Pathophysiological concepts and screening of cardiovascular disease in dialysis patients
7 Sneaky Habits That Can Cause Heart Problems
It's well known that certain habits, like smoking or drinking excessive amounts of alcohol, can damage your heart over time.
But many of the everyday habits that we don't really think about — how frequently we brush our teeth, the supplements we take and the amount of coffee we drink — can also take a toll on the health of our hearts.
What we do, eat and drink can significantly influence our blood pressure, cholesterol and heart rate, and ultimately influence our overall heart function.
Here are a few everyday habits that can contribute to heart problems:
Crash Dieting Or Eliminating Certain MacronutrientsDr. Daniel Edmundowicz, the chief of cardiology at Temple University Hospital, said that people often think they are eating a healthy, balanced diet but, in actuality, are setting themselves up for heart problems down the road.
For example, he's seen people adhering to a low cholesterol diet avoid healthy fats, an important macronutrient. Then, they may eat too many carbohydrates. While this type of diet wouldn't cause an increase in cholesterol levels, it can lead to weight gain and put a lot of stress on the sugar system and diabetes system, according to Edmundowicz.
Crash dieting can similarly tax the cardiovascular system, and research has shown that a sudden and extreme shift in eating habits can lead to a deterioration in heart function.
"Going from one extreme to another really doesn't help," Edmundowicz said.
Social Isolation And LonelinessBeing isolated from others can also have a profound impact on our heart health, according to Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John's Health Center in Santa Monica, California.
A recent study found that older women have a 8% higher risk of cardiovascular disease when living in social isolation and a 5% higher risk for cardiovascular disease when they're living with loneliness. For people experiencing both social isolation and loneliness, the risk for heart disease grows to 27%.
Social isolation can also contribute to depression, and depression can lead to cardiovascular risk factors like hypertension, sedentary lifestyle and poor eating habits, according to Edmundowicz.
"Social isolation is a biggie, and it does contribute to poor heart health," Edmundowicz said.
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Social connection can help improve heart health outcomes.Poor Dental HealthDental issues — like gum and tooth decay — can increase the risk of bacterial infections in the bloodstream. According to Tadwalkar, it's very easy for bacteria in the mouth to travel to the blood.
Recent research also found that regularly having your teeth cleaned is linked to better heart health outcomes.
Edmundowicz said it's known that gingivitis and poor oral health causes an inflammatory state that could exasperate heart problems like high cholesterol or plaque rupture.
"Good oral hygiene is important. We can't say 100% that brushing and flossing every day is going to prevent a heart attack, but it can increase one's vulnerability if they have the other standard risk factors," Edmundowicz said.
Certain Medications And SupplementsSome medications have been found to trigger cardiovascular issues. ADHD medications, for example, can ramp up the nervous system and cause increased heart rate and blood pressure. Drugs with a diuretic effect, such as the anti-hormonal medication Spironolactone, can decrease blood pressure, and in people with naturally low blood pressure, lead to symptoms like lightheadedness and dizziness.
Tadwalkar stressed that this doesn't mean that everyone needs to be concerned about their medications. However, those who are predisposed to blood pressure or heart rhythm issues may need to be careful with the dosing of their medications. Your physician should take your heart health history into consideration while figuring out the right dosage for you.
Supplements can also impact the heart, especially among people taking vitamins and herbal supplements they don't actually need. Supplements can interact with prescribed medications and also have destructive effects on the heart, according to Tadwalkar. He recommends talking to a physician about supplements to determine if they may have cardiovascular effects.
Too Much CaffeineCaffeinated coffee is generally safe and protective for the heart. Research suggests that drinking two cups of coffee per day provides the greatest cardiovascular benefits.
But too much coffee can have a negative effect because it "can speed up the heart, cause increased heart rate, cause contraction of the blood vessels and increased blood pressure, and certainly if you're prone to rhythm disturbances of the heart, the caffeine at high doses can cause that," Tadwalkar said.
Caffeine is considered safe until 300 to 400 milligrams, and after that, it can have a cascade of negative effects.
Research has also shown that filtered coffee is associated with better cholesterol levels than unfiltered coffee, such a French press. "Oftentimes we don't link cholesterol with coffee, but filtered coffee has less bad cholesterol content than less filtered coffee," Tadwalkar said. In general, the blacker the coffee, the healthier it is for the body.
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Your daily coffee habit can be beneficial for your heart — but only up to a certain point.Unmanaged StressWhen the body's fight-or-flight system is chronically activated, it can cause inflammation in the body and prolonged release of stress hormones like adrenaline. These factors together can cause physiological changes in the body, including increases in blood pressure, high cholesterol, obesity, insulin resistance and electrical rhythm disturbances, according to Tadwalkar.
Chronic stress can also increase the risk of blood clotting throughout the body. If a clot forms in an artery that's already narrow, it can cause a heart attack. "This is why people who have a lot of chronic stress, you may see, oftentimes, will end up with a heart attack," Tadwalkar said.
