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People with obstructive sleep apnea are far more likely die suddenly in their sleep from heart-related problems than the rest of the population, according to researchers at the Mayo Clinic in Rochester, Minnesota. They found that the pattern for people with obstructive sleep apnea is actually opposite that of the general population, who are more likely to die from a heart attack, cardiac arrest, or other heart-related incidents during the day.

In a study published in the New England Journal of Medicine, the researchers reviewed the death certificates of 112 Minnesota residents who had been tested for sleep apnea and who died suddenly from cardiac causes between the period of July 1987 and July 2003.

Of those who died between the hours of midnight and 6 a.m., 46% had obstructive sleep apnea, compared with 21% who had other diagnoses. Among the general population, only 16% die from cardiac causes during the specified hours, the authors note.

The study also found that the likelihood of dying of cardiac causes overnight correlated directly with the severity of obstructive sleep apnea.

The overnight hours are generally thought to be a period of reduced risk of sudden death from cardiac causes because sleep minimizes the stresses that can trigger heart attacks and other problems. In fact, in the general population or among people with other diagnoses, the risk of suddenly dying from a heart-related incident peaks between the hours of 6 a.m. and noon, the researchers say.

Sleep apnea is a condition that causes sufferers to stop breathing for numerous brief periods during sleep. This causes oxygen levels in the body to drop and carbon dioxide levels to climb, straining the heart.

While the causes of sleep apnea can vary, the Mayo Clinic study dealt specifically with people who suffered from obstructive sleep apnea. An estimated 17% to 24% of North American adults suffer from this specific form of sleep apnea, which occurs when air can’t get into the lungs due to a blockage in the upper airway. This condition is most common in people who are overweight, though it can also occur in people of normal weight who have a physical characteristic, such as a large tongue, which can restrict airflow.

These interruptions in breathing typically cause the sleeping person to briefly wake up gasping for air, as many as hundreds of times during the night. Many people with sleep apnea are also loud snorers and tend to feel extremely tired in the daytime due to the pattern of repeated waking during the night.

But while these things may seem like an exhausting inconvenience (both to sleep apnea sufferers and their partners), the Mayo Clinic study is one of the first to highlight the risk that may be associated with this condition. A previous study found that habitual snorers were more likely than occasional snorers or people who don’t snore to die of cardiac causes during sleep, but it did not delve into the cause of the snoring.

But while this research underscores the danger, a majority of sleep apnea cases go undiagnosed. If you snore, are constantly tired during the day or wake up gasping for air, it’s important to talk to your doctor.

While there are no medications to treat sleep apnea, lifestyle modifications such as losing weight may help. People with sleep apnea can also wear a mask that supplies a constant airflow through the nose or special dental appliances that stop the throat from closing or the tongue from falling back. In some cases, surgery may be required to prevent overnight lapses in breathing.

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Nearly every day is bringing new evidence that if you want to protect your heart, you may have to pay a lot more attention to your teeth, your stomach, and lots of other areas that on first thought you wouldn’t have associated with damage to your heart.

Why? Because “inflammation” is fast joining high cholesterol levels as a major threat to your cardiovascular system. You see, it’s long been known that half of all heart attacks occur in people with seemingly normal cholesterol levels. That means either that so-called “normal” cholesterol levels may actually be too high (and there is evidence that some people - those with extra cardiac risk factors - really should aim for the lowest possible cholesterol levels, not just those that are at the higher range of “normal”), or that there is more to why your blood vessels plug up than simply the fat content of your bloodstream. That “something” is probably inflammation.

Most experts now accept that a major cause of why your heart gets damaged is through inflammation of the endothelium, the lining of the arterial wall, and when those endothelial cells become damaged, they are more prone to developing those fatty plaques that are the cornerstone by which we diagnose atherosclerostic damage to vessel walls. There’s also this: inflammation of the endothelial cells probably has its source in other locations in the body: gum disease, for example, or the stomach bugs that cause ulcers but which many people carry “silently.”

So what is the evidence for this theory, you wonder. As a start, several studies have shown that people with higher levels of a chemical called c-reactive protein (CRP) in their blood have higher risks of heart disease and stroke, and the higher the CRP levels, the worse that risk. CRP is a marker for inflammation.

