People sleeping less than six hours a night were twice as likely to have a stroke or heart attack and 1.6 times as likely to have congestive heart failure. And those sleeping more than eight hours each night were two times as likely to have angina and 1.1 times more likely to have coronary artery disease.

A healthy lifestyle maintained throughout young adulthood and middle age [correlates] with low cardiovascular disease risk in middle age. [Investigators claim this is the first study to have shown this.]
The majority of people who maintained five healthy lifestyle factors from young adulthood (including a lean body mass index (BMI), no excess alcohol intake, no smoking, a healthy diet and regular physical activity) were able to remain in this low-risk category in their middle-aged years.
In the first year of the study, when the participants’ average age was 24 years old, nearly 44% had a low cardiovascular disease risk profile. Twenty years later, overall, only 24.5% fell into the category of a low cardiovascular disease risk profile.
Sixty percent of those who maintained all five healthy lifestyles reached middle age with the low cardiovascular risk profile, compared with fewer than 5% who followed none of the healthy lifestyles.
Researchers used data collected over 20 years from the Coronary Artery Risk Development in (Young) Adults (CARDIA) study. It began in 1985 and 1986 with several thousand 18 to 30 year-olds and has since followed the same group of participants.
For this study, the researchers analyzed data such as blood pressure, cholesterol, blood sugar, BMI, alcohol intake, tobacco use, diet and exercise from more than 3,000 of the CARDIA participants to define a low cardiovascular disease risk profile and healthy lifestyle factors.
“Many studies suggest that people who have low cardiovascular risk in middle age will have a better quality of life, will live longer and will have lower Medicare costs in their older age"...

Some studies have suggested that consumption of diet soft drinks may be associated with Type 2 diabetes and development of the condition known as metabolic syndrome — high blood pressure, abdominal obesity and other risk factors. Now a 10-year epidemiological study has found a link between diet soft drinks and cardiovascular disease.

[Among] 2,564 adults over 40 living in Manhattan,] diet and regular soft drink consumption were both associated with a number of risk factors for cardiovascular disease.

Even after controlling for many of those risks, including diabetes, the researchers found that daily consumption of diet soda was still independently associated with an increased risk for stroke, heart attack and death.

Still allowing plastic in your kitchen? In your food? In your children's toys?

Participants with diabetes were stratified by insulin therapy at baseline: group A treated with insulin only; group B treated with insulin and oral hypoglycemic agent; and group C receiving no insulin treatment.
During a mean follow-up of 3.9 years, the researchers found that 4.6% of the cohort without diabetes died, compared with 15, 12.5, and 7.3% of groups A, B, and C, respectively. The hazard ratios (HRs) for all-cause mortality were 4.3, 4.2, and 2.0 for groups A, B, and C, compared with individuals without diabetes. The leading cause of death in groups A, B, and C were ESRD, ESRD and CAD, and CAD, respectively. The HRs for these conditions were at least twice as high as the HRs for all-cause mortality, extending to 17.3, 17.9, and 5.1 in groups A, B, and C, respectively, for ESRD.
"Excess mortality persists among people with young-onset diabetes of long duration, with ESRD and CAD as the leading contributors to mortality," the authors write.

[Excuse me? Don't the numbers, if correctly reported, suggest that insulin-and-drug therapy increases mortality by over two-thirds, and insulin-only therapy more than doubles mortality?—DMM]

Children and adolescents participating in moderate to vigorous physical activity have a lower cardiometabolic risk profile. [Physical activity correlated with better waist circumference, blood pressure, triglycerides, HDL cholesterol, and insulin in study subjects] regardless of the amount of time they spend sedentary.
[Based on the findings,] children should be encouraged to increase their participation in physical activity] rather than decrease the amount of time they spend sedentary, "as this appears more important in relation to cardiometabolic health."
[In pooled data from 14 studies (1998-2009) connected to the International Children's Accelerometry Database.] the time spent in moderate to vigorous physical activity has a weak to moderate association with the amount of time children spend sedentary, and this had suggested that both variables might be independently associated with cardiometabolic risk.
[A]ctivities ingrained early in life set the stage for what individuals do in their later and older years. "We're living in an age right now where it's so easy to do no physical activity at all...kids can basically go through an entirely normal childhood existence where, unless they're forced or choose to play sports, they don't have to do anything. This study shows that the more activity that you do, even if it's outside the context of typical exercise, really does make a difference."
In the ICAD analysis, 20,871 children and adolescents from Australia, Brazil, Europe, and the US had [physical-activity levels] monitored for an average of 5.2 days using the accelerometer, and the mean daily time spent engaged in moderate to vigorous physical activity was 30 minutes. The mean daily time spent sedentary was 354 minutes.
Kids in the [most active] tertile spent more than 35 minutes per day engaged in moderate to vigorous physical activity, whereas those in the bottom tertile were moderately or vigorously active just 18 minutes per day. The mean difference in waist circumference between the most active and least active kids with the most sedentary time was 5.6 cm [and 3.6 cm] in those with less sedentary time. Similarly, the difference in systolic blood pressure between the most active and least active kids with the most sedentary time was 0.7 mm Hg[, while there was a 2.6-mm-Hg difference] between the most active and least active kids who reported less sedentary time. The variations in HDL cholesterol, insulin, and triglyceride levels were similar when analyzed by physical-activity levels and sedentary time.
Overall, the results showed that higher levels of physical activity were associated with better cardiometabolic risk factors across the tertiles of sedentary time. In contrast, sedentary time was not associated with any of metabolic outcomes independent of the time engaged in moderate and vigorous activities. The researchers note that they did not qualify what specific activities the children were engaged in while being sedentary. For this reason, reducing television viewing time is still considered an important goal of parents and public-health policy because TV watching is also associated with other unhealthy behaviors, such as snacking and drinking soda.

According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease, projected to reach second place by 2020. There is also strong evidence that it is an independent risk factor for heart disease, and several studies show that prolonged depression is associated with selective and possibly permanent damage to the hippocampus, a region of the brain critical to memory and learning.
Add the fact that 2 percent to 12 percent of depressed people eventually commit suicide, and the [supposed evolutionary] “advantages” of depression suddenly don’t look so good....
What is natural, the thinking goes, is best. If we are designed to suffer depression in response to life’s ills, there must be a good reason for it, and we should allow it to take its painful and natural course.
But unlike ordinary sadness, the natural course of depression can be devastating and lethal. And while sadness is useful, clinical depression signals a failure to adapt to stress or loss, because it impairs a person’s ability to solve the very dilemmas that triggered it.
Even if depression is “natural” and evolved from an emotional state that might once have given us some advantage, that doesn’t make it any more desirable than other maladies. Nature offers us cancer, infections and heart disease, which we happily avoid and do our best to treat. Depression is no different.

