Posts Tagged ‘heart attack’

No Added Heart Attack Risk With Testosterone Therapy in Older Men

Testosterone therapy does not increase the risk of heart attack, or myocardial infarction (MI), among older men, according to a comprehensive new study.

“We believe this is a methodologically rigorous study and should be thoughtfully weighed, critiqued, and discussed alongside the other studies of testosterone therapy and cardiovascular outcomes,” said lead author Jacques Baillargeon, PhD, Director, Epidemiology Division and Associate Professor of Preventive Medicine & Community Health at the University of Texas Medical Branch in Galveston.

“Although recent observational studies have reported an increased risk of cardiovascular disease associated with testosterone use, there is a large body of evidence that is consistent with our finding of no increased risk of MI associated with testosterone use,” Dr. Baillargeon said.

He noted that there are cardiovascular risks associated with untreated hypogonadism (a condition in which the body doesn’t produce enough testosterone) and those should be factored into the risk-benefit assessment about testosterone therapy.

INCREASE IN TESTOSTERONE PRESCRIPTIONS

Testosterone prescriptions for older men in the United States have increased more than 3-fold over the past decade.

This trend has been driven by increases in direct-to-consumer marketing; rapid expansion of clinics specializing in the treatment of low testosterone; the development of new drugs and improved delivery mechanisms, particularly dermal gels; and greater diagnostic awareness of hypogonadism, stated Dr. Baillargeon.

The retrospective study used information from 25,000 Medicare beneficiaries aged 66 years and older.

It compared more than 6,300 men treated with testosterone for 8 years with more than 19,000 who were not treated with testosterone.

“We found that use of intramuscular testosterone therapy was not associated with an increased risk of MI,” Dr. Baillargeon said.

In fact, testosterone was associated with a possible protective effect — reduced risk of MI in patients with the highest prognostic risk index.

There were no differences in risk in patients in the lower prognostic risk groups.

HOW TESTOSTERONE AFFECTS THE HEART

There are a number of physiologic pathways whereby testosterone therapy may affect the risk of adverse cardiovascular events.

“Some have reported that testosterone therapy may improve cardiovascular health by way of decreasing fat mass, insulin sensitivity, and lipid profile,” said Dr. Baillargeon.

“Also, testosterone may possess anti-inflammatory and anticoagulant properties.”

He continued, “It is possible that our findings of a protective effect among men in the highest MI prognostic group reflect a process whereby testosterone reduces peripheral vascular resistance, thereby reducing stress on the heart among those who have some degree of coronary artery disease.

It is important to note that there are also postulated mechanisms through which testosterone may increase the risk of cardiovascular disease.

Given the broad range of proposed biologic pathways, it is important to conduct further research on this topic.”

CONCERNS ABOUT TESTOSTERONE THERAPY

Several recent studies have raised concerns about cardiovascular risks associated with testosterone therapy, in particular for older men.

On June 19, the FDA expanded labeling on testosterone products to include a general warning about the risk of blood clots in veins.

The FDA and European Medicines Agency also are further examining the safety of these products.

The researchers reported their results in the July 2, 2014 issue of the Annals of Pharmacotherapy.

Mediterranean Diet Reduces Diabetes, Inflammation

Two new studies show the heart-healthy benefits of eating a Mediterranean diet.

One study linked the diet to a lower risk of diabetes, especially among those at high risk for cardiovascular disease.

The other study tied the eating plan to lower levels of platelets and white blood cells, 2 markers of inflammation, which has been associated with a greater risk of heart attack and stroke.

The Mediterranean diet frequently emphasizes fresh fruits and vegetables, whole grains, beans, nuts, fish, olive oil, and even a glass of red wine.the_mediterranean_diet_

Eating an anti-inflammatory, Mediterranean style diet has been shown to not only be a delicious and enjoyable way to eat, but also is wonderful for your health.

Earlier research has shown that following the traditional Mediterranean diet also is linked to weight loss, a reduced risk of heart disease and related death, and lower blood pressure and blood cholesterol levels.

Mediterranean Diet Reduces Risk of Diabetes

In the first pooled analysis of studies evaluating the possible role of the Mediterranean diet in diabetes development, adherence to this diet was associated with a 21% reduced risk of diabetes compared with the control dietary groups.

The likelihood of developing diabetes was almost 27% less in those at high risk for cardiovascular disease than in controls.

“Adherence to the Mediterranean diet may prevent the development of diabetes irrespective of age, sex, race, or culture,” said lead investigator Demosthenes Panagiotakos, PhD, professor at Harokopio University, Athens, Greece.

“This diet has a beneficial effect, even in high risk groups, and speaks to the fact that it is never too late to start eating a healthy diet.”

Dr. Panagiotakos and colleagues systematically reviewed 19 original research studies that followed more than 162,000 participants for an average of 5.5 years.

