Could a Little Drinking Help Those With Heart Failure?

FRIDAY, Dec. 28, 2018 (HealthDay News) — A new study suggests that an occasional drink won’t harm, and might even help seniors with heart failure.

Heart failure patients who drank in moderation — a drink a day for women, two for men — had an average survival that was a year longer than nondrinkers, the researchers found.

“My patients who are newly diagnosed with heart failure often ask me if they should stop having that glass of wine every night,” said senior study author Dr. David Brown, a cardiologist and professor of medicine at Washington University in St. Louis. “And until now, I didn’t have a good answer for them.”

But one cardiologist who wasn’t involved in the study pushed back hard against any recommendation that drinking is “healthy” for people with heart failure.

“We know with certainty that alcohol is a cause of heart failure,” said Dr. David Majure, who help directs cardiovascular care at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.

“This research can be added to the long history of observational studies that will delight the alcohol industry and confuse the public,” Majure said. “In no way should one conclude from this study that alcohol consumption of any quantity is safe or can prolong life after a diagnosis of heart failure.”

Brown and his colleagues agreed that the study couldn’t prove that moderate alcohol intake caused the benefit in longevity. It’s possible that other factors among drinkers might be responsible, they said.

In the study, the St. Louis team collected data on nearly 5,900 Medicare recipients who took part in a major U.S. heart health study from 1989 to 1993. Among the participants, nearly 400 developed heart failure.

Heart failure is a condition in which the heart loses the ability to pump sufficient blood to the body. It can be caused by a heart attack, or by chronic conditions such as diabetes or kidney disease.

After taking into account factors such as age, sex, race, education, income, smoking and blood pressure, the researchers found that moderate drinkers (seven or fewer drinks per week) lived an average of 383 days longer than nondrinkers.

For purposes of the study, “one drink” was defined as a 12-ounce beer, a 6-ounce glass of wine or a 1.5-ounce shot of liquor.

Dr. Eugenia Gianos directs the Women’s Heart Health program at Lenox Hill Hospital in New York City. She agreed that the study population was “small,” so “I would be very hesitant to draw conclusions” about drinking from the research.

“It’s also possible that other factors that go along with drinking alcohol — having a social network, positive outlook, good coping mechanisms, optimal diet or active lifestyle — are at play” in boosting drinkers’ longevity, Gianos said.

Brown stressed that certainly, “People who develop heart failure at an older age and never drank shouldn’t start drinking.”

Still, “our study suggests people who have had a daily drink or two before their diagnosis of heart failure can continue to do so without concern that it’s causing harm,” he said in a university news release.

But even then, “that decision should always be made in consultation with their doctors,” Brown added.

The report was published online Dec. 28 the journal JAMA Network Open.

More information

For more on heart failure, visit the American Heart Association.

Heart Failure Takes Heavy Toll, Even for Those With Stronger Hearts

TUESDAY, Dec. 18, 2018 (HealthDay News) — Having a stronger heart after being hospitalized for heart failure may not translate into a better outcome, new research suggests.

Levels of physical and mental decline were similar among patients with weaker or stronger hearts, and surprisingly, those with stronger hearts had higher rates of depression and lower quality of life in the study.

“The results speak to how bad heart failure is across the board,” said senior study author Dr. Gordon Reeves, an associate professor of cardiology at Thomas Jefferson University in Philadelphia.

“Heart failure is one of the most common reasons for older patients to be in the hospital and the issues experienced as a consequence of a heart failure hospitalization can have a huge effect on their daily function and independence,” he noted in a university news release.

“This appears to be true regardless of the pumping function of the heart and, in some regards, may actually be worse in those in whom the squeezing function is preserved,” Reeves said.

Many treatments for heart failure — including medications like angiotensin converting enzyme inhibitors or beta blockers, and certain types of pacemakers — are only effective in patients with weaker hearts, the researchers explained.

There are far fewer treatments for heart failure patients with stronger hearts, which is the most common type of heart failure in older adults and more likely to affect women, they added.

“We think of these results as a call to action for the cardiology community,” said Reeves. “These findings indicate we need to do more than decongesting the hearts of these patients.”

The study included more than 200 patients and was published recently in the journal Circulation: Heart Failure.