Individuals who maintained or improved their fitness levels had a 26% and 28% lower risk of developing hypertension, a 42% and 52% lower risk of developing metabolic syndrome, and a 26% and 30% lower risk of developing elevated levels of LDL cholesterol, respectively....
[Subjects who got fatter in follow-up, as measured by percentage of body fat,] had a 26%, 71%, and 48% higher risk of developing hypertension, metabolic syndrome, and hypercholesterolemia, respectively...compared with individuals who lost weight. Similar results were observed when BMI was used as the criterion for fatness levels.
Every 1-MET improvement in fitness was associated with a 7%, 22%, and 12% lower risk of developing hypertension, metabolic syndrome, and hypercholesterolemia, respectively, while every unit increase in percentage of body fat was associated with a 4%, 10%, and 5% increased risk of developing the cardiovascular risk factors...
"In the real world, people change their fitness levels or fatness over time...Fitness and fatness, not the baseline levels, but the changes over time, are both independently important to reduce cardiovascular disease risk factors."
[Patients who had stable or increasing amounts of fatness in combination with loss of fitness had significantly higher rates of cardiovascular risk factors when compared with] individuals who gained fitness over time and lost fat. They did observe that losing fitness regardless of fat changes and getting fatter irrespective of the change in fitness levels were associated with a higher risk of developing metabolic syndrome. The adverse effects of getting fatter were attenuated slightly if fitness was maintained or improved, while declines in fitness could be offset by reductions in body-fat percentage.
"Maintaining or improving fitness levels and preventing fat gain are both important, independent of the changes of each other...[T]he ideal combination is to improve fitness and prevent fat gain, but as long as individuals maintain fitness and fatness, they are not likely to be at higher risk of cardiovascular disease risk factors. Losing weight and gaining fitness is very challenging to the general population, but maintaining fitness and fatness are less so and more doable."

[A new study] suggests that hyperglycemia (high blood sugar) injures the heart, even in patients without a history of heart disease or diabetes...[E]levated levels of glycated hemoglobin (HbA1c), a marker for chronic hyperglycemia and diabetes, were associated with minute levels of the protein troponin T (cTnT), a blood marker for heart damage. The high-sensitivity test they used detected levels of cTnT tenfold lower than those found in patients diagnosed with a heart attack....[H]yperglycemia may be related to cardiac damage independent of atherosclerosis....
Higher levels of HbA1c were associated in a graded fashion with elevated levels of high-sensitivity cTnT. This relationship was present at HbA1c levels even below the threshold used to diagnose diabetes. Using conventional tests, troponin T can be detected in 0.7% of the population and is associated with heart attacks and death. With the high-sensitivity cTnT test, low levels of troponin were found in 66% of the study population....
"[G]lucose might not only be related to increased atherosclerosis, but potentially elevated glucose levels may directly damage cardiac muscle"...

• High blood glucose makes your blood “sludgy,” slowing circulation so cells can’t get the oxygen and nutrients they need. Margaret commented, “I can tell if my sugars are high in the morning, because ‘groggy’ doesn’t begin to describe it. ‘Drugged’ is how it feels.”
• Low sugars levels also cause fatigue, because when blood sugar is low, there is not enough fuel for the cells...
• [With vascular inflammation caused by igh blood glucose,] immune cells called monocytes come into the brain, causing fatigue....
• [P]eople with diabetes are more likely than others to have thyroid problems. If your thyroid level is low, you are likely to feel tired, sleepy, and depressed.
• Low testosterone levels, especially in men. Men with diabetes are much more likely to have low testosterone.
• Infections: People with diabetes often have infections they don’t know about. Infections take energy to fight, which can cause fatigue and raise blood sugar levels. A common source is urinary tract or “bladder” infections. They often hurt, but sometimes have no symptoms, except for the fatigue. Silent dental infections and vaginal infections are also common and fatiguing.
• Undiagnosed heart disease : If you get tired after tasks that you used to sail through, it could be time to for a heart check-up....
• Many drugs for diabetes, blood pressure, depression, pain, and other issues can cause fatigue. Read labels, ask your doctor or pharmacist....
• Some people are too wound up or too busy to sleep. Or they’re up to use the bathroom all night, or they have obstructive sleep apnea (OSA), which can wake them up many times an hour....
• [Rotating shifts or working nights] can cause fatigue directly by messing with your body clock or indirectly by disrupting sleep.
• Depression is very common with diabetes. Most depressed people feel fatigued, even if they don’t feel sad. Even at low levels, depression can sap your motivation....
• Doing too much: If you’re ripping and running all day, not taking breaks or even stopping to breathe much, you are courting fatigue....
• Stress: In small doses, psychological or physical stress can give you energy, but if it goes on too long, it will wear you out...
• Too much carbohydrate — especially refined carbs — can make anyone tired, especially with diabetes. Kat wrote, “now that I am eating a higher protein/fat, lower-carbohydrate diet, I have shaken off that really sleepy/extreme fatigue that I used to have every day.”
• According to WebMD, too much caffeine can cause fatigue through a rebound effect. They also say that dehydration, or not drinking enough liquid, is a major cause of fatigue.
• Being out of shape or having weak muscles: Not moving our bodies contributes to fatigue. Of course, it’s hard to exercise when you’re fatigued.

“Previous studies have demonstrated that those who get less sleep are more likely to also be obese, have diabetes or cardiovascular disease, and are more likely to die sooner, but this new analysis has revealed that other sleep problems, such as difficulty falling asleep, staying asleep, or even too much sleep, are also associated with cardiovascular and metabolic health issues"...
The researchers examined associations between sleep disturbances and other health conditions, focusing on perceived sleep quality, rather than just sleep duration. After adjusting for demographic, socioeconomic and health risk factors, patients with sleep disturbances at least three nights per week on average were 35% more likely to be obese, 54% more likely to have diabetes, 98% more likely to have coronary artery disease, 80% more likely to have had a heart attack, and 102% more likely to have had a stroke.
Grandner and colleagues analyzed data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) of 138,201 patients[—]the world’s largest telephone survey, designed to monitor health-related behaviors in the general population.
“This study is one of the largest ever to link sleep problems with important cardiovascular and metabolic diseases. It joins other studies that show that sleep is an important part of health, just like diet and physical activity"...

