C-Reactive Protein and Body Fat, The Missing Link to Heart Disease?

Researchers at The University of Texas M. D. Anderson Cancer Center and The University of Texas Health Science Center in Houston have found that human fat cells produce C-reactive protein (CRP), which is linked to both inflammation and an increased risk of heart disease and stroke. The researchers believe this explains why those who are overweight have a higher risk of developing both of these health problems.

In recent years body fat has been studied as an organ in itself, capable of producing a number of different biologically active molecules. These molecules include inflammatory proteins called cytokines, and the hormone resistin, which is linked to insulin resistance and the development of type 2 diabetes. Overweight people, even those who are healthy, tend to have higher levels of CRP in their blood, but until now researchers had very little understanding as to why this is true.

"This study is the first to show how body fat participates in the inflammatory process that leads to cardiovascular disease," said study leader Edward T. H. Yeh, M.D., who is both chairman of the Department of Cardiology at M. D. Anderson and director of the Research Center for Cardiovascular Disease at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases at the UT Health Science Center at Houston. Dr. Yeh's team had previously discovered that CRP is manufactured in the walls of blood vessels, but with this study they were attempting to make the connection between obesity and higher CRP levels.

Dr. Yeh's team decided to see whether fat cells themselves are stimulated by the inflammatory cytokines or resistin to produce CRP. They recruited plastic surgery patients to donate fatty tissue that would have been discarded after their surgery. They then removed the fat cells, cultured them and stimulated them under a number of different conditions. They discovered the fat cells produced cytokines, resulting in inflammation. This inflammation in turn triggered an increased production of CRP. They also learned that resistin, which is produced by fat cells, could stimulate CRP production.

"We know that patients (who are overweight) have higher levels of CRPs, as well as a higher risk of developing heart disease and stroke, but no one understands why that is," Yeh said. "If fat cells by themselves produce inflammatory signals that trigger cells to produce CRPs, and if CRPs also produce biological effects on vascular walls, that could explain the higher risk of cardiovascular disease."

Dr. Yeh's team also discovered why aspirin, the statin drugs, and a medication for diabetes (troglitazone) help to reduce CRP levels. Because the researchers knew from other studies that these drugs reduced CRP levels in patients, they exposed the cultured fat cells that were producing higher CRP levels to these medications and measured CRP decline. This gave them direct proof that these drugs affect CRP production at the cellular level.

Dr. Yeh points out that there is still much that isn't known about CRP, including why fat cells produce inflammation and how CRP participates in that process, but the team is encouraged by the proof that currently used medications can prevent the damage that results from the inflammatory process.

This research provides us with some interesting information about the role of CRP. From a clinician's standpoint I believe that I have one more piece of evidence for individuals when discussing their need to take an aspirin, a statin drug, and a glitazone when managing obesity, heart disease, and diabetes risk. It doesn't tell us yet when an elevated CRP level is high enough to be concerned, or if an elevated level is the same regardless of an individual's gender or ethnicity. But that's info for another post :>)

Laurie

As I see it, every day you do one of two things: build health or produce disease in yourself.

Adelle Davis, health and fitness author

Related Topics: WebMD Video: How 'Microbubbles' Can Help Your Heart, 4 Heart Risks Facing American Women

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Whole Grains Cut Diabetes, Heart Disease Risk - Study

From the world of dietary confusion, another gem: "diets rich in whole grains can lower the risk of diabetes and heart disease" according to a study reported on Reuters Health on February 7, 2006.

The study synopsis then reports that the analysis of diet records and blood samples of 1,000 middle-aged individuals suggests that the risk of heart disease and diabetes is lower in those who eat diets that include a large percentage of whole grains. So far so good. But then the article says, "such diets would include bran, whole wheat, fruit and vegetables."

While I completely agree that fruits and vegetables are important parts of a healthy diet, they are not, the last I knew, considered to be whole grains. The title of the article is "Whole Grains Cut Diabetes, Heart Disease Risk - Study." It doesn't say whole grains plus fruits and vegetables cut risk; it says whole grains.

But wait, there is more fun to be had!

This is one of those articles that just serve to confuse the consumer, as evidenced by the rest of the content, in which the authors note that a greater intake of whole grains was associated with more physical activity, greater fruit and vegetable intake, less smoking and alcohol consumption, and intake of fewer saturated and monounsaturated fats.