“Over 70 percent of Medicare beneficiaries who are hospitalized for heart failure [HF] die or are re-hospitalized by one year after discharge,” Dr. Kelsey Flint, from the Rocky Mountain Regional VA Medical Center, and Dr. Daniel Forman, from University of Pittsburgh Department of Medicine, noted in an accompanying editorial.

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart failure.

Obesity Ups Survival in Heart Failure, but That's No Reason to Pile on Pounds

THURSDAY, Dec. 6, 2018 (HealthDay News) — Obese people with heart failure may live longer than those who are thinner — especially if they are “metabolically healthy,” a new study suggests.

The study, of more than 3,500 heart failure patients, is the latest to look into the so-called “obesity paradox.” The term refers to a puzzling pattern that researchers have noted for years: Obese patients with heart disease tend to survive longer than their normal-weight counterparts.

“It has consistently been observed in large studies,” said Dr. Gregg Fonarow, co-chief of cardiology at the University of California, Los Angeles. “But the mechanisms contributing to this paradox continue to be debated.”

Fonarow was not involved in the new research, but has worked on studies reaching similar conclusions.

The pattern is dubbed a “paradox” because obesity actually raises your risk of developing heart disease in the first place.

So it’s not clear, Fonarow said, why it would be linked to better survival after the disease develops.

In the current study, South Korean researchers followed 3,564 patients who were hospitalized with heart failure symptoms. Overall, about 2,000 were overweight or obese, while more than 1,500 were of normal weight.

Heart failure is a chronic condition in which the heart muscle can no longer pump blood efficiently enough to meet the body’s needs. It causes symptoms such as breathlessness, fatigue and fluid buildup.

In general, the study found, heavier patients tended to show less deterioration in the structure and function of the heart’s main pumping chamber.

And the highest survival rate was seen among overweight or obese patients who were metabolically healthy — meaning they did not have high blood pressure, high cholesterol or abnormal blood sugar levels.

Among those patients, more than 79 percent were still alive three years later. That compared with 64 percent of normal-weight patients in good metabolic health.

Patients in the normal-weight group who were metabolically unhealthy fared worst: Only 55 percent were still alive after three years. Metabolically unhealthy obese people fared about the same as normal-weight, metabolically healthy people — with a survival rate of about 66 percent.

However, it was apparently not easy to be overweight and metabolically healthy: Only 12 percent of overweight/obese patients were, said researcher Dr. Chan Soon Park.

Park, of Seoul National University Hospital, was scheduled to present the findings this week at a meeting of the European Society of Cardiology, in Milan, Italy.

What do the results mean? They do not prove that obesity, itself, provides a survival advantage, said Dr. Gurusher Panjrath.

Panjrath, who was not involved in the research, chairs the American College of Cardiology’s heart failure and transplant section.

He noted that the study — like most previous ones — used body mass index (BMI) to divide patients into weight categories.

People with a BMI of 23 or higher were considered “overweight/obese,” while those with a lower BMI were considered “normal-weight.” For example, a 5-foot-8-inch person who weighs 151 pounds has a BMI of 23. (The definitions used for Asian populations are different from those used in the United States and elsewhere, Park said.)

But BMI — a measure of weight in relation to height — is an imprecise gauge, Panjrath explained.

He said the normal-weight group in this study might have included some patients who were actually more sick and frail. In contrast, people who had more muscle, and may have been relatively fitter, could have fallen into the overweight category.

In fact, Panjrath said, a number of studies have suggested that cardiovascular fitness levels — rather than weight — are critical to heart disease patients’ outlook.

That includes heart failure.

Often, people develop heart failure after suffering a heart attack that damages the heart muscle, or because of poorly controlled high blood pressure.

Obesity is a risk factor because it contributes to the conditions that can cause heart failure, Panjrath explained. There’s also some evidence those extra pounds might directly affect heart muscle function, he said.

Once people are diagnosed with heart failure, Panjrath said, the priority is to boost their fitness levels through exercise, and control conditions like high blood pressure and diabetes.

“Fitness is more important than fatness,” Panjrath said. He added, though, that weight loss is encouraged when patients are severely obese.

Park said that since weight loss can be difficult, efforts to improve factors like blood pressure and fitness may be more practical.

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

More information

The American Heart Association has more on managing heart failure.

Saunas Seem to Do a Heart Good, Research Shows

THURSDAY, Nov. 29, 2018 (HealthDay News) — Love your time in the local sauna? Your heart may love it, too.

