Cardiovascular Health

How Does Snoring Affect Cardiovascular Health?

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Snoring is a common disorder that affects 20%-40% of the general population. The mechanism of snoring is the vibration of anatomical structures in the pharyngeal airways. The flutter of the soft palate explains the harsh aspect of the snoring sound, which occurs during natural sleep or drug-induced sleep. The presentation of snoring may vary throughout the night or between nights, with a subjective, and therefore inconsistent, assessment of its loudness.

Objective evaluation of snoring is important for clinical decision-making and predicting the effect of therapeutic interventions. It also provides information regarding the site and degree of upper airway obstruction. Snoring is one of the main features of sleep-disordered breathing, including hypopnea events, which reflect partial upper airway obstruction.

Obstructive sleep apnea (OSA) is characterized by episodes of complete (apnea) or partial (hypopnea) collapse of the upper airways with associated oxygen desaturation or awakening from sleep. Most patients with OSA snore loudly almost every night. However, in the Sleep Heart Health Study, one third of participants with OSA reported no snoring, while one third of snoring participants did not meet the criteria for OSA. Therefore, subjective assessments of snoring (self-reported) may not be sufficiently reliable to assess its potential impact on cardiovascular (CV) health outcomes.

CV Effects

OSA has been hypothesized as a modifiable risk factor for CV diseases (CVD), including hypertension, coronary artery disease (CAD), atrial fibrillation, heart failure, and stroke, primarily because of the results of traditional observational studies. Snoring is reported as a symptom of the early stage of OSA and has also been associated with a higher risk for CVD. However, establishing causality based on observational studies is difficult because of residual confounding from unknown or unmeasured factors and reverse causality (ie, the scenario in which CVD increases the risk for OSA or snoring). A Mendelian randomization study, using the natural random allocation of genetic variants as instruments capable of producing results analogous to those of randomized controlled trials, suggested that OSA and snoring increase the risk for hypertension and CAD, with associations partly driven by body mass index (BMI). Conversely, no evidence was found that CVD causally influenced OSA or snoring.

Snoring has been associated with multiple subclinical markers of CV pathology, including high blood pressure, and loud snoring can interfere with restorative sleep and contribute to the risk for hypertension and other adverse outcomes in snorers. However, evidence on the associations between snoring and CV health outcomes remains limited and is primarily based on subjective assessments of snoring or small clinical samples with objective assessments of snoring for only 1 night.

Snoring and Hypertension

A study of 12,287 middle-aged patients (age, 50 years) who were predominantly males (88%) and generally overweight (BMI, 28 kg/m2) determined the prevalence of snoring and its association with the prevalence of hypertension using objective evaluation of snoring over multiple nights and multiple daytime blood pressure measurements. The findings included the following observations:

  • An increase in snoring duration was associated with a 3-mmHg increase in systolic (SBP) and a 4-mmHg increase in diastolic blood pressure (DBP) in patients with frequent and regular snoring, compared with those with infrequent snoring, regardless of age, BMI, sex, and estimated apnea/hypopnea index.
  • The association between severe OSA alone and blood pressure had an effect size similar to that of the association between snoring alone and blood pressure. In a model where OSA severity was classified and snoring duration was stratified into quartiles, severe OSA without snoring was associated with 3.6 mmHg higher SBP and 3.5 mmHg higher DBP, compared with the absence of snoring or OSA. Participants without OSA but with intense snoring (4th quartile) had 3.8 mmHg higher SBP and 4.5 mmHg higher DBP compared with participants without nighttime apnea or snoring.
  • Snoring was significantly associated with uncontrolled hypertension. There was a 20% increase in the probability of uncontrolled hypertension in subjects aged > 50 years with obesity and a 98% increase in subjects aged ≤ 50 years with normal BMI.
  • Duration of snoring was associated with an 87% increase in the likelihood of uncontrolled hypertension.

Implications for Practice

This study indicates that 15% of a predominantly overweight male population snore for > 20% of the night and about 10% of these subjects without nighttime apnea snore for > 12% of the night.

