Accidental eye injuries: causes and prevention

How’s this for statistics to make you think seriously about protecting your eyes:

• More than a million people in the US have eye injuries each year.
• Accidental eye injury is one of the leading causes of vision loss and impairment.
• 90% of the said injuries are actually preventable.

Although a lot of eye injuries may occur in the workplace, many people are not aware that a lot of injuries also happen at home and at leisure time.

Here are major ways of injuring your eyes:

Fireworks and firecrackers

In almost every country, fireworks are part of national celebrations. Today is Canada Day. The 4^th of July is just around the corner. Fireworks are beautiful and fun but they can cause major injuries, including the eyes, to users as well as to bystanders. Keep firecrackers out of little children’s sight and reach. Not only are they fire hazards, they can also cause injuries.

Chemicals

Those who are dealing with chemicals in the workplace wear eye protection gear. I’ve worked in a lab before and knew the risks and the precautionary measures. What we tend to forget is that household chemicals can also be hazardous and can cause permanent eye damage. Medicine.Net recommends that

when using household chemicals, read instructions and labels carefully, work in a well-ventilated area and make sure to point spray nozzles away from you.

Machinery and appliances

Household appliances and machinery can also cause eye injuries. Look at your hobby room, your workshop. Do you wear protective eyewear when you use that electric saw? That potter’s wheel? The kitchen blender? Any other moving machinery?

How about the lawnmower or the power trimmer? Projectiles in the form of stones, branches and pieces of debris can shoot from these machines during use. These projectiles present risk not only for the machine operator but for the bystanders as well.

Sports and recreation

Sports and other recreational activities are fun but they can cause eye damage, too. A blow from a hockey stick, puck, or ball can have some devastating effect on the eye. In April, I posted a resource post on Sports Eye Safety.

So what do we do in case of an eye injury?

Medicine.Net recommends:

• Injuries such as cuts, chemical burns or foreign bodies stuck in the eye are emergencies. Don’t try to treat these yourself - contact your Eye M.D. or emergency room for help immediately.
• Even a seemingly light blow can cause a serious eye injury. If a black eye, pain or visual problem occurs after a blow, contact your Eye M.D. or emergency department immediately.
• In case of a chemical burn to the eye, flush the eye with clean water and seek emergency medical treatment immediately.

For more information about eye injury prevention, check out recommendations by the American Academy of Ophthalmology

               

Obesity and surgery

Obese patients and their doctors may face special challenges when undergoing and performing surgery. Health experts warn that health care provider should not underestimate the risks but on the other hand, should not dismiss obese patients as hopeless cases. The American Heart Association recently released a new Science Advisory on performing surgery on obese patients Let us look at  some of the issues surrounding obesity and surgery.

Proper evaluation is difficult in obese patients.

Performing an evaluation in highly obese patients can be difficult because of many co-existing conditions. Heart problems in particular are easily underestimated during a physical examination. According to lead author Dr. Paul Poirier,

“A severely obese patient can be technically difficult to evaluate prior to surgery. For example, severely obese people might feel chest tightness that could be a symptom of their obesity or of an underlying cardiac problem. Doctors need to carefully evaluate severely obese patients before they have surgery.”

Surgery can be difficult in obese patients.

Surgeons report that surgery can be challenging in severely obese patients. There was a big scandal in the UK a few years ago when some health care providers refused to perform surgery on obese patients

Obese patients are prone to complications.

Obese patients are more likely to suffer complications after surgery such as infections, and pulmonary embolism, and are more likely to stay on a ventilator and have a prolonged hospital stay.

Obese patients are not at higher risk for death.

Despite of these, the mortality rates during surgery do not depend on body mass index (BMI). According to Dr. Poirier

“Some surgeons are under the impression that severely obese patients are more likely to die in surgery than people who are not obese, and won’t operate on them as a result. This is not true. Severely obese patients are at increased risk for pulmonary embolism, wound infection and other conditions. But they are not more likely than their lower-weight counterparts to die as a result of surgery.”

