Low birth weight associated with cardiovascular risk in kids

Low birth weight is linked not only to poor health outcomes at birth but also to chronic health conditions later in life.

In a recent study, West Virginia University researcher  explored how low birth weight correlates to cardiovascular risk factors in childhood. She and her colleagues assessed data of 20,000 fifth-graders born in West Virginia. They discovered that if children had a low birth weight, they were more likely to exhibit cardiovascular risk factors in fifth grade.

"Previously it was thought that risk factors for cardiovascular diseases were only observed in adults because cardiovascular disease is mostly seen in adults," said  a researcher. "But in the past few years, we've seen that these risk factors are observed in children as well."

The team analyzed data from three sources: West Virginia birth certificates, the West Virginia WATCH/Birth Score program and the CARDIAC project. The children in the study comprised were all born full term -- between 1994 and 2010 -- across West Virginia's 55 counties.

The researchers considered each child's birth weight and his or her body mass index in fifth grade, among other variables. They also evaluated each fifth-grader's level of triglycerides -- fat that circulates in the blood -- and various cholesterol types.

"Low birth weight was associated with higher levels of 'bad' cholesterol and lower levels of 'good' cholesterol," she said. In addition, children with a low birth weight tended to have higher triglyceride level. These traits are risk factors for heart attack, stroke, peripheral artery disease, atherosclerosis and other disorders.

Even after the researchers took into account the children's BMIs, socio-demographics, family medical histories and other factors, the relationship between these risk factors and low birth weight remained significant.

"We know that cardiovascular disease is one of the leading causes of morbidity and mortality not only in the U.S. but also in West Virginia," she said. According to the Centers for Disease Control and Prevention, the state has the 10th-highest rate of death from heart disease and the 12th-highest from stroke.

"We also know that low birth weight, which is an important predictor of a child's health moving forward, is one of the poorest health indicators in West Virginia," she said. About one in 10 babies born in the state has a low birth weight.

"Low birth weight doesn't just happen at birth spontaneously," said  a member of the research team and an associate professor of bio-statistics. "It's a sign of slow growth in the womb. So, I think there's an opportunity for intervening during pregnancy to reduce factors that can influence suboptimal fetal growth."

That window of opportunity extends beyond birth and infancy, too. "We don't want to say that once you have a low birth weight, there's nothing you can do," she said. "Now that you know there's a low-birth-weight baby, you can make sure they have proper postnatal feeding, monitor their growth and teach kids about good diet, nutrition, physical activity and prevention of risky health behaviors such as smoking. You can intervene from childhood into adulthood."

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Never too late to start statins for clogged leg arteries

Statins, a class of drugs that reduce illness and mortality in those who are at high risk of cardiovascular disease can also prove effective for those with the peripheral arterial disease even if they start its medication late after diagnosis.

According to the study patients who stop the drug are at similar risk to those who never start. The research showed the importance of starting and adhering to lifelong medication, preferably at a high dose.

Around 200 million people worldwide have peripheral arterial disease (PAD), a condition in which arteries in the legs are clogged. This restricts blood flow to the legs and raises the chances of stroke and heart attack.

 

Around 30 per cent of patients have pain and cramping in their legs when they walk – referred to as intermittent claudication – while others have gangrene in the feet due to poor circulation.

 

Statins are recommended for all patients with PAD, together with smoking cessation, exercise, healthy diet, and weight loss.

Statins diminish the risk of stroke and heart attack by reducing low-density lipoprotein (LDL) cholesterol, which causes blocked arteries (atherosclerosis).

The study shows that adherence to statins is essential for the best prognosis. We also show that it is never too late to start medication and benefit from it. On top of that, it is crucial not to reduce the dose because LDL cholesterol levels rise again, thus increasing the overall risk on top of the residual risk for further events, said a Dr. 

The study examined whether adherence to statin therapy influenced survival in patients with symptomatic PAD. The study enrolled 691 patients admitted to hospital between 2010 and 2017 and followed-up for a median of 50 months.

At the beginning of the study, 73 per cent of patients were on statins, increasing to 81 per cent at the 50-month follow-up. The dose of drug also increased between the two time periods, which was paralleled by a significant drop in LDL cholesterol from 97 to 82 mg/dL.

