’s group concluded. “The results of the ongoing trials are needed to assess if higher doses of omega-3 [fatty acids] (3-4 g/d) may have significant effects on risk of major vascular events.”

Neuropsychologists say ‘broken heart syndrome’ is real — and it may have killed Debbie Reynolds


“I want to be with Carrie.”

Hours before the stroke that ultimately killed Hollywood legend Debbie Reynolds, the actress and dancer turned to her son Todd and said that she missed her daughter Carrie Fisher — who died Dec. 26 following a heart attack — and wanted to be with her. They were among her last words.

AlterNet reported on Thursday that “broken heart syndrome” is a real lethal disorder identified by neuropsychologists that has a history stretching back thousands of years.

“There’s been a beautiful history that you can die from misery or loneliness or literally from a broken heart,” said stress psychophysiology specialist Prof. Brian Hughes to AlterNet’s Alexandra Rosenmann.

According to American Heart Association (AHA), “broken heart syndrome” is what is known as stress-induced cardiomyopathy or takotsubo cardiomyopathy. It is a temporary heart condition brought on by intense or prolonged stress. And in some cases, it can be fatal.

 Women are more likely than men to experience the sudden, intense chest pain — the reaction to a surge of stress hormones — that can be caused by an emotionally stressful event,” says the AHA. “It could be the death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic rejection,”

“The ancient Greeks and Romans felt that many emotions were reflected in the body and the people with different characteristics and different personality types have different body shapes and body functions,” said Hughes, who is the president of the international Stress and Anxiety Research Society (STAR).

“Nowadays we often feel that these notions are myths and superstitions, or in the case of fiction, artistic license,” he continued. “However there’s actually a very consistent line of research linking emotional function to the brain and to physical health and disease in the body and one of the most compelling examples this relates to cardiovascular function and especially to the notion of cardiovascular stress reactivity.”

The University Hospital of Zurich has conducted a long-term study of “broken heart syndrome,” following 1,000 patients who have been diagnosed with the condition.

 Their research specifically examines the link between brain activity and heart function. Many of the patients affected by the syndrome, they say, are women over the age of 50.

“We know from experiments on animals that long-term stress can be fatal. Under fire from too much adrenaline, noradrenaline and cortisol, a whole range of organs start to fail after certain time and the animal dies,” said University Hospital’s Lutz Jäncke.

Watch video about this story, embedded below:

Watch a video about the University Hospital of Zurich’s study of broken heart syndrome, embedded below:

What you need to know about health risk calculators


Ever since researchers with the legendary Framingham Heart Study created the first calculator to gauge the chances of having a heart attack, such tools have become a routine part of medicine. But the results aren’t as straightforward to interpret as the answers you used to get from your old high-school graphing calculator. The problem has to do with the challenge of interpreting the concept of risk.

Let’s use as an illustration the heart risk calculator designed by the American College of Cardiology and the American Heart Association to accompany their latest guidelines for the use of cholesterol-lowering statins.

It asks for 10 pieces of information, from age to cholesterol levels and smoking status, in order to estimate the chance of having a first “atherosclerotic cardiovascular disease event,” better known as heart attack or the most common type of stroke. Add your information and hit the “Calculate” button. The tool returns a number that represents your chance of having an event over the next 10 years. But what does this really mean? Experts disagree about the best interpretation.

Say the number you get is 10 percent. One way to interpret it is like this: In a group of 100 people with the same risk factors as you, 10 will have an event over the course of the next decade. Experts call this the epidemiologic risk. While it can be helpful in planning an treatment and prevention efforts across an entire population, it probably doesn’t fully answer your questions about yourself. Am I going to be one of the 10 with an event or the 90 without an event? What about my other risk factors not included in the calculator? For example, you may have had one or two parents who died young from a heart attack or stroke, which would increase your risk, or you may exercise every day and be at the highest level of cardiorespiratory fitness, which would lower it.

Ideally, instead of knowing the risk of having heart attack in the next 10 years, we would rather know the definitive answer — am I going to have one or not?

Individual factors like smoking or high blood pressure or diet quality have been linked with disease risks for decades. Using statistical techniques, it is possible to capture the prognostic power of such factors into a risk estimate. If one indicator sketches an individual’s portrait, many of them working together (10 in the case of the heart risk calculator) carve a statue of the same subject, adding dimensions to the prediction.

