The study, conducted by Dutch researchers, used data from the Zutphen study to assess whether cocoa could reduce blood pressure and improve cardiovascular health. In total, 470 elderly men aged between 65 and 84 were used in the 15 year study which began in 1985.

The men were divided into three groups according to chocolate intake with the highest group averaging at least 2.25g of cocoa per day while the lowest group consumed less than 0.5g per day on average. After adjusting for other factors such as BMI and age, the researchers found that compared to men in the lowest group for cocoa intake, the men in the highest group had systolic and diastolic blood pressures that were 3.1 and 2.0 mm Hg lower respectively.

The researchers also found that regular chocolate eaters were much less likely to die from cardiovascular causes such as heart disease and stroke. Men in the highest group for cocoa intake were half as likely to die during from cardiovascular disease during the study than men in the lowest group for cocoa consumption.

Interestingly, after adjusting these results for blood pressure, the men who ate the most cocoa were still less likely to die from cardiovascular disease meaning that the lower risk of cardiovascular death was not due to the lower blood pressures observed in the regular cocoa eaters but by some other mechanism.

It is thought that the flavanols found in chocolate are responsible for the cardiovascular benefits of cocoa. In particular, catechins and epicatechins which are found in cocoa, wine, and green tea leaves, are thought to be the most beneficial compounds. It is believed that catechins and epicatechins reduce the build up of plaques in the arteries and improve the function of the cells lining the blood vessels known as endothelial cells. Flavanols are also thought to reduce LDL cholesterol levels and improve blood flow throughout the body.

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The study, conducted by researchers from the Paul Brousse hospital in France and the Department of Epidemiology and Public Health in London, focused on 10,308 middle-aged participants from the Whitehall II study. The participants, initially aged between 35 and 55, were followed from 1985-1988 up to the conclusion of the study in 2002-2004.

The participants completed six tests of cognitive ability. The tests were on reasoning, phonemic and semantic fluency, memory, vocabulary and a mini-mental-state-examination (MMSE). The MMSE is a 30 point test that is often used to screen for Alzheimer’s disease and other dementias. The researchers standardized the results of the tests to T-scores (mean score standardized to 50 with standard deviation of 10).

The researchers found that men with a history of heart disease performed significantly worse in reasoning, vocabulary, and MMSE. Furthermore, T-scores for men became progressively worse the longer they had been suffering from heart disease.

Amongst women, a history of heart disease was associated with lower performance scores in the phonemic and sementic fluency tests.

The authors of the study believe that heart problems in mid-life may be a precursor for dementia in later life, underlining the importance of maintaining a healthy heart. According to lead researcher Dr Archana Singh-Manoux: “Our results should give an added incentive to reduce the risk factors for coronary heart disease (CHD), as by so doing we could also be reducing the chances of cognitive decline.”

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The research, conducted by Marc McRae of the National University of Health Sciences in Illinois, involved the analysis of results from 13 trials on the effects of vitamin C on cholesterol levels. The minimum dosage of vitamin C taken across the studies was 500mg/day for a period of between 3 and 24 weeks.

When the data from all the studies was pooled, vitamin C supplementation resulted in an average reduction of 7.9mg/dL for LDL cholesterol levels while HDL cholesterol levels increased by 1.1mg/dL. LDL cholesterol is the so called “bad” cholesterol because high LDL cholesterol levels are associated with an increased risk of heart disease. HDL cholesterol on the other hand appears to have preventative effects on heart disease.

The study also found that vitamin C reduced triglyceride levels in the blood by 20.1mg/dL. High levels of triglycerides in the blood leads to atherosclerosis (the hardening of the arteries) and an increased risk of heart disease and strokes.

McRae added that the 7.9mg/dL reduction in LDL cholesterol levels was equivalent to around a 6.6% reduction in coronary heart disease risk while the 20.1mg/dL reduction in triglyceride levels corresponded to a 2.4% reduction in coronary heart disease risk.

While the minimum dosage of 500mg per day is quite high and would be difficult to achieve through diet alone, most vitamin C supplements contain at least this amount. Vitamin C is also well tolerated in the body and no short or long term adverse effects have been observed from the use of vitamin C supplements.

It is believed that vitamin C reduces LDL levels by increasing the ability of the liver to transform cholesterol into bile acids. Vitamin C may also reduce the oxidation of LDL cholesterol and increase the number of LDL-receptors thus increasing the rate of removal of LDL cholesterol from the blood.

