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Heart Disease Newsletter
September 3, 2012
In this Issue
• Irregular Heartbeat May Pose Higher Stroke Risk for Women Than Men
• Smoking After Stroke Triples Risk of Death Within Year: Study
• Stroke Prevention: More Sweet News for Chocolate Lovers
• Stressful Jobs Linked to Heart Woes in Women



Irregular Heartbeat May Pose Higher Stroke Risk for Women Than Men

But large study of atrial fibrillation found this only holds true in oldest patients

FRIDAY, Aug. 31 (HealthDay News) -- Women older than 75 who have a heart rhythm disorder called atrial fibrillation are 20 percent more likely to have a stroke than men in the same age group with atrial fibrillation, according to a large new study.

However, researchers said the findings suggest that being a woman should not be included as an independent risk factor for stroke or blood clots, either in guidelines for treatment or risk assessment of patients with atrial fibrillation, because the difference doesn't hold for women younger than 75.

The study included more than 87,000 atrial fibrillation patients in Denmark. Of those patients, more than 51 percent were female.

After one year of follow-up, female patients younger than 75 did not have an increased risk of stroke, but those over age 75 had a 20 percent increased risk, the investigators found.

The study was presented Sunday at the European Society of Cardiology's annual meeting in Munich.

"Our findings could have an impact on current guidelines used in the treatment of atrial fibrillation; however, more research is needed to confirm our results," study author Anders Mikkelsen of Copenhagen University Hospital Gentofte, Hellerup, Denmark, said in a society news release.

Female sex has been suggested as a risk factor for stroke and blood clots in atrial fibrillation patients, but the 2010 European Society of Cardiology guidelines for management of atrial fibrillation consider being female a minor risk factor.

For women with atrial fibrillation, the guidelines recommend blood thinners for those who are younger than 65 and have one additional risk factor, and for those ages 65 to 74 with no additional risk factors.

Blood thinners can lower the risk of stroke and blood clots in atrial fibrillation patients, but they increase the risk of bleeding disorders and should therefore be given only to patients at high risk of stroke and blood clots.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. National Heart, Lung and Blood Institute has more about atrial fibrillation.




Smoking After Stroke Triples Risk of Death Within Year: Study

The sooner patients resumed habit after leaving hospital, the worse they fared

FRIDAY, Aug. 31 (HealthDay News) -- People who don't kick their smoking habit after having a stroke have a threefold increased risk of death within a year, a new study warns.

The investigators also found that the sooner stroke survivors start smoking again, the greater their risk of death within one year.

In the study, Italian researchers looked at 921 patients who were regular smokers before they suffered an ischemic stroke, which is caused by a lack of blood flow to the brain. All of the patients attended smoking-cessation counseling sessions while in the hospital and said they were motivated to remain smoke-free once they left the hospital.

No nicotine replacement therapy or other smoking cessation help was provided to the patients after they were discharged from the hospital.

The patients reported their smoking status at one, six and 12 months after leaving the hospital. By the end of the first year, 53 percent of them had resumed smoking. Older patients and women were most likely to begin smoking again, the study found.

Within one year, 89 patients had died. That works out to a one-year probability of death of 9.6 percent. After adjusting for a number of other factors, the researchers concluded that patients who resumed smoking were three times more likely to die than those who didn't begin smoking again.

The study was presented Tuesday at the European Society of Cardiology annual meeting in Munich.

"It is well established that smoking increases the risk of having a stroke," study author Furio Colivicchi, from San Filippo Neri Hospital in Rome, said in a society news release. "Quitting smoking after an acute ischemic stroke may be more effective than any medication in reducing the risk of further adverse events. However, on the other hand, our study shows that stroke patients resuming active smoking after leaving the hospital can raise their risk of dying by as much as threefold."

The sooner patients started smoking again, the greater their risk of death within a year. For example, those who resumed smoking within 10 days of leaving the hospital were five times more likely to die within a year than those who didn't resume smoking.

"The results of this study suggest that health-care providers should take smoking cessation interventions more seriously, as recommended treatments are not making their way into practice," Colivicchi said. "A successful program to help stroke patients quit smoking should take a comprehensive long-term approach, including individual counseling, post-discharge support and pharmacological treatment."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

While the study uncovered an association between smoking in stroke patients and death within one year, it did not prove a cause and effect relationship.

More information

The National Stroke Association offers a stroke recovery guide.




Stroke Prevention: More Sweet News for Chocolate Lovers

But it's still too soon for recommendations, researchers say

WEDNESDAY, Aug. 29 (HealthDay News) -- Eating moderate amounts of chocolate might reduce a man's risk of stroke in addition to its other reported benefits, a new Swedish study finds.

Researchers followed more than 37,000 men for more than 10 years, and found that those who ate the most chocolate had a 17 percent lower risk of stroke than those who never ate chocolate.

