Cardiovascular Disease Risk Factors in Women: The Impact of Race ...
SCRATCH-HTN
About the studySCRATCH-HTN aims to explore a new way of managing high blood pressure (BP), specifically in people who have raised BP despite being on antihypertensive medications; participants will use an external self-administered device, which produces a small electrical current, and will potentially result in a decrease in BP.
The aim of the study is to assess how effective the device is in the treatment of hypertension and whether it is comfortable and safe to use.
This study is conducted in accordance with the ethical standards of the institutional research ethics committee (REC number: 21/WS/0157) and is a registered clinical trial on clinicaltrials.Gov (NCT05179343) ) and ISCRTN (ISRCTN14509154).
Please see PIS - SCRATCH-HTN [PDF 348KB] for more information about the study.
Why is it important?High BP is the leading risk factor for death and illness from a cardiovascular event, and managing high BP is a key focus of treatment for cardiovascular diseases. Antihypertensive drugs are widely available, however a high number of people with high BP fail to achieve a healthy BP value despite receiving 1 or more anti-hypertensive medications. For uncontrolled hypertensive patients, including drug-resistant patients, the lack of an effective therapy is a major health challenge and an urgent unmet clinical need. One potentially highly effective strategy to improve BP control in hypertension is via redressing the nervous system imbalance, which is linked with the development of hypertension; the brain controls the cardiovascular system by sending commands through the nervous system. In this study, we will utilise a device that produces a very small electrical current to the nerves at the front area of the ears (the tragus). With this strategy, we aim to redress the nervous system imbalance, and treat hypertension.
Who can participatePIS - SCRATCH-HTN [PDF 348KB] to view the participant information sheet
You can participate if you are aged ≥18 years and <80 years and:
Have one or more of the following associated conditions:
If you're a female, you should be post-menopausal or surgically sterile or willing to use contraception during the period of the trial.
What happens nextIf you decide to take part in the study, we will first carry out a screening assessment to make sure you are suitable for the trial. If you are suitable, we will train you to use the device. You will be asked to use the device for 30 minutes for 14 days, and once a week thereafter for 10 weeks. Please see the following video showing the device and how to use it.
Watch the SCRATCH-HTN Video
During the trial you will be asked to remain on your medication and not change it throughout the trial. You will be asked to come to the clinical facility at least five times in a period of 4 months.
Please note that all information provided and collected is confidential, and we will only use the anonymised data for purpose of analysis and research.
ContactFor further information about the SCRATCH-HTN study, please email our research personnel at help-scratchhtn@qmul.Ac.Uk
Address: William Harvey Clinical Research Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry Queen Mary University of London, Charterhouse Square, London EC1M 6BQ
Chief investigator: Dr Ajay GuptaTrial coordinator: Alexandra PapaCo-investigators: Dr David Collier, Dr Manish SaxenaTrial Nurse: Patrizia Ebano
Additional resources for participants and others interestedThis trial is funded by the National Institute for Health Research.
5 Studies On Saturated Fat — Time To Retire The Myth?
The relationship between saturated fat consumption and heart disease is still debated. Here are 5 studies that suggest saturated fat has little effect on heart disease for most healthy adults.
Since the 1950s, people have believed that saturated fat is bad for human health.
This was originally based on observational studies showing that people who consumed high amounts of saturated fat had higher rates of death from heart disease (1).
The diet-heart hypothesis states that saturated fat raises LDL (bad) cholesterol in the blood, which then supposedly lodges in the arteries and causes heart disease (2).
While this hypothesis has never been proven, official dietary guidelines from the U.S. Department of Agriculture, the American Heart Association, and the World Health Organization all recommend limiting your intake of saturated fat (3, 4, 5).
While the issue is still debated, numerous recent studies have turned up mixed results on the link between saturated fat consumption and heart disease.
This article reviews 5 recent, high quality studies on this issue.
1. Hooper L, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Systematic Review, 2020.Details: This systematic review and meta-analysis of randomized controlled trials was performed by the Cochrane collaboration, an independent organization of scientists.
The review includes 15 randomized controlled trials with 56,675 participants.
Each of these studies had a control group, reduced saturated fat or replaced it with other types of fat, lasted for at least 24 months, and looked at hard endpoints such as heart attacks or death.
Results: The study showed that reducing total saturated fat intake could decrease the risk of cardiovascular events by approximately 17% but had no effect on the risk of dying from heart disease or other causes.
More specifically, replacing some saturated fat with polyunsaturated fat in the diet led to a 21% lower risk of cardiovascular events, while replacing saturated fat with carbohydrates was linked to a 16% lower risk.