Regular nighttime snoring is associated with elevated blood pressure and uncontrolled hypertension, regardless of the presence or severity of OSA.

Physicians must be aware of the potential consequences of snoring on the risk for hypertension, and these results highlight the need to consider snoring in clinical care and in the management of sleep problems, especially in the context of managing arterial hypertension.

Bone Formation Protein Protective of Cardiovascular Health in Patients with Type 2 Diabetes.

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Cardiovascular health, heart disease

Researchers at the University of Granada (UGR), Spain have shown that sclerostin, a bone formation inhibitor protein, is also protective of the cardiovascular health of patients with type 2 diabetes.

The research was conducted by the MP20-Biomarkers of Metabolic and Bone Diseases research group at the Biohealth Research Institute in Granada (ibs.GRANADA). Led by Manuel Muñoz Torres, MD, PhD, a professor of medicine at UGR, the study of 260 people included 121 controls and 139 patients with type 2 diabetes. The study authors noted that this study was the first of its kind to examine whether sclerostin, a bone formation inhibitor protein, plays a detrimental or protective role in the development of atherosclerotic process in T2D population.

The study showed that patients with both type 2 diabetes who also had heart disease had significantly higher levels of sclerostin, pointing to a potential link between the protein and atherosclerosis. Sclerostin was also demonstrated to play a beneficial role in reducing arterial calcification, which is also associated with the development of atherosclerosis. They found that sclerostin overexpression reduced calcium deposits, decreased cell proliferation and inflammation, and promoted cell survival.

“Sclerostin could play a protective role in the development of atherosclerosis in T2D patients by reducing calcium deposits, decreasing proliferation and inflammation, and promoting cell survival in VSMCs under calcifying conditions,” the researchers wrote in their study which appears in the journal Cardiovascular Diabetology. “Therefore, considering the bone-vascular axis, treatment with anti-sclerostin for bone disease should be used with caution.”

The published results were a part of the doctoral thesis of researcher Sheila González Salvatierra and raise concerns about the use of anti-sclerostin antibody treatments in patients with type 2 diabetes as this may increase cardiovascular risk in this patient population. This class of drugs is often used in treating patients with osteoporosis and other bone diseases.

The investigators noted that a broad number of previous studies has described how the elevation of serum sclerostin levels associated with cardiovascular alterations. However, the function of this protein at the vascular level had not been studied in depth.

“Our biochemical results suggest a potential beneficial role of sclerostin on (cardiovascular diseases) in type 2 diabetes patients due to its inverse association with some cardiovascular risk factors such as LDL-c, calcium, and diastolic blood pressure, which are considered the main factors contributing to susceptibility to atherosclerosis,” the team noted.

The researchers noted that while sclerostin is clinically important in vascular calcification, the exact biochemical processes that regulate the protein are not yet well understood. This suggests the need for additional research to better understand the potential protective role it plays at the vascular level.

The investigators did note some limitation of the study, namely that the cross-sectional design did not allow for the establishment of a cause and effect relationship; the study cohort was comprised of only Caucasians; and the use of common antihypertensive, antihyperlipidemic and antidiabetic drugs in patients may have influenced the results.

Nevertheless, the team believes their findings have clinical significance.

“These findings, both basic and clinical, contribute to the current understanding of the shared mechanisms between systemic bone and vascular physiology and pathology,” the researchers concluded. “Thus, our results emphasize the importance of considering the bone-vascular axis when designing therapeutic approaches for the treatment of impaired bone metabolism or vascular diseases.”

Cardiovascular health: Irregular sleeping habits may increase atherosclerosis risk

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A study found a link between irregular sleeping patterns and an increased risk of atherosclerosis in older adults

  • A new study finds a link between irregular sleeping patterns and subclinical symptoms of atherosclerosis in older people.
  • Atherosclerosis-related diseases are the leading cause of death in the United States.
  • The study underscores the importance of establishing regularity in one’s sleep routine.