New research from sauna-loving Finland suggests that for people aged 50 and older, saunas may lower their odds of risk of dying from heart disease.

Specifically, just 5 percent of Finns in the study who spent more than 45 minutes in a sauna each week died of heart disease over the 15-year study period, compared to 10 percent of those who spent less that 15 minutes a week in saunas, the researchers said.

Of course, the study couldn’t prove cause-and-effect — it’s possible that sauna-loving folk have other heart-healthy habits that might explain the findings.

Still, “there are several possible reasons why sauna use may decrease the risk of death due to cardiovascular disease,” said study co-author Dr. Jari Laukkanen, head of cardiology at the University of Eastern Finland. His team published its findings Nov. 28 in the journal BMC Medicine.

“Our research team has shown in previous studies that high sauna use is associated with lower blood pressure,” he noted in a journal news release. “Additionally, sauna use is known to trigger an increase in heart rate equal to that seen in low- to moderate-intensity physical exercise.”

One U.S. expert who looked over the findings agreed that heat can often be therapeutic to the human body, but the sauna experience might differ a bit in America.

“The greatest benefit [in the study] was observed in individuals who took 4-7 saunas per week, a frequency that Americans are unlikely to achieve,” noted Dr. Cindy Grines, who directs cardiology at Long Island Jewish Medical Center in New Hyde Park, N.Y.

“In addition, this study used dry heat, and whether the results are similar with steam baths or hot tubs is not known,” she said.

Laukkanen’s team agreed that because the data came from one area in Finland, the findings might not apply to other populations.

The study relied on data from nearly 1,700 Finnish men and women. Participants were asked about their use of saunas, and these data were compared with deaths from cardiovascular disease. Data for the study were collected between 1998 and 2015 and the average follow-up was 15 years.

Frequency of sauna use did seem tied to heart health. Among people who used a sauna four to seven times a week, 3 percent died from heart disease over 15 years, but that number rose to 10 percent for those who used the sauna just once a week, the study found.

Dr. David Friedman is chief of heart failure services at Long Island Jewish Valley Stream Hospital in Valley Stream, N.Y. He said that it’s tough to draw firm conclusions from the study, but the findings suggest that sauna use “could be a helpful additional strategy” for heart health, along with improved diet and more exercise.

But another cardiologist stressed that Americans shouldn’t begin think of saunas as substitutes for exercise.

“Moderate to high intensity exercise has a cardioprotective effect,” explained Dr. Satjit Bhusri, who practices at Lenox Hill Hospital in New York City. The new findings don’t necessarily mean that “everyone should spend the day at the spa [instead],” he said.

More information

For more information on cardiovascular disease , visit the American Heart Association.

AHA: After 2 Breast Cancer Diagnoses, Survivor Learns She Needs a New Heart

TUESDAY, Oct. 16, 2018 (American Heart Association) — The hair loss, fatigue and nausea were a given. As a nurse, Toni C. Wild had seen patients faced with these common side effects of chemotherapy. What Wild did not expect when she was diagnosed with breast cancer at age 29 is that the chemotherapy drugs she received would damage her heart.

“It certainly has been quite the journey,” said Wild.

Wild was diagnosed with breast cancer in 1992. Her treatment included a lumpectomy followed by radiation and the chemotherapy drugs Cytoxan (cyclophosphamide) and Adriamycin (doxorubicin). Because both of these drugs can affect the heart, Wild’s doctors performed an echocardiogram to measure her heart function before and after her treatment. Both tests showed her heart was in tiptop shape.

In 1998, Wild learned a new tumor had developed in her other breast. This time her treatment included a double mastectomy, followed by another round of the same chemotherapy drugs. Again, the echocardiograms showed her heart was fine and Wild returned to playing racquetball and running 5K races near her home in Hattiesburg, Miss.

Three months later, in March 1999, Wild went back to her doctor. She had developed a nagging cough and was always exhausted. This time, the echocardiogram showed she had heart failure, a chronic condition in which the heart doesn’t pump blood as well as it should.

Wild began taking drugs to keep her heart pumping. The medications worked for a decade. But then an echocardiogram revealed her heart had weakened further. Wild’s doctors told her she needed a new heart.

Earlier this year, the American Heart Association issued a scientific statement addressing heart disease in breast cancer patients. The statement is meant to help patients like Wild.