A desirable LDL cholesterol level is less than 100mg/dL while a desirable HDL cholesterol level is greater than 60mg/dL. Triglyceride levels lower than 150mg/dL are considered optimal.

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The study, conducted by Norwegian researchers, involved the study of around 25,000 people from Norway who were initially free of heart disease, diabetes, and thyroid problems. The participants were followed for an average of 8.3 years during which 410 people died from coronary heart disease.

The researchers found that levels of thyrotropin were much lower in those who had died of coronary heart disease (CHD). Thyrotropin is produced in the pituitary gland and stimulates the growth and function of the thyroid gland. Thyrotropin levels are considered to be an accurate marker of thyroid function

Women with the lowest thyrotropin levels were 41% more likely to die from CHD than those with average thyrotropin levels and 69% more likely to die from CHD than the women with the highest thyrotropin levels. Although low thyrotropin levels were linked to a higher CHD risk in men, the association was not statistically significant.

An under-active thyroid is known to lead to weight gain, an increase in blood cholesterol levels, and hypertension (high blood pressure) which are all significant risk factors for heart disease. Extremely low thyroid function can lead to bradycardia (extremely low heart rate), depression, fatigue, muscle wasting, hair loss, and even death in rare cases.

Hypothyroidism is generally treated through the administration of the thyroid hormones thyroxine and/or triiodothyronine.

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One of the largest studies on the effects of exercise on heart disease prevention was published in The New England Journal of Medicine in August of 1999. The study consisted of 72,488 females from the Nurses Health Study (NHS). The participants were 40 to 65 at the beginning of the study in 1986. The study continued for eight years during which 645 coronary deaths (475 deaths from heart attacks and 170 from other coronary heart disease) were observed.

The researchers found a strong association between total physical activity and the risk of developing coronary heart disease. After adjusting for factors such as BMI, smoking status, and alcohol consumption, those in the top 20% for total exercise were 34% less likely to have a coronary disease event than those in the lowest 20% for total exercise.

The researchers found that their was little difference in terms of heart disease reduction between those who exercised vigorously compared to those who got their exercise from walking. Those who exercised vigorously for 7 or more hours per week were 24% less likely to develop heart disease than those who did not. Those who walked for 7 or more hours per week were 26% less likely to develop heart disease. Those who both exercised vigorously and walked for more than 7 hours each were 30% less likely to develop coronary heart disease than those who did neither.

The researchers did however find that brisk walking at a speed of 3 mph or greater was more beneficial than easy-paced walking at a speed of less than 2 mph. Those who did their walking at a brisk pace were 36% less likely to have a coronary event than those who did their walking at an easy pace.

Exercise has numerous benefits on the heart - it both raises HDL levels and reduces LDL levels, it also reduces body fat levels and blood pressure levels which are major heart disease risk factors. Exercise is also thought to improve the elasticity of the arteries which helps in the prevention of atherosclerosis.

Doctors generally recommend 30 minutes of exercise a day in order to receive the full heart benefits of exercise however studies show that less than a quarter of adult Americans get this amount of daily exercise.

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One of the largest studies on the relationship between heart disease and height was published in the American Journal of Epidemiology in 1995. That study involved 119,741 women from the Nurses Health Study (NHS) who were initially free of heart disease and ranged in height from 56 inches (1.42m) to 77 inches (1.96m).

The researchers found that shorter women were more likely to be obese, have high cholesterol levels, and be diagnosed with diabetes while taller women were more likely to consume alcohol and smoke cigarettes.

From 1976 to 1990, 3,638 cardiovascular events were observed including 1,304 heart attacks and 1,343 cases of angina.

After adjusting the results for known cardiovascular risk factors such as BMI, smoking, serum cholesterol levels, and hypertension the researchers found that women who were 67 inches (1.70m) or taller were 27% less likely to suffer from coronary heart disease and 23% less likely to suffer from a heart attack than women who were less than 62 inches (1.57m) in height.

A study of 22,071 male physicians in the United States published in the journal Circulation in 1993 yielded similar results.

That study found that men who were 73 inches (185cm) or higher were 35% less likely to suffer a heart attack than men who were 67 inches (170cm) or shorter.

While the precise reasons why shorter people are more likely to develop heart disease are unknown there are several possible mechanisms. One is that taller people tend to have lower levels of fibrinogen in their blood. Fibrinogen is involved in the blood clotting process however high levels of fibrinogen has been associated with increased coronary heart disease risk.

Shorter individuals are also more likely to be overweight and develop diabetes which are two established risk factors for heart disease however even after these are taken into account, tall people still tend to be less susceptible to heart disease.

