Health for life

Researchers at the Linda Crnic Institute for Down Syndrome and the University of Colorado School of Medicine have found that a single mechanism may underlie the damaging effect of cholesterol on the brain and on blood vessels.

High levels of blood cholesterol increase the risk of both Alzheimers disease and heart disease, but it has been unclear exactly how cholesterol damages the brain to promote Alzheimers disease and blood vessels to promote atherosclerosis.

Using insights gained from studying two much rarer disorders, Down Syndrome and Niemann Pick-C disease, researchers at the Linda Crnic Institute for Down Syndrome and the Department of Neurology of the University of Colorado School of Medicine found that cholesterol wreaks havoc on the orderly process of cell division, leading to defective daughter cells throughout the body.

In the new study published this week in the on-line journal PLOS ONE, Antoneta Granic, PhD, and Huntington Potter, PhD, show that cholesterol, particularly in the LDL form, called bad cholesterol, causes cells in both humans and mice to divide incorrectly and distribute their already-duplicated chromosomes unequally to the next generation. The result is an accumulation of defective daughter cells with the wrong number of chromosomes and theore the wrong number of genes. Instead of the correct two copies of each chromosome, and thus two copies of each gene, some cells acquired three copies and some only one.

Granic and Potters study of the effects of cholesterol on cell division included a prominent finding of cells carrying three copies of the chromosome (#21 in humans and #16 in mice) that encodes the amyloid peptide that is the key component of the neurotoxic amyloid filaments that accumulate in the brains of Alzheimer patients.

Human trisomy 21 cells are significant because people with Down syndrome have trisomy 21 in all of their cells from the moment of conception, and they all develop the brain pathology and many develop the dementia of Alzheimers disease by age 50. Earlier studies by Granic, Potter and others have shown that as many as 10% of cells in an Alzheimer patient, including neurons in the brain, have three copies of chromosome 21 instead of the usual two. Thus, Alzheimers disease is, in some ways, a form of acquired Down syndrome. Furthermore, mutant genes that cause inherited Alzheimers disease cause the same defect in chromosome segregation as does cholesterol, thus indicating the presence of a common cell division problem in both familial and sporadic (non-familial) Alzheimers disease.

The new research also found trisomy 21 neurons in the brains of children with what, until now, was thought to be an unrelated neurodegenerative disease (Niemann Pick type C), caused by a mutation affecting cholesterol physiology. This result suggests that neurodegeneration itself might be linked to chromosome missegregation.

Such a model is supported by the finding of Thomas Arendt, MD, and colleagues at the University of Leipzig that 90% of the neuronal cell death observed at autopsy in Alzheimer patients is due to the creation and selective loss of neurons with the wrong number of chromosomes.

Identifying the specific problem caused by cholesterol will lead to completely new approaches to therapy for many human diseases, including Alzheimers disease, atherosclerosis and possibly cancer, all of which show signs of defective cell division. Granic and Potter already have found a potentially simple approach to preventing cholesterol from causing cells to distribute their chromosomes unequally into their new daughter cells. Specifically, when cells in culture were first treated with ethanol, the subsequent exposure to bad cholesterol was without effect on cell division: Each daughter cell received the correct number of chromosomes.

Researchers publishing in the journal Nutrition show that Omega-3 fatty acids found in fish and natural foods including nuts and seeds can lower levels of dangerous homocysteine, an amino acid linked with increased risk of cardiovascular disease and dementia. Reviewing data from eleven trials including more than 720 study participants, scientists found that introducing Omega-3 fats from dietary or supplemental sources were associated with significantly lowered levels of plasma homocysteine.

Study shows clear benefits of a healthy diet, exercise, maintaining normal weight and not smoking

A large, multi-center study led by Johns Hopkins researchers has found a significant link between lifestyle factors and heart health, adding even more evidence in support of regular exercise, eating a Mediterranean-style diet, keeping a normal weight and, most importantly, not smoking.