The AHA advisory recommends the following:

• The recommendations are meant for all health care providers, from cardiologists, to surgeons, to anesthesiologists, providing pre-operative evaluation recommendations, as well as recommendations on management and care for obese patients during and after any type surgery, be it a knee replacement or a heart operation.
• The health care provider should especially pay attention to obesity-related conditions such as:
  • Heart failure
  • Atherosclerosis (thickened or narrowed arteries)
  • High blood pressure
  • Heart rhythm disorders
  • History of blood clots (especially pulmonary embolism)
  • Poor exercise capacity
  • Pulmonary hypertension related to sleep apnea
• The health providers should take into consideration age, gender, as well as the abovementioned conditions as independent factors for mortality or complication from surgery.
• Health care providers should advise patients to be as healthy as possible before surgery. This may include losing weight, keeping blood pressure under control (for those with hypertensiotn, or keeping blood sugar level under control (for those with diabetes).
• Extra, non-invasive tests may be performed if it aid in pre-surgery evaluation, such as ECG or chest X-ray.
• Surgeons should discuss with patients the risks associated with a particular surgery for a patient their size.

In providing this advisory, the AHA aims to give obese patients the best possible care they deserve.

               

Can your pulse rate predict your heart attack risk?

Researchers and scientists are continuously searching for ways to predict who is most likely to have a heart attack and who isn’t. French researchers report this could be as easy as measuring a person’s pulse rate three times.

The study looked at 7,746 French male civil servants. Their heart rates (measured by their pulse rates) were measured at rest (baseline), right before physical exercise (mild mental stress in anticipation of the exercise) and during exercise.

The results of the study show that “men whose heart rate increased the most during mild mental stress just before an exercise test had twice the risk of dying of a sudden heart attack in later life than men whose heart rate did not increase as much.”

The highest increase in heart rate during the mild mental stress was at least 12 beats a minute, the lowest, less than four beats per minute. The study participants who exhibited the highest increase in heart rate had twice the risk of sudden death due to a cardiac event compared to men who had the lowest increase.

However, those participants who had the highest increase in heart rate during the actual physical exercise had less 50% the risk of death compared with the men whose heart rate increased the least. The highest incidence of death due to a cardiac event occurred among the participants who increased their heart rate the most during mild mental stress and the least during exercise. There were none reported among those whose heart rate increased the least during mild mental stress and the most during the exercise test.

The authors think that the mechanism behind this effect lies with interaction between the autonomic (ANS) and sympathetic nervous systems (SNS). Vagus nerves are an important part of the ANS which controls the body’s autonomic functions including the heart beat. The SNS is responsible for increasing the heart rate and the dilation of blood vessels in the voluntary muscles and constriction of blood vessels in the skin and intestines during physical exercise.

According to lead researcher Professor Xavier Jouven

“There is a balance between the accelerator (sympathetic activation) and the brake (vagal activation). If vagal withdrawal occurs it is like releasing the brake. During an ischaemic episode, when blood flow to the heart is reduced, sympathetic activation occurs to counteract it. However, if there is no protection by the vagal tone (the brake), the activation can become uncontrolled and then it becomes dangerous. Our underlying assumption, which this study appears to have proved correct, is that the faster the vagal withdrawal in response to mental stress, the greater will be - during an ischaemic episode - the damaging effect of sympathetic activation unopposed by vagal activity.”

Heart attacks or myocardial infarctions are a major health problem in many developing countries. The US alone reports between 200,000 to 400,000 deaths due to heart attack each year. In 27 European countries, the mortality count is 486,000.

This method of predicting who is susceptible and who is not is easy, cheap, and non-invasive. However, it has only been tested for men. It still remains to be seen whether the same pulse rate readings can be a predictor of heart attack in women.

               

Preeclampsia may not just be a temporary pregnancy complication

Preeclampsia belongs to a group of hypertensive disorders of pregnancy. Other related disorders are pregnancy-induced hypertension and toxaemia. These conditions can cause life-threatening pregnancy complications that endanger both the mother and the baby.

