Olive oil has been traditionally used as the main culinary and dressing fat in Mediterranean countries and is a key component of the Mediterranean diet. Well-known for its health benefits, it has become more popular worldwide in recent decades. Olive oil is high in monounsaturated fatty acids, especially oleic acid, and other minor components including vitamin E and polyphenols, contributing to its anti-inflammatory and antioxidant properties (1).
Cardiovascular disease (CVD), a leading cause of global death, can be largely prevented with a healthy lifestyle (1). Current recommendations highlight the importance of dietary patterns including healthy sources of dietary fats, such as those high in unsaturated fat and low in saturated fat (SFA), for primary prevention of CVD (2). Olive oil is high in monounsaturated fat (MUFA), especially oleic acid, and other minor components including vitamin E, polyphenols, and lipid molecules that may contribute to its anti-inflammatory and antioxidant properties (3). Olive oil has been traditionally used as the main culinary and dressing fat in Mediterranean regions, and recently, it has become more popular worldwide. Early ecological studies observed inverse associations between average country-level consumption of olive oil and the risk of CVD (4). Clinical trials have shown that the consumption of olive oil improves cardiovascular risk factors, including inflammatory and lipid biomarkers (5). In addition, observational studies found that olive oil intake is inversely associated with CVD (6–8) and all-cause death (7).
When Natalie Hollabaugh tested positive for Covid-19 in March 2020, her recovery felt extremely slow. Eighteen months later, she was still suffering from a litany of symptoms, including fatigue, shortness of breath, headaches and joint pain. She saw a cardiologist and a pulmonologist, who both ruled out other health problems, she said. And they advised her to start exercising, suggesting that some of her symptoms may have been a result of being out of shape. So Ms. Hollabaugh dutifully began using an exercise bike, speed walking on a treadmill and walking her dogs several miles a day.
Worldwide, heart disease and strokes are the leading causes of death. They’re also the leading killers of Americans, accounting for one out of every three deaths in the United States. But there’s good news, too. About 80 percent of all cases of cardiovascular disease are preventable. You can lower your risk markedly by making some changes to your lifestyle including doing some things that are easy, simple and even enjoyable. (Two of our favorites? Drink red wine and get a dog.) Here's what you need to know about heart health, along with some of the best ways to improve and protect yours.
We share with you today the AVATAR trial.
Background: Surgical aortic valve replacement (SAVR) represents a class I indication in symptomatic patients with severe aortic stenosis (AS). However, indications for early SAVR in asymptomatic patients with severe AS and normal left ventricular function remain debated.
Methods: The Aortic Valve replAcemenT versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR) trial is an investigator-initiated international prospective randomized controlled trial that evaluated the safety and efficacy of early SAVR in the treatment of asymptomatic patients with severe AS, according to common criteria (valve area ≤1 cm2 with aortic jet velocity >4 m/s or a mean trans-aortic gradient ≥40 mm Hg), and with normal LV function. Negative exercise testing was mandatory for inclusion. The primary hypothesis was that early SAVR would reduce the primary composite endpoint of all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure, as compared to a conservative strategy according to guidelines. The trial was designed as event-driven to reach a minimum of 35 prespecified events. The study was performed in 9 centers in 7 European countries.
Results: Between June 2015 and September 2020, 157 patients (mean age 67 years, 57 % men) were randomly allocated to early surgery (n=78) or conservative treatment (n=79). Follow-up was completed in May 2021. Overall median follow-up was 32 months: 28 months in the early surgery group and 35 months in the conservative treatment group. There was a total of 39 events, 13 in early surgery and 26 in conservative treatment group. In the early surgery group, 72 patients (92.3 %) underwent SAVR with operative mortality of 1.4 %. In an intention-to-treat analysis, patients randomized to early surgery had a significantly lower incidence of primary composite endpoint than those in the conservative arm (HR 0.46, 95 % CI 0.23-0.90, p=0.02). There was no statistical difference in secondary endpoints, including all-cause mortality, first heart failure hospitalizations, major bleeding or thromboembolic complications, but trends were consistent with the primary outcome.
Conclusions: In asymptomatic patients with severe AS, early surgery reduced a primary composite of all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure compared with conservative treatment. This randomized trial provides preliminary support for early SAVR once AS becomes severe, regardless of symptoms.
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At CCC Mount Sinai, our team of skilled and seasoned cardiac professionals can evaluate, diagnose and recommend treatments as they pertain to this and other heart conditions. Make an appointment today and know you have the best care. Call 201-499-7361 or go online to learn more.