Patients who stopped taking a statin had a similar mortality rate (33 per cent) to those who never took the drug (34 per cent). Adhering to statins throughout the 50 months was linked with a 20 per cent rate of death.

Taking high-dose statins throughout the study was linked with the lowest mortality rate (10 per cent) while reducing the dosage during the study was related to the highest death rate (43 per cent).

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Is your leg under attack? Know from the specialist

Smart people think on their feet and act. And then we stand tall on our feet all day long, walk and run around to get our chores done. So your legs are not just your wheels in the journey of life, but almost have a heart of its own. And yet our legs are perhaps the most neglected body part.  

Often workout and exercise help to keep our strained muscles relaxed, but sudden leg attack is not unheard of either. 

Some professions require people to be on their feet 24x7, like those of a chef, traffic police, doctor, nurse, or an event manager. Standing all day can be detrimental to one’s health. 
Varicose vein and Peripheral Arterial Disease (PAD) are two diseases which can easily attack people whose daily lifestyle puts a lot of stress on their legs. It is essential to get your leg meticulously checked by expert doctors whenever you see any of these symptoms appearing.

 

Varicose veins are the veins with damage in the return pump valve. Varicose vein is a commonly occurring condition with up to 10-15 % of the women and men are affected with symptoms of pain and swelling of the lower limbs, enlarged blue veins on the thigh or calf and their accompanying problems like leg aching, eczema, lipodermatosclerosis, cellulitis or venous ulcer.Standing for a long period does not cause varicose veins per se, nevertheless hastens the deterioration of malfunctioning valves which aggravates the development of varicose veins.
Symptoms like aching, discomfort and heaviness in the legs, swollen ankle, brown spots on skin are common. Change in skin colour should be an initial indicator to visit a specialist  immediately. Maintain a healthy lifestyle that includes regular exercise, avoid prolong standing, wearing high heels and take good nutritional supplements. Try elevating your legs when resting, and not crossing them when sitting may prevent the advance of varicose veins.
Accurate diagnosis and proper treatment of varicose veins can ensure that most of them do not recur. Surgery for the varicose veins with any means has got a minimal standard recurrence rate. 

 

However, as the symptoms are unacceptable or unbearable for many people, even if the results of the treatment are not permanent, it is still preferable to no treatment at all. Graduated elastic compression stockings are good for temporary relief of symptoms and are used below knee with standard pressure. Foam Sclerotherapy is an injection of a sclerosing solution into veins and mainly used to treat localized varicosities. 

 

Laser or Radio-frequency treatment involves puncture of the vein under ultrasound guidance and burning the vein with the use of Laser/RF.Laser or Radiofrequency procedure normally takes around 30 minutes for one leg and performed under local anesthesia.The patient can return home the same day of procedure &can resume normal activities within 24 hours. The patient might have a little pain during the procedure as there will be 3-4 small needle pricks to introduce anesthesia and most of the patients can tolerate it very well.
Peripheral artery disease (PAD) is often caused by atherosclerosis, where fat deposits (plaques) build up in the arteries and reduce blood flow. In this disease your legs don't receive enough blood flow to keep up with demand. 

 

This causes symptoms, most notably leg pain while walking aka claudication. Intermittent claudication means painful cramps in your hip, thigh or calf muscles after activity, such as walking or climbing stairs. The other features of this disease include coldness in your lower leg or foot, especially when compared with the other side, sores or wounds on your toes, feet or legs that heals slowly and a change in the color of your legs.
The risk of developing PAD includes smoking, diabetes, high blood pressure, high cholesterol, family history of vascular disease such as PAD, aneurysm, heart attack or stroke & obesity. If peripheral artery disease progresses, it is painful to walk even short distance and it may even occur when you are at rest or when you are lying down. It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed may temporarily relieve the pain. Severe PAD can lead to loss of limb.  A specialist check for signs of the disease with a simple test of pulses in your feet.
One of the most effective preventive measures of PAD is regular physical activity.You must modify your lifestyle and follow thorough healthy routine in daily life. Eating a nutritious diet can control your blood pressure and cholesterol levels. A diet low saturated fat, trans fat and cholesterol ensures lower blood cholesterol levels, but cholesterol-lowering medication and anti-platelet medications to help prevent blood clots may also be necessary. 