Conclusion: People who reduced their saturated fat intake were just as likely to die from heart disease and other causes as those who ate more saturated fat.
However, partially replacing saturated fat with polyunsaturated fat or nutrient-dense carbohydrates, such as whole grains, may be beneficial for heart health and disease prevention.
These results are similar to a previous Cochrane review conducted in 2015 (6).
2. Steur M, et al. Dietary fatty acids, macronutrient substitutions, food sources and incidence of coronary heart disease: Findings from the EPIC-CVD case-cohort study across nine European countries. Journal of the American Heart Association, 2021.Details: This observational study looked at the association between specific types of fat from various food sources and the risk of developing heart disease.
The study included data from 16,073 people in nine countries in Europe.
Results: Total saturated fat intake was not associated with a higher risk of heart disease. However, specific foods high in saturated fat had different effects on the risk of heart disease.
For example, each 1% increase in total energy intake from yogurt or cheese was linked to a 7% and 2% lower risk of heart disease, respectively.
Conversely, increased intake of red meat and butter were associated with a 7% and 2% higher risk of heart disease, respectively.
Conclusion: Though total saturated fat intake has no effect on the risk of heart disease, certain foods high in saturated fat may impact heart health differently.
For this reason, the researchers point out that it's important to consider the overall composition of foods rather than focusing only on the individual nutrients they contain.
3. Trieu K, et al. Biomarkers of dairy fat intake, incident cardiovascular disease, and all-cause mortality: A cohort study, systematic review, and meta-analysis. PLoS Medicine, 2021.Details: This review looked at evidence from 18 observational studies on the link between saturated fat intake from dairy products and risk of heart disease and death.
The studies included more than 40,000 participants and measured blood levels of pentadecanoic acid and heptadecanoic acid, both of which are saturated fats found in dairy.
Studies also measured levels of trans-palmitoleic acid, a type of trans fat found naturally in foods such as milk, cheese, and yogurt.
Results: Higher blood levels of pentadecanoic acid and heptadecanoic acid were linked to a lower risk of heart disease but not death.
Blood levels of trans-palmitoleic acid were not associated with the risk of heart disease or death.
Conclusion: Consuming higher amounts of saturated fat from dairy may be associated with a reduced risk of heart disease.
However, more studies are needed, as researchers note that the biomarkers used in this study did not distinguish among specific types of dairy products, each of which could impact the risk of heart disease differently.
4. Gaeini Z, et al. The association between dietary fats and the incidence risk of cardiovascular outcomes: Tehran Lipid and Glucose Study. Nutrition & Metabolism, 2021.Details: This study evaluated the association between consumption of different types of dietary fats and the risk of heart disease.
The study followed 2,809 adults over an average of 10.6 years and used a food frequency questionnaire to estimate dietary fat intake.
Results: The study didn't find any connection between total intake of saturated fat or the consumption of specific saturated fatty acids — like myristic acid, lauric acid, palmitic acid, and stearic acid — and the risk of heart disease.
The study also found that replacing saturated fats with other macronutrients in the diet had no effect on heart disease risk.
Conclusion: Saturated fat intake was not associated with a higher risk of heart disease.
Furthermore, the researchers didn't find any benefit to consuming other macronutrients instead of saturated fats, indicating that a low fat diet may not be necessary for the prevention of heart disease.
5. Gribbin S, et al. Association of carbohydrate and saturated fat intake with cardiovascular disease and mortality in Australian women. Heart, 2021.Details: This study focused on the effects of carbohydrate and saturated fat intake on the risk of heart disease, stroke, type 2 diabetes, obesity, high blood pressure, and death.
The study included 9,899 women ages 50–55, whom the researchers followed for 15 years.
Results: Increased saturated fat intake was not associated with a higher risk of heart disease or death and was linked to lower rates of obesity, type 2 diabetes, and high blood pressure.
Additionally, moderate carbohydrate intake (41–43% of total daily calorie intake) was associated with the lowest risk of heart disease but had no effect on the risk of death.
Conclusion: In women, consuming saturated fat doesn't increase the risk of heart disease or death and may be linked to a lower risk of other conditions, including obesity, type 2 diabetes, and high blood pressure.
Key findings
People with certain medical conditions or cholesterol problems may need to monitor their saturated fat intake.
However, the study results selected for this article are pretty clear that saturated fat has little effect on heart disease for most healthy adults and that some foods high in saturated fat may even be beneficial for heart health.