As my colleagues Ralph B. D’Agostino, Allan D. Sniderman, and I wrote earlier this year in JAMA, if all past, present, and future predictors of a particular disease were known — and it was possible to quantify them — one could build an algorithm that would give a definitive answer about that disease occurring for each individual.

Until then, it’s important to make the best of the useful tools that Framingham and other reputable sources have created for us. To make that happen, physicians and other experts need to convey the result that emerges from a risk calculator in ways that people can easily grasp.

The Framingham Heart Study, for example, includes in one of its calculators a “heart/vascular age” in addition to the 10-year risk of cardiovascular disease. A heart/vascular age younger than your chronological age is good, one older than your chronological age isn’t.

An approach we are exploring at the Duke Clinical Research Institute capitalizes on human’s natural tendency to compare themselves with others. Telling an individual that she has a 15 percent chance of having a heart attack in the next 10 years may offer some motivation to adopt healthier habits, while telling her that 90 percent of women her age have a better risk profile than hers may be even more motivational.

The risk estimates offered by today’s models and algorithms are limited by the data on which they were developed and the information they include. With more and more data becoming available, predictive analytics become more powerful and more useful to precision medicine, which aims to tailor treatment to individual patients. Electronic health records may help us build calculators that can provide estimates in a doctor’s office or at a patient’s bedside.

It is important to keep in mind that health risk calculators don’t assess the benefit that may come from treatment. One that inadequately addresses the root causes of a disease may do little to bring down the risk, while an effective therapy may offer an incremental or long-term benefit among individuals at moderate or even low risk.

The quality of the data that go into building a risk calculator matters. Not every calculator can be trusted. Turning up high in a Google search doesn’t always mean that a calculator’s validity and performance are trustworthy. A few, like those produced by the Framingham Heart Study, have been thoroughly assessed and validated.

Risk calculators will likely become more common in everyday clinical settings, partially because more data are available to build them and partially because the medical community and the public find them to be useful. Innovations such as machine learning applied to the “big data” available in electronic health records and other sources will only serve to improve the performance of these calculators and increase their value.

But even with advances such as machine learning, we are unlikely to ever create a calculator that moves us from prognostication to certainty and delivers the correct answer for each individual. That shouldn’t dissuade us from using health risk estimates. But we cannot let the appeal of a number that appears easy to understand pass for real understanding of what that number means. If we settle for that, what will be at risk is the potential benefit of these calculators for patient health.

American Heart Association says Ibuprofen may exacerbate heart failure


A recent statement from the American Heart Association has revealed that many common drugs, including ibuprofen, may cause or worsen heart failure. The organization is also reportedly urging doctors to thoroughly check over all of their patients’ medications, including those that they take without a prescription, in order to ensure their lives aren’t at risk.

Image: American Heart Association says Ibuprofen may exacerbate heart failure

Heart failure occurs when the heart is unable to efficiently pump blood around the body. Some of the symptoms include extreme tiredness, breathlessness and swelling of the legs. It often develops in patients who have suffered a heart attack or stroke, and the condition tends to deteriorate over time

The CDC reports that nearly 6 million American adults will experience heart failure. Statistics from 2009, indicate that roughly one-in-nine deaths list heart failure as a contributing condition. Nearly half of all people diagnosed with heart failure will die within five years of their diagnosis, according to the CDC. In other words, heart failure is a serious condition. Given that the average heart failure patient takes about seven medications daily, it is easy to see where things could become problematic. This is especially true if their medications are not being managed properly.

The statement from the AHA was released in July, and was also published on the website of the organization’s journal Circulation. Robert L. Page II, the chair of the committee that formulated the statement has commented: “Since many of the drugs heart failure patients are taking are prescribed for conditions such as cancer, neurological conditions or infections, it is crucial but difficult for healthcare providers to reconcile whether a medication is interacting with heart failure drugs or making heart failure worse.” Page is also a professor in the Department of Clinical Pharmacy and the Department of Physical Medicine and Rehabilitation at the University of Colorado Schools of Medicine and Pharmacy.  He also notes that while patients are often instructed to read food labels and be mindful of their diets, they are not often advised to watch what over-the-counter drugs they may be taking.