Original article published 11/13/21 in American Heart Association Journal by authors: Marko Banovic, Svetozar Putnik, Martin Penicka, Gheorghe Doros, Marek A. Deja, Radka Kockova, Martin Kotrc, Sigita Glaveckaite, Hrvoje Gasparovic, Nikola Pavlovic, Lazar Velicki, Stefano Salizzoni, Wojtek Wokakowski, Guy Van Camp, Serge D. Nikolic, Bernard Iung and Jozef Bartunek on behalf of the AVATAR-trial investigators
A new study highlights an independent association between obstructive sleep apnea and coronary plaque presence and burden, suggesting it may be a risk factor for coronary events.
What is the central question of this study?
Are chronotropic responses to a 6-minute walk test different in women with post-acute coronavirus disease 2019 (COVID-19) syndrome compared with control subjects?
What is the main finding and its importance?
Compared with control subjects, the increase in heart rate was attenuated and recovery delayed after a 6-minute walk test in participants after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Women reporting specific symptoms at time of testing had greater impairments compared with control subjects and SARS-CoV-2 participants not actively experiencing these symptoms. Such alterations have potential to constrain not only exercise tolerance but also participation in free-living physical activity in women during post-acute recovery from COVID-19.
The short-term cardiopulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well defined. However, the implications of cardiopulmonary sequelae, persisting beyond acute illness, on physical function are largely unknown. Herein, we characterized heart rate responses to and recovery from a 6-minute walk test (6MWT) in women ∼3 months after mild-to-moderate SARS-CoV-2 infection compared with non-infected control subjects. Forty-five women (n = 29 SARS-CoV-2; n = 16 controls; age = 56 ± 11 years; body mass index = 25.8 ± 6.0 kg/m2) completed pulmonary function testing and a 6MWT. The SARS-CoV-2 participants demonstrated reduced total lung capacity (84 ± 8 vs. 93 ± 13%; P = 0.006), vital capacity (87 ± 10 vs. 93 ± 10%; P = 0.040), functional residual capacity (75 ± 16 vs. 88 ± 16%; P = 0.006) and residual volume (76 ± 18 vs. 93 ± 22%; P = 0.001) compared with control subjects. No between-group differences were observed in 6MWT distance (P = 0.194); however, the increase in heart rate with exertion was attenuated among SARS-CoV-2 participants compared with control subjects (+52 ± 20 vs. +65 ± 18 beats/min; P = 0.029). The decrease in heart rate was also delayed for minutes 1–5 of recovery among SARS-CoV-2 participants (all P < 0.05). Women reporting specific symptoms at the time of testing had greater impairments compared with control subjects and SARS-CoV-2 participants not actively experiencing these symptoms. Our findings provide evidence for marked differences in chronotropic responses to and recovery from a 6MWT in women several months after acute SARS-CoV-2 infection.
LDL, or “bad” cholesterol, is a major risk factor for coronary heart disease. Now a new study suggests that, like smoking, it has a cumulative effect over a lifetime: The longer a person has high LDL, the greater their risk of suffering a heart attack or cardiac arrest.
Coronary heart disease, also known as “hardening of the arteries,” is the leading cause of death in the United States. It is caused by a buildup of plaque in the arteries that narrows the vessels and blocks the flow of oxygenated blood to the heart. Often, people have no symptoms and remain unaware they have the disease for years until they develop chest pain or suffer a catastrophic event like a heart attack.
Using data from four large prospective health studies, researchers calculated LDL levels over time in 18,288 people who had multiple LDL tests taken at different ages. They calculated their cumulative exposure to LDL and followed their health for an average of 16 years. The study is in JAMA Cardiology.
The researchers found that the longer a person had high levels of LDL — no matter what their LDL level is in young adulthood or middle age — the greater the risk for coronary heart disease. Compared with those in the lowest quarter for cumulative exposure, those in the highest had a 57 percent increased risk.
They found no increased risk for stroke or heart failure associated with cumulative LDL exposure. The researchers suggest that many factors can contribute to heart failure, and their study had too few cases of stroke to achieve statistical significance.
The study controlled for race and ethnicity, sex, year of birth, body mass index, smoking, high-density lipoprotein (HDL, or “good” cholesterol), blood pressure, Type 2 diabetes and the use of lipid-lowering and blood pressure medicines.
In people under 40, current guidelines recommend treatment with cholesterol-lowering statin drugs only with LDL readings higher than 190, but the researchers found that the increased risk for coronary heart disease may start at a much lower level. (LDL levels below 100 are generally considered normal.)
“Our figures suggest that the risk starts at LDL levels as low as 100,” said the lead author, YiYi Zhang, an assistant professor of medical sciences at Columbia. “That doesn’t necessarily mean that a person under 40 with an LDL of 100 should immediately start treatment. We need more evidence to determine the optimal combination of age and LDL level.”
Dr. Tamara Horwich, a cardiologist and professor of medicine at the University of California, Los Angeles, who was not involved in the study, noted that medical guidelines on choosing who needs statin therapy are heavily weighted toward older people, since advancing age is a major risk factor for complications from heart disease.
