Managing Chronic Pain in Patients with Hemophilia
How High Cholesterol And Hypertension Increase Heart Disease Risks In Younger Adults
Cardiovascular issues aren't just a concern for the young at heart.
A new study says younger adults may be at a greater risk for developing artery-narrowing atherosclerosis and may be especially vulnerable to the effects of elevated blood cholesterol and hypertension, two typical modifiable cardiovascular risk factors.
Undertaken at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) in Spain, the research concludes that people need to start paying attention to their cardiovascular health at a younger age.
Published this week in the Journal of the American College of Cardiology, the findings stress that younger adults need to aggressively control cardiovascular risk factors.
Researchers said that primary prevention strategies need to include "surveillance of subclinical atherosclerosis and early cardiovascular risk factor control."
"Screening for subclinical atherosclerosis from an early age together with aggressive risk-factor control could help to reduce the global burden of cardiovascular disease," said Dr. Valentin Fuster, the study's co-leader and CNIC general director as well as physician-in-chief at Mount Sinai Medical Center in New York, in a statement.
The research team said subclinical atherosclerosis often progresses in middle-aged individuals, especially when blood pressure and LDL-cholesterol levels are even mildly elevated.
They also said both medical professionals and the general public should be aware that atherosclerosis progression can be halted if risk factors are managed aggressively from an early age.
"In this study, we show that moderate increases in blood pressure and cholesterol have a much more pronounced impact on atherosclerosis progression in younger people," said Dr. Borja Ibáñez, CNIC scientific director and a cardiologist at Hospital Universitario Fundación Jiménez Díaz in Madrid, in a statement.
The team said few studies have investigated the progression of silent atherosclerosis in people who are symptom free – whether they're young or apparently healthy in middle-age – and how this disease progresses throughout life.
The PESA-CNIC-Santander study (Progression of Early Subclinical Atherosclerosis) started in 2009 in close collaboration between the CNIC and Santander Bank.
More than 4,000 apparently healthy bank employees in Madrid ages 20 to 39 volunteered for an exhaustive, noninvasive analysis of the carotid, femoral, and coronary arteries and the aorta.
Participants also provided blood samples for advanced genomic, proteomic, and metabolomic analysis.
The researchers said the study's findings have important implications for cardiovascular prevention and personalized medicine. It shows controlling risk factors (principally elevated cholesterol and hypertension) should begin early in life, when arteries are more vulnerable to the effects of the risk factors.
Dr. Guiomar Mendieta, a cardiologist and the study's first author said in a statement the study's other key finding was atherosclerosis, which was previously believed to be irreversible, can disappear if risk factors are controlled from an early stage.
Dr. Samantha Lee, a director of cardiac telemetry at Northwell Health in New York who was not involved in the research, told Medical News Today that the "incredibly thorough study" sends an important message.
She noted that the longer someone has high cholesterol and high blood pressure, the more likely they are to have atherosclerosis, which she called "a fancy term for plaque build-up in the arteries."
"This isn't a new idea," Lee said. "But what is novel about this study is the amount of plaque in your arteries can actually go away (as seen in 8 percent of participants) by treating your cholesterol and blood pressure at a young age. By waiting to treat these risk factors, you might miss out on the opportunity for your atherosclerosis to improve."
Dr. Rigved Tadwalkar, a cardiologist at Providence Saint John's Health Center in California who also was not involved in the study, told Medical News Today the study shows screening for subclinical atherosclerosis at an early age could play an important role in identifying those at risk.
"Given these findings, it would be worthwhile for healthcare professionals to start assessing cardiovascular risk earlier on, including during check-ups in early adulthood," Tadwalkar said. "This approach is consistent with the idea of early intervention and aggressive control of cardiovascular risk factors as a means for reducing cardiovascular disease burden."
Tadwalkar said most people at higher risk are still older, but the research highlights an important fact: younger individuals are also vulnerable to cardiovascular disease.
"Proactive strategies are of importance, even in apparently healthy young adults," Tadwalkar said. "We know that those with a family history of cardiovascular diseases may face an increased risk, additionally warranting early testing and vigilant monitoring, especially considering that the progression of atherosclerosis is often silent."
Tadwalkar said people should watch out for elevated blood cholesterol levels and hypertension.
"Moderate increases in these risk factors were shown to have a more pronounced impact on atherosclerosis progression in younger individuals," Tadwalkar noted.
He said other indicators may include poor dietary habits, lack of physical activity, and smoking, all known contributors to elevated cholesterol and hypertension.
Dr. Nieca Goldberg is the medical director of Atria New York City and a clinical associate professor of medicine at NYU Grossman School of Medicine.