Ibuprofen is cited as being especially problematic for patients with heart failure. Patients who take ibuprofen or similar drugs are 10 times more likely to experience flare-ups. It’s estimate that they are also about 33 percent more likely to require a hospital admission.

This underlines how very dangerous just about any drug can be, especially if you have a preexisting health condition.

Restrict Kids to 25 Grams or Less of Daily Added Sugar


Experts reviewed current scientific evidence for heart health effects.

Children and adolescents should consume no more than 25 grams of added sugars a day, according to a new scientific statement from the American Heart Association (AHA).

The statement in Circulation addresses the health concerns in young children and adolescents as a result of consumption of added sugars, such as an increased risk of cardiovascular disease, hypertension, obesity, and insulin resistance leading to type 2 diabetes.

 “There has been a lack of clarity and consensus regarding how much sugar is considered safe for children, so sugars remain a commonly added ingredient in foods and drinks, and overall consumption by children remains high — the typical American consumes about triple the recommended amount of added sugars,” said lead author Miriam Vos, MD, of the Emory University School of Medicine in Atlanta, said in a press release.

After examination of the literature on five main categories of blood pressure, lipids, obesity, insulin, and non-alcoholic fatty liver disease, the AHA recommends that children between the ages of 2 and 18 years should consume ≤25 g, or about 100 calories (approximately 6 tsp.) of added sugars each day.

For children under the age of 2 years, all added sugars should be avoided, due in part, to the establishment of “taste preferences” early in life, the statement authors noted.

“I congratulate the AHA on their bold new statement on added sugar consumption. After decades of misplaced concern about fat in the diet, this statement helpfully shifts focus to the main problem with diet today — excessive intakes of processed carbohydrates,” said David Ludwig, MD, PhD, director of the new balance foundation obesity prevention center at Boston Children’s Hospital, told MedPage Today, “But it’s important not to lose sight of other processed carbohydrates — including white bread, white rice, and potato products — that have similar metabolic effects as sugar and are also over-consumed.”

Ludwig, who is the author of the book Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently, pointed out that a high level of sugar intake is a “historical aberration. Most people across the world and throughout time ate sugar as an occasional treat, not a major component of the diet. With a simultaneous focus on welcoming back nutritious high fat foods (like nuts, full fat dairy, olive oil and dark chocolate), the shift to a diet low in sugar and other processed carbohydrates is entirely feasible and will likely produce major reductions in rates of obesity, diabetes and heart disease.:

 Although there is a lack of data directly linking the quantities of added sugars and heightened cardiovascular (CVD) risk, Vos and colleagues focused on studies where correlations were observed. They cited major gaps in the literature, urging for future longitudinal, randomized, controlled studies to further examine the effects of added sugars in adolescence.

In order to help parents follow the new recommendations, the authors pointed out that “starting in July 2018, food manufacturers will be required to list the amount of added sugars on the nutritional facts panel.”

“Until then, the best way to avoid added sugars in your child’s diet is to serve mostly foods that are high in nutrition, such as fruits, vegetables, whole grains, low-fat dairy products, lean meat, poultry and fish, and to limit food with little nutritional value,” Vos said.

The statement was developed by several AHA councils, including the nutrition committee of the council on lifestyle and cardiometabolic health and the council on cardiovascular disease in the young.

Too Much Salt: How A Diet Too High In Sodium Can Affect Your Heart, Brain, And Even Bone Health


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Sodium, the main component in table salt, can be detrimental to the body in high quantities. 

Salt has always been of high importance to humanity. In ancient Egypt, salt was an integral part of religious ceremonies, and the Moors in Africa would trade salt pound for pound with gold. Part of our adoration for salt, however, lies in its main ingredient, sodium. (It’s also composed of chloride and iodine sources.) According to the American Heart Association, about 75 percent of the sodium we consume comes not from the salt shaker, but rather in processed and restaurant food.

Our Love Affair With Salt

Sodium is essential to human health. The mineral helps to regulate fluids by letting the body know when it’s time to replenish or dispose of water. Along with that, sodium also maintains nerve transmissions and muscle contractions — functions vital to our survival. As a result, our bodies evolved a desire for sodium akin to addiction to ensure that we never went without enough.