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Nitric oxide signals the smooth muscle in the blood vessels to relax which improves blood flow Nitric oxide has beneficial effects on many heart disease risk factors. Several studies have demonstrated a link between hypertension and low levels of nitric oxide in the blood. It is thought that nitric oxide widens the blood vessels and arteries which reduces the pressure exerted by the blood on vessel walls. Nitric oxide may also play a role in preventing the hardening of the arteries (atherosclerosis).

While high levels of nitric oxide in the blood are thought to be associated with a lower risk of heart disease only a few lifestyle and dietary factors have been shown to influence nitric oxide production in the body.

It is believed that a diet rich in arginine increases the production of nitric oxide however studies have produced mixed results as to whether arginine can reduce the risk of coronary heart disease.

Arginine rich foods include dairy products such as milk, yogurt, cheese, meats such as beef, pork, chicken, turkey, tuna, salmon and lobster, bread - particularly whole grain breads, seeds, and nuts.

One study found that a high salt intake is associated with lower levels of nitric oxide in the blood. It is thought that salt impairs the ability of enzymes to convert arginine into nitric oxide.

A recent study found that nitrate and nitrite rich foods such as fruits, vegetables and cured meats can improve a patients outcome following a heart attack. Nitrites and nitrates are converted to nitric oxide during periods of oxygen deprivation such as during a heart attack, this in turn helps open clogged or closed arteries improving recovery after a heart attack.

High levels of exercise are thought to encourage the endothelium to produce more nitric oxide while diets high in saturated fat are thought to damage the endothelium and reduce nitric oxide production. Mediterranean style diets, which are both high in mono-unsaturated fat and low in saturated fat, are thought to improve both endothelial function and nitric oxide production.

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One study, published in the journal Archives of Internal Medicine in February 2004, looked at data from 10 previous studies in order to determine the effects of dietary fiber intake on the risk of heart disease.

In total the 10 studies included a combined 91,058 men and 245,186 women over study periods of 6 to 10 years. Over that time 5,249 cases of heart disease were observed with 2,011 deaths due to heart disease occurring. The researchers found that a 10 gram per day increase in dietary fiber intake was associated with a 14% decrease in the incidence of heart disease and a 27% decrease in death due to heart disease.

The study found that both fiber from cereal, which resulted in a 25% reduction in coronary deaths, and from fruit, which led to a 30% reduction in coronary deaths, were beneficial however no association was found between fiber from vegetables and a reduction in heart disease.

A second study, published in the journal Circulation in 1996, found that the risk of dying from a coronary event was 29% lower for those in the highest 20% of fiber intake compared to those in the lowest 20%. The results of that study are presented in the graph below.

It is believed that fiber has positive effects on several heart disease risk factors, high fiber intake can lead to a reduction in LDL cholesterol levels, reduced weight and body fat, lower blood pressure, lower triglyceride levels, and improved blood sugar control. Fiber has also been implicated in a reduction in the risk of certain cancers such as colo-rectal cancer.

Fiber comes in two forms: soluble fiber and insoluble fiber and both are believed to have similar heart health benefits. Most health professionals recommend that individuals get between 25 and 40 grams of fiber each day. Most people fall far short of these levels however with the average American consuming just 15g per day.

Excellent sources of fiber include (percentage of fiber included in brackets): lentils (30.0%), almonds (11.8%), oats (10.6%), bran cereal (10.0%), peanuts (9.5%), dates (7.5%), prunes (7.1%), cooked peas (5.2%), avocados (4.9%), apples (3.9% with skin on), broccoli (3.0%), carrots (3.0%), spinach (2.7%), and bananas (2.4%).

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Researchers at the National Institutes of Health and Harvard Medical School in Boston analyzed 44,636 women who were part of of the Nurses Health Study. At the beginning of the study in 1976, the average age of the women was 50. The participants were followed up every two years for the duration of the 16 year study. The researchers looked for associations between a large waist size and an increased risk of death from cardiovascular disease, cancer, and total mortality.

Over the entire study period, 3,507 deaths were observed with 1748 caused by cancer and a further 751 due to cardiovascular diseases such as heart disease and stroke. The main findings of the study are presented in the graph below.

The women with the largest 20% of waists (a waist size of 35 inches or more) were found to be 79% more likely to die from all causes of mortality at a given age compared to women in the lowest 20% of waist sizes (28 inches or less). Women in the highest quintile of waist sizes facing a 99% increased risk of dying from cardiovascular disease at a given age compared to women in the lowest quintile. Cancer mortality risk was found to be 63% higher for women in the highest quintile of waist sizes compared to the lowest quintile.