The conditions are all characterized by elevated blood pressure during the second half of pregnancy but in addition, preeclampsia is characterized by increased concentrations of proteins in the urine.

About 10% of pregnancies are affected by pregnancy-induced hypertension while preeclampsia affects 5 to8% of pregnancies. Preeclampsia is common in low-income countries, where it occurs in about 1 out of every 100 up to 1 out of 700 pregnancies. In contrast, it estimated to occur in about 1 in 1000 pregnancies (Source: Clinical Evidence BMJ).

Aside from high blood pressure, symptoms of preeclampsia also include “swelling, sudden weight gain, headaches and changes in vision“.

It has always been thought that once the baby is delivered, the condition of preeclampsia is resolved. Apparently not, according to this joint research by American and Danish researchers. The effects of preeclampsia may actually track through life and brings with it increased risk for future cardiovascular problems including hypertension, diabetes and blood clots. And the risks increase with every pregnancy.

According to lead author Dr. Michael J. Paidas, director of the Program for Thrombosis and Hemostasis in Women’s Health in the Department of Obstetrics, Gynecology & Reproductive Science at Yale University:

“The only reliable treatment for preeclampsia is delivery of the baby. But while delivery may ‘cure’ preeclampsia in the moment, these mothers are at high risk of chronic hypertension, type 2 diabetes mellitus and blood clots for the rest of their lives.”

There is therefore a great need to prevent preeclampsia not only to prevent complications that threaten both mother and baby, but also to prevent long-term health problems.

According to MayoClinic, preeclampsia may be caused by the following:

• Insufficient blood flow to the uterus
• Damage to the blood vessels
• A problem with the immune system
• Poor diet

The risk factors for the condition are

• First pregnancy
• Preeclampsia in a previous pregnancy
• Maternal age above 35
• Pregnancy with multiples
• Obesity
• Gestational diabetes
• Family of history preeclampsia
• Underlying medical conditions before pregnancy such as cardiovascular disease, diabetes, or kidney disorder.

Aside from medical management, lifestyle changes can also help prevent or manage preeclampsia. Previous studies, for example, indicate that preeclampsia can be prevented by exercise and intake of dietary fiber.

               

Synthetic HDL has potential to control cholesterol levels

Two main types of cholesterol are found in our body, the low density lipoprotein (LDL) and the high density lipoprotein (HDL) cholesterol. LDL is considered to be the “bad” cholesterol and should therefore be kept low whereas HDL is the “good” cholesterol whose high levels bring some positive effects. High levels of LDL cholesterol results in a condition called hyperlipidemia and can cause cardiovascular disorders.

Researchers at the Northwestern University have just created a synthetic HDL, a molecule very similar to the naturally occurring HDL, from its molecular size to its surface composition.

“We have designed and built a cholesterol sponge. The synthetic HDL features the basics of what a great cholesterol drug should be,” according to researcher Prof Chad A. Mirkin of the Northwestern School of Medicine.

The synthetic HDL was synthesized in the lab with two lipid layers covered by the main component of natural HDL - the APOA1 protein and a gold nanoparticle in its core.

According to Dr. Shad Thaxton, another researcher in the team

“Cholesterol is essential to our cells, but chronic excess can lead to dangerous plaque formation in our arteries. HDL transports cholesterol to the liver, which protects against atherosclerosis. Our hope is that, with further development, our synthetic form of HDL could be used to increase HDL levels and promote better health.“

Currently available anti-cholesterol drugs such as statins are effective in lowering LDL cholesterol levels but can’t increase the HDL levels. The sponge-like synthetic HDL is supposed to be able “sop up” the bad lipoproteins, thereby, lowering LDL while increasing HDL at the same time. It is hope that the future of hyperlipidemia management lies in this new molecule.