 

Tobacco smoking increases your risk of PAD as well as your risk for heart attack and stroke, so quit smoking.If surgery is prescribed then angioplasty is a form of minimally invasive surgery that intend to access many regions of the body via major blood vessels.  In this procedure, dilatation of the arterial stenosis done along with deployment of metallic stent that relief the symptoms. Surgery is only required when symptoms are severe and ability to perform basic functions like walking, standing have been hampered.

 

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Daily stress may put you at risk of stroke and heart disease

Sounding an alarm bell for those who take unnecessary stress at workplace or at home, researchers have now linked chronic psycho-social stress with an heightened risk of developing heart disease and stroke. According to the team from Massachusetts General Hospital and Harvard Medical School, heightened activity in the amygdala — a region of the brain involved in stress — can lead to cardiovascular disease in humans apart from established causes like smoking, high blood pressure and diabetes. Previous research has also shown that the amygdala is more active in people with post-traumatic stress disorder (PTSD), anxiety and depression but before this study, no research had identified the region of the brain that links stress to the risk of heart attack and stroke. ‘Our results provide a unique insight into how stress may lead to cardiovascular disease. This raises the possibility that reducing stress could produce benefits that extend beyond an improved sense of psychological wellbeing,’ said lead author Dr Ahmed Tawakol from Massachusetts General Hospital and Harvard Medical School.

Eventually, chronic stress could be treated as an important risk factor for cardiovascular disease, which is routinely screened for and effectively managed like other major risk factors, Dr Tawakol added in a paper published in the prestigious journal The Lancet. In the study, 293 patients were given a combined PET/CT scan to record their brain, bone marrow and spleen activity and inflammation of their arteries.  The patients were then tracked for an average of 3.7 years to see if they developed cardiovascular disease.  In this time, 22 patients had cardiovascular events including heart attack, angina, heart failure, stroke and peripheral arterial disease. Those with higher amygdala activity had a greater risk of subsequent cardiovascular disease and developed problems sooner than those with lower activity. The researchers also found that the heightened activity in the amygdala was linked to increased bone marrow activity and inflammation in the arteries, suggesting this may cause the increased cardiovascular risk. (Read: 7 COOL ways to de-stress within minutes!)

Although more research is needed to confirm that stress causes this chain of events as the study was relatively small, these findings could eventually lead to new ways to target and treat stress-related cardiovascular risk, the researchers noted. ‘These clinical data establish a connection between stress and cardiovascular disease, thus identifying chronic stress as a true risk factor for acute cardiovascular syndromes,’ wrote Dr Ilze Bot, Leiden Academic Centre for Drug Research, Leiden University, The Netherlands, in a linked comment.

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'Hunger Hormone' May Treat Artery Disease

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 The appetite-regulating hormone ghrelin could be used to treat an advanced form of peripheral artery disease characterised by pain at rest, non-healing ulcers, and gangrene, say researchers, including one of Indian-origin.

The researchers focused on treatment of critical limb ischemia (CLI), a severe obstruction of blood flow to the extremities that often requires major amputations and in half of all cases leads to death within five years. Its leading risk factors are diabetes, obesity and age.

"Our results provide a platform for future studies to look at the long-term potential of ghrelin to see if it could indeed become a standard treatment for CLI," said one of the researchers Rajesh Katare from University of Otago in New Zealand.

Using a mouse model of CLI, the researchers showed that administering ghrelin daily over two weeks markedly improved blood flow in affected limbs.

They found that ghrelin promoted growth of new structurally and functionally normal blood vessels, improved cell survival, and decreased tissue fibrosis.

The findings are exciting as currently there are no drugs treatments for CLI and other techniques are effective in only half of the cases, Mr Katare pointed out.

The researchers also studied ghrelin's action at the molecular level in tissue with restricted blood supply and identified that the hormone modulated downstream signalling cascades involved in new blood vessel growth and cell survival.

The findings appeared in the journal Endocrinology.

Statins could increase your daily fat intake

The Indian Express reported a study which revealed that individuals taking statins (cholesterol-lowering drugs) tend to gradually raise their consumption of fat and calories.
 