The link between waist size and cardiovascular disease existed even in women within the healthy BMI range. Women with a normal BMI (between 18.5 and 25) and a waist size greater than 88cm were three times more likely to die of cardiovascular disease than women with a normal BMI and a waist size of 88cm or lower.

The researchers concluded that measures of abdominal fat such as waist size and the waist to hip ratio are strong predictors of cancer mortality, cardiovascular mortality, and total mortality. Although the study consisted only of women, the authors believe that similar patterns exist in men.

A study published in 2005 in the same journal had found that a large waist size (greater than 88cm), combined with elevated triglyceride levels increased the probability of developing metabolic syndrome by 370%. Metabolic syndrome is associated with a large increase in the probability of an individual developing heart disease and/or diabetes.

The research comes on the back of a recent study suggesting that a large belly in mid-life increases an individuals risk of developing Alzheimer’s disease and other dementias. These studies emphasize the importance of maintaining a healthy waist size throughout life.

An ideal waist size is less than 30 inches (76cm) for women and 35 inches (89cm) for men.

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The researchers looked at data from 1,739 offspring of the Framingham Heart Study with an average age of 59 years. The participants had their blood levels of Vitamin D recorded in 1996, as well as their blood pressures, current smoking habits, diabetes status, cholesterol levels, and physical activity levels. The participants were free of heart disease and other cardiovascular problems at the beginning of the study.

After an average follow up period of 5.4 years, 120 (6.9%) of the participants had developed some form of cardiovascular disease, with 65 of the patients suffering from coronary heart disease, 19 suffering from heart failure and 28 suffering cerebrovascular events such as strokes.

The researchers found that after adjusting for age and sex, the risk of developing cardiovascular disease was 2.04 times higher in the group that had vitamin D levels less than 15ng/mL compared to those with vitamin D levels greater than 15ng/mL. Furthermore, the group with vitamin D levels less than <10ng/mL had 2.63 times greater risk of cardiovascular disease than the group with vitamin D levels greater than 15ng/mL.

After adjusting the results for other cardiovascular disease risk factors such as blood pressure, diabetes status, cholesterol levels, and BMI, the relative risks of cardiovascular disease dropped slightly to 1.62 times and 1.80 times greater for the <15ng/mL and the <10ng/mL groups respectively.

The researchers also found that in participants with hypertension, vitamin D deficiency increased cardiovascular risks by an even greater amount while in individuals without hypertension, vitamin D deficiency led to only a small, non-significant increase in cardiovascular disease risk.

The research authors concluded that: “These prospective, community-based data suggest that vitamin D deficiency is associated with increased cardiovascular risk, above and beyond established cardiovascular risk factors. The higher risk associated with vitamin D deficiency was particularly evident among individuals with hypertension.”

The study also found that vitamin D levels across the participants were quite low with less than 10% of the participants having levels of vitamin D in the blood greater than 30ng/mL which is considered optimal. Vitamin D deficiency is relatively common, particularly in the winter months and in people living in very high or very low latitudes were sunlight exposure is insufficient to allow the body to synthesize vitamin D. In these people vitamin D must be consumed through dietary sources such as fortified milk and cereals, fatty fish and fish oils, mushrooms, and eggs.

The researchers added that: “Low levels of vitamin D are highly prevalent in the United States, especially in areas without much sunshine, 20 to 30 percent of the population in many areas has moderate to severe vitamin D deficiency.”

Vitamin supplementation is another way to increase vitamin D levels however experts urge caution as in people without a vitamin D deficiency, additional vitamin D will not necessarily improve cardiovascular health and in some recent studies, high doses of some vitamins have actually been shown to increase mortality.

The research appears in the American Heart Association’s journal, Circulation.

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Smoking has many effects on the body that lead to increased coronary heart disease risk. First, toxic substances in cigarettes such as carbon-monoxide, nicotine, and aromatic hydrocarbons lead to inflammation of the arteries and blood vessels in the body. The build up of plaque in the arteries and scarring of the arterial walls due to this inflammation leads to atherosclerosis which is a strong risk factor was heart disease.

Nicotine in cigarettes also causes an increase in blood pressure and heart rate as well as increasing LDL (the “bad” cholesterol) and decreasing HDL (the “good” cholesterol). Smoking also reduces the bloods ability to transfer oxygen to and from the heart which results in reduced aerobic fitness.