A 2011 Australian study found that the brain responds to sodium similar to how it does for substances such as heroin, cocaine, and nicotine, which may explain why so many of us tend to overindulge in high-sodium foods. Unfortunately, too much of a good thing can actually prove deadly.

Your Brain On Salt

A 2011 Canadian study on 1,200 older sedentary adults with normal brain function found that over the course of three years, high-sodium diets were linked to increased risk of cognitive decline. This result was “independent of hypertension and global diet quality” and “suggests that sodium intake alone may affect cognitive function in sedentary older adults above and beyond the effects of overall diet,” the researchers wrote.

The reason why sodium is detrimental to the brain is not fully understood, but according to Dr. David L. Katz, a researcher involved in the study, physical exercise may be able to protect the brain from the effects of too much salt, Medscape reported.

Kidneys

Sodium plays a key role in balancing the levels of fluid in our bodies by signaling to the kidneys when to retain water and when to get rid of water. A high-sodium diet can interfere with this delicate process and reduce kidney function. The result is less water removed from the body, which may lead to higher blood pressure. As explained by The World Action on Salt and Health, this excess strain on the kidneys can lead to kidney disease or exacerbate kidney problems in those already with the condition.

High-sodium diets may also increase your risk of developing renal stones, also known as kidney stones. The main cause of kidney stones is urinary calcium, a mineral which is noted to increase in those with high-sodium intake.

Bones

Excessive calcium excretion in the urine is believed by some experts to increase the risk of bone thinning. According to WASH, over long periods of time, this excessive calcium loss is associated with osteoporosis, especially in postmenopausal women.

Heart

Due to salt’s fluid retention effect, in some individuals excessive amounts of salt in their diet can lead to high blood pressure. High blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood, and high blood pressure can lead to many serious conditions, such as stroke and heart failure. Although blood pressure increases naturally with age, according to the American Heart Association, reducing your salt intake can help prevent your blood pressure from increasing too much.

Skin

Excessive salt in the diet can cause a symptom known as edema. As reported by Medical News Today, edema is characterized by swelling, particularly in the hands, arms, ankles, legs, andfeet, caused by fluid retention. Excessive salt consumption commonly causes edema; however, the symptom can be caused by a number of other health concerns ranging from menstruation to genetic disposition. Edema is non-life threatening and is a symptom of another underlying health condition, rather than a condition on its own.

While edema may be an extreme symptom of excessive salt consumption, even something as simple as having an extra-large popcorn the night before can leave your skin looking a bit puffier than usual. Dr. Neal B. Schultz, a dermatologist practicing in New York City, told Shapethat susceptibility to swelling due to salt consumption increases with age.

Stomach

A 1996 study published in the International Journal of Epidemiology found that death from stomach cancer in both men and women was closely linked to salt consumption. High salt intake is also associated with stomach ulcers. The reason for this is not completely understood, but one study theorized that the salt may have an adverse effect on the mucous lining of the stomach and cause the stomach tissue to become abnormal and unhealthy, according to Livestrong.

Sugar Addiction Doesn’t Just Lead To Obesity; It Affects Your Heart Health, Brain Function, And Even Your Sex Life


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The adverse effects a high-sugar diet can have on the human body include more than just obesity. Photo courtesy of Shutterstock

In moderation, sugar is essential for a healthy body. Millions of years ago our ancestors relied on sugar-rich fruit for survival. Not only did the nutrient give them enormous amounts of energy, but it also helped in the storage of fat — something which could be the difference between life and death during hard times. Those who didn’t consume enough sugar had neither the energy nor physical capabilities to reproduce and therefore were unable to pass on their genes.

As a result, the human brain evolved an interesting survival mechanism: a near-insatiable desire for sweetness. Sadly, in modern days this evolutionary edge often does more harm than help. Many, especially in the United States, consume far more sugar than is needed for survival. While weight gain and teeth decay may be the most obvious consequences of excessive sugar consumption, there are many other “hidden” effects of consuming too much of the sweet stuff.

Heart

When consumed, sugar enters into the blood stream, and at high levels blood sugar has adverse effects on our most important organ: the heart. In a 2013 study published in theJournal of the American Heart Association, researchers found that large amounts of sugar, particularly glucose, stressed out the heart and decreased the muscle’s function. If left to progress for too long, this eventually leads to heart failure, The Cleveland Clinic reported.