In another study, a researcher took a group of people who had suffered heart attacks and randomly assigned some to get antibiotics, and some to get placebo. At the end of a year, the group on antibiotics had fewer second heart attacks and fewer episodes of chest pain requiring urgent intervention. Antibiotics, of course, counteract infection, which is a type of inflammation (more on this below).

There’s more evidence from a practical perspective. It is now thought that part of the reason the group of medications known as statins (Lipitor®, Zocor®, Pravachol®, etc.) are so effective at lowering the rate of heart attack is not just because they lower cholesterol levels (which they do), but also because they exert an anti-inflammatory effect as well (they lower levels of CRP). So when you take a statin, you are getting a double dose of heart protection.

So now for the good news (sort of): you can lower your risks of heart attack by lowering your levels of CRP, that is, by lessening the inflammation in your body, but it’s the same-old, same-old, I’m afraid (I did say “sort of good news”). CRP levels have been shown to go down with weight loss (in the overweight) and exercise. Inflammation also goes down, of course, with the regular use of ASA, although ASA is a powerful medication with several potential side effects, particularly on bleeding tendencies, so discuss it with your doctor first before starting on ASA for this reason.

And as previously stated, of course, statin medications have also been shown to lower CRP levels.

But what about antibiotics? Why doesn’t everyone just take a week’s worth of antibiotics once a year to protect their heart? First, because we still have no idea why antibiotics might work for this problem (in the study I noted earlier in which antibiotics did work, even the researcher who headed the investigation says he doesn’t know why that happened) and second, because, the potential side effects of such an approach - especially the potential for bacterial resistance to those medications - is far too great.

For now, why not just work out, eh?

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Know your heart attack symptoms it may save your life

It’s long been medical dogma - because that’s what older studies found - that the cardinal sign of a heart attack is chest pain, especially “crushing” pain under the breast bone. Over the last few years, however, spurred on in part by the women’s movement, researchers discovered that what happens in the typical middle-aged white man, by far the most common type of patient enrolled in most older heart attack studies, is not necessarily what happens in everyone else, especially women, of course.

So, we now know that some heart attack patients have symptoms besides crushing central chest pain, symptoms such as overwhelming nausea, intense sweating, irregular heartbeat, shortness of breath, even fainting. What we didn’t know is how commonly this occurs, but we fixed that gap in our knowledge with a study in the Journal of the American Medical Association that concluded that a staggering one-third of patients do not have chest pain when presenting to the hospital with a heart attack. The groups at highest risk for this “atypical” picture (although, if you ask me, if 33% of people have something, it’s not that atypical) were women, people with chronic heart failure, those who had suffered a stroke, diabetics, the elderly, and members of minority ethnic groups.

What’s so important about this news is that the quicker you act in a heart attack - even something as simple as taking an ASA at the first hint of trouble but also, of course, getting to a hospital ASAP to get those clot-busting, life-saving interventions that have to be given within 6 hours of the start of a heart attack - the better your prognosis, and the warning from this study is not to wait until you have chest pain before considering you might be suffering a heart attack, but if you have any suspicion at all, to throw in the towel and to get help - by calling 9-1-1 as soon as possible.

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I am told that Sherlock Holmes believed that there was only so much space for lease in the memory room of his brain, so he refused to learn or remember what he considered to be useless facts lest they displace information more vital to his work.

I can only conclude that most of you hold to this theory, too, because according to the Heart and Stroke Foundation, a whopping 42% of Canadians with high blood pressure (HBP) aren’t aware that they have it. And even if you do choose to devote some brain space to monitoring blood pressure, researchers at Heart and Stroke say many who use home monitoring devices aren’t using them properly - and therefore aren’t getting accurate readings. It should be no surprise, then, that HBP remains a significant cause of strokes, heart attacks, kidney failure, and several other debilitating conditions.

And for you arrogant young ‘uns who are smirking right now that it’s only old people who could be so dumb, I don’t believe that you do any better than us older folks. Go on, admit it. Do you know your blood pressure level? Have you checked it in the last year, as we advise you to do in order to improve your chance of good health later on? If you have high blood pressure, it’s never too early to find out.