Never mind that the last I knew, moderate intake of monounsaturated fats such as olive and canola oils was thought to improve blood HDL (good) cholesterol levels, but suddenly, the scientists become as puzzled as I am about their results! They hedge their bets by saying that there "appears to be" a lower risk of diabetes and heart disease associated with increased intake of whole grains, but that the "exact mechanism for how this works is unclear." Don't you love that line?

Let's see, how many ways to decrease heart disease and diabetes risk can we identify in individuals who:

• exercise more


• eat more fruits and vegetables


• eat less saturated fat


• smoke and drink less

Does anyone hazard a guess that all those things might decrease their individual risk of developing heart disease and diabetes? Geez, even a lowly human with no backgound in science can state the obvious in this one folks.

This is exactly the kind of 'fuzzy logic' science that makes people who are trying to do the right thing shake their heads.

We all know that the things listed above will help to improve our health, but doing them all often seems overwhelming.

When we see a headline that appears to be a "pass directly to go" mechanism for decreasing health risks, we all read it with anticipation. At last! Science will help us understand just how much of what to eat and we'll be healthier! We've been waiting for this definitive plan! When it turns out to be another piece of nutrition news that is a message we've already heard, it's annoying at best.

At worst it makes the 'science' of risk management look like one more ill-defined, poorly controlled study that doesn't really improve our prevention knowledge at all. No wonder the public shakes it collective head and beelines for their favorite fast food chain, with the attitude that they'll have a salad with that burger and fries, and we should let them know when we figure this grain thing out.

As a sideline to this story, apparently someone has figured out that barley, like oats, has some specific health benefits. You can read about it here.

Laurie

There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.
~ Mark Twain (1835 - 1910)

Related Topics: Reaping the Benefits of Whole Grains, 5 Superfoods for Your Heart

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Another Weight Loss Miracle?

According to the CDC's records from 1999-2002, nearly two-thirds of U.S. adults are overweight and about 30% are obese, based on body mass index (BMI).

Being overweight is a drag. Whether you have 5 pounds or 250 pounds to lose, it is never easy for anyone. I have struggled to maintain my weight for years; right now I have another 10 pounds to lose, but in the past I have been as much as 30 pounds overweight. People look at me and think I look fine, especially those in the category of having more than 10 pounds to lose. But I'm here to tell you, it's relative. It seems as though it should be easier to lose a few pounds than a lot, but I'm sure you know the saying, "a journey of 1000 miles begins with the first step." I think it's actually harder to lose a few pounds, because you keep putting off that first step: by not changing your habits or by fooling yourself into believing that one more bite of something won't matter.

There is a new weight loss drug called Acomplia. Positive results on its weight-loss outcomes were recently published in the New England Journal of Medicine (Note: the study was funded by its manufacturer, Sanofi-Aventis). Acomplia has been previously touted as a drug for smoking cessation, so we may be getting a bigger bang for our buck.

Somehow this drug seems too good to be true. If you read the two articles that are linked above, you'll see that Acomplia appears to help people lose weight, especially that all-important abdominal fat that greatly increases cardiovascular risk; it helps people quit smoking without gaining a lot of weight and it improves 'good' HDL cholesterol. Whew, quite the little miracle!

There are design omissions in the current weight-loss study that are pointed out in the first article, including that none of the participants had other health issues, such as diabetes or psychiatric problems such as depression. As far as I'm concerned "psychiatric problems" is a nice way of saying there were no food addicts in the bunch. Funny, that would be me; I love to eat and my husband trained as a chef! Now you see what I'm up against, LOL.

When I needed to quit smoking I sucked it up and quit. It was hard. Now I'm going to have to so the same thing with weight loss. I'm going to have to follow the two rules that actually and consistently work when it comes to weight loss: eat less and exercise more (calories in and calories out). When I had a lot of weight to lose, I got really excited to see a pound slip away; now that it's increments of 1/4 or 1/2 a pound somehow it's not as satisfying. It's too slow! But somehow I have to stay on this mission, because my 5th decade is coming, and I've already seen the effects of each decade on my metabolism and how hard it is to lose weight as the years pass.