The researchers found that adopting those four lifestyle behaviors protected against coronary heart disease as well as the early buildup of calcium deposits in heart arteries, and reduced the chance of death from all causes by 80 percent over an eight-year period. Results of the study, "Low-Risk Lifestyle, Coronary Calcium, Cardiovascular Events, and Mortality: Results from the Multi-Ethnic Study of Atherosclerosis," are described in an online article posted June 3, 2013 by the American Journal of Epidemiology.

"To our knowledge, this is the first study to find a protective association between low-risk lifestyle factors and early signs of vascular disease, coronary heart disease and death, in a single longitudinal evaluation," says Haitham Ahmed, M.D., M.P.H., the lead author who is an internal medicine resident with the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins.

"We evaluated data on more than 6,200 men and women, age 44-84, from white, African-American, Hispanic and Chinese backgrounds. All were followed for an average of 7.6 years. Those who adopted all four healthy behaviors had an 80 percent lower death rate over that time period compared to participants with none of the healthy behaviors," says Ahmed.

Study participants all took part in the ongoing Multi-Ethnic Study of Atherosclerosis (MESA), a prospective examination of the risk factors, prevalence and prevention of cardiovascular disease. MESA participants were recruited from six academic medical centers and did not have a diagnosis of cardiovascular disease when they were enrolled.

All participants had coronary calcium screening using computed tomography (a CT scan) when they were first enrolled in the study to see if there were early signs of calcium deposits in their heart arteries that are known to contribute to heart attack risk. As the study progressed, the researchers also assessed whether the participants had a heart attack, sudden cardiac arrest, chest pain, angioplasty or died due to coronary heart disease or other causes.

The researchers developed a lifestyle score for each of the participants, ranging from 0 (least healthy) to 4 (healthiest), based on their diet, body mass index (BMI), amount of regular moderate-intensity physical activity and smoking status. Only 2 percent, or 129 participants, satisfied all four healthy lifestyle criteria.

"Of all the lifestyle factors, we found that smoking avoidance played the largest role in reducing the risk of coronary heart disease and mortality," says Roger Blumenthal, M.D., a cardiologist and professor of medicine at the Johns Hopkins University School of Medicine, director of the Ciccarone Center and senior author of the study. "In fact, smokers who adopted two or more of the healthy behaviors still had lower survival rates after 7.6 years than did nonsmokers who were sedentary and obese."

Blumenthal, who is also the president of the American Heart Associations Maryland affiliate, says the findings "bolster recent recommendations by the American Heart Association, which call for maintaining a diet rich in vegetables, fruits, nuts, whole grains and fish, keeping a BMI of less than 25, being physically active and not smoking."

The researchers emphasize that their study shows the importance of healthy lifestyle habits not just for reducing the risk of heart disease, but also for preventing mortality from all causes.

"While there are risk factors that people cant control, such as their family history and age," says Ahmed, "these lifestyle measures are things that people can change and consequently make a big difference in their health. Thats why we think this is so important."

Its been too long since Ive spoken about cholesterol, too long I tell you. For those of you who dont know, I would sum up my view on cholesterol like this: its the most overhyped risk factor for heart disease there is. All you hear in the media is "Watch your cholesterol!" or "Cheerios lower cholesterol!" or "This food is cholesterol-free, so its good for you!". Bollocks. Bollocks I say.

First of all, the cholesterol in the food you eat barely has any effect on the cholesterol in your blood, if it has any effect at all. And second, lets set the record straight on "high cholesterol"... please for the love of God, quit worrying about it. Your total cholesterol is just about meaningless unless its taken in context with your triglycerides, HDL, and LDL... even better, your LDL particle number. Despite having no real, accurate clinical implications though, "high cholesterol" has taken on this sort-of boogey man role, scaring every health-conscious person into Lipitor land.

Anyway, I came across something today that was just too good not to write about; this stuff needs to be shared. This study was designed to analyze lipid-lowering therapy, but thats not the part I want to talk about here; its the cholesterol levels of the patients that piqued my interest. The researchers examined 65,396 patients hospitalized for heart disease (heart attack or angina) across the United States. Below youll find a screenshot of the baseline blood lipid data, taken within the first 24 hours of admission. You would expect, based on what you think you know, that heart disease patients must have had high cholesterol, right?

