Lori Borealis's Library tagged heart →  View Popular

• Obstructive sleep apnea (OSA). The more common of the two
  forms of apnea, it is caused by a blockage of the airway, usually when the soft
  tissue in the back of the throat collapses during sleep.
• 
  Central sleep apnea. Unlike OSA, the airway is not blocked
  but the brain fails to signal the muscles to breathe due to instability in the
  respiratory control center.

Am I at Risk for Sleep Apnea?




Sleep apnea can affect anyone at any age, even children. However, risk
factors include:



• Male gender
• Being overweight
• Being over the age of forty
• Having a large neck size (17 inches or greater in men and 16 inches or
  greater in women)
• Having larger tonsils
• Having a family history of sleep apnea

WASHINGTON - Conventional tests won’t uncover heart disease in as many as 3 million U.S. women — because instead of the usual bulky clogs in main arteries, these women have a hard-to-spot buildup in smaller blood vessels, researchers said Tuesday.

These are the women who come to the doctor complaining of chest pain or shortness of breath but sometimes are sent away undiagnosed, not knowing they’re actually at high risk for a heart attack in the next few years.

“The No. 1 message for women is, ‘Pay attention to your symptoms,”’ said Dr. George Sopko, a heart specialist at the National Institutes of Health, which sponsored the research. “If you don’t have visible blockages, that doesn’t mean you’re not at risk.”

Blood pressure readings taken on an arm that is slack can be up to 10 percent higher than those taken on an arm that is at a right angle to the body, new research shows.

The surprising study warns that this disparity can throw off treatment choices. Unfortunately, the researchers could not say which kind of reading was more accurate, although the American Heart Association (AHA) recommends bending your elbow at a 45-degree angle during a blood pressure reading.

Regardless of whether patients sat, stood or lay down, blood pressure numbers rose when their arms were slack and dipped when their lower arms were at right angles to their upper bodies. In the first position, 41 percent of patients appeared to have high blood pressure levels; in the second position, only two in every 10 did.

"Arm position is important, and it should be consistent from measurement to measurement," says study co-author Dr. David Guss, director of emergency medicine at the University of California at San Diego Medical Center.

In recent years, heart experts have revised their estimates of ideal blood pressure levels. While the cutoff used to be 140/90, cardiologists now consider rates higher than 115/75 to be unhealthy. Someone who has a blood pressure reading of 135/85 will double his or her risk of heart attack compared to someone at the 115/75 level, Goodman says.

Guss says he first became interested in the issue of arm position and blood pressure levels while measuring his own pressure as a medical student. He noticed the readings went up and down depending on where he put his arm.

"Migraine with aura has been associated with an adverse cardiovascular risk profile and prothrombotic factors that, along with migraine-specific physiology, may increase the risk of vascular events," write Tobias Kurth, MD, ScD, from Brigham and Women's Hospital and Harvard Medical School in Boston, Mass, and colleagues. "Although migraine with aura has been associated with increased risk of ischemic stroke, an association with cardiovascular disease (CVD) and, specifically, coronary events remains unclear."

This prospective cohort study evaluated 27,840 US women aged 45 years or older who were enrolled in the Women's Health Study, were free of CVD and angina at study entry (1992-1995), and who had data on self-reported migraine and aura status, and lipid measurements. Follow-up data for this analysis were available through March 31, 2004.

The main endpoint was the combined end point of major CVD (first instance of nonfatal ischemic stroke, nonfatal myocardial infarction, or death due to ischemic CVD). Secondary outcomes were first ischemic stroke, myocardial infarction, coronary revascularization, angina, and death due to ischemic CVD.

At study entry, 5125 women (18.4%) reported any history of migraine. Of the 3610 women with active migraine, defined as migraine in the prior year, 1434 (39.7%) reported aura symptoms. During a mean of 10 years of follow-up, there were 580 major CVD events.