A recent study explores a connection between atherosclerosis, not maintaining a regular bedtime, and sleeping for inconsistent periods of time.

The study found that older people who varied sleep time by an average of two hours within a single week and those who changed their bedtimes by an hour and a half were significantly more likely to exhibit subclinical symptoms of atherosclerosis.

According to a press release, here’s what the researchers measured to investigate the presence of plaque in the arteries:

  • calcified fatty plaque buildup in arteries — coronary artery calcium
  • fatty plaque buildup in neck arteries — carotid plaque presence
  • thickness of the inner two layers of the neck arteries — carotid intima-media thickness
  • narrowed peripheral arteries — the ankle brachial index

They detected calcified plaque in arteries, the primary underlying cause of strokes and heart attacks. When they measured participants’ blood pressure at their arms and compared that figure to blood pressure at their ankles, the resulting high ankle brachial indexes indicated stiffness in their blood vessels. Both symptoms may be signs of developing atherosclerosis.

People who significantly varied their bedtimes by more than 90 minutes within a week had high levels of coronary artery calcium — compared with those who varied their bedtimes by 30 minutes or less.

Atherosclerosis is a condition in which cholesterol, fatty deposits, and cellular waste products in your blood form sticky plaques on the insides of your arteries. The plaques thus thicken artery walls and can cause them to harden. The condition inhibits blood flow, preventing sufficient oxygen from being delivered to your organs.

According to the United States National Institutes of HealthTrusted Source (NIH), half of Americans aged 45-84 have atherosclerosis without knowing it, and the disease linked to atherosclerosis is the leading cause of death in the U.S.

The study appears in the Journal of the American Heart AssociationTrusted Source.

Large study on sleep and disease risks

The study involved 2032 participants in the separate community‐based MESA (Multi‐Ethnic Study of Atherosclerosis). MESA aimed to investigate the characteristics and risk factors of subclinical symptoms of atherosclerosis across a diverse population of older people.

To that end, just over half of the participants in MESA were women. Thirty-eight percent of the participants self-identified as White, 28% as Black or African American, 23% as Hispanic, and 11% as Chinese. They were also geographically diverse, recruited from St. Paul, MN; Baltimore City and Baltimore County, MD; Chicago, IL; Forsyth County, NC; Los Angeles County, CA; Northern Manhattan and the Bronx, NY.

The participants ranged from 45 to 84 years old, with an average age of 69, and all were free of diagnosed cardiovascular disease.

Each participant wore a wrist device for seven days that tracked their periods of being awake or asleep. They also completed sleep diaries.

Finally, each individual participated in one night of in-home sleep monitoring that measured their breathing, sleep stages, sleep duration, heart rate, and the time they went to bed.

In the current study, people whose sleep duration varied by an average of two hours per week were 1.33 times more likely to have high coronary artery calcium scores than those with more regular sleep patterns. They were also 1.75 times more likely to have abnormal ankle brachial indexes.

When assessing people whose bedtimes varied by an average of 90 minutes over the course of a week, researchers found a 1.39 times increase in the likelihood of calcified artery plaques.

“Our results add to growing evidence from recent studies that have connected irregular sleep patterns to cardiovascular risk,” said the study’s lead author, Dr. Kelsie M. Full of Vanderbilt University.

Other studies, Dr. Full noted, already connect poor sleep to cardiovascular conditions such as hypertension, type 2 diabetes, and heart disease.

The connection between sleep and atherosclerosis

“Our bodies have a natural 24-hour internal clock, known as the circadian rhythm, that regulates many physiological processes, including sleep-wake cycles. When we consistently go to bed and wake up at different times, it can disrupt our circadian rhythm and lead to what’s called ‘social jet lag,’” said Dr. José M. Ordovás of Tufts University, who was not involved in the study.