I don't have time to wait for a 'maybe miracle' drug and if you're overweight or still smoking, neither do you.

Laurie

Life is what happens to you while you're busy making other plans.
John Lennon (1940 - 1980)
English singer & songwriter, "Beautiful Boy"

Related Topics: Acomplia Weight Loss is Short-Term, Find the Diet That's Right For You

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Driven to Distraction? Here's Why

As I age I notice that I hate chaos (I also wonder about people who seem to like it. How's that helping them?).

A recent study of adults over 65 indicates that as we become older it becomes more difficult to filter out the distractions around us, causing older adults to have more difficulty staying focused on a task.

The study uses magnetic resonance imagery (MRI) to measure brain function during a series of tests for perception and recall; the results indicate that there is a gradual and age related loss of ability to weed out distractions to the task at hand. The authors think that this tendency toward being more easily distracted puts older adults as greater risk for injury.

They also note that this knowledge creates an opportunity to educate individuals about this increased risk, and to help them develop strategies to maintain concentration, and sometimes safety. For example, turning down music or the TV while trying to balance the checkbook, or not talking on a cell phone while trying to drive the car would be appropriate adaptations to this change in brain function.

The authors note that participants in this study had an average secondary school education and that other studies have shown that the more education an adult has, the better they adapt to changes in brain function as they age. I'm just hoping they're right about that :>)

Laurie

Why is it that our memory is good enough to retain the least triviality that happens to us, and yet not good enough to recollect how often we have told it to the same person?
Francois de La Rochefoucauld (1613 - 1680)
French author & moralist

Related Topics: Menopause & Memory: Search for Links, Foods to Improve Your Concentration

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The Importance of Nursing Care

II recently responded to a question on my message board in which an individual asked about the potential benefits of being taken care of by "big city" versus a "small city" cardiologist. Apparently the poster was having a discussion with a sibling, who thought that their mom should be going to the city for her medical care.

In my response I pointed out that the most important factor in hospitalization and recovery without complications is not the surgeon or the physician, it's the nursing care. Now before all my physician readers get their knickers in a knot (sorry, I just love that visual), I did point out that it is important to make sure that the doctor is qualified to perform the surgery or manage the type of illness in question, and that there are circumstances in which a city hospital's expertise is warranted. In other words, you might want to read the original message.

Now in the journal "Health Affairs" and reported on Reuters Health Information, there is an article about a study that attempts to quantify the potential costs and savings to hospitals by increasing registered nursing hours.

Based on data from 800 acute-care hospitals, researchers concluded that increasing the RN to LPN ratio, while keeping the number of total nursing hours the same, would cost hospitals $811 million, but save $1 billion in the short term. The study found that hospitals could avoid 5,000 annual patient deaths if they boosted the number of registered nurses by replacing some licensed practical nurses with RNs; LPNs require less training and education compared with RNs. Although this appears to limit job opportunities for LPNs, the study actually calls for an overall increase in the number of RNs and LPNs in practice; it just changes the "mix" on any given unit and shift.

A number of studies in the last decade have pointed to human error in the frequency of patient deaths, and in hospital complications such as urinary tract infections, heart attacks, and poor post-operative outcomes.

A large number of these studies point to improved outcomes with increased nurse to patient ratios. As a result the state of Rhode Island, where I practice, is going to start publishing the nurse to patient ratios at all of the state's hospitals annually, so that individuals may use this as a factor in their choice of hospital for elective admissions. It will be amazing to see what happens to nursing salaries once this goes into effect and hospitals have to compete with one another for staff. Stay tuned for that ride folks!

So as I pointed out to the person writing to me at WebMD, the best choice may be the facility that has the greatest number of registered nurses on staff. There is just one problem with this plan: there aren't enough nurses to go around. The state of California implemented laws to mandate staffing ratios in 2004, but many hospitals haven't been able to implement them due to the nursing shortage. Other countries, such as England and Australia are complaining about U.S. efforts to recruit nurses away from home with higher salaries; those countries are suffering similar nursing shortages and have lower pay scales. The U.S. Department of Labor projects that we will need 1 million replacement nurses by 2012, just 6 years from now, and yet the American Association of Colleges of Nursing reports that nursing schools turned away 32,000 interested students in 2004 because they didn't have enough faculty to teach them.