Inflammation and the [age-related accumulation of the toxic molecule amyloid beta contribute to] increased risk of age-related macular degeneration (AMD), the largest cause of blindness in people over 50 in the developed world...
"When we gave older mice the vitamin D we found that deposits of amyloid beta were reduced in their eyes and the mice showed an associated improvement of vision. [Amyloid beta is linked to Alzheimer's disease;] new evidence suggests that vitamin D could have a role in reducing its build up in the brain"...
Professor Jeffery and his team...found that the mice that had been given the vitamin D supplement also had significantly less amyloid beta built up in their blood vessels, including in the aorta...
"[V]itamin D could be useful in helping to prevent a range of age-related health problems, from deteriorating vision to heart disease"....
For much of human history our ancestors lived in Africa, probably without clothes, and so were exposed to strong sunlight all year round. This would have triggered vitamin D production in the skin. Humans have only moved to less sunny parts of the world and adopted clothing relatively recently and so might not be well adapted to reduced exposure to the sun.

[David Agus, MD:] "Reimbursement for preventive medicine's always difficult in our country...[T]he problem is most people change health plans all the time. So if you're that health plan, why should you spend money on something that's not going to affect a person until a decade from now? And so one of things we really have to change is we have to push prevention... a heart attack costs hundreds of thousands of dollars. A couple hundred dollar tests along with a drug can prevent it. Obviously it's cost effective as a return on investment"....
[Bill Weir:] Since my HDL (good cholesterol) levels are in fine shape, he explained that I don't need a low-fat diet, but a "good-fat diet,"—olive oil, canola oil, [heart-smart] eggs and cold-water fish—eaten on a consistent schedule. When you have lunch at noon one day and 3 p.m. the next, you're releasing stress hormones that can hurt in the long run, Agus said.
Instead of hitting the gym hard in the morning and then sitting all day (which can be as bad for you as smoking), the doctor encourages more movement throughout the day....
And he ordered me to skip the fish oil capsules and multivitamin in favor of the freshest real food I can find.
"You're not vitamin deficient...You look at all the large studies with vitamins and most of them have caused problems rather than benefits. And you don't need to be on them. So real food, regular schedule, live healthy."

Low levels of vitamin D may confer a cardiovascular benefit, but too much vitamin D may have the opposite effect. The critical threshold appears to be a serum 25-hydroxyvitamin D concentration of 21 ng/mL—more than that level increases C-reactive protein (CRP), a biomarker for cardiovascular disease, but lower serum concentrations of 25-hydroxyvitamin D lower CRP levels.
A multivariate analysis that tracked 25-hydroxyvitamin D concentrations as well as CRP in more than 15,000 healthy adults revealed that above the threshold for benefit, CRP increased with each 10-ng/mL increase in 25-hydroxyvitamin D.
In a univariate analysis, CRP levels decreased as levels of 25-hydroxyvitamin D increased up to the median of 2 ng/mL.... [?]
The mean age of participants was 46, and the median serum 25-hydroxyvitamin D and CRP levels were 21 ng/mL and 0.21 mg/dL, respectively. [No significant difference in levels of 25-hydroxyvitamin D was found between near-equal numbers of men and women.] Whites had significantly higher baseline levels of 25-hydroxyvitamin D than nonwhites.
Significantly more people with a body mass index greater than 30 kg/m2 had lower 25-hydroxyvitamin D levels at baseline (41% versus 25%, P<0.0001); the same was true for smokers (22% versus 18%, P=0.004)....
"From our results, it appears that vitamin D supplementation among asymptomatic subjects with baseline vitamin D values of greater than 21 ng/mL might have no additional effects on systemic inflammation, as measured by changes in the serum CRP levels"...
[The] study found a significant inverse relationship between CRP and 25-hydroxyvitamin D levels less than 21 ng/mL.
[P]rior studies assessing the relationship between vitamin D status and markers of inflammation have yielded inconsistent results.

Amer M, Qayyum, R "Relation between serum 25-hydroxyvitamin D and C-reactive protein in asymptomatic adults (from the Continuous National Health and Nutrition Examination Survey 2001 to 2006" Am J Cardiol 2012; 109: 226–230

Asked to address the concerns of naysayers, who argue that there is little proof that reducing salt in the diet will have an effect on health outcomes and who say that the administration should not get involved in "nanny-state" activities like regulating the amount of sodium people consume, Bakris said that government-backed salt-reduction campaigns "have been very effective in the UK, in Finland (with a dramatic improvement in mortality) and in Japan, and there is absolutely no reason we should not do this.

"The reality is that there needs to be some guidance to the general public about this—most people do not read labels, most people don't pay attention, and they don't know how much salt is too much... Clearly, the FDA does have a role as a regulatory body to adjust sodium standards in foods so that they are in keeping with the current guidelines."

"It's certainly true that people who are in their 20's and teens don't need salt restriction for blood-pressure control, [but it is an acquired taste. If] you don't learn from a young age, it's going to catch up with you in your 40's, 50's, and 60's, when you actually will need some salt restriction..."

In response to what Bakris calls the "outcomes mafia, who say that unless we have an outcomes study it's impossible to make any conclusions," he remarked, "[C]ommon sense has to prevail. The FDA as a regulatory body has accepted the notion that lowering of blood pressure is a validated surrogate for a reduction in cardiovascular mortality and morbidity... To do an [outcomes] clinical trial...you would need well over 100 000 people, so it's not feasible. Let's be reasonable."

"If you are telling me that reducing BP by 5 to 7 mm Hg, which is what most of these salt restrictions will do, is not going to translate into a benefit, then I think we have to throw out all the clinical trials we have to date...[No meta-analysis of any clinical trials] fails to show that a reasonable reduction in blood pressure has not [sic] been associated with a benefit, certainly on stroke and to a lesser degree on coronary events...[T]he data are very consistent."

"I think the conflict of interest here needs to be established,...With all due respect, many of the people who are saying this are also consultants to the Salt Institute, they are lobbyists in their own right. They spin the data to make it suit what their needs are."

* Higher chocolate intake is related to a decreased risk for cardiometabolic disorders overall in 5 of 7 studies.
* Higher chocolate intake is related to a reduced risk for cardiovascular disease by 37%, diabetes by 31%, and stroke by 29%. There is no link between chocolate intake and heart failure.

Buitrago-Lopez A, Sanderson J, Johnson L, et al. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ 2011; DOI:10.1136/bmj.d4488

Five of the seven studies showed a significant inverse association between chocolate consumption and cardiovascular disease. Compared with the lowest levels of chocolate consumption, the highest levels of consumption were associated with a 37% reduction in the risk cardiovascular disease and a 29% reduction in the risk of stroke. There was no association between chocolate consumption and heart failure risk and no association in women between chocolate consumption and the incidence of diabetes.

Lead study author Adriana Buitrago-Lopez, RN, and colleagues noted that “Although overconsumption can have harmful effects, the existing studies generally agree on a potential beneficial association of chocolate consumption with a lower risk of cardiometabolic disorders. Our findings confirm this, and we found that higher levels of chocolate consumption might be associated with a one-third reduction in the risk of developing cardiovascular disease.”