Goldberg, who wasn't involved the study, told Medical News Today that young people are at risk for atherosclerosis, as "autopsy studies in young people who have died in car accidents have shown atherosclerosis."
"What is new about this study is that it advocates for early risk factor intervention," Goldberg said. "Genetics show that you are at risk and an unhealthy lifestyle accelerates the process."
Goldberg said everyone needs to work on lowering their cardiovascular risk factors, the earlier the better.
"It is about advocating healthy lifestyles and living the talk," she said. "It is important to address this in school children with healthy lunch programs and stop smoking campaigns for young people. We need to get better at our messaging to people of all ages."
"One way is to encourage them to get a primary care doctor where risk factors like blood pressure, weight and laboratory testing can be ordered for cholesterol and glucose," Goldberg said.
Dr. J. Wes Ulm, a bioinformatic scientific resource analyst and biomedical data specialist at the National Institutes of Health who wasn't involved in the study, told Medical News Today that "as a rule, CAD (coronary artery disease) risk factors are remarkably modifiable by sustained lifestyle improvements across a vast genetic spectrum."
"Increased exercise of various forms, moderation of refined sugar and saturated fat intake (and replacement of saturated and trans fats with unsaturated fats), better stress management, meditation, smoking cessation, minimization of alcohol intake, healthy weight maintenance — all are quite effective in nudging the above CAD risk factors in a healthier direction, including in younger people," Ulm said.
Ulm added that the study could have much broader societal significance.
"One of the most significant public health conundrums of our era is the markedly diminished life expectancy of Americans compared to citizens of other developed countries, even when controlling for common factors, genetic and otherwise," Ulm said.
"It is here that the referenced research may have some of its most interesting and surprising implications, in helping to underscore the immense and often underappreciated importance of specific geographic, structural, and cultural factors that encourage certain lifestyle choices," he said.
Tadwalkar added that sleep apnea and poor sleep quality are emerging as noteworthy factors for cardiovascular disease. He said lifestyle modifications play a pivotal role, including adopting a heart-healthy diet low in saturated fats and cholesterol, engaging in regular physical activity, and avoiding tobacco.
"These lifestyle changes can contribute significantly to managing contributory risk factors such as high cholesterol levels and blood pressure," Tadwalkar said. "Regular health check-ups and screenings are critical for early detection of risk factors. This can also help identify individuals who need to move beyond lifestyle modifications alone and into pharmacological interventions, such as cholesterol-lowering medications or antihypertensive drugs."
Dear Doctor: Are There High Blood Pressure Medications That Don't Cause Constipation?
DEAR DR. ROACH: I'm 58 years old and was diagnosed with high blood pressure back in 2021. Since then, I've been prescribed atenolol, which slows down my heart rate. I was later prescribed 10 mg of amlodipine, which I'm told relaxes and dilates my blood vessels.
I wouldn't say it's severe, but I never experienced ongoing constipation problems until I started taking these medications (more the amlodipine), which is why I'm hoping that there is a vasodilator without that particular side effect or another medication you can recommend. -- M.D.C.
ANSWER: Atenolol is more likely to cause constipation than amlodipine is, but constipation is certainly possible with either of these medicines. When a prescribed medicine causes a side effect, I usually try to find as close a medicine as possible to the one I am no longer prescribing. But sometimes closely related medicines have closely related side effects.
Drugs that end in "-pine" are a type of calcium channel blocker (felodipine, nifedipine and isradipine), so I would consider trying one of those first to see if that helped and didn't have the constipation side effect.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) also work by relaxing small blood vessels and are unlikely to cause constipation. I favor those over other medications because the long-term safety and effectiveness data on them for treatment of high blood pressure is excellent.
I sometimes see people treated with hydralazine, a potent vasodilator. This medicine is more often used in people with heart disease (especially heart failure) than in people with high blood pressure and normal heart function. Drug-induced lupus is a major concern with hydralazine, so it is best used when other options aren't indicated or working.
DEAR DR. ROACH: For the past year, I have been experiencing shortness of breath. I have been tested six ways to Sunday and aced every one, and I have also been seen by several specialists. They have basically given up.
I am a 73-year-old male in decent condition. The only medication I take is apixaban, as I experience the occasional atrial fibrillation (AFib). I have recently read that apixaban can cause shortness of breath, but I can't test that theory, since I can't stop taking it. I'm not sure what to do next. -- M.H.
ANSWER: It's always wise to consider drug effects when a new symptom appears, as medications are so often the culprit. If your doctors really thought it likely, they could try a different anticoagulation drug to see if that makes the symptom go away. In your case, I think it's possible, but unlikely. In placebo trials, shortness of breath wasn't reported by people taking apixaban.