Furthermore, recent research emphasizes that it's important to consider the overall composition of foods and the way that they interact with our bodies rather than focusing solely on the individual macronutrients they contain (1, 7).
For example, while processed foods and whole foods may both contain protein, fats, and carbohydrates, these foods have different effects on health (8).
This concept may also apply to saturated fats, as the fats found in nutrient-dense ingredients such as milk, cheese, and yogurt impact health differently than the saturated fats found in processed meats or sugary desserts.
That said, replacing some of the saturated fat in your diet with unsaturated fat may offer several health benefits.
This is not because saturated fat is "bad" but because unsaturated fats are particularly healthy and have been shown to protect against heart disease (9).
Nutritious sources of unsaturated fats include nuts, seeds, fatty fish, extra-virgin olive oil, and avocados (10).
Still, there doesn't seem to be any reason for most people to worry about saturated fat.
Other issues are much more worthy of your attention, such as limiting your intake of sugar-sweetened beverages and processed foods, following a well-balanced diet, and getting plenty of physical activity in your daily routine.
High Blood Pressure And Erectile Dysfunction (ED)
To treat erectile dysfunction (ED), you have to lower high blood pressure. Some people are able to do that through lifestyle changes alone. Others need help from prescription high blood pressure medication.
A problem for many men, though, is that some types of blood pressure drugs can cause erectile dysfunction. That may make it tough to stay on medication, especially if high blood pressure never caused any symptoms before. An estimated 70% of men who have side effects from high blood pressure medicine stop taking it.
While many drugs used to treat high blood pressure have been linked to erectile dysfunction, some are much less likely than others to cause problems. Certain high blood pressure drugs may even improve erectile dysfunction for some men.
It's known that diuretics (or water pills, like hydrochlorothiazide) and beta-blockers (like Atenolol) can also cause erection problems. These are also the first drugs that a doctor is likely to prescribe if you are not able to lower your high blood pressure through diet and exercise.
If you take a diuretic, you should stay on it until high blood pressure is under control. If erection problems persist, or blood pressure goes back up, then your doctor might switch to a drug that's less likely to cause erectile dysfunction. Or, a combination of medications might work better to control high blood pressure and lower the risk of erectile dysfunction.
If you take a beta blocker, you may also want to ask your doctor if it might cause erectile dysfunction. You might be better off on a medication less likely to cause a problem.
Some families of high blood pressure drugs rarely cause ED as a side effect. They include:
ACE (angiotensin converting enzyme) inhibitors -- such as Capoten, Lotensin, Prinivil, and Zestril for example -- widen blood vessels and increase blood flow. Erectile dysfunction is rarely a side effect, occurring in less than 1% of patients. There are several different drugs in this category. This seems to be true of all of them.
There are also drugs known as calcium channel blockers, such as Amlodipine, Diltiazem, or Verapamil. As a group, they rarely cause erectile dysfunction. But erection problems may be less common with some individual drugs within that group than with others. Your doctor can tell you which.
In general, alpha-blockers do not often cause erection problems either. In one study, a small number of men actually had a 100% improvement in their erectile dysfunction after 2 years on the alpha-blocker Cardura.
Drugs known as ARBs (angiotensin II receptor blockers, like Losartan) are not only unlikely to cause erection problems, but they may improve sexual function in men with high blood pressure.
One study looked at the drug Cozaar, an ARB. At first, just 7% of men and women in the study said they felt sexually satisfied overall. After 12 weeks of Cozaar, about 58% said they were sexually satisfied. The percentage of men who reported having erectile dysfunction dropped from 75% to 12%.
Another study compared the drug Diovan, an ARB, with Coreg, a beta-blocker. The study compared the effect of the two drugs on blood pressure and frequency of sexual intercourse.
The drugs controlled blood pressure equally well. But people who took the ARB reported having sex more often during the 16 weeks of treatment. They said they had sex about eight times a month before, and 10 times a month after. People taking the beta-blocker had sex much less often: eight times a month before, and four times a month after.
Tell your doctor if you think blood pressure medicine may be causing erectile dysfunction.
If it is medication, and not just high blood pressure, switching to another prescription may solve the problem. Never stop taking medicine without your doctor's OK.
But high blood pressure itself still could be to blame for your erectile dysfunction. In that case, ask about trying an erectile dysfunction drug like Cialis, Levitra, Stendra, Staxyn, or Viagra.
You should only take these drugs once your high blood pressure is under control. They are not safe for men with untreated high blood pressure. They are also not safe for men taking alpha-blockers, or men taking nitrate drugs for heart disease.
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