Flavonoids in chocolate have previously been linked with a reduced risk of heart disease and better mental performance. It's thought they may protect against cardiovascular disease through antioxidant, anti-clotting and anti-inflammatory factors, or by reducing cholesterol.

But neurologists aren't sending patients to the candy store based on this new report.

"You have to be very careful with these types of observational studies," said Dr. Richard Libman, vice chair of neurology at the Cushing Neuroscience Institute in Manhasset, N.Y.

While the research shows an association between chocolate consumption and stroke reduction, it does not show cause and effect. "There is no way to take from this study that chocolate causes a lower risk of stroke," Libman said.

The only way to prove whether or not chocolate reduces stroke risk is to do a randomized trial where some eat chocolate and others don't, he said. They would have to be followed for many years to see if chocolate made a difference, he added.

And eating too much chocolate can only add to the U.S. obesity epidemic and the health problems that go along with it, Libman noted.

For the report, published in the Aug. 29 online edition of Neurology, a team led by Susanna Larsson, from the Karolinska Institute in Stockholm, questioned men aged 49 to 75 about their diet and specifically how much chocolate they ate.

>Over the decade of follow-up, almost 2,000 men had a first stroke, they found. The risk was lower among those with greatest chocolate consumption, a median of about one-third of a cup of chocolate chips, or a little more than two ounces, a week.

A further analysis of five studies that included more than 4,200 stroke cases found those who ate the most chocolate reduced their risk of stroke 19 percent, compared with those who never ate chocolate, the researchers added. For every 50 grams of chocolate eaten a week -- about one-quarter cup of chocolate chips -- the risk of stroke declined by about 14 percent.

Benefits of chocolate have been associated with dark chocolate, but about 90 percent of the chocolate eaten in Sweden is milk chocolate, Larsson noted. Milk chocolate is fattier and contains less cocoa than dark chocolate.

Another expert agrees that chocolate, eaten in moderation, does appear to help the heart.

"There is a clear aggregation of research evidence indicating that chocolate, and in particular dark chocolate, confers a heart health benefit," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine in New Haven, Conn.

"Risk factors for heart disease and stroke are much the same, so it stands to reason that such benefit would extend to stroke," he said.

While the research doesn't prove cause and effect, "it's worth noting that this analysis carefully controls for many other factors, such as other important aspects of diet, including fruit and vegetable intake," he said. "The benefit of chocolate remains persuasive after accounting for such factors."

Because of chocolate's caloric, fat and sugar content, it is best thought of like red wine, where some is good but more isn't necessarily better, Katz said.

"Ongoing research will help establish the ideal 'dose' of chocolate for health benefits," he said. "In the interim, evidence favors the equivalent of roughly one ounce per day of chocolate with a cocoa content of 60 percent or higher."

Because chocolate consumption was self-reported and only at the start of the study, the researchers said more research is needed before recommendations are made.

Whether the new findings apply to women isn't clear. Four previous studies found an association between eating chocolate and reduced risk of stroke for women, or men and women combined, but the results for two of those studies weren't statistically significant.

More information

For more information on stroke, visit the American Stroke Association  External Links Disclaimer Logo.




Stressful Jobs Linked to Heart Woes in Women

Heart attack risk is higher when women have demanding jobs, lack decision-making opportunities

THURSDAY, July 19 (HealthDay News) -- Women with demanding jobs that provide few opportunities to make decisions or use their creativity are at increased risk for heart attacks, according to new research.

For the study, researchers analyzed data provided by 22,000 women over 10 years regarding their job strain, job insecurity and other health and lifestyle information. Most participants were white health professionals. The women, whose average age was 57, answered questions about the pace of their workday, how hard they worked and to what extent they had to juggle competing demands.

After taking into account factors such as age, race and income, the investigators found that women with high job strain were 38 percent more likely to have heart-related events, such as stroke, heart surgery to clear blockages, or death. Heart attack risk was 70 percent higher, according to the report published July 18 in PLoS ONE.

Women who had highly stressful jobs but who also had a lot of control over their work -- such as physicians, executives, nurses, teachers and managers -- also had higher risk of cardiovascular events, according to the researchers from Brigham and Women's Hospital.

"Previous long-term studies of job strain, defined by the combination of psychological demand and job control, and heart disease risk have mainly focused on men and a more restricted set of cardiovascular conditions," said Dr. Michelle Albert, a cardiologist and researcher at Brigham and Women's Hospital and associate professor at Harvard Medical School in Boston.

"Our study indicates that high job strain can negatively affect your health. There are immediate and definite long-term, clinically documented cardiovascular health effects of job strain in women, and it is important for women and their health care providers to pay attention to the stresses of their job," Albert explained in a news release from Partners HealthCare.

While the researchers found an association between stress at work and heart attacks, they did not prove that there is a direct cause-and-effect relationship between job strain and heart attacks or other cardiovascular problems.

More information

The U.S. National Library of Medicine has more about heart disease in women.

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