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Rev up Your Heart

Old-fashioned cardio can also keep your memory spry by improving a number of aspects of brain functions. Last year, researchers from the University of Illinois, Urbana, put two groups of older, healthy adult volunteers on different regimens. One group did aerobic training three times a week for 1 hour; the other did non-aerobic stretching and toning. MRIs taken after 3 months showed that the aerobics group actually increased their brains' volume (which could reflect new neurons or cells) and white matter (connections between neurons) in the frontal lobes, which contribute to attention and memory processing. The aerobic exercisers, who ranged from age 60 to 79, had the brain volumes of people 2 to 3 years younger, said Arthur Kramer, PhD, who reported his results in the Journal of Gerontology: Medical Sciences. Taking a 1-hour walk at a brisk, slightly breathless pace three times a week will likely confer the same benefits.

Study: Don't rush into heart procedures

Combo of lifestyle changes, drugs found as effective as angioplasty in less severe cases

Mar 27, 2007 04:30 AM
Joseph Hall
Health Reporter
The Star, Canada

Angioplasty procedures performed on millions of North Americans are no more effective at preventing many heart attacks than aggressive medication, diet and exercise regimens, according to a major new study led by Hamilton researchers.

In less threatening cases, the use of angioplasty and stents to open up partially blocked arteries should be considered only after rigorous medication and lifestyle changes have been tried, says a McMaster University cardiologist who helped lead the study.

"We're not saying that angioplasty is not necessary (for many)," says Dr. Koon Teo, who led the Canadian arm of the study.

"We do say that for people with angina (chest pain) and partial blockages, angioplasty might not be necessary in the initial stages. Instead of having it as the first line, we should make sure they get medical therapy."

The study will be published next month in the New England Journal of Medicine. Results were announced yesterday at a American College of Cardiology Conference in New Orleans . During angioplasty, a tiny balloon is inserted into a coronary artery via a catheter to the blockage site, where it's blown up to reopen the vessel. Most heart surgeons now also insert a stent, a meshed metal tube that expands onto the artery wall to keep it open when the balloon is removed.

The procedure has become an almost automatic option for many physicians treating partial artery blockages, Teo says.

However others "felt, and still feel, that too many of these angioplasties were being done for no good reason at all except for seeing a blockage," he says.

His study, which looked at 2,287 patients in 50 U.S. and Canadian hospitals, showed that aggressive, less expensive and non-invasive treatments were just as effective at preventing heart attacks and deaths.

All the patients involved had so-called stable coronary artery disease. Half were treated with angioplasty and Optimal Medical Therapy, the other half with OMT alone.

The latter included the use of cholesterol reducing statins, aspirin, beta blockers, blood sugar and blood pressure controls for diabetics, stop-smoking instruction, weight reduction and exercise.

To their surprise, researchers found the number of heart attacks and deaths recorded after a median 4.6 years were almost identical in both groups.

The study found 211 heart attacks and deaths occurred in the angioplasty group and only 202 among patients who underwent medical therapy alone.

The study was conducted between 1999 and 2004 and involved people suffering from angina and at least 70 per cent blockage in one or more coronary arteries. Some 41 per cent of the patients were Canadian, Teo says.

The angioplasty group did experience slightly better relief from chest pain, although the other patient group also showed significant improvement, he says.

Teo says angioplasty procedures are low risk, but the danger is many patients tend to believe post-surgery that they've been "cured" and can continue poor habits such as "a steak every second day," says Teo.

Dr. Vladimir Dzavik of University Health Network, a co-investigator, says the study does not apply for heart patients with severe arterial obstructions or a history of cardiac arrest. In more stable cases, however, medical therapies "ought to be tried first for sure," he says. "People are jumping too fast to (surgical) intervention."

Ontario Health Insurance Plan data shows about 21,500 angiogram procedures were done in the 2005-2006 fiscal year. Billings to OHIP were about $8.2 million, although it is not clear how many involved first-line treatments of less serious cases.

Salt Awareness

When it comes to adding extra flavour to foods, you hear common phrases like, "may I have the salt please", or "this food requires more salt". Do we actually need all this extra salt in our diet? Health experts emphatically say no! The reason for this is that excessive intakes of salt predisposes one to developing high blood pressure, a known risk factor for cardiovascular disease (CVD). Professor of cardiovascular medicine and chairman of WASH (World Action on Salt and Health) group, Graham MacGregor, says, "CVD is the leading cause of death and disability worldwide, and it has been estimated that if we just reduce our salt intake by a few grams per day, we can all reduce our risk of CVD". Most people consume about 10-15g (2-3 teaspoons) salt per day, more than twice the recommended limit of 5g per day (1 teaspoon). WASH is a global group that aims to reduce salt intakes worldwide by persuading food companies to reduce the salt content of their food products and at a government level, to have policies on salt reduction in place. Global health experts from 28 countries are joining hands this week to help increase awareness and urge people to eat less salt! Activities planned around the world include, surveys of the salt content of restaurant meals, speaking to chefs and government, increasing awareness amongst consumers by having posters and providing them with leaflets of information. Individuals need to take the onus upon themselves to change their dietary habits in the interest of improving their health while the food industry should ensure that their products contain less salt, thus allowing the consumer access to healthier products, says, Shân Biesmon-Simons, Registered Dietician and Director for Nutrition & Education at The Heart & Stroke Foundation SA.

Apart from just adding salt to your food, many products contain hidden salt e.g. processed meats & cheeses, meat extracts, stock cubes and powders, salted snacks, cheese spreads, canned foods and regular breads. It seems to be a common ingredient in products as it is an inexpensive way of enhancing the flavour, texture and shelf-life of foods. This increased usage and availability of high salt foods has sparked global interest in urging the public to consume less added salt and salt laden foods.

How can I reduce salt in my diet?

• Cut back on the amount you use in cooking and use alternatives like pepper, garlic, ginger, lemon juice, curry powders, chillies and herbs to enhance the flavour of your food.
• Avoid putting the salt shaker on the table when eating.
• Purchase fresh or frozen products, as tinned products can contain plenty of salt.
• When choosing canned products, opt for the ones that state "no added salt" on the label or tinned in water or tomato sauce.
• When eating out, asked for your meals to be prepared without salt.
• The words sodium, mono-sodium glutamate and sodium bicarbonate are indicative that the product contains hidden salt. Examples of these include, packet soups, stock cubes, soya sauce, smoked foods, chips, cheesy biscuits, salted butter, some commercial salad dressings, salted nuts and some convenience and instant meals.
• Understanding food labels can be valuable. A low sodium product should contain 120mg sodium per 100g or less, while very low sodium products have 40mg sodium per 100g or less.
• Choose Heart Mark approved products as these are lower in sodium as well as saturated fat, cholesterol, added sugar and higher in fibre (where applicable).

What about salt substitutes?

• Low sodium salts are available but do contain plenty of potassium. It's use should be avoided by those who are diabetic, have kidney disease or existing heart disease as potassium excretion might be impaired in these groups of people.
• Vegetable salts are also not advisable as these are also generally high in salt.
• It is best to wean yourself off salty foods and allow yourself to adapt to alternative flavours.

The Heart and Stroke Foundation SA recommends that people should aim to consume a diet low in sodium, coupled with general healthy eating principles and increased physical activity
Written by Ayesha Seedat, Registered Dietician, The Heart and Stroke Foundation SA.

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