Interventional cardiologist Dr. Hoang Nguyen, not involved in the study, told Medical News Today:

“The authors suggested that disturbance in sleep regularity promotes cardiovascular disease by disturbing the natural circadian rhythm of the body, thereby affecting inflammation, glucose metabolism and sympathetic neurohormal response. All of these factors are known to cause cardiovascular disease.”

“During sleep, the sympathetic nervous system (SNS) activity is typically reduced, allowing the body to rest and recover,” Dr. Ordovás explained.

“However, sleep disorders such as sleep apnea can lead to increased SNS activity, which can cause hypertension and other CVD risk factors,” he added.

The press release noted that due to the limitation of sleep and atherosclerosis being measured simultaneously, the researchers were unable to assess “if greater sleep irregularity causes the development of atherosclerosis.”

Too little sleep, too much, and just right

Dr. Full noted that their study tracked people who often got less or more sleep than usual and found no difference in their atherosclerosis indicators.

The NIHTrusted Source recommends that older adults, like all other adults, get between seven and nine hours of sleep each day.

It is possible to get too much sleep, according to other research. Dr. Ordovás reported that both a short sleep duration of fewer than 7 hours per night and a long sleep duration of more than 9 hours per night have both been associated with an increased risk of CVD.

“What is interesting about this study is that the authors went beyond the quality of sleep, and investigated the regularity of sleep,” said Dr. Nguyen.

“I find this part interesting, as it opens up a myriad of questions on the underlying reasons for this, and has implications on possible interventions from a health care provider standpoint to improve cardiovascular health.”

“Addressing sleep issues,” said Dr. Ordovás, “and promoting healthy sleep habits may help to reduce the risk of CVD by reducing inflammation, oxidative stress, and other risk factors associated with sleep disturbances.”

Healthy dietary patterns linked to better CV health in Hispanic, Latino individuals

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Dietary patterns varied among Hispanic/Latino background groups, but healthier dietary scores were associated with reduced CVD risk and lower odds of developing hypertensive disorders of pregnancy, two speakers reported.

According to study findings presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Scientific Sessions, higher dietary scores were associated with lower risk for CVD across the Hispanic/Latino group background, regardless of whether the individual was born in the U.S. or not.

A selection of healthy items.
Source: Adobe Stock

According to results from a second study, lower intake of solid fats, refined grains and cheese and higher intake of vegetables, oil and fruits were associated with lower risk for any hypertensive disorders of pregnancy among Hispanic/Latina women.

Dietary score and CVD risk

“Our research demonstrates that higher scores in any of the three heart-healthy dietary patterns is associated with lower cardiovascular risk, suggesting that it may not be necessary to conform to one specific dietary pattern to achieve better cardiovascular health. Thus, people may have more choices for healthy diets,” Yi-Yun Chen, MD, MSc, resident at Jacobi Medical Center at the Albert Einstein College of Medicine, said in a press release.

For this analysis, researchers included 10,766 adults from the Hispanic Community Health Study/Study of Latinos with no known CVD at baseline. Participant backgrounds included Mexican, Puerto Rican, Cuban, Dominican, Central American and South American. Individual dietary scores were based on 24-hour dietary recalls at baseline, using three dietary quality indices: the Alternate Mediterranean diet, the Healthy Eating Index-2015 and the healthful Plant-based Diet Index.

“These diets share several similar components, such as higher consumption of whole grains, vegetables, fruits, nuts and legumes,” Chen said in the release. “Higher dietary scores for each of the three diets represent better individual healthy eating patterns.”

The primary outcome was a composite of major incident CVD, including CHD and stroke, during an average follow-up of 6 years.

Chen reported that average dietary quality indices score varied widely between all background groups (P for all < .001), with the highest and healthiest observed among Mexican participants and the lowest among Puerto Rican participants.

Hispanic/Latino individuals who were U.S.-born had lower dietary quality scores compared with those born outside of the U.S. (P for all < .001). According to the presentation, the differences were primarily driven by intake of healthy plant-based foods such as whole grains, fruits, vegetables, legumes and nuts.