Triggers of stress are all around us, and it can be hard to escape. Because those triggers aren't going away, it's crucial to learn how to effectively manage your stress, said Tadwalkar, who recommends stress-relieving activities like meditation, yoga, exercise and enjoyable hobbies.
Too Much Or Too Little SleepMost people need about seven to eight hours of sleep a night — too much or too little sleep can contribute to cardiovascular issues, including heart attack and stroke.
It's not just about the quantity of sleep, but the quality, too. High-quality, regenerative sleep is crucial to maintaining a healthy heart. Lower-quality sleep is linked to high blood pressure, elevated cholesterol and atherosclerosis (a build up of plaque in the arteries).
"We want people to sleep well, and for the expected duration of time, to really protect their heart," Tadwalkar said.
New Blood Test Can Predict Heart Disease 30 Years In Advance
Researchers have discovered that a simple blood test can predict a woman's risk of heart disease up to 30 years in advance.
By measuring two types of fats in the blood, along with a marker of inflammation called C-reactive protein (CRP), doctors can estimate a woman's chances of developing heart-related problems, such as heart attacks or strokes, even decades later.
This research, funded by the National Institutes of Health, was recently presented at the European Society of Cardiology Congress 2024 and published in the New England Journal of Medicine.
Dr. Paul M. Ridker, a key researcher and director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston, emphasized the importance of these findings.
"We can't treat what we don't measure, and we hope these findings bring us closer to identifying and preventing heart disease earlier," he said.
The study followed nearly 28,000 female healthcare providers in the United States who participated in the Women's Health Study.
These women, who were on average 55 years old when the study began between 1992 and 1995, were tracked for 30 years.
During this time, 3,662 of the participants experienced serious heart-related events, such as heart attacks, strokes, surgeries to restore blood flow, or even death due to cardiovascular issues.
Researchers focused on three specific blood markers: low-density lipoprotein (LDL) cholesterol, lipoprotein(a) [Lp(a)], and C-reactive protein (CRP). LDL cholesterol is often called "bad cholesterol" because high levels can lead to plaque buildup in the arteries, increasing the risk of heart disease.
Lp(a) is another type of fat partly made of LDL and is influenced by genetics. CRP is a protein that increases in the blood when there is inflammation in the body.
The study found that women with the highest levels of LDL cholesterol had a 36% higher risk of heart disease compared to those with the lowest levels.
Those with the highest levels of Lp(a) had a 33% increased risk, and those with the highest CRP levels had a 70% increased risk. When all three markers were high, the risk was even more significant—more than 1.5 times higher for stroke and more than 3 times higher for coronary heart disease.
Although this study focused on women, the researchers believe that similar results would be found in men. The study highlights the important role that inflammation plays in heart disease, especially when combined with high levels of fats in the blood.
To reduce the risk of heart disease, the researchers recommend primary prevention strategies. These include regular physical activity, a heart-healthy diet, managing stress, and avoiding smoking. For those with higher risks, medications that lower cholesterol and reduce inflammation may be necessary.
While LDL cholesterol is commonly tested during routine check-ups, testing for Lp(a) and CRP is less consistent. Some countries recommend regular screening for Lp(a), especially since high levels often run in families. In the U.S., doctors may order these tests for patients with heart disease or a family history of it.
As new therapies and approaches are developed, doctors hope to offer more personalized treatments for those at risk. One such therapy, colchicine, traditionally used for gout, was approved in 2023 by the FDA to reduce heart disease risk in people with atherosclerosis, a condition where plaque builds up in the arteries.
Additional anti-inflammatory treatments are also being explored to help protect heart health.
These findings underline the importance of early detection and proactive measures to maintain cardiovascular health, potentially saving lives decades down the line.
If you care about heart health, please read studies about the best time to take vitamins to prevent heart disease, and calcium supplements could harm your heart health.
For more information about health, please see recent studies that blackcurrants can reduce blood sugar after meal and results showing how drinking milk affects risks of heart disease and cancer.
Source: National Heart, Lung and Blood Institute.
Kidney Disease Medication Found To Reduce Risk Of Cardiovascular Death In Certain Heart Failure Patients In New Study
CNN —
A medication that is currently used for chronic kidney disease in patients with type 2 diabetes has been found to reduce the risk of worsening heart failure and cardiovascular death in certain people with heart failure, according to a new study.
The medication, finerenone, could be an effective therapy in people with heart failure who have mildly reduced or preserved ejection fraction, suggests the study, published Sunday in the New England Journal of Medicine.
"People don't realize this, but if you're hospitalized for heart failure, you have a life expectancy that can be worse than most cancers, and so we have been desperately looking for therapies that can lower that risk," said Dr. Scott Solomon, professor of medicine at Harvard Medical School and the Edward D. Frohlich Distinguished Chair at Brigham and Women's Hospital, who was a trial principal investigator in the study.
