Under-Nutrition During Childhood Leads To Greater Risk Of Heart Disease In Later Life

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Main Category: Heart Disease
Also Included In: Pediatrics / Children's Health;  Cardiovascular / Cardiology;  Nutrition / Diet
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A study published online today in the European Heart Journal research showed the first concrete evidence that acute under-nutrition during the time that children grow up can have a significant impact on their future health.

Researchers conducted a study on women who were children, teenagers or young adults during the Dutch famine in 1944-45 and discovered that an increased risk of coronary heart disease in later life is linked to under-nutrition, particularly in the adolescent years.

The authors of the accompanying editorial, state that the discovery stresses the importance for policy makers and health professional to take these findings into account for designing and implementing disease screening and prevention programs. ?

Researchers from the University Medical Center in Utrecht and the University of Amsterdam conducted a study of 7,845 women who were aged between 0-21 and were living in The Netherlands at a time when a combination of circumstances at the end of the Second World War resulted in severe food shortages in the west of The Netherlands. During the period from October 1944 official daily rations for the general adult population dropped from 1400 calories to between 400-800 calories at the height of the famine from December 1944 to April 1945. Six months later, the liberation of the Netherlands ended the famine abruptly. ?

Female participants for the study were recruited from 1993 to 1997 through a breast cancer-screening program that was followed up until the end of 2007. The researchers divided the women into three groups. The first group consisted of women who were unexposed, i.e. women who reported being "hardly" exposed to hunger and weight loss during the famine; the second group containing those severely exposed, i.e. women who reported being "very much" exposed to hunger and weight loss with the third group containing those with moderate exposure, i.e. the remaining women whose famine experience was somewhere between these two experiences. ?

? They discovered that the risk of coronary heart disease in comparison with unexposed women, was marginally higher overall for women with moderate exposure to the famine, and significantly higher among those who had been severely exposed.

Women with severe exposure, who were aged between 10-17 at the start of the famine had a statistically significant 38% increased risk of coronary heart disease in later life compared to those who had been moderately exposed. Women who were unexposed had no increased risk. The researchers adjusted factors that could misconstrue the results, such as age at start of the famine, smoking, and education (as a measure of socio-economic status) and discovered a 27% increased risk of coronary heart disease for the severely exposed women compared to those unexposed.

Additional examinations revealed that the risk of stroke seemed to be lower for women of all ages exposed to famine, compared to those who were not exposed. Women who were exposed to famine at the ages between 18 to 21 years (ages that are not sensitive growth periods) seemed to have a lower risk of stroke compared to those who were unexposed, although this lower risk was not statistically significant.

? The authors imply the relevance of the study's results for today by commenting that:

"The Dutch famine of 1944-45 is a 'natural experiment' in history, which gave us the unique possibility to study the long-term effects of acute under-nutrition during childhood, adolescence, and young adulthood in otherwise well-nourished girls and women. Our findings support the notion that disturbed postnatal development, particularly in adolescence, can have important implications for adult health. The contemporary relevance of our findings is that famine and under-nutrition are still a major problem worldwide; the first millennium developmental goal is to eradicate extreme hunger. Since the incidence of CVD [cardiovascular disease] is the number one cause of death globally, and rising in many parts of the world, further research into the impact of under-nutrition during sensitive periods of growth and maturation is warranted."? ?

Annet van Abeelen (a PhD epidemiology student at the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and at the department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam (The Netherlands) who is the first author of the study), added that more research was needed to confirm the findings and to explore the possible mechanisms underlying the effects of famine on the risk of future heart disease.? ?

She commented:

"However, our study pinpoints the crucial role childhood plays in adult health. More knowledge in this field may lead to unique opportunities for prevention in the future.

According to the developmental origins of chronic disease hypothesis, as first proposed by Professor David Barker, nutritional influences early in life may change the structure and function of the body. While these changes may be beneficial for short-term survival, they may lead to chronic diseases in later years. Our study indicates that growth that has been hampered by under-nutrition in later childhood, followed by a subsequent recovery, may have metabolic consequences that contribute to an increased risk of diseases later in adulthood."? ?

The authors have several possible explanations for the effects of famine on coronary heart disease, such as unhealthy lifestyles, changes in metabolism, or traumatic stress, but commented that each of these required further research. Ms van Abeelen added that more research was also required for the findings on stroke considering that these results were based on just 235 stroke cases. ? ?

Professor Kausik Ray and colleagues at St George's University of London (London, UK), writes in an accompanying editorial:

"These results add further weight to the suggestion that adolescence is a particularly sensitive period open to epigenetic modifications and that dietary mismatch in post-famine nutritional availability contributes to coronary disease risk."