All-cause, cardiovascular, and respiratory mortality were elevated among participants with glucose intolerance. The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l (83 mg/dl [95% CI 4.2-5.3]). The dose-response relation was best fitted by a single slope above this level, with no evidence of nonlinearity, compared with Cox models using other threshold levels, and those containing log 2hBG terms. There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l. Between this level and 11.1 mmol/l (200 mg/dl), the age-adjusted hazard ratio was 3.62 (95% CI 2.3-5.6). The graded relationship was attenuated by 45% after adjustment for baseline coronary heart disease (CHD), BMI, systolic blood pressure, blood cholesterol, smoking, physical activity, lung function, and employment grade.
CONCLUSIONS:
A threshold model with linear slope [rising from 83mg/dL] best described the dose-response relationship between postload blood glucose and CHD mortality risk.

Cardiovascular risk is already increased in people with impaired glucose tolerance. Moreover, higher-than-optimum blood glucose is a major cause of cardiovascular mortality in most world regions of the world. Whether dysglycemia is a marker for a more complex metabolic condition or may directly contribute to excess cardiovascular risk is still a matter of debate. However, experimental work has shown how increased glucose level can trigger multiple mechanisms of susceptibility to atherosclerosis, and diabetes prevention trials have indicated that along with reduction of the rate of conversion toward diabetes, significant improvement in cardiovascular risk factors occurs. Moreover, in the STOP-NIDDM trial, targeting postprandial glucose was associated with reduction in new cases of hypertension, myocardial infarction, and any cardiovascular events. In conclusion, dysglycemia should be included in the list of established cardiovascular risk factors and early treatment introduced in the attempt to improve cardiovascular morbidity and mortality.

[We excluded subjects] with diabetes or cardiovascular disease (CVD) at the baseline examination (1971–1974)....
CONCLUSIONS—Long-term hyperglycemia and subdiabetic glycemia increase risk for microalbuminuria. Microalbuminuria, type 2 diabetes, and CVD seem to arise together over the course of decades, consistent with the hypothesis that they share a common antecedent.

Strict glycaemic control is strongly advocated in people with type 2 diabetes to prevent vascular disease. However, the outcomes of two large clinical trials have indicated the potential dangers of pursuing this policy in those at high risk of cardiovascular disease, with an excess of fatal vascular events being associated with a higher frequency of severe hypoglycaemia. Hypoglycaemia secondary to insulin and sulphonylurea therapy is often associated with serious morbidity; anecdotal evidence has long implicated hypoglycaemia as a potential cause of myocardial ischaemia or a cardiac arrhythmia. Hypoglycaemia provokes sympatho-adrenal activation and counterregulatory hormone secretion, which exert pronounced cardiovascular effects. Although well tolerated in healthy people, the superimposition of these profound physiological effects on a diseased coronary vasculature and a dysfunctional cardiac conductive system may induce serious or even fatal cardiovascular events. These risks should influence therapeutic targets and the approach to diabetes management in people with diabetes with established vascular disease in whom exposure to severe hypoglycaemia could be dangerous.

[Six men age 30-65, overweight but otherwise healthy, consumed 2 tablespoons of culinary spices—rosemary, oregano, cinnamon, turmeric, black pepper, cloves, garlic powder and paprika—in each serving of a test meal of chicken curry, Italian herb bread, and a cinnamon biscuit, or an otherwise identical control meal without the spices.]
"We selected [spices that had shown] potent antioxidant activity previously under controlled conditions in the lab."
[The spices increased antioxidant activity in the blood by 13% and decreased insulin response decreased by about 20%.]
Oxidative stress contributes to heart disease, arthritis and diabetes. [The spice dose used provided equivalent antioxidants to those in 5 oz. red wine or 1.4 oz. dark chocolate.]
Adding 2 tablespoons of spices to meals did not cause stomach upset in the participants. "They enjoyed the food and had no gastrointestinal problems...The participants were notified ahead of time that they would be eating highly spiced foods..."

Just three weeks of a high-fibre, low-fat diet and moderate exercise could slow key changes in the body crucial to the development of diabetes... <br />
The new study, along with previous work on the so-called Pritkin diet and exercise programme, found that just 3 weeks of the programme reversed the clinical diagnosis of type 2 diabetes - or its precursor, called metabolic syndrome. The programme worked in half of the overweight patients following it. <br />
"[Contrary to common belief,] type 2 diabetes and metabolic syndrome can be reversed solely through lifestyle changes," says Christian Roberts [of UCLA], who led the study. <br />
The prevailing view is that such an improvement could take place only in months or years rather than weeks, Roberts told New Scientist. "The effect can be very dramatic given that, of the vast majority of people who go through the programme, at least 50% are no longer clinically defined as diabetic after three weeks, which suggests this disease is reversible."

Heart disease is a leading killer in industrialized nations and the No. 1 killer of women in the US. Women [under 50 are hard] to assess for long-term cardiovascular risk. <br />
“Nearly all women under 50 [are at low risk. As they age, risk increases dramatically. Low fitness levels help identify long-term risk]”.... <br />
Blood-based and imaging techniques [are used to improve risk prediction;] fitness has not been examined until now....<br />
[The JACC study] evaluated more than 11,000 men....Within each age group, higher levels of fitness were associated with lower levels of traditional risk factors. <br />
[The Circulation study] examined more than 66,000 participants without cardiovascular disease, ages 20 to 90[ who were] followed until death or the end of the study period; follow-up lasted up to 36 years....[Adding fitness to the traditional risk factors significantly improved] ability to classify participants’ short-term (10 years) and long-term (25 years) risk.

[Among nearly 12,000 US nurses with a history of heart disease or stroke, regular coffee drinkers were no more likely to die than non-drinkers during a study spanning over 20 years for some subjects. No link was found between coffee intake and risk of death from heart attack, stroke or any other cause—even among women who drank 4 or more cups a day]. <br />
[The long-running Nurses' Health Study began tracking more than 100,000 female nurses in 1976. The new research focuses on 11,697 women who developed heart disease or had a stroke from 1976 to 2002.] Of those women, 62% continued to drink [unde]caffeinated coffee after their diagnosis. <br />
Overall, 1159 women had died by 2004. That risk was no greater among coffee drinkers than non-drinkers, including women who drank at least four 4 cups a day.... <br />
Some research [links coffee to increased blood pressure in those who metabolize caffeine slowly; the reverse pattern shows] in people who quickly process caffeine—more coffee, lower heart risks.