Studies estimate that smokers have between two and four times the risk of developing heart disease than those who have never smoked. Smokers also have around three times increased risk of other cardiovascular diseases such as strokes, peripheral arterial disease, and aneurysms.

The good news is that within two years of stopping smoking, a third of the excess risk of coronary heart disease attributed to smoking is eliminated. For the average smoker, after 15 years without smoking, the risk of coronary heart disease is almost the same as for someone who has never smoked. The longer the duration of smoking and the earlier an individual begins smoking, the longer it takes for the increased cardiovascular risks to disappear.

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The data from the study came from children aged 7-10 years who were part of the Cardiovascular Health in Children and Youth Study, a follow up of the participants was conducted 7 years later when the individuals were aged between 14 and 17 years. The children’s physical activity, aerobic fitness, body mass index (BMI), blood pressure, and blood lipid levels were measured.

Of the 389 children in the study, 18 had developed metabolic syndrome by the follow-up period. After controlling for other variables, those with metabolic syndrome were more than 6 times more likely to have low aerobic fitness levels and 5 times more likely to have low physical activity levels as children compared to those who did not have metabolic syndrome.

Metabolic syndrome is a collection of symptoms that collectively are associated with an increased risk of cardiovascular diseases and diabetes. The symptoms are impaired glucose tolerance, high blood pressure. obesity - especially central obesity (high levels of visceral fat), low HDL cholesterol levels and high blood triglyceride levels. If an individual has three or more of these symptoms they are considered to have metabolic syndrome.

It is thought that as many as 25% of American adults have metabolic syndrome and if current health trends continue, this figure could rise to 50% within 30 years. Those with metabolic syndrome have a five-fold increased risk of developing type-2 diabetes and are at twice the risk of coronary heart disease.

Other studies have demonstrated a link between poor aerobic fitness and each of the individual symptoms of metabolic syndrome so it is perhaps not surprising that those who are inactive and/or have poor physical fitness are more likely to develop metabolic syndrome. Inactive individuals are known to have higher LDL and lower HDL cholesterol levels, higher blood pressures, an impaired response to insulin, higher BMI’s, and a greater percentage of body fat.

Furthermore, inactive individuals tend to have increased inflammatory markers such as C-reactive protein and fibrinogen which measure the level of inflammation occurring in the body. Chronic inflammation of the arteries leads to a loss of elasticity, the hardening of the arteries, and eventually atherosclerosis which is a strong cardiovascular disease risk factor.

Children are recommended to get at least an hour a day of physical exercise however it is estimated that over half of all children in the United States fall short of this amount.

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In 1987, a group of scientists at the University of Florida studied the effects of pectin on serum cholesterol levels in a group of 27 individuals who were at a moderate to high risk of heart disease. Half of the subjects consumed the equivalent of three table spoons of pectin derived from grapefruit peel and pulp each day for eight weeks while the other half were fed a placebo.

At the end of the eight weeks, the pectin and placebo groups were reversed and the study continued for a further eight weeks. No other dietary or lifestyle changes were made over the sixteen week study period.

The research, led by physician Dr. James Cerda, found that the pectin supplementation reduced plasma cholesterol levels by an average of 7.6%. Furthermore, the pectin reduced low-density lipoprotein levels (the so-called “bad cholesterol”) by 10.8% and the ratio of LDL to HDL by 9.8%. The researchers concluded that “a grapefruit pectin-supplemented diet, without change in lifestyle, can significantly reduce plasma cholesterol.”

Dr. James Cerda had previously tested the effects of pectin on animals and found that pigs fed a diet containing 3 percent grapefruit pectin for a year reduced their cholesterol levels by more than a third.

Another study, published in the Journal of Nutrition, found that a diet consisting of 7% pectin reduced blood cholesterol levels in rats by 27% and liver cholesterol levels by 17%. The researchers believe the reduction in serum cholesterol is caused by an increase in the excretion of bile acid in the body which in turn stimulates the production of bile acid in the liver. Bile acid is produced from cholesterol so an increase in bile acid production leads to a decrease in cholesterol stores. The rats on the pectin diet experienced a 168% increase in fecal bile acid secretion.

Pectin is found in fruits such as apples, plums, lemons, cranberries, grapefruit, and oranges. Some vegetables such as carrots, lettuce, and spinach also contain pectin. The highest concentrations of pectin are found in citrus peels. Care should be taken before adding grapefruit to a diet program as grapefruit can interact with compounds in some drugs leading to an increase in their potency.