The authors highlight that according to the United Nations Food and Agriculture Organization 925 million people worldwide are undernourished and that a recent report by the Association of Teachers and Lecturers in the UK revealed, that three-quarters of their students arrived at school hungry with these numbers increasing since the start of the global recession. ?

Prof Ray and colleagues relate to studies of people who starved during the Chinese famine (1959-61) and the siege of Leningrad (1941-44) in their comment:

"Taken together there appear to be consistent data showing that nutritional status in childhood may impact significantly on chronic diseases processes in later life. The findings of these recent studies could have significant practical impact on immigrant populations who try to adapt to the relatively more affluent and nutritionally rich environments, particularly those escaping from man-made and natural catastrophes. For instance, first-generation Asians in the UK have a higher incidence of cardiovascular disease than Caucasian counterparts. As cardiovascular disease carries the largest economic and population burden in developed countries and is fast approaching similar importance in developing countries, further work is now needed to better understand the mechanisms behind these associations and devise public health strategies which could have a significant impact on disease burden in years to come."?

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Posted in: Childhood,disease,During,Greater,Heart,Later,Leads,UnderNutrition

Marital Satisfaction Plays Role in Heart Bypass Survival

Study Suggests Happily Married Men and Women Live Longer After Heart Bypass Surgeries

Aug. 22, 2011 -- People who are married and who undergo heart bypass surgery are more than twice as likely as their unmarried counterparts to be alive after 15 years, a new study indicates.

University of Rochester researchers tracked 225 people who had undergone bypass surgery between 1987 and 1990, asking them about their marital status at the time of surgery and to rate their marital satisfaction a year after their operations.

They found that marital satisfaction plays an important role in long-term survival after heart bypass surgery.

The effect of marital satisfaction was found to differ between men and women.

Fifteen years after bypass surgery, 83% of wives deemed happily married were still alive, compared to 28% of women in unhappy marriages and 27% of unmarried women, the study shows.

Among men, 83% of happily married husbands were alive 15 years after bypass surgery, compared to 60% of men in less-than-satisfying marriages and 36% of unmarried men.

"There is something in a good relationship that helps people stay on track," Kathleen King, PhD, RN, FAAN and professor emeritus from the University of Rochester's School of Nursing, says in a news release.

Rochester psychology professor Harry Reis, PhD, says marital satisfaction is "every bit as important to survival after bypass surgery as more traditional risk factors like tobacco use, obesity and high blood pressure."

Reis says wives need to feel satisfied in their relationships to get a health benefit, even though "the payoff for marital bliss is even greater for women than for men."

He says that some research has indicated that marriage is not beneficial for women, but the new study, because it factored in satisfaction levels, perhaps gets at the truth more accurately.

"A good marriage gets under your skin whether you are male or female," Reis says.

Supportive spouses may be a major ticket, King says, because they are most likely to encourage health behaviors like exercise and to discourage bad ones, like smoking.

A nurturing marriage provides patients with sustained motivation to care for themselves and gives them a significant reason to "stick around so they can stay in the relationship that they like," she says.

Previous research has shown that people with lower hostility in their marriages have less of the type of inflammation that is linked to heart disease, the researchers say, and this may be another reason why people in the bypass study benefited from happy marriages.

The study is published online Aug. 22 in Health Psychology, a publication of the American Psychological Association.

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Posted in: Bypass,Heart,Marital,Plays,Satisfaction,Survival

Quicker Angioplasty Times for Heart Attack Patients

Time to Treatment Has Dropped 32 Minutes in Just 5 Years, Study Finds

Aug. 22, 2011 -- More than 90% of patients who have a heart attack and need an emergency treatment to open the artery now have it within the recommended 90 minutes after they get to the hospital, new research finds.

Some patients get the treatment even more quickly, says researcher Harlan M. Krumholz, MD, the Harold H. Hines Jr. Professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine. In a national analysis, his team looked at how quickly the treatment, angioplasty, was done in 2010, compared to 2005.

"The median time (half longer, half less) went from 96 minutes to 64," Krumholz tells WebMD. "I think it's breathtaking."

In 2005, 44% of heart attack patients who needed angioplasty were treated within the 90-minute window. In 2010, 91% were, the researchers found.

"This is outstanding news," says P.K. Shah, MD, director of cardiology at Cedars-Sinai Medical Center in Los Angeles. He was not involved in the study but reviewed the findings.

The study is published in Circulation:Journal of the American Heart Association.

During angioplasty, the blocked artery is opened. The doctor passes a thin balloon-tipped tube into the vessel. The balloon is inflated, restoring blood flow, and then withdrawn. In some cases, a stent will be put in to keep the vessel open.

Even though doctors knew speed was important, only one-third of patients who needed angioplasty got it within 90 minutes in 2002. Some had to wait more than two hours after getting to the hospital.