"We've made enormous strides in the field of heart failure in the last 20 to 25 years, but mostly that's been in the type of heart failure called heart failure with reduced ejection fraction, when the heart doesn't pump very well," Solomon said. But when it comes to heart failure with mildly reduced or preserved ejection fraction, few therapies are available.
"That's the reason that we did this trial," he said. "There's still a huge unmet need in this population."
Ejection fraction refers to the percentage of blood the heart pumps out with each beat. When someone has heart failure with mildly reduced or preserved ejection fraction, their heart could be pumping normally, or somewhat normally, but still be showing signs or symptoms of heart failure. More than 6 million people in the United States are living with heart failure, and it's estimated that nearly half of all patients with heart failure have a mildly reduced or preserved ejection fraction.
The new study "highlights the importance of this type of heart failure, which is only growing as our population ages," Solomon said.
Heart failure with mildly reduced or preserved ejection fraction often can be managed with medications called sodium-glucose co-transporter 2 or SGLT2 inhibitors, which help lower blood sugar. But the new study suggests that finerenone "could potentially be a second pillar of therapy in patients with heart failure with mildly reduced or preserved ejection fraction," Solomon said.
Finerenone, sold under the brand names Kerendia and Firialta, was approved in 2021 by the US Food and Drug Administration to reduce the risk of serious complications in certain adults with chronic kidney disease associated with type 2 diabetes.
In order for the drug to get FDA approval for use in these people with heart failure, Bayer, the pharmaceutical company behind finerenone, would need to apply to the agency for an expanded indication.
The new study, funded by Bayer, included more than 6,000 people 40 and older in 37 countries who had heart failure and mildly reduced or preserved ejection fraction.
Between September 2020 and January 2023, the patients were separated into two groups; 3,003 were provided a daily dose of finerenone, and 2,998 were given a placebo.
The international team of researchers found that there were 1,024 heart failure events among people in the placebo group, compared with 842 events in the finerenone group.
Additionally, 8.7% of the participants in the placebo group died from cardiovascular causes during the course of the study, compared with 8.1% of the finerenone group, the data showed.
"The reduction in morbidity and mortality that we see will translate to years of life free of heart failure events in these patients," said Solomon, who presented the study findings Sunday at the European Society of Cardiology conference in London.
Finerenone is a type of mineralocorticoid receptor antagonist, or MRA. These drugs work by blocking the receptor for the hormone aldosterone. Aldosterone makes the kidneys hold on to salt and water, which can raise your blood pressure. When the drug blocks the receptor, the kidneys release excess water and salt from the blood, which can also affect potassium levels, but the drug prevents the loss of potassium. It's important to keep potassium at certain levels because too much in the blood can damage the heart, and low levels can affect certain functions in the body.
The researchers found that people taking finerenone showed a higher risk of hyperkalemia, or having too much potassium in the blood. But very few of them – 0.5% of patients in the finerenone group and 0.2% in the placebo group – were hospitalized for hyperkalemia.
"Any drug that works in this way, the mineralocorticoid receptor antagonists, will raise potassium in the blood," Solomon said. "This is a very well-established and known side effect, but these drugs reduce the risk of low potassium, which also places patients at risk."
Bayer previously released top line results from this study in early August. In that announcement, Dr. Christian Rommel, head of research and development at Bayer's Pharmaceuticals Division, said the company is "eager to bring finerenone to eligible patients as soon as possible."
A separate paper, published Sunday in The Lancet, reviewed four clinical trials on MRAs in heart failure and found "significant reductions" in heart failure hospitalizations among heart failure patients.
The meta-analysis showed that steroidal MRAs reduced the risk of cardiovascular death or heart failure hospitalization in patients with heart failure who had reduced ejection fraction, and nonsteroidal MRAs reduced this risk in people with heart failure who had mildly reduced or preserved ejection fraction. Finerenone, a nonsteroidal MRA, was among the drugs in the trials.
If the FDA expands the use of finerenone as a heart failure therapy, cardiologist Dr. Michelle Bloom said, she would think about it as an option for her patients with mildly reduced or preserved ejection fraction.
"I would certainly consider using finerenone," Bloom, heart failure cardiologist and system director of the Cardio-Oncology Program at NYU Langone Health in New York, said in an email.
"However, I think the question is what the benefit of finerenone will be over the more traditional MRAs such as spironolactone and eplerenone. This remains to be answered," she said.
Get CNN Health's weekly newsletterOverall, heart failure patients with preserved ejection fraction "have historically been difficult to treat and manage," Dr. Jayne Morgan, an Atlanta-based cardiologist and vice president for medical affairs at the heart health company Hello Heart, said in an email.
The new study "certainly provides support for additive therapy with finerenone. However certainly more data is needed, including independent data not financed by the sponsor," Morgan said. "Further, we'd like to see more Blacks and minorities enrolled to truly make the data relevant to all sufferers."
In the study, the researchers noted that few Black patients were enrolled.
Still, the study findings give "reason for cautious optimism," Morgan said.
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