An environmental scan report published last year in the Journal of American College of Cardiology revealed staggering global CVD statistics. CVD currently accounts for 17.3 million deaths per year and that number is expected to grow to more than 23.6 million by 2030. Additionally, elevated blood pressure was found to cause 51 percent of stroke deaths and 45 percent of coronary heart disease deaths. The report also noted that stroke mortality exceeds ischemic heart disease mortality in 74 World Health Organization member countries, with China, Africa and South America having an excessively higher rate of stroke than the other countries. The study revealed that despite the projection that heart disease and stroke will be the leading cause of death through the year 2030, only 150 new cardiovascular drugs are in development, contrasted with the more than 700 underway for the treatment of cancer.
Research in mice and human volunteers has suggested a mechanism that may contribute to an association between eating red meat and increased risk of cardiovascular disease (CVD). It involves microbes in the gut.
People who regularly eat red meat have an increased colonization of intestinal bacteria that break down the carnitine in red meat into a metabolite that promotes increased cholesterol deposition in the artery wall, the researchers report. Their study was published online April 7, 2013 in Nature Medicine.
Energy drinks are another major source of carnitine, senior author Dr Stanley L Hazen (Cleveland Clinic, OH) told heartwire. If someone regularly eats red meat or drinks energy drinks, “microbes that like carnitine become more abundant [in the gut], and now you are much more capable of making this metabolite . . . trimethylamine-N-oxide (TMAO),” he said. “This paper showed [that TMAO] . . . essentially leads to an enhanced capacity to deposit cholesterol on the cells of your artery wall.”
Does this mean that physicians should advise all their patients to become vegetarians and avoid drinking energy drinks? Hazen says that people need to be aware that “a can of an energy drink can have more carnitine than a porterhouse steak.”
For now, “it makes sense to adhere to a lower-cholesterol, lower-saturated-fat diet [that will be] more heart healthy in terms of decreasing the nutrients that give rise to forming TMAO, [since] this may be one of the hidden contributors to heart disease.”
Only a fraction of people who have established heart disease or a past stroke are adhering to the most basic lifestyle recommendations known to reduce their risk of a future event. Those are the latest findings from the sweeping Prospective Urban Rural Epidemiology (PURE) study, a global snapshot of cardiovascular disease risk factors and health status encompassing both rich and poor nations and urban and rural communities.
Previous analyses from PURE have highlighted the underuse of proven medications for the secondary prevention of cardiovascular disease-CVD (particularly in underdeveloped countries), published in the Lancet in 2012.
PURE was conducted in 17 countries, across more than 600 communities, and enrolled 153 996 adults.
In their latest paper, published in the April 17, 2013 issue of the Journal of the American Medical Association, Teo and colleagues, with senior author Dr Salim Yusuf (McMaster University), zero in on the 7519 PURE study participants who had self-reported coronary heart disease or previous stroke.
As Teo and colleagues note, 18.5% continued to smoke following their index diagnosis, only 35% took up high levels of work- or leisure-related physical activity, and just 39% reported following a healthy diet.
In all, 14% reported not engaging in any of the three healthy lifestyle behaviors defined by the study, while just 4% tried to adopt all three.
“This study shows that a large gap exists between actual and ideal participation in the three key lifestyle behaviors of avoidance of (or quitting) smoking, undertaking regular physical activity, and eating a healthy diet after a CHD or stroke event,” they write.
“Nearly one-fifth of individuals continued to smoke, only about one-third undertook high levels of physical activity, and only two-fifths were eating a healthy diet.”
It is time that the Consultant Physicians pull up their socks and started emphasizing on these aspects of treatment.
Ever wondered what makes a food taste good? Most of the time it is the salt and/or oil/fat which make the food tasty. However we have some revealing facts about salt and its after-effects!
Researchers estimate that in 2010, adults in most parts of the world consumed about twice as much salt as recommended, and millions of Cardiovascular disease (CVD) deaths worldwide were linked to excess sodium [1,2].
These findings were presented at EPI|NPAM 2013, the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.
In the first study, Dr Saman Fahimi (Harvard School of Public Health, Boston, MA) and colleagues reported that in 2010, adults in 187 countries consumed, on average, 3950 mg sodium a day—roughly twice the maximum intake recommended by the World Health Organization (WHO) (2000 mg/day) or the AHA (1500 mg/day).
In the second study, Dr Dariush Mozaffarian (Harvard School of Public Health) and colleagues reported that in the same year, they estimate that excess dietary salt led to 2.3 million deaths from CVD worldwide and about one in 10 deaths from CVD in the US.
The average salt consumption in the US was 3600 mg/day, and the US ranked 19th of the 30 largest countries, in estimated numbers of CVD deaths that were thought to be related to excess salt consumption.
“Sodium intake in only six countries of 187 countries met the WHO guidelines,” Fahimi said.
When counseling patients about the impact of dietary salt on heart health, physicians need to be aware that salty snacks such as peanuts and chips are not the only culprits, Mozaffarian said. “In the US and in most highly developed countries, 90% of the salt in the diet comes from packaged foods,” where salt is used as a preservative; perhaps surprisingly, bread is the number-one source of salt, and cheese is a major source, he noted.
High-salt diet, a universal finding!
Excess sodium intake was universal—seen in men and women of all ages, living in low- to high-income countries. In 2010, the average daily sodium intake exceeded 2000 mg in 181 countries and exceeded 3000 mg in 119 countries.
Sodium intake varied widely between different parts of the world. Kazakhstan had the highest sodium intake (6.0 g/day), followed by Mauritius (5.6 g/day), and Uzbekistan (5.5 g/day), whereas Kenya (1.5 g/day), Malawi (1.5 g/day), and Rwanda (1.6 g/day) had the lowest daily intake of sodium.
Model linked CVD deaths to sodium intake:
Globally, of the CVD deaths attributed to high dietary sodium, 42.1% were from CHD, 41.0% were from stroke, and 16.9% were from other types of CVD.
Deaths from CVD that were related to dietary salt did not occur only in older men in wealthier countries:
Four in five deaths were in low- and middle-income countries.
40% of the deaths were in women,
One in three deaths occurred in people younger than 69.
So, guys take that salt with a pinch of salt! Try herbs instead!