I'm more concerned about your underlying AFib, the abnormal heart rhythm. AFib commonly causes a fast heart rate, fast enough to cause symptoms at times. If you haven't already gotten one, a prolonged heart monitor will catch fast heart rates. If you keep a symptom log, it can signify if your heart rate correlates to the shortness of breath. If so, you may benefit from medication to keep your heart rate in the normal range. It is common to have shortness of breath without a cause, despite extensive evaluation.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Cholesterol And Heart Disease In African Americans
While African Americans have slightly lower cholesterol levels than other racial groups, they are more likely to die from heart disease. Socioeconomics, lifestyle, and racism in medicine all play a role.
Heart disease is the leading cause of death among all genders and most racial and ethnic groups in the United States.
Elevated blood cholesterol levels contribute to the risk of developing heart disease. Cholesterol can build up in the artery walls, causing them to narrow — this can decrease blood flow to the brain, heart, kidneys, and other areas of the body.
While death from heart disease is more common in African Americans than in other racial groups, they tend to have lower cholesterol levels. It is important to note that most datasets on this topic combine non-Hispanic, Black adults and African American adults into one racial group.
This article examines the relationship between cholesterol and heart disease in African Americans.
The reported rates of heart disease among Black and African American individuals are slightly higher than in white individuals. However, the death rate is between 22 to 25% higher among the former.
This means that Black and African American people have disproportionately higher rates of death from heart disease than their white counterparts.
The following table includes the age-adjusted prevalence of heart disease by percentage of adults in 2019:
The following table includes the age-adjusted death rates per 100,000 population for heart diseases in 2019:
There is a lower percentage of Black and African American adults with high total cholesterol than white individuals. The percentage of the population with high total cholesterol between 2015–2018 is as follows:
Cholesterol is a waxy, fat-like substance that is in all of the body's cells. The body makes cholesterol to help produce hormones, vitamin D, and substances that help with food digestion.
Healthcare professionals often refer to high-density lipoprotein (HDL) as "good" cholesterol and low-density lipoprotein as "bad" cholesterol.
Higher HDL levels may help lower the risk of heart attack and stroke and have an association with a reduced risk of heart disease.
Conversely, there is an increased risk of cardiovascular disease associated with high LDL levels.
LDL moves cholesterol around the bloodstream to where the body needs it for cell repair, depositing it in the artery walls. Over time, cholesterol deposits can accumulate, narrowing or blocking the arteries that supply blood to the heart and other parts of the body.
Narrowed or blocked arteries prevent blood from reaching the heart, brain, and other organs, possibly resulting in heart attack, stroke, or heart failure.
However, even though African Americans are more likely to have lower LDL levels than other groups, they still have higher rates of death from heart disease. This means factors other than cholesterol may increase their risk of adverse heart disease outcomes.
High cholesterol is not the only factor that may raise a person's risk for heart disease. Additional risk factors for heart disease may include:
Although these risk factors can affect people of all races and ethnicities, some are more prevalent in African Americans.
For example, high blood pressure is more common. The 2017 American College of Cardiology and American Heart Association guidelines state that approximately 54.9% of non-Hispanic Black people meet the definition for high blood pressure compared with 47.3% of non-Hispanic white individuals.
Diabetes is also more prevalent. The Office of Minority Health states that African American adults were 60% more likely than non-Hispanic white adults to receive a diabetes diagnosis in 2018 and twice as likely to die from it in 2019.
Additionally, 2023 research found that obesity affects 49.6% of African Americans compared with 42.2% of non-Hispanic white people.
African Americans may also have certain socioeconomic factors that may affect their heart disease outcomes, such as lower income, lower education level, unemployment, and certain environmental factors.
Societal determinants of health, including lower income, less education, and environmental factors, have links to structural racism. Centuries of structural racism in the U.S. May have disproportionately exposed African Americans to these factors.
People with lower incomes are less likely than people with higher incomes to:
People with a lower education level are more likely to:
Certain environmental factors can also have associations with a higher risk of heart disease, such as:
Among African Americans, there can be significant barriers to accessing healthcare, with higher rates of poverty and lower rates of health insurance. The lack of access to healthcare prevents early disease screening and the management of risk factors that improve heart disease outcomes.
People can take the following steps to help lower their risk of heart disease:
If someone has a condition, such as high blood pressure or diabetes, a doctor may recommend lifestyle changes and prescribe medicines to manage them.
African Americans have a greater risk of adverse outcomes from heart disease than other racial groups.
Although high cholesterol is a significant risk factor for heart disease, it may not explain the disparity in death rates from heart disease among African American people.
Other risk factors for heart disease, such as high blood pressure or diabetes, may contribute. Socioeconomic factors also play a substantial role in creating barriers that prevent African American communities from accessing high quality healthcare.
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