Chen reported lower relative CVD risk among participants in the highest tertile of adherence to healthy eating pattern measured by the three dietary indices compared with those in the lowest tertile:

  • the Alternate Mediterranean diet (RR = 0.54; 95% CI, 0.37-0.81; P for trend = .002);
  • the Healthy Eating Index-2015 (RR = 0.64; 95% CI, 0.39-1.05; P for trend = .033); and
  • the healthful Plant-based Diet Index (RR = 0.56; 95% CI, 0.35-0.88; P for trend = .009).

Moreover, the associations between dietary quality scores and risk for CVD was no different with regard to Hispanic/Latino backgrounds (P for interaction for all .24) or place of birth (P for interaction for all .25).

“Since greater adherence to all three healthy dietary patterns was associated with a lower risk of cardiovascular disease, we suggest that increasing the consumption of healthy, plant-based foods may help the younger generation achieve better cardiovascular health similar to their relatives who were born outside the U.S.,” Chen said in the release.

Dietary pattern in pregnancy

For this second study, Luis E. Maldonado, PhD, MPH, postdoctoral scholar and research associate in the department of population and public health sciences at the Keck School of Medicine at the University of Southern California in Los Angeles, and colleagues evaluated the impact of dietary patters on risk for hypertensive disorders of pregnancy among Hispanic/Latina women.

The researchers included 464 participants in the MADRES study, a cohort predominantly consisting of Hispanic/Latina women in Los Angeles. Participants completed up to two 24-hour dietary recalls during their third trimester of pregnancy. Data on hypertensive disorders of pregnancy were gathered using maternal medical records. Dietary patterns of interest included the solid fats, refined grains and cheese (SRC) diet, the vegetables, oil and fruits (VOF) diet and the Healthy Eating Index-2015. The primary outcomes were any hypertensive disorder of pregnancy, gestational hypertension or preeclampsia.

Maldonado and colleagues observed a hypertensive disorder of pregnancy in 21.6% of the cohort, gestational hypertension in 6.67% and preeclampsia in 12.1%.

The highest quartile of SRC dietary pattern intake was associated with greater odds of having any hypertensive disorder of pregnancy (OR = 3.5; 95% CI, 1.34-9.1; P for trend = .01) and preeclampsia (OR = 3.59; 95% CI, 1.11-11.62; P for trend = .058) compared with the lowest quartile, especially among women with gestational diabetes (P for hypertensive disorder of pregnancy = .008; P for preeclampsia = .01).

In contrast, the VOF dietary pattern was associated with lower odds of preeclampsia among individuals in the highest quartile of intake compared with the lowest (OR = 0.33; 95% CI, 0.12-0.93; P for trend = .031).

Researchers observed no association between Healthy Eating Index-2015 score and likelihood of hypertensive disorder of pregnancy, gestational hypertension or preeclampsia.

“Our study findings suggest that a diet with relatively higher intakes of non-starchy vegetables, oils and fruit may lower the likelihood of developing a high blood pressure disorder during pregnancy, among our study group of predominantly low-income Hispanic/Latina women,” Maldonado said in a press release. “Conversely, a diet with relatively higher intakes of solid fat, refined grains and cheese may increase the likelihood of a diagnosis of a serious condition, called preeclampsia.”

Reference:

Greater T2D Risk Seen in Women with Gestational Diabetes

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Long-term cardiovascular health may be compromised for mothers with gestational diabetes mellitus (GDM), a new study reported.

A retrospective cohort study found women with gestational diabetes mellitus (GDM) were nearly 22 times more likely to develop type 2 diabetes, in an adjusted model (adjusted incidence rate ratio 21.96, 95% CI 18.31-26.34, P<0.001), according to Barbara Daly, PhD, RN, of the University of Auckland in New Zealand, and colleagues.

The risks for hypertension and ischemic heart disease were also significantly increased among women who previously experienced GDM (aIRR 1.85, 95% CI 1.59-2.16, P<0.001; aIRR 2.78, 1.37-5.66, P=0.005, respectively), they reported in PLOS Medicine.