So get with the program, all of you: memorize or write down your blood pressure (as well as other vital facts such as your lipid levels), check it regularly, and if it’s elevated consistently despite your attempts to control it with lifestyle modification, have it treated (usually that means medications) and get checked regularly to see that your blood pressure has been lowered to safe levels. And if in the process of having to remember your blood pressure, you happen to forget other essential data like all the words to this week’s Number One song or how many homers Ken Griffey hit last year, well, that’s life, eh!

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The globe artichoke is one of the oldest known cultivated vegetables, originating from Ethiopia, with Italy currently being the world’s largest producer.

It was valued in ancient Greece and Rome as a digestive aid, available only to the wealthy due to its scarcity.

It was the French and Spanish explorers who fist brought artichokes to the shores of the United States, and today virtually all of the globe artichokes grown in the US are produced in Castroville, California.

Health Benefits of Artichokes

* Nutrients
Globe artichokes are an excellent source of dietary fiber, magnesium, and the trace mineral chromium. They are a very good source of vitamin C, folic acid, biotin, and the trace mineral manganese. They are a good source of niacin, riboflavin, thiamin, vitamin A, and potassium.

* Cholesterol
There have been numerous studies on artichoke extract ever since European scientists first discovered cynarin’s ability to lower cholesterol in the 1970’s. Caffeoylquinic acids, such as cynarin are the active ingredients in artichokes that lower cholesterol, with higher concentrations in the leaves. A 6 week double blind, placebo controlled clinical trial of 143 patients has demonstrated without a doubt to the effectiveness of artichoke leaf extract for lowering cholesterol. The decrease of total cholesterol in the group that received the extract was 18.5% compared to 8.6% in for the placebo group. LDL-cholesterol decrease in the AE group was 22.9% and 6.3% for placebo. LDL/HDL ratio showed a decrease of 20.2% in the AE group and 7.2% in the placebo group.. A compound found in artichoke called luteolinis is also believed to assist with reducing cholesterol.

* Irritable bowel syndrome
In a trial involving 208 adults, results provide support for the notion that artichoke leaf extract has potential value in relieving IBS symptoms.

* Indigestion
In a double-blind trial, 247 patients with dyspepsia (digestive problems) were treated with artichoke leaf extract, and the results demonstrated an improvement in their dyspeptic symptoms. Dyspepsia is often attributed to insufficient flow of bile from the gallbladder, and there is evidence that artichoke leaf has the ability to stimulate this flow.

* Diabetes
The carbohydrate in artichokes is in the form of inulin, which has been shown to stabilize blood sugar levels in diabetics. The artichokes must be fresh, as the inulin will eventually convert to other sugars as the artichoke ages.

* Hangovers
Contrary to what some would like to believe, a study demonstrated the ineffectiveness of artichoke extract in the cure of alcohol-induced hangovers.

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Diet and drugs

High cholesterol is usually treated with healthy diet changes, exercise, and medications. For people at a high risk of heart disease, medications are started right away, in combination with a healthy diet and exercise. For people at lower risk of heart disease, the doctor may recommend trying diet and exercise changes alone for 3 to 6 months, and adding medications if this does not reduce cholesterol to the desired levels.

What should your cholesterol levels be? Based on Canadian guidelines, your doctor will choose cholesterol target levels based on your risk of heart disease. Factors that increase your risk of heart disease include your age, gender, blood pressure, whether you smoke, and whether you have medical conditions such as diabetes, peripheral arterial disease, chronic kidney disease, or a history of stroke. Your doctor will consider these factors and calculate your risk of heart disease in the next 10 years.

Surgical treatment for lowering cholesterol

An operation called ileal bypass lowers the level of blood cholesterol by decreasing the amount of cholesterol and bile acids taken up from the intestines. Your doctor will not likely consider such a procedure except in extreme cases and where other methods of lowering cholesterol have been unsuccessful.

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In order to function properly, your heart needs a large and continuous stream of oxygen-enriched blood, which is supplied directly to your heart muscle through your coronary arteries. If your coronary arteries become clogged, blocked, inflamed, infected, or injured, the blood flow to your heart will be reduced, which can cause injury to your heart muscle and in turn lead to heart disease or cardiovascular disease (CVD). Some of the more common outcomes of heart disease include myocardial infarction, ischemic heart disease and angina, and arrhythmias.