Dr. Laxmi Mehta, a preventive cardiologist at Ohio State University Wexner Medical Center in Columbus and lead author of the AHA statement, said advances in early detection and treatment of breast cancer over the past three decades have helped reduce death rates from breast cancer. Yet these treatments can result in heart damage.

Mehta said women with breast cancer should get the best treatment for the disease, but also be aware that the side effects of chemotherapy drugs such as doxorubicin and cyclophosphamide include heart failure, arrhythmias and other heart-related conditions.

Mehta, director of the Women’s Cardiovascular Health Program at Wexner Medical Center, encourages women who have been diagnosed with breast cancer to eat lots of fruits and vegetables, to exercise, and to follow other good habits to help keep their hearts healthy.

While breast cancer may get more attention, heart disease is actually the top cause of death for U.S. women. The most recent estimates from the Centers for Disease Control and Prevention show 298,840 women died of heart disease and 41,524 died from breast cancer in 2015.

Wild said the news that she needed a new heart took her back to the day when, as a young widow, she signed off on donating her first husband’s heart, kidneys and other organs.

“I was very emotional because I knew somebody, somewhere was getting ready to say goodbye to their loved one,” Wild said. “It was a very bittersweet moment.”

Today, as she nears the 10-year anniversary of getting her new heart, Wild, now 55, is going strong. In fact, she’s moved up from 5Ks to full marathons, in part to honor her donor.

Motivated by her experience and that of other breast cancer survivors, Wild has taken up heart disease as a cause. She encourages women to eat right and exercise to protect their hearts. She also urges women to listen to their bodies and seek medical advice when they feel something is off.

“I want all women to know that it is a possibility that heart disease can happen to anyone,” Wild said.

Too Much Meat, Dairy Tied to Heart Failure Risk

TUESDAY, May 29, 2018 (HealthDay News) — Maybe you should skip the cheeseburger and shake, guys. Middle-aged men who often feast on meat, dairy and other high-protein foods could be on a path to heart failure, researchers report.

Protein from fish and eggs, however, isn’t linked to an increased risk for heart failure, the investigators found.

“High-protein diets have been gaining popularity during the recent years, but their long-term health effects are not completely known,” said Jyrki Virtanen, one of the study authors.

“Our findings indicate the high protein intake may have some adverse effects on health, especially if the protein is coming from animal sources,” said Virtanen. He’s an adjunct professor of nutritional epidemiology at the University of Eastern Finland.

However, one U.S. heart expert isn’t convinced the study conclusions are valid.

“It is not entirely clear from this study whether these findings are related to the diets reported by participants or related to other factors,” said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.

According to the American Heart Association, one in five Americans aged 40 and older will develop heart failure. The condition weakens the heart, so that it cannot pump enough blood and oxygen to meet the body’s needs.

Heart failure can shorten life expectancy. And because no cure exists, prevention — through diet and lifestyle — is vital, the researchers noted.

How and why protein might increase the risk for heart failure isn’t clear, Virtanen said.

Amino acids are the building blocks of proteins. Virtanen speculated that some amino acids may be involved in heart failure. “This hypothesis, however, is very preliminary and needs further confirmation,” he said.

Besides the protein itself, food preparation may play an important role in heart failure risk, Virtanen suggested.

“For example, previous studies suggest that it would be wise to prefer baked or broiled fish instead of processed meat,” he said.

Whether the same risk of heart failure applies to women is another question that can’t be answered yet, Virtanen added.

“Because there is currently little research published on this topic, we find it important that our results are confirmed in other populations and also in women,” he said.

For the study, Virtanen and his colleagues collected data on more than 2,400 Finnish men and followed them for 22 years on average. The men were aged 42 to 60 when the study started.

Over the study period, 334 developed heart failure. Among that group, 70 percent of protein consumed was from animal sources and 28 percent from plants, the findings showed.

Virtanen’s team divided the men into four groups based on how much protein they ate daily. Comparing men who ate the most protein with those who ate the least, they calculated the risk for heart failure.

That risk was 33 percent higher for all protein sources overall, but 43 percent greater for animal protein and 49 percent higher for dairy. Plant protein was linked to a 17 percent increased risk of heart failure, according to the report.

Only protein from fish and eggs was not tied to heart failure risk in this study.

The study cannot prove a direct cause-and-effect relationship, however. And the researchers said it’s too early to recommend limiting protein intake to prevent heart failure.