High LDL cholesterol levels and low HDL levels are risk factors for coronary heart disease and stroke. The risk profiles based on LDL, HDL and total (LDL + HDL) cholesterol levels are as follows:

• High LDL cholesterol values above 130 mg/dL indicate increased risk.
• HDL values below 40 mg/dL indicate increased risk.
• A total cholesterol level of <200 mg/dL reflects a low risk for cardiovascular disease.
• A total cholesterol level of 200 to 240 mg/dL indicates moderate/borderline risk.
• A total cholesterol above 240 mg/dL is considered to be high risk.

It will take another while till the effectiveness and safety of the synthetic HDL can be tested and proven. In the meantime, the American Heart Association (AHA) recommends the following ways in keeping your cholesterol levels under control:

• Schedule a screening
• Eat foods low in cholesterol and saturated fat and free of trans fat
• Maintain a healthy weight
• Be physically active 
• Follow your healthcare professional’s advice

Photo credit: Stock.Xchng

               

Antioxidant supplements: do they work?

Resource post for December

In an era when people are becoming more and more health-conscious, vitamin pills are becoming more and more popular. Millions of people are swallowing vitamin supplement pills everyday, believing that these medications are beneficial to their health, especially their hearts. These supplements range from vitamin cocktails to omega-3’s to antioxidants. These “power pills” or “health supplements” are supposed to keep our body strong and healthy and prevent a wide range of diseases, from heart disease to high blood pressure, from aging to cancer.

In this resource post, I am reviewing the recent updates on vitamin and antioxidant supplementation and answer the question: Do we really need them?

Vitamin supplements

A 2007 meta-analysis by Bjelakovic and colleagues on vitamin supplements came up with surprising results: not only are the benefits of antioxidants suspect, they can actually increase overall mortality. A group of researchers analysed data from clinical trials which used supplementation of the antioxidants vitamin A, vitamin E, beta-carotene, vitamin C and selenium used as stand-alone supplements or in combination in people with a variety of health conditions. The results showed that most of these vitamins actually do not have a discernable health benefits to those who took them. Furthermore, vitamins A and E and beta-carotene (but not Vitamin C) and selenium can actually result in increased mortality.

Based on their results, Bjelakovic and colleagues discourages the use of synthetic vitamin supplements. Instead, we should go for the natural sources of these vitamins - fresh fruits, vegetables and nuts.

Antioxidant supplements

In a more recent review paper, the same researchers evaluated several clinical trials involving over 200,000 people which compared the efficacy of antioxidant supplements versus placebo in the primary and secondary prevention of cardiovascular gastrointestinal, neurological, ocular, dermatological, rheumatoid, renal, and endocrinological disorders

The authors reported that:

“We found no evidence to support antioxidant supplements for primary or secondary prevention. Vitamin A, beta-carotene, and vitamin E may increase mortality. Future randomised trials could evaluate the potential effects of vitamin C and selenium for primary and secondary prevention. Such trials should be closely monitored for potential harmful effects. Antioxidant supplements need to be considered medicinal products and should undergo sufficient evaluation before marketing.“

Folic acid and vitamin B

It has always been a popular belief that folic acid and vitamin B can protect us from the monsters which are heart disease and stroke by reducing the levels of the amino acid homocysteine in the blood. Homocysteine is believed to be a biomarker for cardiovascular diseases. Unfortunately, the results of this long-term trial seem to cast doubts on the homocysteine theory.

“The trial included more than 5,400 U.S. women who were health professionals. Some had a history of cardiovascular disease, and others had three or more coronary risk factors, such as high blood pressure, obesity or diabetes. Half of the women took a daily combination pill containing 2.5 milligrams of folic acid, 50 milligrams of vitamin B6, and 1 milligram of vitamin B12, while the other half took a placebo.”

These women were “blinded” - that means they didn´t know whether they were taking vitamins or placebo - and followed-up for more than 7 years. The results of the trial were a bit disappointing. 14.9% of those who took the vitamin pills had at least 1 cardiovascular event, such as a heart attack or stroke. 14.3% of those who were given placebo also had at least 1 cardiovascular event within the same period of time. The difference between the 2 groups was not significant.