General risk factors for heart disease

Those you can’t change:

* Family history: Genetic predisposition can play a role in the development of heart disease. Your doctor will want to know if you have a family history of heart disease.
* Age: Wear and tear on your body is cumulative. The heart is no exception. The older you are, the more wear and tear your system will have and the greater the risk of your system not functioning as it did when you were younger.

Those you can change:

* Smoking: Smoking reduces the blood’s oxygen level, injures artery walls, and raises your heart rate and blood pressure.
* High-fat diet: Diets high in fat, especially saturated fats, increase the risk of fatty buildup in the arteries.
* High blood cholesterol: Cholesterol is a fatty substance required by your body to make cells. But your body only needs a certain amount. High blood cholesterol can cause arteriosclerosis.
* Physical inactivity: Regular exercise helps to strengthen your heart muscle and keep it in good working order.
* Hypertension or high blood pressure: Hypertension means your blood is hitting too hard against your artery walls. High blood pressure can increase your risk of stroke, aneurysm, heart failure, heart attack, and kidney damage.
* Obesity: Being significantly overweight or obese increases your blood pressure, causing your heart to work too hard on less oxygen, and it increases your risk of diabetes.
* Stress: Stress increases your heart rate and blood pressure, which in turn causes damage to your arteries and heart.
* Diabetes: Men with sugar diabetes (diabetes mellitus) have 3 or 4 times the likelihood of developing atherosclerosis, resulting in angina, heart attacks, strokes, or peripheral vascular disease. Women with diabetes are at an even higher risk - probably 4 times that of non-diabetic women.

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Over the past four decades, the evidence has been accumulating that cholesterol is related to heart disease, particularly angina and heart attacks. Numerous studies now show that the higher a populations’ average cholesterol level, the more frequently heart disease occurs in that population. For example, populations with very low cholesterol, such as the Chinese in Mainland China, have an extremely low rate of heart disease.

Animal studies are also indicative. Rabbits fed cholesterol showed that some of the dietary cholesterol gets deposited in the arteries, and this is what causes “hardening of the arteries” and narrowing of the arteries, known as arteriosclerosis or atherosclerosis. This then results in decreased blood flow to the heart muscle, which leads to chest pain during exercise or other stresses (angina) and/or heart attacks.

Another link between cholesterol and heart disease is seen in people with inherited disorders of cholesterol, such as familial hypercholesterolemia. Individuals with this inherited high level of cholesterol develop heart disease early in life. For example, if an individual inherits two genes for this disorder, extensive narrowing of the arteries can occur as early as 5 to 6 years of age.

Most importantly, clinical trials using cholesterol-lowering regimens, either diet or drugs, have shown a significant reduction in cardiac problems, including angina and heart attack.

The benefit of lowered blood cholesterol in preventing angina and heart attack has been shown in many large studies. In the Lipid Research Clinic Study, for every 1% decrease in blood cholesterol, there was 2% decrease in the likelihood of a heart attack. In people who suffer from angina or have had a heart attack, lowering of LDL-cholesterol not only decreased the frequency of subsequent episodes (including stroke) but also increased their overall survival.

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What’s Yours At?

Although we’ve been measuring blood pressure for about 2 centuries, which is even longer than the Liberals have been running Canada as their fiefdom (young ones won’t believe this, but there really was a time before Sheila Copps), there is still lots we don’t know about blood pressure.

To start, it was always vigorously maintained that the lower or diastolic pressure was much more important in determining the risks of complications attributed to high blood pressure (HBP) than was the upper or systolic pressure. Studies over the last few years have shown, however, that not only is an elevated systolic pressure also a major risk factor for HBP-related complications, but for some people, particularly middle-aged men (a group that for some reason really captures my attention), a high systolic pressure may be even more dangerous than a raised diastolic pressure in leading to future negative health consequences such as strokes and perhaps dementia.

As well, a “normal” blood pressure has long been held to be anything below 140/90, but an update from the famous Framingham study found that even blood pressure readings in the “high normal” range, that is, 130-140/85-90 were related to a higher risk of complications than were lower blood pressures.