That triggered the Centers for Medicare & Medicaid Services to begin reporting publicly the percentage of patients who were treated within the recommended window.

Soon after, national efforts were launched by organizations, including the American College of Cardiology and the American Heart Association, to improve treatment times.

Doctors call the window the "door-to-balloon time."

Krumholz and his colleagues analyzed nationwide hospital data collected by the Centers for Medicare & Medicaid Services. It includes more than 300,000 patients. They had emergency angioplasty from Jan. 1, 2005, through Sept. 30, 2010, including some not covered by Medicare.

Every year, nearly 250,000 people in the U.S. have the type of heart attack that blocks part of the blood supply to the heart and requires angioplasty, according to the American Heart Association.

In 2010, 70% of the patients were treated in less than 75 minutes. In 2005, only 27% were.

A time window of 60 minutes may become the new standard, the researchers say.

This study did not look at the effect of the speedier treatment on death rates. However, Krumholz says other research, including his own, has found that treatment delays are linked with higher death rates.

Krumholz reports chairing a cardiac scientific advisory board for UnitedHealth.

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Posted in: Angioplasty,Attack,Heart,patients,Quicker,Times

Why a healthy marriage is good for the heart

But while men are more likely to live on regardless of the state of their marriage, women only enjoy the benefit if they and their husband are happy together.

Researchers from the University of Rochester in America found that 83 per cent of happily married women who had heart bypass operations lived on for another 15 years, compared with just 28 per cent in unhappy unions and 27 per cent of unmarried women.

For happy husbands the survival rate was also 83 per cent, but even those who were not content with their marriage stood a 60 per cent chance of survival, compared with just 36 per cent who were unmarried.

Prof Kathleen King, who led the research, said that having a supportive husband and wife encouraged people to live a healthier lifestyle, for example by taking more exercise or giving up smoking.

Being in a healthy marriage also motivates patients to take care of themselves after surgery because they have a reason to "stick around", she said.

Prof Harry Reis, who co-authored the study in the Health Psychology journal, said a happy marriage was "every bit as important to survival after bypass surgery as more traditional risk factors like tobacco use, obesity, and high blood pressure."

Earlier research has also shown that people with less hostility in their marriages had lower levels of a type of inflammation that is linked to heart disease.

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Posted in: Healthy,Heart,marriage

Is Calcium Test the Best Way to Check Heart Risk?

Study Shows CAC Testing May Help Identify Patients Who Could Benefit From Statin Drugs

Aug. 18, 2011 -- An imaging test that identifies calcium in the coronary arteries of the heart is a more accurate indicator of heart attack risk in seemingly healthy people than a widely used test that measures inflammation, a new study shows.

Researchers say coronary artery calcium (CAC) testing can better identify people with normal cholesterol who could benefit from treatment with cholesterol-lowering statin drugs than the C-reactive protein (CRP) blood test.

Statins were once prescribed only to people with high cholesterol, but that changed following the publication of a practice-changing study known as the JUPITER trial in 2006.

JUPITER found that patients with normal cholesterol benefited from treatment with statins when they had elevated levels of inflammation, as measured by CRP.

Patients in the study with normal cholesterol and elevated CRP who took statins had fewer heart attacks than patients with the same characteristics who did not take the drugs.

Based on the findings, it was estimated that an additional 6.5 million adults in the U.S. might benefit from treatment with statins.

But the new study suggests that far fewer patients would actually benefit.

The study included 950 participants in another trial followed for an average of just under six years who also had normal cholesterol and elevated CRP levels.

All the participants underwent CT scans to look for evidence of calcium in the coronary arteries, which is an indicator of possible plaque buildup and heart disease.

Even though all of the study participants would have been candidates for statins under the JUPITER guidelines, CAC testing indicated that about half had a very low risk for heart attack or stroke.

Three out of four heart attacks, strokes, or other blood-clot-related events over the follow-up period occurred in the 25% of patients with the highest CAC scores, and almost all heart attacks (95%) occurred in people with some measurable level of calcium in their coronary arteries.

"The JUPITER trial suggested that all of the people in our patient population should be treated with statins, but our analysis suggests that half are at very low risk," cardiologist and study researcher Michael J. Blaha, MD, of Baltimore's Johns Hopkins Ciccarone Preventive Cardiology Center, tells WebMD.

Blaha believes CAC imaging will prove to be a better test for assessing cardiovascular risk than CRP in generally healthy patients for whom treatment decisions are unclear.

He adds that a trial like JUPITER is needed to determine if patients treated with statins based on CAC findings have fewer heart attacks and strokes.

Cardiologist Robert Bonow, MD, who is a past president of the American Heart Association (AHA), says until such a trial is done it will not be clear if coronary calcium screening influences treatment and changes outcomes.

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Posted in: Calcium,Check,Heart