High amounts of fructose, another type of sugar commonly found in artificially sweetened food, lowers levels of “good” cholesterol, Women’s Health reported. This can trigger the production of a certain type of fat known as triglycerides, which travel from the liver to the arteries and increase your risk for experiencing a heart attack or stroke.

Brain

A 2002 study conducted at the University of California, Los Angeles, stumbled upon a frightening link between excessive sugar consumption and brain health. The study found that diets high in sugar affected the neuronal and behavioral plasticity associated with a chemical known as brain-derived neurotrophic factor (BDNF). This leads to decreased function in the ability to efficiently form new memories and store new information. Other research has also linked low levels of this chemical to depression and dementia.

Kidneys

The kidneys play an important role in filtering our blood, so high levels of sugar in the blood can cause excessive work and subsequent damage. High amounts of blood sugar are known to be one of the main contributors to type 2 diabetes. Many years of excessive sugar filtration seriously compromise kidney function and this may lead to waste products leaking into the body.

According to the American Diabetes Association, the eventual result of decreasd kidney function is kidney disease. If left untreated, the kidney will completely fail. Individuals with kidney failure need to receive an organ transplant or have their blood filtered by a machine via dialysis.

SUGAR_PREVENTION_finalEating too much sugar can affect many parts of the human body. Photo courtesy of Tantika Tivorat viaPrevention

Sexual Health

Because high amounts of sugar in a diet can affect blood flow, excessive sugar consumption is also linked to erectile dysfunction in men. A 2005 study from The Johns Hopkins University School of Medicine found that one particular sugar interferes with the chain of events needed to achieve and maintain an erection. The blood sugar, O-GlcNAc, is present in elevated levels in those with diabetes and has been observed to interrupt the enzyme responsible for a successful erection, News Medical reported.

A 2007 study also found that consuming too much fructose and glucose could turn off the gene that regulates the levels of active sex testosterone and estrogen, two important human sex hormones.

Joints

Arthritis is a term used to describe various types of joint pain and inflammation. According to a 2002 study published in the American Journal of Clinical Nutrition, in elevated levels processed sugar can increase the inflammation which causes joint pain. For this reason, those who suffer from chronic arthritis are advised to keep their sugar consumption low, although individuals of various health descriptions will benefit from a low sugar diet.

Skin

Dr. Nicholas Perricone, a dermatologist and nutritionist, told The Huffington Post that large consumptions of sugar are “a burst of inflammation throughout the body.” Just as the inflammation caused by sugar can lead to joint pain, this same inflammation breaks down the collagen and elastin in our skin.

The unfortunate result of this is an acceleration of the aging process and increased sagging skin and wrinkles. Those with high sugar diets are also more likely to develop insulin resistance, which can cause excess hair growth and dark patches to appear on the neck and in body creases.

Liver

The liver is not immune to the effects of excessive sugar consumption. High sugar diets lead to fat build-up in the liver which, in some cases, causes the liver to become inflamed. If left untreated, this will eventually have the same effect on the liver as excess alcohol consumption, which leads to the formation of scar tissue, a condition known as cirrhosis.

“The most common cause of liver cirrhosis is alcohol, and after that it’s fatty liver disease, from bad diet,” Dr. Aseem Malhotra, a London cardiologist and member of the Academy of Medical Royal Colleges obesity group told The Daily Mail.

AN AVOCADO A DAY MAY HELP KEEP BAD CHOLESTEROL AT BAY


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Eating one avocado a day as part of a heart healthy, cholesterol-lowering moderate-fat diet can help improve bad cholesterol levels in overweight and obese individuals, according to new research published in the Journal of the American Heart Association.

Researchers evaluated the effect avocados had on traditional and novel cardiovascular risk factors by replacing saturated fatty acids from an average American diet with unsaturated fatty acids from avocados.

Forty-five healthy, overweight or obese patients between the ages of 21 and 70 were put on three different cholesterol-lowering diets. Participants consumed an average American diet (consisting of 34 percent of calories from fat, 51 percent carbohydrates, and 16 percent protein) for two weeks prior to starting one of the following cholesterol lowering diets: lower fat diet without avocado, moderate-fat diet without avocado, and moderate-fat diet with one avocado per day.