Still, she said, “From autopsy studies, we have known for some time that atherosclerosis begins to develop in the arteries of young individuals, as early as the teens and 20s. I think this study may entice physicians to move the needle back on the age of starting, or at least thinking about starting, statin therapy.”
Young people have a low short-term risk, Dr. Zhang said, but a high long-term risk. “The main message is to try to maintain low LDL through middle age. That will reduce your heart disease risk.”
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This study showcases how important it is to get your cholesterol checked, even from a very young age. We know this to be the case at CCC-Mount Sinai all too well. Just ask Dr. Rick Pumill to discuss his son Christopher's journey. He's been prescribing him Statin since age 19 and he still has high LDL, despite regular exercise and a very good diet. Moreover, Christopher Pumill is a cardiologist too, so he knows all too well about the risks and benefits of a sustaining a good level of LDL.
We asked Dr. Christopher Pumill to add his perspective to this article:
"In all truthfulness, if you are obese, your cholesterol will change dramatically with diet and weightloss. However, if your cholesterol is elevated at a young age, it is very likely genetic. And therefore modification of diet will have a much smaller impact. For patients who are younger with high cholesterol, we often need medications (as in my case) and consideration of genetic testing and consultation, as it can be hereditary."
His dad, Dr. Rick Pumill adds:
"I truly believe, having a personal connection with patients improves compliance and I also believe that making them understand that there are times that their abnormal studies are not their fault, makes a difference as well."At CCC-Mount Sinai, your health and family are important to us. Call us today at 201-499-7361 or go to our website to schedule an appointment for a cholesterol check on you or your children. We can evaluate the whole family and help to treat (if necessary).
Authored by Maria Hergueta and published 10/18/21 on the NYtimes.com.
Trust. Care. Peace of mind.
The COVID-19 pandemic underscored how
Doctors are an important piece of our sanity puzzle. Now, as before, we turn to doctors to be a stabilizing force. We look for physicians whose skills and expertise we trust, who make us feel cared for, and who give us peace of mind as they help us on our road to wellness.
But with so many practicing physicians within driving or commuting distance throughout the Garden State, finding the right one can be a daunting task. You need a tool that helps you sort through the options.
For nearly 30 years, Castle Connolly has asked tens of thousands of physicians across the United States to recommend physicians for inclusion on the health care research company’s list of Top Doctors.
For primary care and specialty physicians alike, being recognized as a Top Doctor is the one true mark of excellence in the profession, a sure sign that they are recognized by their peers as among the best in their specialty. And for consumers, the Top Doctor list is a trusted tool for finding a doctor with whom they’ll be in good hands.
Patients with RA had one time and half the risk of cardiovascular events than other people.
Although each autoimmune disease is associated with specific tissue or organ damage, rheumatic diseases share a pro-inflammatory pattern that might increase cardiovascular risk. Retrospective and prospective studies on patients affected by systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) highlighted the concept of “accelerated atherosclerosis”. Therefore, the purpose of this systematic review and meta-analysis is the assessment of symptomatic or asymptomatic cardiovascular events among patients with rheumatic diseases as RA and SLE.
The literature research obtained all manuscripts published in the English language between 2015 and 2019 for a total of 2355 manuscripts. After selection through inclusion and exclusion criteria, four articles examined cardiovascular risk in RA patients, 8 in SLE patients, and 2 in RA and SLE patients. Patients with SLE had a RR of 1.98 (95% CI: 1.18–3.31) of symptomatic cardiovascular events compared to the unexposed cohort. The meta-regression analysis showed that younger patient (age per year increase β = −0.12 95%CI: −0.20, −0.4), belonging to studies conducted in continent different from America (β = −0.89; −95% CI: 1.67, −0.10), after 2000 (β = 0.87; 95% CI: 0.09, 1.65) and with a higher quality score 0.80 (95% CI: 0.31, 1.29) had a higher risk of cardiovascular events. In patients with RA, the RR of cardiovascular events was 1.55 (95% CI: 1.18–2.02).
These data are helpful to implement cardiovascular preventive strategies among people suffering from rheumatologic diseases to decrease the incidence of cardiovascular events. However, these implementation needs to build a higher network between rheumatologists and primary care healthcare workers to furnish the same information to patients and monitor their preventive practice compliance.
If you are affected by systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), we encourage you to setup an appointment with one of our expert CCC - Mount Sinai cardiology specialists. Call 201-499-7361 to schedule an appointment. We can help!
Original article published in Science Direct on August 26, 2021 by: Vincenzo Restivo, Stefania Candiloro, Mario Daidone, Rosario Norrito, Marco Cataldi, Guiseppa Minutola, Francesca Caracci, Serena Fasano, Francesco Ciccia, Alessandra Casuccio and Antonino Tuttolomondo.