RECOVERY HEART RATE<br />
<br />
"Recovery" heart rate is a determination of how long it takes your heart rate to return to normal after you stop exercising. This concept is mostly for people who are out of shape. People with a slower recovery are at higher risk of sudden death than people who recover more quickly.<br />
<br />
Researchers at the Cleveland Clinic exercised patients on a treadmill, then measured their heart rate 1 minute after running stopped and compared it to their peak heart rate. The failure of heart rate to fall rapidly after exercise stopped was associated with increased overall mortality (Cole CR, et al. 1999).<br />
<br />
A similar result was seen in a study from France. Cardiologists exercised patients on a stationary bike for 10 minutes, then measured their heart rate 1 minute after cycling stopped and compared it to their peak heart rate. Patients with the poorest recovery had 2.1 times the risk of sudden death compared to patients with the best recovery (Jouven X, et al. 2005).

[4,045 men age 60 to 79 years old participated in this analysis,] classified as having no prior diabetes or MI, late-onset diabetes (diagnosed >60 years of age), early-onset diabetes (diagnosed <60 years of age), or having a prior MI. During follow-up, there were 373 major CHD events and 1,112 deaths from all causes.<br />
<br />
Early- and late-onset diabetes were both associated with an increased risk of major CHD, cardiovascular disease (including cardiovascular disease mortality and nonfatal MI), and all-cause mortality compared with individuals without diabetes, even after adjustment for various risk factors, including C-reactive protein (CRP). The risk, however, was significantly higher among individuals who developed diabetes before 60 years old -- those with an average disease duration of 16 years -- than among those who developed diabetes later in life. Those who developed diabetes earlier in life had a risk of CHD and cardiovascular disease similar to men with a prior MI.

If you work 11-hours a day average...your risk of developing heart disease will be 67% higher...[R]esearchers believe doctors should include data on a patient's working hours when listing risk factors for heart disease, such as smoking status, total body weight, diabetes, and blood pressure. <br />
[Analysis of 11 years of follow up on 10,000 civil servants, 7095 of whom began the study with no signs of heart disease, used data on heart attacks and development of other cardiovascular diseases, medical screening results every 5 years, and health and hospital records]. <br />
[Adding hours generally worked each week to a list of risk factors improved heart disease risk assessment by 5%.] <br />
Doctors commonly use the Framingham risk model to determine an individual's risk for developing coronary heart disease over a ten-year period. This risk model includes several factors, including blood pressure, smoking status, lipid levels, etc., but no psychological factors, such as workplace stress.

Conclusions In this population-based cohort, systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality.

[A new study finds] low salt intake does not prevent hypertension and raises heart attack and stroke risk. [S]ome of its limitations have exacerbated the salt debate to new heights. Even [the CDC, in a highly unusual step, pointed out flaws in the study's conclusions]...<br />
Researchers from the University of Leuven, Belgium, measured urinary salt (sodium) levels in 3,681 [subjects over 8 years;] 1,499 completed every scheduled urine test. When the study began, none of them had any cardiovascular disease [and] 2,096 had normal blood pressure levels...[T]hose with lower salt intake over [8 years] had a higher risk of heart attack and stroke... <br />
[T]his is not the first study to point to a higher death risk among low salt intakers....Dr. Michael Alderman from the Albert Einstein College of Medicine [also found] low salt intake meant a higher risk of death. Dr. Alderman [edits the American Journal of Hypertension, and] used to be an unpaid consultant for the Salt Institute.

When oxidized LDL [adheres to an artery wall, a series of reactions occur to repair the damage it causes].... <br />
The body's immune system responds to the damage to the artery wall caused by oxidized LDL by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized-LDL forming specialized foam cells. These white blood cells are not able to process the oxidized-LDL, and ultimately grow then rupture, depositing a greater amount of oxidized cholesterol into the artery wall. This triggers more white blood cells, continuing the cycle. <br />
Eventually, the artery becomes inflamed. The cholesterol plaque causes the muscle cells to enlarge and form a hard cover over the affected area. This hard cover is what causes a narrowing of the artery, reduces the blood flow and increases blood pressure.

Calcium scanning shows plaques in coronary arteries long before symptoms develop, and has been consistently shown to effectively identify patients with silent heart disease and those at risk for a heart attack or sudden death. The test is rarely covered by insurance although numerous, consistent studies show that it detects these patients more accurately than standard blood tests... <br />
[Screened patients had better long-term risk profiles than the unscreened].... <br />
[After 4 years, patients initially scanned significantly improved in several risk factors: systolic blood pressure, LDL, waist size among the round, and weight in the heavy]. <br />
[Framingham Risk Score, a widely used assessment of] risk of having a heart attack or dying within 10 years, increased in the no-scan group, but remained unchanged in those who had initial scans. Individual risk factor profiles, based on the 7 modifiable risk factors [identified to all subjects, improved in both groups, but more] in the scan group.

[Black heart failure patients are hospitalized more often than white patients. We looked for racial differences] in health literacy and access to outpatient medical care, and to identify factors associated with these differences.... <br />
Black race was strongly associated with worse health literacy and all measures of poor access to care in unadjusted analyses. After adjusting for demographics, noncardiac comorbidity, social support, insurance status, and socioeconomic status (income and education), the strongest associations were seen between race and: health literacy (OR 2.13, 95% CI 1.46 to 3.10), absence of a medical home (OR 1.76, 1.19-2.61), and cost as a deterrent to seeking health care (OR 1.55, 1.07 to 2.23). <br />
[I]mportant racial differences in health literacy and access to care exist among patients with heart failure. These differences persist even after adjustment for a broad range of potential mediators, including educational attainment, income, and insurance status.

The treatment goals for patients with diabetes have evolved significantly over the last 80 years, from preventing imminent mortality, to alleviating symptoms, to the now recognized objective of normalization or near normalization of glucose levels with the intent of forestalling diabetic complications....

Meta-analysis of four clinical trials (ACCORD, ADVANCE, UKPDS and VADT) assessed ` effects of more intensive...glucose control on the risk of cardiovascular events in patients with type 2 diabetes. The meta-analysis comprised 27,049 participants who experienced a total of 2,370 major cardiovascular events over 4.4 years. The risk of having a major cardiovascular event was reduced by 9% in patients who received the more intensive compared with the less intensive glycemic control (HR, 0.91; 95%CI, 0.84-0.99). In particular, the risk of nonfatal/fatal myocardial infarction was reduced by 15% in the more intensive versus the less intensive treatment group. However, the risk of severe hypoglycemia was increased by more than 2-fold (HR, 2.48; 95%CI, 1.91-3.21) in patients receiving the more intensive glycemic control. Thus, caution should be exercised in assigning intensive glucose-lowering strategies to patients with type 2 diabetes (Turnbull, F.M. et al. Diabetologia 2009, 52(11): 2288).