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The American Heart Association (AHA) recommends that people aim for a BMI of between 18.5 and 24.9 however most Americans have a BMI well above this range. Approximately 70% of American men and 60% of American women have a BMI greater than 25 and around 35% of Americans have a BMI greater than 30 (these individuals fall into the obese category). The proportion of Americans with a BMI over 25 has more than doubled over the last 30 years.

The major drawback of the Body Mass Index is that it does not take into account a persons body composition. An athlete or body builder for example may carry little body fat and yet have a BMI well over 25.

Waist size on the other hand gives a good indication of the amount of fat a person is carrying, particularly around the stomach area. Abdominal fat is considered an important risk factor for cardiovascular diseases such as coronary heart disease and stroke. Abdominal fat is also a risk factor for diabetes because it leads to a reduction in the body’s response to insulin, this results in larger amounts of insulin needing to be secreted by the pancreas to control blood sugar levels. This eventually leads to insulin resistance and the onset of type-2 diabetes.

Most doctors recommend a waist size of under 37 inches (84 cm) for men and 32 inches (81 cm) for women. As of 2008, the average american man has a waist size of around 40 inches, an increase of 5 inches compared to 40 years ago. The average American woman has a waist size of 37 inches, an increase of 7 inches over the last 40 years.

One study, presented at the annual conference of the American College of Cardiology in Atlanta, found that a 14 cm increase in waist size correlated to around a 30% increase in heart disease risk. The data was collected from over 160,000 individuals in 63 countries and represents one of the largest studies on the effects of waist size on heart disease.

A study of post-menopausal women conducted at the Washington University School of Medicine also found that the correlation between waist size and three different heart disease risk factors: insulin sensitivity, HDL-cholesterol, and triglyceride levels was stronger than the correlation between BMI and the three risk factors. The authors of the study concluded that waist circumference was a better measure of heart disease risk than BMI in middle aged and older women.

Recently it has been suggested that the waist to hip ratio is a better predictor of heart disease than either BMI or waist size alone. The waist to hip ratio is calculated by dividing the circumference of the waist at it’s smallest point by the circumference of the hips at their widest point. An optimal waist to hip ratio is less than 0.8 in women and 0.9 in men.

A study, published in the American Journal of Epidemiology in 1998, found the waist to hip ratio to be a far better predictor of heart disease than BMI. The results of that study are presented below.

As can be seen from the graph, the men in the top 25% for waist to hip ratio were twice as likely to develop coronary heart disease compared to men in the lowest quartile. BMI on the other hand appeared to have little effect on the probability of developing heart disease with those in the top group only around 15% more likely to develop heart disease than the men in the lowest group for BMI.

A reduction in waist size is best achieved through cutting body fat. Body fat levels can be lowered through cardiovascular workouts such as brisk walking, running, swimming, and playing certain sports such as squash, tennis, and basketball. Some studies have also suggested that cardiovascular exercise in the morning on an empty stomach may be the most effective way to burn body fat as the body’s glycogen stores are lower at this time. Glycogen is the bodies preferred source of energy and glycogen stores must be used up before the body begins using fat as a source of energy.

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Emotions such as anger, hostility, stress, and happiness all play a role in either reducing or increasing heart disease risk. Researchers believe that in individuals that have none of the traditional risk factors associated with heart disease, emotions may be responsible for as many as 50% of heart attacks.

Studies have linked anger, hostility and depression to heart disease, suggesting individuals who display high levels of the three emotions have higher levels of C-reactive protein (CRP) which leads to narrowing of the arterial walls and an increased risk of heart disease.

A study, conducted at Duke University in the United States, involved healthy men with no heart disease risk factors completing a questionnaire assessing their levels of the emotions: anger, depression, and hostility. Those men who rated their levels of depression, hostility, and anger to be high, had levels of CRP between 2 to 3 times higher than those with lower scores in the three emotions.

Another possible mechanism that may explain the correlation between these emotions and heart disease is that more aggressive individuals tend to have higher levels of the hormone testosterone and individuals with high testosterone levels tend to be at a higher risk of heart disease.

Happiness on the other hand has been shown in numerous studies to have a protective effect on the heart. One study, published in the journal Proceedings of the National Academy of Sciences found that happier individuals had 32% lower levels of the stress hormone cortisol which has been linked to heart disease. Happier individuals also had lower levels of blood fibrinogen (also associated with heart disease) and also had lower heart rates.

Other studies have also found it link between positive emotions such as joy, love and happiness and lower blood pressure and conversely a link between negative emotions and higher blood pressure has also been established.