The study results had important implications, namely:

• The homocysteine - cardiovascular link needs to be re-examined; homocysteine may not be an appropriate biomarker for cardiovascular disease.
• Taking folic acid does not prevent cardiovascular disease.
• Flour in the US and some other countries is fortified with folic acid. Additional supplementation is not necessary except for pregnant women.

Pregnant women are routinely advised to take folic acid supplement to prevent birth defects that can affect the baby´s nervous system, leading to the condition of spina bifida. Natural sources of folic acid are green leafy vegetables and citrus fruits.

Vitamin D and calcium

This trial evaluated the effects of vitamin D and calcium supplements on blood pressure and hypertension risk of healthy women. The study involved 36,252 postmenopausal women who were followed up for about 7 years. The results show that

“the precision of this study excludes a BP-lowering effect of calcium supplementation of clinical or public health importance…[the analysis] “is strongly suggestive of an absent relationship between vitamin D intake and hypertension”

Selenium and Vitamin E

A more recent development comes from the large-scale study called SELECT (Selenium and Vitamin E Cancer Prevention Trial) which assessed whether selenium and vitamin E supplements can prevent prostate cancer as suggested by earlier studies. Recently, about 5 years into the study, the National Cancer Institute (NCI) decided to stop the study due to lack of preventive effects as well as”concerning” findings that showed a slight increase risk of developing prostate cancer among those who took vitamin E and diabetes among those who took selenium. Even though the “slight increased risks” observed in this study of 35,000 healthy men were not statistically significant, they are risks that couldn’t be ignored.

What the experts have to say

The American College of Cardiology and American Heart Association (AHA) do not recommend the use of antioxidant supplements as specified in 2002 Guideline Update in for the management of chronic angina. In 2005, the AHA science advisory board issued that statement that “scientific data do not justify the use of antioxidant vitamin supplements” in the prevention of cardiovascular diseases.

“… in agreement with many in the field, we conclude that the existing scientific database does not justify routine use of antioxidant supplements for the prevention and treatment of CVD.25-28,29 This conclusion is consistent with theAmerican College of Cardiology/American Heart Association 2002 Guideline Update for the management of patients with chronic stable angina, which states that there is no basis for recommending that patients take vitamin C or E supplements or other antioxidants for the express purpose of preventing or treating coronary artery disease…”

Conclusion

Vitamins and minerals are essential for our health. But we have to be careful about our sources of essential nutrients. In spite of all the claims of these supplements, they are no substitute to the natural fresh fruits, vegetables, and nuts as well as a healthy lifestyle.

 

Photo credit: stock.xchng

               

Resource article for July: Alcohol and CVD Part I

Part I: The Health Benefits of Alcohol - “Eat, drink and be healthy”

Drinking alcohol has been linked to a wide range of health effects, ranging from the very good to the very bad. A post in June reported on the adverse effects of heavy drinking on cardiovascular health. On the other hand, light to moderate drinking has been shown to have long lasting beneficial effects. The only problem is how to determine the boundary between healthy and unhealthy alcohol consumption. Some researchers are concerned that recent reports about the health benefits of alcohol may mislead people to drink more than they should, thereby doing more harm than good to their health.

The next series of resource posts will be dedicated to the link between alcohol consumption and cardiovascular disorders. In the first 2 posts, I will review recent studies on the pros and cons of alcohol consumption. This first part concentrates on the pros.

 What are the health benefits of alcohol?

Light-to-moderate alcohol drinking has been linked to increased levels of good cholesterol HDL and lower risk for coronary heart disease (CHD). These protective effects seem to be stronger in men than in women and in people living in the Mediterranean region. Light-to-moderate drinking leads to increase in HDL cholesterol whereas heavy drinking has been linked to increased LDL cholesterol.