However, during the 25-year study period, there was no increased risk seen for cerebrovascular disease, which included stroke and transient ischemic attack, among women with GDM (aIRR 0.95, 95% CI 0.51-1.77, P=0.87).

Drawing upon the Health Improvement Network database in the U.K., the analysis included 9,118 women with a history of GDM, who were then matched with 37,281 pregnant controls. Women with GDM were more likely to be non-white, and were overweight or obese at baseline.

Among women who developed ischemic heart disease during follow-up, only around 36% also developed type 2 diabetes. The authors pointed out this suggested “that the risk of cardiovascular disease is not always mediated through type 2 diabetes.”

In an ethnic subgroup analysis, white, South Asian, and Afro-Caribbean women with GDM were all more likely to develop type 2 diabetes post-partum:

  • White: IRR 35.2 (95% CI 20.0-58.5)
  • South Asian: IRR 22.15 (95% CI 6.42-76.4)
  • Afro-Caribbean: IRR 15.40 (95% CI 6.54-36.25)

“The current National Institute for Health and Care Excellence (NICE) guidelines recommend screening for type 2 diabetes (between 6 and 13 weeks postpartum and an annual glycated hemoglobin test) and lifestyle changes (weight control, diet, and exercise) for women diagnosed with GDM,” the authors highlighted.

However, only 58% of women with GDM in the analysis reported having a glycemic measurement in the first year post-partum, according to medical records. This eventually decreased to only 40% and 24% of such women undergoing a glycemic measurement in years 2 and 3 after delivery.

The authors also added, “there is no recommendation to screen, identify, and actively manage cardiovascular risk factors (including hypertension, dyslipidemia, and smoking) in women diagnosed with GDM in the postpartum period in the current 2015 NICE guidelines.”

“Guideline recommendations for screening and management of hypertension, lipids, and smoking cessation are lacking and need to be reviewed,” they suggested.

While around 80% of women with GDM reported a blood pressure measurement in the first year after delivery, only half of those women had a measurement in years 2 and 3 post-partum. During the first 3 years after delivery, only around 28% and 23% of women with GDM had serum cholesterol or triglycerides measured, respectively.

 Although the authors stated their findings were congruent with prior observational analyses, they noted their effects estimates were higher for type 2 diabetes and ischemic heart disease compared with prior studies, as well as lower effect estimates for hypertension.

“The findings report on a large population and identify an at-risk group of relatively young women ideally suited for targeting of risk factor management to improve long-term metabolic and cardiovascular outcomes,” they wrote, adding that “targeting these high-risk women may also provide better value for money for prevention programs, as they are already known to general practice.”

“While the value of preventing cardiovascular outcomes requires further studies, there is some evidence that targeting this subgroup of women may yield benefits in reducing conversion to type 2 diabetes,” the authors stated.

11 Fascinating Facts About the Human Heart.

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Your heart is the center of your cardiovascular system. It is responsible for pumping blood through your body, carrying nutrients in and taking waste out. Having good cardiovascular health is an important factor of optimal wellness.

Sadly, many people do not pay enough attention to their cardiovascular system. According to a study published in the Journal of the American Heart Association (JAHA), one in 10 adult Americans has poor cardiovascular health.i This is often caused by a nutritionally-deficient processed food diet, a sedentary lifestyle, and chronic stress.

I truly believe that achieving optimal heart health is not difficult, as long as you follow a healthy diet and  lifestyle.*

The Structure of the Human Heartii

Your heart works as a “pump” to keep your blood moving inside of you, delivering nutrients and oxygen to all areas of your body while carrying away waste products and carbon dioxide. When your heart muscle contracts or “beats,” it pushes blood through your heart and all over your body.