The two moderate fat diets both provided 34 percent of calories as fat (17 percent of calories from monounsaturated fatty acids, whereas the lower fat diet provided 24 percent of calories as fat (11 percent from MUFAs). Each participant consumed each of the three test diet for five weeks. Participants were randomly sequenced through each of the three diets.

Researchers found:

  • Compared to the baseline average American diet, low-density lipoprotein (LDL) – the so called ‘bad cholesterol’ – was 13.5 mg/dL lower after consuming the moderate fat diet that included an avocado. LDL was also lower on the moderate fat diet without the avocado (8.3 mg/dL lower) and the lower fat diet (7.4 mg/dL lower), though the results were not as striking as the avocado diet.
  • Several additional blood measurements were also more favorable after the avocado diet versus the other two cholesterol-lowering diets as well: total cholesterol, triglycerides, small dense LDL, non-HDL cholesterol, and others.

These measurements are all considered to be cardio-metabolic risk factors in ways that are independent of the heart-healthy fatty acid effects, said Penny M. Kris-Etherton, Ph.D., R.D., senior study author and chair of the American Heart Association’s Nutrition Committee and Distinguished Professor of Nutrition at Pennsylvania State University in University Park, Pennsylvania.

“This was a controlled feeding study, but that is not the real-world – so it is a proof-of-concept investigation. We need to focus on getting people to eat a heart-healthy diet that includes avocados and other nutrient-rich food sources of better fats,” Kris-Etherton said.

“In the United States avocados are not a mainstream food yet, and they can be expensive, especially at certain times of the year. Also, most people do not really know how to incorporate them in their diet except for making guacamole. But guacamole is typically eaten with corn chips, which are high in calories and sodium. Avocados, however, can also beeaten with salads, vegetables, sandwiches, lean protein foods (like chicken or fish) or even whole.”

For the study researchers used Hass avocados, the ones with bumpy green skin. In addition to MUFAs, avocados also provided other bioactive components that could have contributed to the findings such as fiber, phytosterols, and other compounds.

According to researchers, many heart-healthy diets recommend replacing saturated fatty acids with MUFAs orpolyunsaturated fatty acids to reduce the risk of heart disease. This is because saturated fats can increase bad cholesterol levels and raise the risk of cardiovascular disease.

The Mediterranean diet, includes fruits, vegetables, whole grains, fatty fish, and foods rich in monounsaturated fatty acids—like extra-virgin olive oil and nuts. Like avocados, some research indicates that these not only contain better fats but also certain micronutrients and bioactive components that may play an important role in reducing risk of heart disease.

Trans Fat Linked to Worse Memory


In yet another reason to avoid trans fats, researchers are reporting that high trans fat intake is associated with deficits in word memory among working-age men.

Researchers found that each gram of dietary trans fatty acids intake per day was associated with an estimated 0.76 fewer words recalled, or 11 fewer words with the highest intake vs none from a mean of 86 words.

Previous studies have already shown adverse effects associated with trans fat consumption, including higher rates of cardiovascular disease and obesity, and these same researchers have also linked trans fat consumption to aggressive behavior.

“Our findings also support an association between higher trans fat consumption and worse memory performance in young adults, that is, those under age 45 who are in key career-building years,” said senior author Beatrice A. Golomb, MD, PhD, professor of medicine at the University of California San Diego (UCSD).

Despite regulatory moves to limit trans fat intakes, the authors noted, these findings “remain relevant because US regulations do not extend worldwide, and presumed dTFA [dietary trans fatty acids] mechanisms have relevance to other exposures.”

The results were presented here at the American Heart Association (AHA) 2014 Scientific Sessions by study lead author Alexis K. Bui, MS, also at UCSD.

Alexis Bui (left) and Dr Beatrice Golomb (right. Photo courtesy of Janis Ritchie

Trans Fats Bad, Chocolate Good

Dietary trans fats are found in such foods as packaged baked goods, some shortenings and margarines, and fast food.