Compared with women with no migraine history, those who reported active migraine with aura had multivariable-adjusted hazard ratios of 2.15 (95% confidence interval [CI], 1.58 - 2.92; P < .001) for major CVD, 1.91 (95% CI, 1.17 - 3.10; P = .01) for ischemic stroke, 2.08 (95% CI, 1.30 - 3.31; P = .002) for myocardial infarction, 1.74 (95% CI, 1.23 - 2.46; P = .002) for coronary revascularization, 1.71 (95% CI, 1.16 - 2.53; P = .007) for angina, and 2.33 (95% CI, 1.21 - 4.51; P = .01) for ischemic CVD death.

Adjustment for age resulted in 18 additional major CVD events attributable to migraine with aura per 10,000 women per year. Women who reported active migraine without aura were not at increased risk for any vascular events or angina.

"In this large, prospective cohort of women, active migraine with aura was associated with increased risk of major CVD, myocardial infarction, ischemic stroke, and death due to ischemic CVD, as well as with coronary revascularization and angina," the authors write. "Active migraine without aura was not associated with increased risk of any CVD event."

Study limitations include self-reported migraine and aura status not classified according to strict International Headache Society criteria; and use of a broad definition of aura, difficulty in distinguishing some aura features from symptoms of transient ischemic attack, lack of detailed information regarding the use of migraine-specific drugs, possible residual confounding because of observational study design, and lack of data regarding the duration of migraine prior to study entry or migraine frequency during follow-up.

"Since migraine without aura is far more common than migraine with aura, our data demonstrate no increased risk of CVD for the majority of migraine patients," the authors conclude. "Future research should focus on a better understanding of the relationship between migraine, aura status, and cardiovascular events."

The Donald W. Reynolds Foundation, Las Vegas, Nev, and the National Institutes of Health supported this study. The authors have disclosed no relevant financial relationships.

In an accompanying editorial, Richard B. Lipton, MD, and Marcelo E. Bigal, MD, PhD, from the Albert Einstein College of Medicine and the Montefiore Headache Center in Bronx, NY, discuss potential explanations for the association between migraine with aura and CVD.

"For patients with migraine with aura, clinicians should have heightened vigilance for modifiable cardiovascular risk factors, such as hypertension, hyperlipidemia, and smoking," Drs. Lipton and Bigal write. "Ultimately, it will be important to determine whether migraine with aura is itself a modifiable risk factor for CVD. Future studies should investigate the possibility that preventive medications for migraine or antiplatelet therapy might reduce the risk of CVD in patients with migraine with aura."

Migraine patients to test implants
Proponents say migraines may settle the questions faster — because the only way a migraine sufferer can receive a PFO-closing implant today is through a clinical trial. Three major U.S. studies have begun recruiting hundreds of patients whose aura-inducing migraines overwhelm medications. Those patients would test competing implants.

Among them is the first dissolvable implant, NMT’s BioStar, made of collagen that’s designed to hold the PFO closed until the heart’s own cells seal it over, and then to degrade. “It’s designed to repair this defect in a very natural way,” said Dr. Michael Mullen of London’s Royal Brompton Hospital, who reported promising results from BioStar’s first human safety test in the journal Circulation last week.

Next up: trying to weld PFOs shut with heat, beaming radiofrequency energy into the heart, instead of using an implant. Studies have begun in Europe.

'We need the data'
None of that research proves a PFO actually causes the ailments, cautioned Dr. Joseph Carrozza of Boston’s Beth Israel Deaconness Hospital, in a debate about whether to close the holes at an international cardiology meeting last week.

“Association is not causation,” Carrozza said, noting that the vast majority of people with PFOs will never report symptoms, and that PFO closure occasionally causes such serious side effects as blood clots and irregular heartbeats.

Sons had a 41% greater risk of developing heart diseaseheart disease if their dads had heart disease and a 55% greater risk if their moms did, the study shows. Daughters had a 17% increased risk of developing heart disease if their dads had a history of heart disease and a 43% increased risk if their moms did.

Children with two parents with heart disease had an 82% increased risk of developing it themselves, the study shows. What's more, children whose parents developed heart disease at an early age (before they turned 55) had a 300% greater risk of developing the disease.

"Of course, clinical attention should be given to patients whose mothers or fathers had heart disease, and special attention should be given to patients if both their parents had heart disease, their mother had heart disease, or if the [parent's] onset was at an early agee," she says.