There are three layers that make up your heart:

  • Pericardium – the thin outer protective sack
  • Myocardium – composed of specialized cells that make up the thick muscular wall
  • Endocardium – the thin inner lining of the heart

Inside your heart are four chambers: two on the left side and two on the right. The two small upper chambers are called the atria, and the two larger lower chambers are called the ventricles. The left and right side of your heart are divided by the septum, a muscular wall.

The human heart has four valves. The ones on the right side of your heart are called the tricuspid valve and the pulmonary valve, while the ones on the left are the mitral valve and the aortic valve. These valves act as gates that open and close, ensuring that your blood travels in one direction through your heart.

The heart gets its blood supply from the coronary arteries, which branch off from the aorta, the main artery. The coronary arteries spread across the outside of the myocardium and provide it with blood.

Although the two sides of your heart are separated, they still work together. The right side receives dark, de-oxygenated blood that has already circulated around your body. This blood is then pumped to your lungs, where it receives a fresh supply of oxygen and turns bright red again.

Try These Natural Heart-Healthy Strategies

When your heart and/or other parts of your cardiovascular system, such as your blood vessels, are not properly cared for, they will fail to function properly, which may lead to certain health issues.*

But the good news is you can maintain normal cardiovascular function by eating a healthy diet and exercising correctly. Here are some of my top recommendations:

  • Consume a well-balanced diet. Choose whole, organic foods rich in vitamins, minerals, and other nutrients, like l-arginine. Some heart-friendly foods you can eat include:
      • Olive oil
      • Coconuts and coconut oil
      • Organic raw dairy products and eggs
      • Avocados
      • Raw nuts and seeds
      • Organic grass-fed meats

    It is best to eat a good portion of your foods raw. Also, be sure to severely limit or eliminate grains and sugar, which are mostly found in processed foods, from your diet.

  • Get plenty of high-quality, animal-based omega 3 fats, such as krill oil.
  • Drink plenty of fresh, pure water every day.
  • Optimize your vitamin D levels through appropriate sun exposure. Many studies have proven the numerous benefits of vitamin D. However, you must first know what your current vitamin D level is. The optimal range is between 50-70 ng/ml, but if you have less-than-optimal heart health, I would recommend 70-100 ng/ml.
  • Get enough exercise. It improves not only your blood circulation, but your overall health as well. However, I do not advise doing prolonged, strenuous cardio such as marathon running, as it puts too much strain on your heart. Instead, opt for short-burst, high-intensity exercises like Peak Fitness, which also optimize your human growth hormone (HGH) production.
  • Maintain a healthy weight.
  • Get plenty of high-quality, restorative sleep.
  • Manage your stress.
  • Avoid smoking or drinking alcohol excessively.

human heart facts

Sodium Consumption and Cardiovascular Health .

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Salt has long been a staple of life.  Once upon a time, it was a form of currency; roads were built to transport it; cities arose to produce and trade it.  And, of course, people ate it.  Today, we continue to consume it the whole world over.

It’s hard to believe something so integral to the human experience, spanning centuries and civilizations, might be bad for the body.  But as the Mrs. Dashes of the world would have us know, salt consumption has been linked to high blood pressure, which in turn has been linked to heart disease — a reason, perhaps, to keep one’s salt intake in check.

Just how much salt are we consuming?  And how much damage can we attribute to the delicious granules that top our pretzels, coat our fries, and cure our meats?  A group of researchers from the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NUTRICODE) used survey data and statistical models to estimate the sodium consumption of adults from 187 nations.  They also performed a meta-analysis of over a hundred randomized interventional studies to calculate the effects of sodium on blood pressure and analyzed pooled data from cohort studies to calculate the effects of high blood pressure, in turn, on cardiovascular mortality.

Their findings, published in this week’s NEJM, might make you think twice before reaching for the saltshaker.  In 2010, the average daily sodium consumption was 3.95 grams, well above the World Health Organization recommendation of 2 grams per day.  In fact, 181 out of the 187 nations — accounting for a whopping 99.2% of adults — exceeded the recommended intake level.  The consequence?  Nearly one in every ten deaths from cardiovascular causes in 2010, the authors estimated, could be attributed to excess sodium consumption.  That translated to 1.65 million deaths globally.  What’s worse, over 40% of these deaths occurred prematurely (i.e., in people younger than 70 years of age).