One such study, published in 2006 in the journal Psychosomatic Medicine found that in Mexicans Americans, those who scored higher on an emotion scale between 0 and 12,with 12 being positive and 0 being negative, were less likely to have high blood pressure. A one point increase in positive emotion score was associated with up to a 9 percent decrease in the odds of being in a high blood pressure category.

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One of these studies, published in the Archives of Internal Medicine in 2000, involved 22,071 male doctors from the United States who were part of the Physicians Health Study. Over half the respondents reported some hair loss by the age of 45 with a third reporting some degree of hair loss on the top of the head. The study found that the more hair loss the doctor had experienced by the age of 45, the more likely they were to suffer heart problems such as heart attacks, chest pains, and angina.

Those who were starting to experience hair at the front of their head were at a 9% greater risk of heart problems compared to men with no hair loss. Those with significant thinning hair or a small bald patch on top of the head had a 23% increased risk of heart problems while those who had lost most or all of the hair from their head had a 36% increased risk of heart problems.

Amongst men with high blood pressure (hypertension), baldness was associated with a 79% increase in heart disease risk compared to non bald men. For men with high cholesterol levels, baldness increased the risk of heart problems by a massive 178% compared to non bald men.

The studies authors concluded that “Vertex pattern baldness appears to be a marker for increased risk of CHD events, especially among men with hypertension or high cholesterol levels.”

Another study, the Framingham heart study, also found an association between severe baldness and the likelihood of dying from coronary heart disease but that the association only existed amongst men under the age of 55.

The reasons why baldness is associated with increased heart disease risk are largely unknown. One possibility is that high levels of dihydrotestosterone (DHT) may increase heart disease risk. High levels of DHT are associated with baldness in younger males but baldness in older males is not generally related to DHT levels. This is why certain hair loss medications that block the production of DHT work in younger people but are ineffective in older men.

DHT is a steroid hormone which is formed from cholesterol. It is possible that high levels of blood cholesterol, which is known to increase coronary heart disease risk, may also stimulate DHT production leading to the observed relationship between baldness and heart problems.

While there is little an individual can do to reduce their risk of heart disease from baldness, it serves as an important warning sign, especially to those with high cholesterol or blood pressure since these individuals have the more to gain in terms of risk reduction through achieving a healthier blood pressure and/or blood cholesterol level.

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Several studies have demonstrated the link between elevated homocysteine levels and increased risk of cardiovascular disease. The Hordaland homocysteine study is a Norwegian study involving over 18,000 individuals. The study found that individuals with higher than average homocysteine levels in the blood tended to have higher blood pressure and higher cholesterol levels and more importantly, were at a much higher risk of developing cardiovascular disease than individuals with lower homocysteine levels.

The following graph demonstrates the effect of high homocysteine levels on both overall mortality and on cardiovascular hospitalizations. As can be seen, as homocysteine levels increase, the odds of both dying or being hospitalized through a cardiovascular problem increase.

The B Vitamins, particularly folic acid, B6 and B12, help convert homocysteine into useful proteins. A deficiency in the B vitamins is associated with high homocysteine levels. Studies have found that both folate and vitamin B12 levels in the blood are inversely correlated with plasma homocysteine levels.

Foods rich in vitamin B-6 include tuna cauliflower, bananas and asparagus. Good sources of folic acid (folate) include: spinach, dried beans and peas, citrus fruits turnips and broccoli. Foods rich in vitamin B-12 include most meats, especially poultry and fish, dairy produce and eggs.

It is recommended that people consume at least 2 to 3 servings of foods rich in B-vitamins daily. Those over the age of 50 should consider taking a vitamin B-12 supplement as the bodies ability to absorb the vitamin decreases with age. It is estimated that as many as a quarter of those aged over the age of 50 maybe deficient in vitamin B-12.

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• Cholesterol And Coronary Heart Disease - The Facts

Are high levels of cholesterol in the blood harmful? In short, yes, a number of studies have found a correlation between coronary heart disease and high levels of serum cholesterol.

The graph below shows the combined results of three Finnish studies from 1972, 1977 and 1982 for men aged between 30 and 59.

As you can see, those with serum cholesterol levels below 5mmol/L made up 10% of the population yet represented less than 3% of total coronary heart disease deaths. Those with serum cholesterol levels above 8mmol/L made up slightly more than 10% of the total population but accounted for over a quarter of coronary heart disease deaths.

The odds of dying from coronary heart disease were found to be almost five times greater for those with cholesterol levels above 8mmol/L compared to those with cholesterol levels below 5mmol/L.