These studies spanned European and non-European populations, which is important because most of the published studies have been European-based and there has been some question of possible confounding factors in these regions, including genetics, the environment, lifestyle, and lower stress levels.

Dr. Panagiotakos said he believes the Mediterranean diet lowers the risk of diabetes by helping guard against obesity.

He presented his study on March 27, 2014 at the American College of Cardiology’s 63rd Annual Scientific Session in Washington, DC.

Mediterranean Diet Lowers Inflammation

To understand whether a Mediterranean diet might favorably influence platelet and white blood cell levels, Italian researchers conducted an analysis of the eating habits of nearly 15,000 healthy Italian men and women aged 35 years or older as part of a large epidemiological study.

The investigators observed that consumption of the Mediterranean diet was directly related to lower levels of platelets and white blood cells, which in turn correlated to lower levels of inflammation.

Those who strictly followed a traditional Mediterranean diet were less likely to belong to study cohorts with relatively high platelet counts and were more likely to belong to cohorts with relatively low white blood cell counts.

“Because the study included healthy participants, the lower levels of platelets and white blood cells in those who were more strictly consuming a Mediterranean diet indicate that this eating plan could account for substantial changes within normal ranges of variability,” said lead author Marialaura Bonaccio, PhD.

“This is an important finding that has implications for how these anti-inflammatory markers are tracked among the general population.”

Dr Bonaccio is with the Department of Epidemiology and Prevention at the IRCCS Istituto Neurologico Mediterraneo NEUROMED in Italy.

The results of her study were published online in the March 31, 2014 issue of Blood.

Double Winner: Patrick Shaw Beat Cancer, Then Heart Disease

When my sister-in-law Carol Peerce died suddenly at age 49 exactly three years ago, it was discovered that radiation-induced heart disease likely led to her heart attack and eventual death.

It turns out the radiation therapy to treat her Hodgkin’s lymphoma 30 years previously had damaged Carol’s heart.

At my wife Margie’s suggestion, I looked into this condition and sure enough found medical evidence that radiation, and chemotherapy, given to Hodgkin’s lymphoma patients put them at risk for later heart problems.

Then I found out that my friend Patrick Shaw, a contractor I knew in East Hampton, was one of these patients as well.

Pat had been diagnosed with Hodgkin’s lymphoma at age 29 and received multiple sessions of radiation therapy and chemotherapy that included heart-toxic anthracyclines.

Little did he know that the radiation therapy and chemotherapy he received to cure his cancer would scar his heart and lead him to have several silent, near-deadly heart attacks and a stroke 20 years later.

Pat’s story, and the heart risks of cancer therapies, are the basis of the cover story for the just released May 2013 issue of Heart Insight magazine.

Heart Risks from Radiation Therapy

Many people survive their cancers, but end up dying of cardiovascular disease.

Among Hodgkin’s lymphoma patients who have received radiation, cardiovascular disease is one of the most common causes of death.

Studies have shown that these patients have an increased risk for coronary artery disease, heart valve disease, congestive heart failure, pericardial disease (disease of the heart lining), and sudden death.

The basic mechanism appears to be radiation-induced damage to the lining of blood vessels.

Compared to the general population, Hodgkin’s lymphoma patients have higher heart risks if they were treated before age 21 or had radiation to the central part of the chest, which increases the risk of death from a fatal heart attack by 1.5 to 3 times.

In addition, a woman who received chest radiation therapy for breast cancer has a 63% increased risk of cardiac death.

With improvements in radiation techniques, including smaller amounts of radiation aimed at specific body areas, the risk of cardiovascular complications has declined.

But patients treated through the mid-1980s have a higher risk of congestive heart failure and heart valve problems.

Pat’s cardiologist, Ronald Drusin, MD, Professor of Clinical Medicine at New York-Presbyterian Hospital, says: “If you had chest radiation for lymphoma in the central part of the chest and have chest pains or tightness and shortness of breath, you should be evaluated by a cardiologist.”

Road to Recovery

For Pat, Dr. Drusin decided that stents to reopen the blocked coronary arteries in his heart were a better choice than bypass surgery because of radiation-induced scarring in Pat’s heart.

Pat felt better after the procedure, although his recovery was complicated by a stroke.

Today, Pat’s prognosis is fine, says Dr. Drusin “as long as he takes good care of himself, which he does.”

Pat is back to work and now pays close attention to his exercise and diet.

As the family chef, he cooks heart-healthy meals containing more whole grains and vegetables, no salt and fewer processed foods.

He checks his blood pressure regularly and takes daily medications, a beta-blocker and baby aspirin, to keep his heart healthy.

On weekends he stays busy with his three sons’ lacrosse games and other activities, including his favorite hobby, building bird houses.

Pat has some simple advice to anyone with symptoms of heart disease:

“As soon as you are not feeling well, get to a doctor,” he says.

“You have to be proactive.

You are in charge of your own heart.”

That’s particularly true if you had radiation or chemotherapy to treat a cancer when you were younger.