The total symptom distress score (range 0–100) was relatively low for diabetic subjects (mean ± SD 8.4 ± 9.4), although it was significantly different from that for subjects with IGM (6.5 ± 7.1) and NGM (6.1 ± 7.9) (F = 3.1, 2 d.f., P = 0.046). Ischemic heart disease was associated with elevated DSC-R scores on three subscales, whereas depression showed higher symptom distress levels across all DSC-R domains.<br />
<br />
CONCLUSIONS—Worsening glucose metabolism is associated with increasing diabetes-related symptom distress. This relationship is attenuated by ischemic heart disease and particularly by depression.

Complications and comorbidities of type 2 diabetes account for high costs and reduced life expectancy. There are only incomplete data on the prevalence of those secondary disorders in Germany. <br />
A total of 390,459 data sets of single patients in Bavaria, who were enrolled to disease management program "type 2 diabetes" between 2004 and 2006, were studied. Data obtained from the initial visit documentation were screened retrospectively and analyzed with statistical methods. <br />
About three-fourths of the diabetic population have hypertension. Adiposity and lipometabolic disorder each are found in half of the population. Macro- and microangiopathic disease each occur in about twenty percent. Calculated prevalences of nephropathy, retinopathy and neuropathy are lower than expected. <br />
Complications of type 2 diabetes were frequently observed in the study population. With regard to neuropathy, nephropathy and retinopathy type-2-diabetics should be examined even more thoroughly.

Results
The prevalence of depression was 11% in the total sample with little difference between the groups with and without any vascular co-morbidity (11.2% vs 10.0%). Single vascular co-morbidities were not associated with increased rates of depression. The final model predicting depression included: having multiple vascular co-morbidities compared with none; having less social support; having experienced a recent stressful life event; female sex; and being a smoker.<br />
Conclusions/interpretation
Rates of depression in those with one additional vascular co-morbidity did not differ from patients with diabetes only. Vascular co-morbidities were only associated with higher depression scores in case of multiple co-morbidities.

From a clinical perspective, type 2 diabetes is a cardiovascular disease, an observation that is supported by a range of epidemiologic, postmortem, and cardiovascular imaging studies. Vascular wall dysfunction, and particularly endothelial dysfunction, has been posited as a "common soil" linking dysglycemic and cardiovascular diseases. Vascular wall dysfunction promoted by environmental triggers (e.g., sedentary lifestyle) and metabolic triggers (chronic hyperglycemia, obesity) has been associated with the upregulation of reactive oxygen species and chronic inflammatory and hypercoagulable states, and as such with the pathogenesis of type 2 diabetes, atherosclerosis, and cardiovascular disease.

[Increased risk for diabetes and coronary heart disease can be predicted even from "normal" BMI (<25 Kg/m2). Each one-unit rise in BMI correlates to ~10% increased risk for early adulthood DM2, and a 12% increase in heart disease risk. Higher risk is significant at an age-17 BMI of ≥ 23.4 Kg/m2 for diabetes and ≥ 20.9 Kg/m2] for heart disease. <br />
[BMI at age 17 predicts diabetes risk mainly by correlating with BMI later in life. For heart disease, BMI at adolescence and at adulthood independently predict risk].... <br />
"[A teen with relatively high BMI who becomes a lean adult practically eliminates added diabetic risk. That person's heart disease risk remains elevated compared to the lean teen who became a lean adult, though still] lower than that of the heavier teen who became an obese adult.... <br />
[Eating habit modification can halt and even reverse] progression of atherosclerosis, the underlying process of heart disease.

Diabetes drugs metformin, gliclazide and repaglinide proved more effective than other treatments in lowering the risks of cardiovascular disease and death, according to a study of more than 100,000 Danish people older than 20. Glimepiride, glibenclamide, glipizide and tolbutamide were linked to a higher risk of all-cause mortality as well as to a higher risk of heart attack, stroke and cardiovascular death, the study found.

The benefits of blueberry consumption have been demonstrated in several nutrition studies, more specifically the cardio-protective benefits derived from their high polyphenol content. Blueberries have shown potential to have a positive effect on everything from aging to metabolic syndrome....Plant polyphenols have been shown to fight adipogenesis, which is the development of fat cells, and induce lipolysis, which is the breakdown of lipids/fat. <br />
“I wanted to see if using blueberry polyphenols could inhibit obesity at a molecular stage,” said [researcher Shiwana] Moghe. The study was performed in tissue cultures taken from mice. The polyphenols showed a dose-dependent suppression of adipocyte differentiation. The lipid content in the control group was significantly higher than the content of the tissue given three doses of blueberry polyphenols. The highest dose of blueberry polyphenols yielded a 73% decrease in lipids; the lowest dose showed a 27% decrease.

This study [tested] the hypothesis that 16 weeks of 60,000 IU monthly supplementation of oral vitamin D(3) would improve flow-mediated dilation (FMD) in African Americans [by a randomized, double-blind, placebo-controlled clinical trial]...At 16 weeks of placebo [or 60,000 IU monthly oral vitamin D(3), serum levels] of 25-hydroxyvitamin D (25(OH)D) increased from 38.2 ± 3.0 to 48.7 ± 3.2 nmol/l and 34.3 ± 2.2 to 100.9 ± 6.6 nmol/l, respectively....[S]ignificant improvements in FMD were only observed in the vitamin D group...Similarly, the vitamin D group exhibited an increase in absolute change in diameter (0.005 ± 0.004 cm) and FMD/shear (0.08 ± 0.04 %/s(-1), area under the curve (AUC) × 10(3)) following treatment, whereas no change (-0.005 ± 0.002 cm and -0.02 ± 0.02 %/s(-1), AUC, respectively) was observed [with] placebo. Supplementation of 60,000 IU monthly oral vitamin D(3) (~2,000 IU/day) for 16 weeks [improves] vascular endothelial function in African-American adults.

Apples are truly a “miracle fruit” that convey benefits beyond fiber content. Animal studies have shown that apple pectin and polyphenols in apple improve lipid metabolism and lower the production of pro-inflammatory molecules. [New research is the first to evaluate] long-term cardioprotective effects of daily consumption of apple in postmenopausal women.... <br />
[160 women ages 45-65 randomly received dried apples (75g/day) or dried prunes to eat daily] for a year. Blood samples were taken at 3, 6 and 12-months...[At 6 months, apple-eating women showed a 23% decrease in LDL ("bad") cholesterol. D]aily apple consumption also led to a lowering of lipid hydroperoxide levels and C-reactive protein... <br />
[Apple consumption increased HDL ("good") cholesterol by c. 4%.The extra 240 calories per day from the dried apple did not cause weight gain in apple-eaters, who] lost on average 3.3 lbs...Part of the reason for the weight loss could be the fruit’s pectin...known to have a satiety effect.