It’s a 12-year study on statin use involving 27,886 men and women participating in a 24-hour dietary recall interview for cholesterol levels and body mass index. It was found that statin use increased from 7.5 per cent in 1999 to 16.5 per cent in 2010 in the group of participants. The cholesterol levels reduced in statin users but their daily calorie intake raised by 9 per cent, and fat consumption increased by 14.4 per cent. Non-users did not show any significant changes in either measure. Body mass index raised in statin users by 1.3 compared with an increase of 0.4 in the non-user group. The effect was seen despite control over factors like age, race, education and conditions like of diabetes and high cholesterol. (Read: Is it necessary to take statins for preventing heart diseases?)

How do statins work? How they prevent heart disease?
‘Cholesterol is a type of fat made by our body. It’s essential for good health and is found in every cell in the body. However, if you have too much ‘bad’ cholesterol (low-density lipoprotein or LDL) in your blood, it can cause fatty deposits to build up on the walls of your arteries. This is known as atherosclerosis – a condition that narrows your arteries.

Statins work by reducing the amount of LDL cholesterol your body makes. They do this by blocking an enzyme in your liver needed to produce cholesterol. This slows down the production of cholesterol by your liver. By reducing cholesterol, statins can help to reduce your risk of having a heart attack, stroke or developing peripheral arterial disease.

There is some evidence to suggest that statins may also work in a number of other ways to help reduce your risk of cardiovascular disease.

One promising benefit of statins appears to be their anti-inflammatory properties, which help stabilise the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart to blood vessels and organs throughout the body.

What precautions should a person take while on statins?
‘Too much of a good thing can be bad, but too little of a bad thing can be even worse. So, first of all, patients on statins should have regular blood tests to monitor their lipid levels,’ says Dr Bela Sharma, senior consultant, internal medicine, FMRI.
Other important things to remember:

• Adherence to prescribed medication dosage is extremely essential.  
• Avoiding drug interactions, mainly with drugs (erythromycin, simvastatin, cyclosporine) that block liver enzymes.
• In case you experience any adverse side-effect, consult your doctor immediately. 
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Arsenic in Environment And Heart Attack, Stroke Risk

People chronically exposed to low to moderate levels of arsenic in their environment may be more likely to suffer a heart attack, stroke or other cardiovascular disease, a study  suggests.

Previous research has linked exposure to high levels of arsenic in drinking water (more than 100 micrograms per liter) with coronary heart disease, stroke, peripheral artery disease and carotid atherosclerosis.

Environmental health researchers decided to explore whether exposure to the lower levels of arsenic more commonly found in drinking water or food also would increase the risk of heart disease.

Regular exposure to more common levels of arsenic did indeed correlate to increased risk of fatal and nonfatal cardiovascular disease, even after adjusting for other risk factors such as smoking, obesity and cholesterol levels, according to the findings.

"It's a chronic long-term health effect," he said. "We need to understand that cardiovascular disease is a very complex illness, and there are many environmental risk factors like arsenic which can contribute."

Although the study found that relatively common levels of arsenic in drinking water were associated with a higher risk of heart disease, it did not prove a cause-and-effect relationship.

Groundwater likely provided the major source of arsenic exposure in some states, researchers said. Private wells in those states often exceed the  standard for arsenic in drinking water of 10 micrograms per liter, and are sometimes as high as 50 micrograms per liter.

Study participants provided urine samples that the research team used to estimate their exposure to inorganic arsenic.

Of the participants, nearly 450 died of cardiovascular disease and almost 1,200 developed either fatal or nonfatal cardiovascular disease. Researchers found that a person's risk of death from cardiovascular disease increased with their arsenic exposure.

The one-quarter of patients who showed the highest levels of arsenic in their urine had about a 50 percent increased risk of death by heart attack or stroke compared to those with the lowest levels of arsenic, Navas-Acien said.

Arsenic exposure also was associated with an increased risk of developing cardiovascular disease.

 People who are concerned about their arsenic intake should have their drinking water tested, she said.

"In particular, people who live in small communities or have private wells should be aware of the arsenic levels in their drinking water," she said. "If you use groundwater and you don't know the levels of arsenic in your drinking water, that can be quite dangerous."

"The best advice we can give people is to eat food that comes from a variety of different regions, as opposed to being raised in a single location," she said.

People also should vary their day-to-day eating patterns, she said.

"There are children out there who drink apple juice every day," she said. "That's risky because we know there are elevated arsenic levels in juice. People need to diversify their diet."

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