In other words, with blood pressure, as with auction bids and the amount of boyfriends your teenage daughter brings home to do “homework” with in her locked room - you may want to aim for the lowest numbers you can get away with.

Finally, a study published in the American Journal of Hypertension found that only 13% of Canadians suffering from HBP are getting adequately treated for it, which is scary indeed, not only for those who will get strokes and heart attacks as a result of not keeping their blood pressure down, but for the rest of us, too, given how much HBP-related complications cost the medical system.

So let me state this as strongly as I possibly can: no matter your age or gender, get your blood pressure checked regularly (at least once a year, more often if it’s borderline or high), and if you have HBP, even that oxymoron of a “high normal” blood pressure, you need to act on it ASAP.

As always, start with lifestyle modification: don’t smoke, limit your alcohol intake, exercise regularly, and try some form of the Mediterranean or DASH diets - lots of fruits, veggies, beans, fish, nuts, low-fat dairy products, and less saturated fat. (As for salt, the current but ever-changing consensus is that in “salt-sensitive” people, blood pressure rises with excess salt intake, while others tolerate salt and need not limit their salt intake; this opinion is, of course, subject to change at a moment’s notice, so take it with a grain of salt - you knew that was coming, I’m sure).

If lifestyle modification doesn’t do it, though, you should start on some sort of blood pressure-lowering medication, remembering that whichever meds you opt for, you must make sure to take them regularly and for as long as your blood pressure stays up, which often means for the rest of your life.

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Walnuts are believed to have originated in Persia or France where petrified shells of roasted walnuts have been discovered dating back 8,000 years from the Neolithic period.

Walnuts (Juglans) were considered food for the gods in ancient Rome and named Juglans regia (Jupiter’s royal acorn ) in honor of Jupiter. Juglans is derived from Jovis glans, meaning Jupiter’s acorn, and regia meaning royal.

Walnuts should not be shelled until ready to use, and once shelled can be refrigerated in a tightly sealed container for up to one year

The United States is the world’s top producer of walnuts, with California providing more than 50% of worldwide walnut supply. China, France, Turkey, Romania, and Iran are other walnut producing countries.

Health Benefits of Walnuts

* Nutrients
Walnuts are an excellent source of antioxidants and the minerals manganese, copper, phosphorus, and magnesium. Walnuts are a very good source of protein, dietary fiber, the amino acid arginine, omega-3 fatty acids and alpha-linolenic acid (ALA). Walnuts are unique because they are rich in n-6 (linoleate) and n-3 (linolenate) polyunsaturated fatty acids.

* Cardiovascular Health
Alpha-linolenic acid (ALA) is an n-3 polyunsaturated fatty acid found mainly in plant sources, especially walnuts. There have been numerous clinical studies that suggest that alpha-linolenic acid (ALA) intake reduces the incidence of coronary heart disease. Alpha-linolenic acid (ALA) in walnuts may reduce cardiovascular risk through a variety of biologic mechanisms, including platelet function, inflammation, endothelial cell function, arterial compliance, and arrhythmia. Walnuts also contain other potentially cardioprotective constituents including phytosterols, tocopherols, squalene and the amino acid arginine.

Walnuts are rich in the antioxidant ellagic acid, and in a preliminary study, it has been suggested that the ellagic acid present in walnuts has a high anti-atherogenic implicating the beneficial effect of a walnut-enriched diet on cardio protection.

* Cholesterol
A diet supplemented with walnuts has been shown to significantly reduce total and LDL cholesterol levels.

* Alzheimer’s Disease
Fibrillar amyloid beta-protein (Abeta) is the principal component of amyloid plaques in the brains of patients with Alzheimer’s disease. Over 90% inhibition of Abeta fibrillization from walnut extract was observed in a laboratory study, suggesting that walnuts may reduce the risk or delay the onset of Alzheimer’s disease by maintaining Abeta in the soluble form.

* Weight Loss
There is some concern amongst dieters about incorporating walnuts into a weight loss program due to the high fat content. A 12-month study of 90 participants has demonstrated that weight gain from daily consumption of walnuts has been shown to be insignificant.

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