• Peanuts [contain heart-healthy monounsaturated fat that can help lower LDL (“bad”) cholesterol. Eating peanuts and nuts can lower heart attack risk: their resveratrol may help prevent oxidation of LDL cholesterol and may stop platelets from forming clots. Peanuts are naturally low in sodium]...<br />
• [Eating peanuts, nuts, or their butters at least 5 times a week lowers diabetes risk by c. 20%.]<br />
• [Eating peanuts twice a week may lower risk of colorectal cancer by 58% in women and 27% in men: resveratrol, along with] phytic acid and phytosterols. <br />
• [Women who eat at least one oz. of peanuts or nuts each] week are 25% less likely to develop gallstones... <br />
• [Despite nuts' high fat and calories, those who eat peanuts and other nuts at least twice a week are less likely to gain weight than those who don’t].... <br />
[In 10 peanuts: 60 calories, 2 g carbohydrate, 5 g fat, 2.4 g protein, 1 mg sodium, 0 mg cholesterol. Peanuts are rich in vitamin E, niacin, folate, potassium, magnesium, copper.]

[The natural foods-based Mediterranean] diet is associated with a lower risk of hikes in blood pressure, blood sugar and triglycerides, as well as a reduced risk of a drop in good cholesterol—all of which are risk factors in metabolic syndrome. <br />
"It is one of the first times in the literature, maybe the first, that someone looks through a meta-analysis at the cardiovascular disease risk factors and not only the hard outcome" of heart disease and other conditions.... <br />
The Mediterranean diet is a pattern marked by daily consumption of fruits, vegetables, whole grain cereals, and low-fat dairy products; weekly consumption of fish, poultry, tree nuts, and legumes; high consumption of monounsaturated fatty acids, primarily from olives and olive oils; and a moderate daily consumption of wine or other alcoholic beverages, normally with meals. Red meat intake and processed foods are kept to a minimum.

[Metabolic syndromedescribes the presence of at least 3] unhealthy traits that spell bad news for the heart, such as belly fat, high blood pressure, low levels of "good" HDL cholesterol, elevated fat levels in the blood (triglycerides), and high blood sugar.... <br />
[35 clinical trials suggest that faithfully eating a Mediterranean diet can modestly] improve each of those traits.... <br />
"[It's reasonable to recommend the Mediterranean diet. W]e can't say that this diet reduces the risk of diabetes." <br />
Nor does the study [show that the diet cuts the risk of death from heart disease,] linked to metabolic syndrome. <br />
[Cost may] could be a barrier to adopting a diet that emphasizes fresh foods, olive oil and fish.... <br />
Olive oil[, a monounsaturated fat that "protects" levels of HDL cholesterol, can cost] more than other cooking oils on supermarket shelves. [When one doctor] suggests this diet to his patients, he makes the point that the much cheaper canola oil is also high in monounsaturated fats.

Medical research tends to practice what philosophers of science call reductionism—trying to understand the nature of something complex (like nutrition and health) by reducing it to the interactions of its parts. Early studies showing that eating more fruits and vegetables was good for health led to a focus on food components, such as fiber, vitamins, and antioxidants. None come close to offering the benefits of food itself. The same story appears to be playing out with fish and fish oil.<br />
If you have heart disease, taking fish oil doesn't seem to replace eating fish...The benefit could be due to fish oil in its natural state (in fish), something else in fish, or maybe the fact that eating fish means eating less red meat. <br />
What if you just don't like fish? Then make sure your doctor has prescribed the best medical therapy for your condition and you are following his or her advice. That is far more important than taking fish oil.

“High-fiber diets can help [lower weight, lower cholesterol and improve hypertension—the major determinants of] long-term risk for cardiovascular disease.” <br />
[The American Heart Association recommends] 25 grams of dietary fiber or more a day. Lloyd-Jones said you should strive to get this daily fiber intake from whole foods, not processed fiber bars, supplements and drinks.<br />
The study of a nationally representative sample of about 11,000 adults considered diet, blood pressure, total cholesterol, smoking status and history of diabetes in survey participants and then used a formula to predict lifetime risk for cardiovascular disease....“Younger (20 to 39 years) and middle-aged (40 to 59 years) adults with the highest fiber intake, compared to those with the lowest fiber intake, showed a statistically significant lower lifetime risk for cardiovascular disease.” <br />
In adults 60 to 79 years, dietary fiber intake was not significantly associated with a reduction in lifetime risk...

The presence of diabetes mellitus approximately doubles the risk of a wide range of vascular diseases according to the study. Evidence is also emerging that diabetes is associated with nonvascular conditions. Fasting glucose levels of more than 100 mg/dL (5.6 mmol/L) were associated with death, but levels of 70 to 100 mg/dL (3.9 - 5.6 mmol/L) were not. Compared with a 50-year-old individual without diabetes, a similar individual with diabetes died 6 years earlier, on average, with excess nonvascular deaths accounting for approximately 40% of the difference in survival time.

[Type 2 diabetes "might as well be a CVD" given the corrosive cardiac effects of unregulated glucose: ≥ 65% of patients die of] heart disease or stroke. <br />
[20 years of data show diabetes remission in 70% of post-bariatric-surgical patients at 2 years, 30% at 15 years. At 20 years, surgery reduced new cases of diabetes 80% in obese patients not diabetic at baseline.] <br />
[Surgery's protective effect seems stronger and longer-lasting than its maintenance of remission. New heart attack or stroke fell 30% or more post-surgery]....<br />
[Bypass patients showed more improvement in blood pressure, heart rate, triglycerides, LDL cholesterol, and insulin resistance, and] in heart function and "geometry", leading to greater cardiac efficiency....<br />
[Surgery, especially procedures to reroute rather than restrict the GI tract, seems to change hormonal secretions in the gut, which may drive its impressive success in improving or resolving the disease.]

“[CVD risk factors have their origins in childhood. We examined the effects of brief, intense exercise] compared to traditional endurance exercise on the markers of CVD in young people.”<br />
[Volunteer school children, forty seven boys and ten girls, were randomly assigned to] moderate (MOD) and high intensity (HIT) exercise teams[. The HIT group ran a series of 20 meter sprints over 30 seconds. T]he MOD group ran steadily for a period of 20 minutes. <br />
[At seven weeks the MODs had trained for 420 minutes; the HITs had trained for] 63 minutes. The estimated energy expenditure for the HIT intervention was 907.2 kcal in comparison to 4410 kcal for the MOD group... <br />
[Both groups showed improved CVD risk factors, with HIT group gains occurring in only 15% of the MOD] exercise time. <br />
[Brief, intense exercise produced] significant improvements in cardiorespiratory fitness, blood pressure, body composition and insulin resistance in healthy adolescent youth after a 7 week intervention...