 How do we define light-to-moderate alcohol intake?

In one research, 20 g or less of alcohol per day seems to be a good amount but increasing this can reverse the effect. However, first time or occasional drinkers should be very careful because even low amounts of alcohol can have a string impact on their health [1].

Danish researchers defined moderate alcohol intake as 1 to 14 units of alcohol a week. 1 unit of alcohol is equivalent to half a pint of beer with normal strength, or half of a glass of wine, or a single shot of a spirit [2].

In another study however, researchers report that 1 glass of red wine might be the threshold between good and bad. After a drinking a second glass, the heart rates of the study participants increased and the heart started to pump more blood that needed [3].

Still another study reports that 2 drinks are too much and can increase a woman’s risk of having breast cancer by 10% [4].

So how does alcohol protect us from CHD?

The mechanisms behind this protection are not so clear. It seems that it is not only alcohol but also other substances in wine and other alcoholic drinks which can reduce plaque deposits in the arteries, helps prevents blood clot formation and increases the concentrations of good (HDL) cholesterol in the blood. Some of these compounds [5] are:

• Resveratrol is supposed to have anti-cancer and anti-inflammatory properties
• Melatonin is a strong antioxidant that can counteract oxidative stress and inflammation
• Flavonoids are strong antioxidants found in many fruit and vegetables.

 Which type of alcoholic beverage is best?

Wine has always been the choice for healthy drinking. It is not the alcohol that gives the protective effect but other substances found in wine. And it also depends on the type of wine. In this study, French wines were found to be better for the heart than German wine. French wines are rich in flavonoids, polyphenols and phytoalexins and have the potential to protect against atherosclerosis. Red wine seems to be richer in resveratol than white wine. The red grape skin produces resveratrol during the fermentation process. The reason why some wines are healthier that others is because of the type of soil where the grapes are grown, not where the wine mature in [5].

Some studies have shown that beer can also have some beneficial effects. In Bavaria (Germany) and the Czech Republic where beer is preferred over wine, moderate beer consumption have shown some protective effects similar to those observed in the Mediterannean region [6].

 Alcohol and food

Drinking alcohol on an empty stomach is a no-no - alcohol is best taken with food. In this study of 2609 white adult New Yorkers, drinking alchohol outside meals, regardless of the amount or the type consumed was found to have a significant effect on hypertension risk. Light to moderate drinking with meals, however, can lower blood pressure, positively affect blood lipids and dissolved blood clots [7].

 A little bit of alcohol goes well with exercise

A study by Danish researchers show than combining exercise with alcohol may actually prolong your life. They studied11,914 men and women, their lifestyle and alcohol consumption for almost 20 years [2]. Their results show that

• Non-drinking couch potatoes have the highest risk of having heart problems - 49% higher than the others.
• The physically active teetotalers have about 33% lower risk than those leading sedentary lifestyles.
• The physical active moderate drinkers have almost 50% lower risk than those leading sedentary lifestyles.
• Among those who are active and doing similar amounts of exercise, the moderate drinkers won hands down, having 30% less likelihood to have heart disease than their non-drinking counterparts.

 Now, this review of several studies indicates that alcohol indeed has some health benefits. But before you reach for that bottle, take note that the definition of light-to-moderate drinking is not so clear, and that the protective benefits of alcohol depends on many factors including gender, diet, and the type of drink. And that is not all. In the second part of this series, I’ll be telling you about the dangerous side of alcohol. Stay tuned!

 Sources:

• 1. Addiction. 2000 Oct;95(10):1505-23
• 2. European Heart Journal January 2008 29(2):204-212
• 3. Am J Physiol Heart Circ Physiol. 2008 Feb;294(2):H605-12. Epub 2007 Nov 30
• 4. Cancer Res. 1988 Apr 15;48(8):2284-7
• 5. J Am Coll Cardiol. 2003 Feb 5;41(3):471-8.
• 6. Alcohol Res Health. 2003;27(1):39-51. Review.
• 7. Hypertension. 2004 Dec;44(6):813-9. Epub 2004 Oct 11

               

Know your diagnostic tools: coronary calcium scan

What is a coronary calcium scan?