Average blood lipid values upon admission among all study participants.

Nope. On average, their cholesterol was 170.1 mg/dl, well below the high limit of 200. If any of these people had visited the doctor for a check-up a week before their hospitalization, the doc would have looked at these numbers and said "Steve, your cholesterol is great! Keep up the great work!" Assuming his name is Steve.

But things werent great. Each of these people experienced an acute coronary event that required hospitalization and very well could have ended their lives. Its irresponsible that were putting so much stock into cholesterol values when they clearly are NOT a good indicator of heart disease risk.

Sometimes it only takes one little piece of data, like this one, to completely change your beliefs on cholesterol and heart disease. I hope this provided the baseball to your brand new home window.

But what does this mean??
Now, theres an excellent chance that many of these people were already taking a cholesterol-lowering drug. Theres no data in the study to show whether this is true, but since so many people are on them, its very likely. So lets say for a moment that they were on statins. Say their normal cholesterol levels are around 220 mg/dl, and the statins bring it down to a more friendly-looking 170. Well, this only destroys the cholesterol and heart disease connection even more doesnt it? First off, it doesnt say much about the efficacy of the drugs. But also, it shows that reducing cholesterol from "high" back into "normal", at least via these mechanisms, is useless.

Okay, let me say it another way... if high cholesterol is the cause of our problems, lowering it should reduce our risk, regardless of the manner by which we do so. If it is not the cause, and it is just an indicator of a problem, then pharmacologically lowering it will NOT reduce our risk. It will, in fact, just make things appear to be fine when they are not.

Its sort of like when we get sick and we get a fever. We may take over-the-counter meds to reduce the fever; it makes us feel better and it takes away one of the symptoms of our illness. But we forget that the fever is an important part of our bodys defense mechanism to fight a bacterial infection... bacteria dont like the heat. We may feel a little better, but we remain just as sick as we were before, and weve now likely prolonged our sickness by messing with our bodys natural defense mechanisms.

The fever is like cholesterol, the symptom. The bacterial infection is the root cause. Got it? Okay its not a perfect analogy, but you get the point.


What is the root cause of heart disease then? If not total cholesterol, what should we focus on? Well thats a big can of worms... there are many factors that go into it. Stay tuned next week for a comprehensive guide on how to prevent heart disease!

People with heart disease have special needs when it comes to dental care. Here are some tips to consider before going to the dentist if you suffer from one of the following heart conditions.
Dental Care After Heart Attack

Wait a minimum of six months after a heart attack before undergoing any dental treatments. Tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medications could result in excessive bleeding during some oral surgery procedures. Ask your dentist if oxygen and nitroglycerin are available in case a medical emergency should arise during your office visit.
High Blood Pressure (Hypertension)

Some high blood pressure drugs can cause dry mouth or alter your sense of taste. Calcium channel blockers in particular can cause the gum tissue to swell and overgrow, resulting in chewing difficulties. If you do experience gum overgrowth, your dentist will give you detailed oral hygiene instructions and may ask you to make more frequent dental visits for cleanings. In some cases, gum surgery may be required. (A gingivectomy is the name of the surgical procedure performed to remove excess gum tissue).

If your dental procedure requires the use of anesthesia, ask your dentist if the anesthesia contains epinephrine. Epinephrine is a common additive in local anesthesia products. Use of epinephrine in some patients with high blood pressure may result in cardiovascular changes - including the rapid development of dangerously high blood pressure, angina, heart attack, and arrhythmias - and theore should be used with caution.
Chest Pain (Angina)

Patients with angina treated with calcium cannel blockers may experience gum overgrowth. In some cases, gum surgery may be required.

Like patients with a previous heart attack, patients with angina may want to ask their dentist if oxygen and nitroglycerin are available in case a medical emergency should arise.