Fixing nursing ratios will take time and money; in the current political climate it seems unlikely that additional federal funding will be forthcoming to encourage students to go to nursing school, to provide LPN to RN training for experienced practical nurses, and to encourage nursing leaders to teach by improving salaries of those who take on this challenging career. It's too bad that the value of saving human lives matters so little to our current administration. But that's the subject of another blog....

Laurie


The art of medicine consists in amusing the patient while nature cures the disease.
Voltaire (1694 - 1778)

Fortunately nurses are good at this...

Related Topics: The Baby Boomer Heart: A User's Guide, Finding Good Medical Care

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Go Red

According to American Heart Association statistics released on this week 483,800 American women died from heart disease and stroke in 2003, the latest year for which detailed information is available. Another 6 million women had coronary heart disease and 3.1 million had strokes, the association said in a special issue of its journal Circulation.

Despite this, studies indicate that only slightly more than half of women (55%) are aware that their greatest health risk is cardiovascular disease (CVD). CVD affects more women's lives than the next five leading causes of death combined, including cancer, chronic lung disease, Alzheimer's disease, diabetes, and accidents.

Today is "Go Red for Women" day, an event started to raise women's awareness that their greatest health risk is heart disease. Tell your friends, your mother, your sister, and your lover. Today, tell every woman you know to love their hearts by exercising, eating well, losing weight, and getting to the doctor for an annual check-up. Offer to help them by walking with them, encouraging them, driving them, whatever it takes. Just don't let your loved one become a statistic this year.

Laurie

Related Topics: Five Steps to a Healthier Heart, Simple Changes to Lower Your Heart Risks

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A Woman's Heart

Scientists continue to struggle to understand why women have a different experience than their male counterparts when it comes to the diagnosis and treatment of heart disease.

Women respond to the same risk factors differently; for example, there is evidence that having a low HDL ("good" cholesterol) level is more predictive of the development of coronary heart disease (CHD) in women than high LDL ("bad" cholesterol) levels are. CHD death is more frequent in women than in men, often because we are older when we develop heart disease, and there is evidence from the Heart Estrogen Replacement and Women's Health Initiative studies that this is not related to the loss of estrogen at menopause.

A new study sponsored by the National Institute of Health indicates what many women already know; their heart disease is different. Women respond differently to conventional treatments, and have different symptoms, such as shortness of breath and fatigue rather than the chest pain or heaviness that men frequently have.

Now there is evidence that conventional heart disease tests may not identify CHD in women because they often have plaque build-up in the smaller heart vessels, rather than large, readily apparent blockages in the main arteries that are frequently the hallmark of CHD in men. In a current study called Women's Ischemia Syndrome Evaluation, or WISE, researchers have found that as many as 2/3 of women with CHD symptoms will appear to have normal coronary arteries on an angiogram. Of those women 1/2 will have a problem called coronary microvascular syndrome, where they develop evenly coated plaques in the small vessels of their hearts.

Unlike the large blockages that are frequently found in their male counterparts, these women's tiny blockages are not visible during the angiogram. The study's overseer, Dr. Noel Bairey-Merz of Cedars-Sinai Hospital in Los Angeles, reports that this type of arterial disease also appears to cause the blood vessels not to dilate the way they are supposed to, a problem that causes further restriction of blood flow through an already narrowed artery. Blood flow restriction causes a loss of oxygen to the heart muscle, causing the pain known as angina. Microvascular syndrome is primarily a problem for women; only about 20% of men have this type of CHD. Dr. Bairey-Merz points out that scientists are just learning about this syndrome because for many years women were not enrolled in studies.

What should women do who suspect that they have heart disease? If you have had a normal angiogram and continue to have symptoms of concern, talk with your health care provider. Microvascular disease is visible on MRI, and a simple questionnaire, such as the Duke Activity Status Index (DASI), can identify women who are likely to have unidentified microvascular syndrome. The questionnaire asks about the individual's ability to perform certain daily tasks, such as light housework; women who pass an angiogram but who score poorly on the DASI are at increased risk of having a heart attack.

Laurie

Keeping your body healthy is an expression of gratitude to the whole cosmos - the trees, the clouds, everything.
Thich Nhat Hanh

Related Topics: Diseases Linked to High Cholesterol, The Baby Boomer Heart

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