To prevent heart failure, the heart association currently recommends a diet high in a variety of fruits and vegetables, whole grains, low-fat dairy products, poultry, fish, beans, nuts and vegetable oils. (Avoid tropical oils such as palm and coconut). A healthy diet limits sweets, sugar-sweetened beverages and red meat.

Fonarow said more studies are needed to further explore the relationship of diet and the risk of heart failure.

A healthy lifestyle is the best way to prevent the disabling condition, he added.

“Key factors to preventing heart failure include maintaining a healthy blood pressure, body weight, cholesterol levels, not smoking and engaging in regular physical activity,” Fonarow said.

The report was published online May 29 in the journal Circulation: Heart Failure.

More information

For more on heart failure, visit the American Heart Association.

Black Heart Failure Patients Less Likely to See a Cardiologist

MONDAY, April 30, 2018 (HealthDay News) — Among heart failure patients, black people are much less likely than white people to have their care overseen by a cardiologist, a new study finds.

Previous research has shown that receiving care primarily from a cardiologist improves in-hospital survival rates for heart failure patients.

In the new study, researchers analyzed data from nearly 105,000 heart failure patients admitted to intensive care units at 497 U.S. hospitals from 2010 to 2014. About 20 percent of the patients were black and the rest were white.

Overall, white patients were 40 percent more likely than black patients to receive primary care from a cardiologist, the findings showed. Black men were 50 percent less likely than white men to do so, and black women were 30 percent less likely than white women.

The study was published April 30 in the journal JACC: Heart Failure.

“Both patients and physicians should know that racial disparities exist in health care,” said study author Dr. Khadijah Breathett.

“Patients must be their own advocates and not fear getting a second opinion, especially when they believe they are not being heard,” said Breathett, who is an assistant professor of medicine, in the division of cardiology, at the University of Arizona’s College of Medicine in Tucson.

“Physicians should adhere to guideline recommendations, advocate for underserved populations and be aware of implicit biases that may adversely affect clinical management,” she said in a journal news release.

“Bias in clinical decision-making has contributed to disparate treatment in racial and ethnic minorities. We must consider that it may be present,” Breathett added.

Dr. Christopher O’Connor, journal editor-in-chief and chief executive officer of Inova Heart and Vascular Institute, said this study “highlights the need for more research on why we continue to observe racial differences with the receipt of optimal care in the U.S. health care system.”

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart failure.

Magnetic Heart Pump Cuts Risk of Blood Clots, Stroke in Study

SUNDAY, March 11, 2018 (HealthDay News) — A new heart pump cuts the risk of blood clots and stroke in patients with heart failure, research funded by the device maker shows.

The study included 366 patients who received either Abbott Inc.’s HeartMate 3 left ventricular assist device or the HeartMate II.

Two years after getting the devices, 151 of the 190 patients (79.5 percent) who got the HeartMate 3 had not suffered a debilitating stroke or needed a second operation to replace or remove the device. That compared with 106 of the 176 patients (60 percent) with the HeartMate II.

Only three people with the HeartMate 3 required another operation, compared with 30 HeartMate II patients. None of the HeartMate 3 patients required re-operation due to blood clots in the pump, the findings showed.

Rates of death and disabling strokes in the two groups were similar, but the overall stroke rate was lower among HeartMate 3 patients. Both groups had similar rates of bleeding and infection, the researchers found.

The study was to be presented Sunday by Dr. Mandeep Mehra at the American College of Cardiology annual meeting, in Orlando, Fla. It was also published online simultaneously in the New England Journal of Medicine.

Mehra is executive director of the Center for Advanced Heart Failure/Cardiomyopathy at Brigham and Women’s Hospital in Boston. “This is a pivotal study in the field of advanced heart failure,” he said.

“Left ventricular assist devices have been in development for 40 years and there have been improvements in their technology, but several challenges exist, including problems of blood clots forming in these devices, requiring device replacement,” Mehra said in a hospital news release.

According to the report, the HeartMate 3 has several design improvements meant to reduce the risk of complications.

The researchers explained that it “runs like a bullet train,” using magnetism, not mechanical bearings, to pump blood. “It is designed to reduce shear stress, which is thought to cause blood clots to form in pumps,” according to the news release.

In the study’s next phase, the researchers will evaluate a larger group — 1,028 patients — two years after receiving a heart pump. Those results are expected by the end of 2019.

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart failure.