In recent years a correlation has been found between the ratio of High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL) and heart disease. A high HDL/LDL ratio is associated with a reduced risk in heart disease. Because of this HDL has been nicknamed the “good” cholesterol” and LDL the “bad cholesterol”. Many scientists believe the ratio of HDL/LDL to be a better predictor of heart disease than total blood cholesterol levels.

It should be noted that HDL and LDL are not themselves cholesterol but actually act as transporters of cholesterol around the body. LDL transports cholesterol from the liver to the tissues where it is needed and HDL cholesterol transports cholesterol from the tissues to the liver where it is excreted as bile.

Scientists have speculated that a low ratio of HDL to LDL may cause heart disease because a lack of HDL carrying cholesterol away from tissues causes cholesterol to build up in the arterial walls leading to atherosclerosis (hardening of the arteries) and the formation of plaques.

LDL cholesterol levels can be lowered through reducing consumption of saturated and trans fats, exercising regularly, quitting smoking, consuming a diet rich in polyunsaturated fats and omega-3 fatty acids, eating large amounts of fibre, and consuming foods rich in antioxidants.

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The research, conducted at the University College London (UCL), was published in January in the European Heart Journal. The study suggested that stressed workers may be up to 68 percent more likely to suffer from coronary heart disease than other workers. The research was conducted using data from the Whitehall II study which began in 1985 and involves more than 10,000 workers from London, England.

The association between stress and coronary heart disease affected both men and women in a similar way. The relationship between the two was strongest among those aged under 50 and weakest amongst those who had reached retirement age.

The study found a direct link between the autonomic nervous system (which controls involuntary actions such as heart beat) and work stress. Stress responses can affect the signals to the heart via the vagus nerve leading to cardiac instability.

One of the papers authors, Dr Tarani Chandola who is a senior lecturer at UCL said “Stress at work is associated with an increased risk of coronary heart disease but the mechanisms underlying this association have remained unclear until now.”

Chronic stress is also believed to increase levels of Cortisol, the “stress” hormone. Cortisol leads to an increase in blood pressure and blood sugar levels, both high blood sugar and blood pressure increase the risk of heart disease.

Researchers also found a link between worker stress and poor health choices such as a diet poor in nutrients, lack of exercise, smoking, and alcoholism. the researchers determined that around 32% of the total effect of work stress on heart disease could be attributed to these unhealthy behaviors.

Workers are much more likely to feel stressed at work compared to workers 50 years ago due to the increasing number of hours spent at work by most people. One study found as many as 96 percent of men feel work related stress. The most common sources of job stress are thought to be: the pressure of having to be the main bread winner, job dissatisfaction, and a perception of a lack of recognition of work achievements from superiors.

Source: “Work stress and coronary heart disease: what are the mechanisms?” - European Heart Journal (EHJ), January 2008

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• Elevated Blood Sugar Levels Lead To Heart Disease

The study, which included over 4,000 men and women from the Framingham Heart Study, found that women with high fasting glucose levels are much more likely to develop heart disease, even if they do not have diabetes. In contrast, fasting glucose levels did not influence heart disease risk in non-diabetic men.

The researchers found that the odds of developing heart disease were more than 75% greater for women with fasting glucose levels between 110 mg/dL and 125mg/dL compared to women with fasting glucose levels below 110mg/dL.

Fasting blood glucose levels above 125mg/dL indicate diabetes while glucose levels between 100mg/dL and 125mg/dL are high, but not high enough for a diagnosis of diabetes to be made. An individual with a fasting blood glucose level between 100mg/dL and 125mg/dL is often referred to as having pre-diabetes and they are likely to develop diabetes in the future without lifestyle and/or diet changes.

People with diabetes are known to be at a much greater risk of heart disease but until now it had been unknown whether people with fasting glucose levels that are above normal, but not high enough to be considered diabetic, were at a greater risk of heart disease.

According to Doctor John B. Buse: “If the fasting glucose test is elevated more than 100 milligrams per deciliter, it means that you are at risk of developing diabetes and you may have some excess risk of heart disease, particularly if you are a woman,” Buse is the director of the Diabetes Care Center at the University of North Carolina and the president for medicine and science at the American Diabetes Association (ADA).

The ADA recommends that everyone over the age of 45 should get a fasting glucose reading in order to test for diabetes. Furthermore those under 45 who are overweight or have any other risk factors associated with diabetes should also be tested. According to Buse, the test should be repeated every three years.

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