“Our findings suggest that AMPK suppression and SREBP activation are a root cause of fatty liver and hyperlipidemia in type 2 diabetes and its associated vascular complications such as atherosclerosis,” said senior author Mengwei Zang, MD, PhD, an assistant professor of medicine at BUSM. <br />
According to the researchers the potential health benefits of polyphenols have been gaining increasing interest. “In our studies, AMPK is potently and persistently activated by polyphenols including the natural compound resveratrol, which is present in red wine, grapes and green tea, as well as the synthetic polyphenol S17834, which is a drug candidate provided by Servier Pharmaceutical Company,” explained Zang. “AMPK directly suppresses SREBP via its phosphorylation, inhibiting the activity of its target lipogenic enzymes in the liver, and accounting for the protective effects of the polyphenols on fatty liver, blood lipids and diabetic atherosclerosis,” she added.

[Bankruptcy and dispossession for health care hardly sounds like "access". But then I don't work for the World Bank.—DMM]
Despite economic growth and lengthened lifespans‚ the region's poor have seen little benefit from improved nutrition‚ higher income‚ or healthcare access. [In Bangladesh‚ India‚ Nepal‚ Pakistan‚ Afghanistan‚ Maldives‚ Bhutan‚ and Sri Lanka‚ people] experience their first heart attacks at an average age of 53‚ six years earlier than people elsewhere. Heart disease is the leading cause of death for South Asians aged 15 to 69‚ and other non–communicable diseases account for 55% of the region's total disease...Many poor people in these countries "have to pay for most of their care out of their savings or by selling their possessions‚ and then find themselves caught in a poverty trap where they can't get better and they can't work‚" said co–author Michael Engelgau‚ a World Bank senior public health specialist.
[I have my doubts about "improved" nutrition as well.—DMM]

400 severely obese people with an average age of 42 who had gastric bypass surgery...were compared with a reference group of more than 300 severely obese individuals who did not have the surgery. After two years‚ patients' body–mass index fell from an average of nearly 48 to about 32‚ with an average weight loss of about 100 pounds. Patients who received the surgery also had smaller waistlines‚ lower blood pressure‚ lower heart rate‚ healthier cholesterol levels‚ and less insulin resistance‚ a precursor to diabetes. Echocardiograms showed that the patients' heart structures had been "remodeled" by reductions in the left ventricular mass and right ventricular cavity area‚ indicating that the hearts were less stressed. The study will continue to follow these patients to observe the weight–loss maintenance‚ ongoing heart health‚ and long–term heart conditions.

Orexigen Therapeutics Inc. has received backing from a Food and Drug Administration (FDA) panel for the new diet pill Contrave‚ a combination of the antidepressant bupropion and the addiction treatment naltrexone. <br />
The drug may become the first prescription weight–loss drug approved in more than 10 years. Outside FDA advisers voted 13–7 that the pill's weight–loss benefits for obese people are greater than its potential long–term cardiovascular risks. The FDA is expected to make a decision on the drug in early 2011.<br />
<br />
Boston Globe (12/08/10)

The U.S. Agriculture and Health and Human Services (HHS) departments [advise Americans over age 51]‚ all African Americans‚ and anyone with hypertension‚ diabetes‚ or chronic kidney disease to reduce [daily sodium intake to] little more than half a teaspoon per day. For everyone else‚ the government still recommends about a teaspoon a day‚ 2‚300 milligrams‚ which is about one–third less than the average consumption. The Institute of Medicine says that it may take years for consumers to become accustomed to a lower–salt diet. The government has issued its recommendations along with new dietary guidelines‚ which are issued about every five years. Dr. Howard Koh‚ assistant secretary at HHS‚ says that food companies must make cuts to accommodate the recommended salt reductions. The government guidelines say people should buy items labeled as low sodium‚ use little or no salt when cooking or eating‚ consume more foods prepared at home‚ and gradually reduce sodium intake.

Cardiovascular disease (CVD) is the leading cause of death in the United States and globally, representing 30% of all deaths worldwide. "Cardiovascular disease risk increases beginning at systolic blood pressure levels of 115 mm Hg...In adults 55 years and older, lifetime risk of developing hypertension is greater than 90%.... <br />
[In a meta-analysis of 25 studies], the researchers found that there was a 23% reduction in risk of stroke; 29% reduction in risk of congestive heart failure (CHF) events; 15% reduction in risk of composite (a combination of disease outcomes) CVD events; and a 13% reduction in risk for all-cause mortality.

More than 90% of [New York's diabetics] have elevated blood pressure, cholesterol or blood sugar--placing them at increased risk of heart attacks, strokes and other complications....Some 500,000 New York City adults have been diagnosed with diabetes; 200,000 more have the condition but don’t know it...1.4 million non-diabetic New Yorkers [may be "pre-diabetic"....A]dults making less than $20,000 a year were almost twice as likely as higher-income adults to have diabetes (15.7% vs. 8.9%). Black New Yorkers were at higher rates than whites (14.5% vs. 10.7%). And Asian New Yorkers had the highest rates of both diabetes (16.1%) and pre-diabetes (32.4%)....[Half of diagnosed diabetics] had elevated blood pressure and nearly two thirds had high cholesterol. Many had not been prescribed medications for either condition, and only 12% were on insulin – compared with 23% nationally...New York City’s medical institutions are failing to meet nationally recognized standards for managing diabetes.

New research from the University of Cincinnati (UC) implicates the primary chemical used to produce hard plastics—bisphenol A (BPA)—as a risk factor for the metabolic syndrome and its consequences.

In a laboratory study, using fresh human fat tissues, the UC team found that BPA suppresses a key hormone, adiponectin, which is responsible for regulating insulin sensitivity in the body and puts people at a substantially higher risk for metabolic syndrome.

Metabolic syndrome is a combination of risk factors that include lower responsiveness to insulin and higher blood levels of sugar and lipids. According to the American Heart Association, about 25 percent of Americans have metabolic syndrome. Left untreated, the disorder can lead to life-threatening health problems such as coronary artery disease, stroke and type 2 diabetes.

Most epidemiological data implicate postprandial hyperglycemia in the development of cardiovascular disease, whereas the link between fasting glycemia and diabetic complications is inconclusive. Moreover, in many studies, postprandial glycemia is a better predictor of cardiovascular risk than HbA1c level. Postprandial glucose may have a direct toxic effect on the vascular endothelium, mediated by oxidative stress that is independent of other cardiovascular risk factors such as hyperlipidemia. Postprandial hyperglycemia also may exert its effects through its substantial contribution to total glycemic exposure. The present review examines the hypothesis that controlling postprandial glucose level is an important strategy in the prevention of cardiovascular complications associated with diabetes.