While no region of the world was spared, there was considerable variability across geographies in sodium-associated cardiovascular mortality rates.  The highest rates were in Central Asia and Eastern and Central Europe.  Among individual countries, Georgia had the highest rate (1967 deaths per 1 million adults per year), while Kenya had the lowest (4 deaths per 1 million adults per year).  Perhaps most striking, more than 80% of sodium-related cardiovascular deaths around the world — four out of every five — occurred in low- or middle-income countries.

There may be a silver lining.  The authors also found that reductions in sodium intake were linked proportionally to reductions in blood pressure (P<0.001 for a linear dose-response relationship).  For a white, normotensive 50-year-old, for instance, a reduction of 2.3 grams per day lowered systolic blood pressure by 3.74 mmHg (95% CI: 2.29 to 5.18).  The exact effect varied by age and race, with greater reductions in older people (vs. younger people), blacks (vs. whites), and people with hypertension (vs. without).

Does that mean low sodium intake translates to better health?  Not necessarily, according to two other articles published in this week’s NEJM.  The Prospective Urban Rural Epidemiology (PURE) study collected fasting morning urine specimens from over 100,000 adults, representing 18 different countries and a range of income levels, and calculated 24-hour urinary sodium excretion (a proxy of sorts for sodium consumption).  This was correlated with blood pressure.

The investigators found a non-linear relationship.  For people who excreted a lot of sodium (in this study, defined as over five grams per day), there was a strong association, meaning each additional gram of sodium was linked to a steep rise in blood pressure (2.58 mmHg per gram).  In contrast, for people with low sodium excretion (less than three grams per day), the association with blood pressure was not statistically significant (0.74 mmHg per gram; P=0.19).  Remarkably, only ten percent of study participants fell into this low-sodium category, and only four percent had sodium excretion levels consistent with the current U.S. guidelines for sodium intake.

Based on these results, Dr. Suzanne Oparil of the University of Alabama at Birmingham suggests in an accompanying editorial, a low-sodium diet might not be the most useful public health recommendation.  She writes, “The authors concluded from the findings that a very small proportion of the worldwide population consumes a low-sodium diet and that sodium intake is not related to blood pressure in these persons, calling into question the feasibility and usefulness of reducing dietary sodium as a population-based strategy for reducing blood pressure.”

The PURE study investigators also tested the correlation between sodium excretion and a composite outcome of death and major cardiovascular events (heart attacks, strokes, heart failure).  They observed that, compared to a reference sodium excretion range of four to six grams per day, a higher level of sodium excretion (seven or more grams per day) was linked to a greater risk of the composite outcome (odds ratio 1.15; 95% CI, 1.02 to 1.30).  But, when they looked at people with very low sodium excretion (below three grams per day), they found an increased risk as well (odds ratio, 1.27; 95% CI, 1.12 to 1.44).

Complicating matters further, the authors also looked at the urinary excretion of potassium.  Compared to a reference level of 1.5 grams per day, a higher potassium excretion level was linked to a reduced risk of the composite outcome.  “The alternative approach of recommending high-quality diets rich in potassium might achieve greater health benefits, including blood-pressure reduction, than aggressive sodium reduction alone,” Oparil writes.

To the scholars in us, these findings are an inspiration for further research.  But how should we apply this knowledge to our daily lives, when we’re sitting in diners wondering whether to shake or not to shake?  It may be presumptuous to read too much into the findings, to infer causality where it has yet to be established.  Still, as a species, we’re better equipped today than we’ve ever been to make smart choices about our diet.  And until more data become available, moderation may be the way to go.

– See more at: http://blogs.nejm.org/now/index.php/a-salty-subject-sodium-consumption-and-cardiovascular-health/2014/08/13/#sthash.mXxuC6yq.dpuf