A coronary calcium scan is a diagnostic tool that looks for the calcium deposits in the walls arteries of the heart.

Why calcium?

Calcium can accumulate on the walls of the arteries leading to calcification. In addition to fatty deposits, calcification is a major component in the formation of plaques in the arteries. These calcifications can lead to obstruction of blood vessels which causes heart attacks, strokes and other cardiovascular disorders.

Who needs the scan?

According to the National Heart Lung and Blood Institute (NHLBI)

“A coronary calcium scan is most useful for people who are at moderate risk for a heart attack. … People at moderate risk have a 10 to 20 percent chance of having a heart attack within the next 10 years. The coronary calcium scan may help doctors decide who within this group needs treatment.”

How does a calcium scan work?

According to NHLBI, 2 machines can be used to perform calcium scan - the electron beam computed tomography (EBCT) and multidetector computed tomography (MDCT). Both these machines are attached to an x-ray machine to make detailed pictures of your heart. From the pictures, doctors can discern calcifications in the coronary arteries and determine your risk for heart problems in the next 2 to 10 years. The patient must lie quietly for 10 minutes in the scanner machine. Otherwise, the procedure is safe, easy, and pain-free.

Any recent research on calcium scans?

A recent article published in the July issue of Journal of the American College of Cardiology reported that coronary calcium scans can predict the likelihood of heart attacks, even in older adults.

“Researchers studied 35,383 adults, aged 40 to 80, in Torrance, CA and Nashville, TN, for an average of 5.8 years after having a coronary artery calcium scan. Among these research volunteers, 3,570 were age 70 or older. In total, 838 deaths were recorded, 320 in women and 518 in men. The study found the overall death risk was higher among those with higher coronary arterial calcium scores.”

Previous studies showed that calcium scans can predict overall death risk in young adults, those with diabetes, those suffering from renal failure, and smokers. This study shows that the scan is effective in measuring overall death risk in the elderly as well.

Calcium scans may currently be the best diagnostic tool that can predict the likelihood of  a heart attack. Knowing the overall death risk of a patient is important. Patients and their doctors can decide on prevention measures that can lower the risk, including diet, medications, interventions, exercise and other lifestyle changes.

Photo credit

               

How earthquakes can affect your heart and your health

In the wake of last week’s catastrophic earthquake in China, we can only imagine the trauma that the victims and their families went through - trauma that will probably stay with them for the rest of their lives. With such  trauma comes psychological stress and with increased stress comes elevated cardiovascular risk.

Several research studies have investigated the effect of acute stressors such as catastrophes and natural disasters on the cardiovascular well-being of the victims and people in the vicinity. A review article by Dr. JE Dimsdale of the University of California at San Diego shows that many of these studies observed an increased cardiovascular risk after earthquakes.

Several specific studies were conducted in conjunction with specific incidents, as follows:

In 1994, on the day of the Northridge, California earthquake, the numbers of deaths due to cardiovascular events was significantly higher compared to the same date in previous years.

During the Hanshin-Awaji earthquake in Japan in 1995, the blood pressure of many patients increased, and didn’t lower at night time as blood pressure normal does - the so-called the nocturnal “dip” in blood pressure.

Another study coincided with the 1999 earthquake in Taiwan. Twelve patients were at that time being routinely studied with Holter monitoring. Results of the Holter monitor were examined and showed dramatic differences between the readings minutes before and minutes after the earthquake. There were pronounced increases in heart rate at the time of the quake of up to 160 beats per minute. However, it’s not only the heart rate that changed abruptly.

“Perhaps more interesting was the observation that the HR variability itself changed, with a relative drop in high-frequency variability and an increase in the low-frequency/high-frequency ratio, denoting relative withdrawal of parasympathetic nervous system activity and an increase in sympathetic nervous system (SNS) activity. These changes were attenuated in patients who were receiving beta-blockers.”

