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July 28, 2009
JAMA articles report the effects of positive behaviors on the heart
The July 22/29, 2009 issue of the Journal of the American Medical Association (JAMA) published two reports that contribute to the growing evidence in support of adopting healthy lifestyle behaviors to help protect the heart.
In one article, researchers from Brigham and Women's Hospital and Harvard Medical School report that men who had greater adherence to 6 lifestyle factors, including maintaining a normal weight, not smoking, engaging in regular exercise, consuming alcohol in moderation, consuming breakfast cereals, and consuming fruit and vegetables, had a lower risk of developing heart failure. The study evaluated data from 20,900 participants in the Physicians' Health Study who were followed for an average of 22.4 years, during which heart failure developed in 1200 men. The researchers found a declining risk of heart failure as more lifestyle factors were practiced. "For example, the lifetime risk for heart failure was approximately 1 in 5 (21.2 per cent) in men adhering to none of the desirable lifestyle factors, compared to 1 in 10 (10.1 percent) in those adhering to 4 or more healthy lifestyle factors," the authors write.
In the second article, another group from Brigham and Women's Hospital and Harvard Medical School describes the benefits of positive lifestyle factors in preventing high blood pressure in women. The team evaluated data from 83,882 participants in the Nurses' Health Study who had normal blood pressure in 1991. Over a 14 year follow-up period, 12,319 cases of hypertension were reported. Women who maintained a body mass index (BMI) of less than 25, engaged in an average of 30 minutes of vigorous exercise per day, scored high on the Dietary Approaches to Stop Hypertension (DASH) diet, consumed alcohol in moderation, used nonnarcotic analgesics less than once per week, and consumed at least 400 micrograms per day of supplemental folic acid had an 80 percent lower risk of developing high blood pressure compared to the rest of the subjects, however only 0.3% of the participants practiced all 6 of these behaviors. The risk of hypertension decreased with adherence to a greater number of lifestyle practices, with body mass index emerging as the most important predictor.
The studies reinforce the theme of the upcoming European Society of Cardiology (ESC) Conference, which is prevention. Concerning the Nurses' Health Study findings, ESC spokesman Professor Joep Perk of Oskarshamn District Hospital in Sweden commented that the results were comparable to those of the Interheart Study which found that 90 percent of first attacks were caused by 9 lifestyle factors. "So there's a consistent pattern here, suggesting that four out of five cases of hypertension or heart attack are amenable to lifestyle intervention. So, most of us can do something about prevention. It's a public health issue, and we need to put our heads together."
Managing congestive heart failure (CHF) means coordinating many influences and factors. The idea is to first stabilize the patient's condition (especially if the patient has acute CHF that may lead to cardiac arrest), then develop a pharmaceutical and lifestyle program specially suited for the patient's metabolism. Dosages of the most popular medications often start at the lower end of their recommended range and are frequently adjusted by physicians until they get the right mix of medications to prevent symptoms, slow the disease, and keep side effects under control. A major problem with these medications is their significant side effects, which may severely reduce a patient's quality of life.
In terms of lifestyle changes, patients may be advised to limit their salt intake to 2 grams per day and their water intake to 1.5 to 2 liters per day. A heart-healthy diet—including increased intake of monounsaturated oils (such as extra virgin olive oil), fruits and vegetables, fiber, and essential fatty acids—is also recommended. Finally, patients may be advised to increase their intake of garlic, onions, and celery, all of which have been shown to lower blood pressure. A successful complementary approach uses the same principles but relies on nutrients and supplements that have far fewer side effects than conventional pharmaceuticals.
The Life Extension Foundation suggests:
- CoQ10—100 to 300 milligrams (mg) daily
- L-carnitine—1 to 3 grams (g) daily
- Taurine—2 to 3 g daily
- Hawthorn—3000 mg daily
- Magnesium citrate—160 mg (in capsule form) 1 to 6 times daily
- Potassium (if low potassium levels are confirmed by a blood test)
- Vitamin C—1000 mg daily
- Vitamin E—800 international units (IU) daily
- Alpha-lipoic acid—150 mg daily
- Fish oil—700 to 1400 mg of eicosapentaenoic acid (EPA) and 500 to 1000 mg of docosahexaenoic acid (DHA)
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