Dietary industrial trans fatty acids have pro-oxidant and cell energy harms, the authors point out. Conversely, foods with antioxidant and cell energy benefits have been favorably linked to word memory in younger adults, before major age-induced variance, they write. For example, a recent report from this group showed that chocolate consumption was associated with better word memory in this same study population (Circulation. 2012;126:A16156).

In the current analysis, the researchers assessed the cross-sectional relationship between trans fat consumption and word memory.

Included were 1018 adults, including 694 men aged 20 years and older, and postmenopausal women without coronary artery disease at baseline. Low-density lipoprotein levels ranged from 115 to 190 mg/dL, and fasting glucose was less than 142 mg/dL on average in this group.

Participants came from a trial of a drug with potential teratogenic effects, so female participants were limited to those who were postmenopausal by age or surgically, Dr Golomb explained. For this analysis, the researchers limited themselves to men because women were not represented in younger age groups.

(When they include the women in their calculation, they still replicated the findings, she said, but because there were so few they don’t feel able to draw a separate conclusion for women.)

Trans fat consumption was established by using a food-frequency questionnaire, expressed in grams per day. They used the Recurrent Words test to assess word memory.

Trans fat intake was measured between 1999 and 2004, at a time right before labeling requirements were put in place for trans fats, Dr Golomb commented, “so there’s slightly higher trans fat consumption at the upper end.”

They used regression analysis, stratified at age 45, to assess the relationship between trans fat consumption and word memory. An age-by-trans fat intake interaction was seen (P = .025), supporting stratification, they note.

Trans fat intake predicted memory only in men aged 20 to 45 years; in this group, each gram of trans fat consumed per day was associated with 0.76 fewer words recalled (P = .006). At the highest intake, this translated to 11 to 12 fewer words recalled from a mean of 86 words recalled on average.

Adjustment for systolic blood pressure, waist circumference, and body mass index, but not lipid or glycemic variables, attenuated the relationship, “consistent with mediation by factors involving, relating to, or concurrently influencing, these factors.”

“As I tell patients, while trans fats increase the shelf life of foods, they reduce the shelf life of people,” Dr Golomb said in a statement from AHA.

Correlation With Behavior Change

Vincent Bufalino, MD, senior vice president and senior medical director of Cardiology-AMG, Advocate Health Care in Glen Ellyn, Illinois, moderated a press conference here where the results of this study were discussed. He said the findings are still early, “but it’s obviously interesting to start to correlate behavior change when consumption is high. That’s a pretty impressive thing,” Dr Bufalino toldMedscape Medical News. “You wouldn’t intuitively think that there would be any connection.”

Memory loss in the advanced stages is still not well understood, but some of it may relate to subclinical atherosclerosis in the brain, he said. In the coronary arena, the link between high calcium scores and subclinical atherosclerosis suggests that a high proportion of people, particularly those with coronary risk factors, do have asymptomatic plaque in their coronary vessels. It would be interesting, then, to know more about the coronary risk profile of the participants in this new study.

“But it’s an interesting observation,” he said. “Now I think it’s incumbent to take it to the next level and try to give us some more in-depth proof that there is a solid association.”

Despite some progress on reducing dietary intake of trans fats, there is still a ways to go, Dr Bufalino said.

“The AHA has led the way, along with work from the government, to begin to really restrict trans fats and get the corporate world to change the oil consumption,” he said. “We’ve had a forum here at the American Heart Association now for the last half a dozen years that I was also part of, that looked at it, tried to understand it, and give feedback back to industry to say, as you’re preparing these products, let’s find ways to prepare them and remove trans fats. So I think we’re moving directionally in a positive way.”

But on the individual level, more information on how much trans fat is being consumed in which individuals foods would be valuable, he added.

“There are many reasons not to eat trans fats, most notably cardiovascular disease, and now a new one about memory loss,” said Penny Kris Etherton, PhD, RD, distinguished professor of nutrition at Pennsylvania State University, University Park, a spokesperson for the American Heart Association in a statement. People should be very careful about avoiding trans fats, and they can do that by looking at the “Nutritional Facts” panel on food packaging to make sure the foods they eat have 0 grams of trans fats.

In addition, consumers should check the ingredient label on foods, she added, to ensure that foods don’t contain any hydrogenated oils or fats, or partially hydrogenated fats. “Then they can be pretty sure that they’re avoiding trans fats completely.”

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