In 2004, Japan was again hit, this time in the Central Nigata area. In total, 3 strong earthquakes and 90 after-shocks occurred in a period of 1 week. During this period, a dramatic increase in incidence of pulmonary embolism was observed.

“The underlying mechanism for [the increased cardiovascular] risk is unclear. Given the emergency conditions surrounding a massive earthquake, it is difficult to conduct fine-grained experimental or epidemiologic studies. Thus, it is not known how much of the risk is conveyed by the emotional trauma acting alone versus factors like forgetting to take routine medications, living in cramped emergency quarters, facing disrupted sleep, and so on. Given the chaos surrounding massive disasters, it is unlikely that such data would ever be gathered.”

 The moral lesson of these stories is that acute stressors - which can come in many different forms, including earthquakes - affect our health almost immediately. This knowledge can help us and our doctors in the control and management of cardiovascular events during stressful times.

Source:

Dimsdale, J E. Psychological Stress and Cardiovascular Disease. Journal of the American College of Cardiology. Medscape 6 May 2008

               

Health Advantages and Risks of Dieting

Nearly everyone thinks that dieting would be a good idea. For many, it is. A recent study showed that the average American now consumes about 22% more calories than those of only a generation ago. With that, it isn’t hard to see why obesity could be a problem.

But dieting is not without risks, especially in an age when so many fad diets clamor for attention. The desire to lose weight rapidly can lead to health problems that outweigh the benefits of dieting. Rapid weight-loss dieting in particular can lead to a ‘rebound’, defeating the purpose in the first place.

* First, what do we mean by ‘diet’ in this context?

No matter what specific weight loss plan one chooses, the basic equation of weight loss can not be eliminated: more calories consumed than burned equals weight gain as the body stores the excess in fat. Conversely, more calories used than taken in leads to weight loss, over the long run.

In a resting state, we burn about 70 calories per hour. In a vigorous hour-long hike we burn about 440 calories. A brisk walk for an hour will use up about 240 calories, jogging nearly 600. But balance that against the average 2,000 calorie per day diet. That shows it can be very difficult to lose weight solely by exercise.

On the other hand, reducing caloric intake means reducing the amount of certain foods and drinks. It may mean an apple rather than a candy bar. It might mean fruit juice instead of that high-calorie cappuccino. The cravings that typically accompany dieting can be hard to quell.

* Second, dieting has to be done right to be beneficial. It requires the right weight loss plan.

Too-rapid weight loss from drastic diets leads to a ‘rebound’ effect. All too many dieters know the frustration of seeing hard-to-shed pounds return a few months or a year later. It tends to encourage subsequent overeating as the dieter is motivated to just give up.

Dieting by foregoing needed nutrients presents even more of a health risk. We need a certain amount of unsaturated fats daily to have proper nerve function and hormone balance. Carbohydrates are the body’s basic energy source, which is used to power everything we do from simple movements to life-preserving cellular reactions. Sodium and potassium are vital to proper heart and nerve function.

But there are definite health advantages for an individual who commits to a healthy diet and weight loss plan.

Obesity is a factor in the development of diabetes. It increases the odds of coronary heart disease. It increases stress on bones. It often plays a role in depression. All these are serious health issues and dieting is one of the best ways to combat obesity.

It isn’t mere vanity to want an attractive body, either. An attractive body is one that is fit. That leads to ample energy to carry out whatever goals one wants to pursue. Lack of energy makes it much harder to motivate oneself to complete challenging tasks.

There’s nothing wrong with wanting an attractive form for psychological or social purposes either. Humans are social. It’s appropriate to take pride in having achieved a certain body type, within the limits of what is possible to each of us. It presents an image of self-regard and that psychological self-assessment is a significant factor in basic health.

Done well, taken up as a long-term lifestyle strategy and not as a quick fix, dieting is healthy.

               

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