While patients with stable angina (chest pain that occurs in a predictable pattern) can undergo any dental procedure, patients with unstable angina (new chest pain or unpredictable chest pain) should not undergo elective (nonessential) dental procedures, and emergency dental care should be performed in a hospital or office equipped with cardiac monitoring capability.
Stroke

If you’ve had a stroke in the past, tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medications could result in excessive bleeding during some oral surgery procedures.

If your stroke has impaired your ability to produce an adequate amount of saliva, your dentist may recommend the use of artificial saliva. If your stroke has affected your face, tongue, or dominant hand and arm, your dentist may also recommend use of fluoride gels, modified brushing or flossing techniques, and strategies others can use to assist you in maintaining good oral hygiene.
Oral Health and Heart Failure

Some medications used to treat heart failure (such as diuretics, or water pills) can also cause dry mouth. Ask your dentist about dry mouth treatments, including the use of artificial saliva.

Points to Remember About Dental Care and Heart Disease

    Give your dentist a complete list of the names and dosages of all the drugs you are taking for your heart condition (as well as any other prescription or nonprescription drugs that you may be taking). This will help your dentist decide on the best treatment course for you including medication selection for dental procedures.
    Give your dentist the name and phone number of your doctor(s) in case your dentist needs to speak to him or her about your care.
    If you are particularly nervous about undergoing a dental procedure as a result of your heart condition, talk with your dentist and heart doctor. Your doctors can provide you with information and work with you on strategies for controlling dental pain and easing your fears.


Is There a Link Between Periodontal Disease and Heart Disease?

Various researchers and government agencies continue to investigate the possible relationship between gum (periodontal) disease and heart disease. Some researchers speculate that bacteria in the mouth that are involved in the development of gum disease move into the bloodstream and cause inflammation in the blood vessels - changes that in turn contribute to heart disease and stroke.

Numerous studies are being conducted that both support and ute the possible link between these two diseases. One study, published in Stroke: Journal of the American Heart Association, found that people who had fewer than 25 teeth at the start of the 12-year trial (teeth loss is the ultimate end result of untreated gum disease) had a 57% greater risk of stroke compared with patients who had 25 or more teeth.

Another study involving over 4,000 patients and 17 years of follow up showed no evidence of a decreased risk of coronary heart disease if chronic gum disease was eliminated. Based on these results, these researchers speculate that the relationship between gum disease and an increase in cardiovascular risk is coincidental and not causal (that is to say that gum disease does not cause coronary heart disease).

The true role, if there is one, between gum disease and heart disease remains to be determined.

Where do you get your protein? If its from red meat (steak and pork), processed meat (bacon and salami), and high-fat dairy foods, it may be increasing your risk of fatal and non-fatal heart attack.

That was the finding of a recent assessment of the very large Nurses Health Study which followed over 84,000 women for 26 years.¹

It found:

• Higher intakes of red meat, red meat excluding processed meat, and high-fat dairy were significantly associated with elevated risk of coronary heart disease (CHD).
  
  
• Higher intakes of poultry, fish, and nuts were significantly associated with lower risk.

And concluded:

"These data suggest that high red meat intake increases risk of CHD."

The study was unique in that it investigated how substituting one source of protein for another, e.g. nuts, fish, or poultry for red meat, affects heart disease risk. It found, for example, that substituting one serving of nuts for one serving of red meat reduced CHD risk by 30%; substituting a serving of fish for red meat reduced it by 24%.

Although the study was conducted on women, the researchers say men are likely to benefit from the findings as well.

Lead author of the study, Adam Bernstein:

"Our research adds to the growing and convincing body of evidence that red meat intake should be minimized or excluded from the diet in order to maintain cardiovascular health."

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¹Major Dietary Protein Sources And Risk Of Coronary Heart Disease In Women, Circulation, August 2010

Shifting Protein Sources Away From Red Meats May Reduce Risk Of Heart Disease In Women, Harvard School of Public Health, Press Release, August 2010