The researchers, based at the Heart Institute, Hadassah University Hospital, Israel, looked at data from 3,009 heart failure patients and 46 825 controls who were free of heart failure. The average follow-up period was 518 days. The researchers found that heart failure patients had a lower median level of serum 25(OH)D (a measure of vitamin D status) than the control group. 25(OH)D levels were 36.9 nmol/L in the heart failure group compared to 40.7 nmol/L in the control group. The percentage of patients who were deficient in vitamin D, defined as a level of 25(OH)D < 25nmol/L, was also higher in the heart failure group compared to the control group – 28% vs 22%.

The researchers found that vitamin D deficiency was a strong risk factor for death in the heart failure group with those deficient in the vitamin 52% more likely to die during the study. Heart failure patients who regularly took a Vitamin D supplement had a 32% reduced risk of death.

Factors associated with vitamin D deficiency in the study included high BMI, low exposure to sunlight, diabetes, female gender, and decreased calcium and haemoglobin levels.

The results suggest that increasing vitamin D levels, either through greater sunlight exposure or supplementation, may be an effective way to lower the risk of death in patients who are suffering from heart failure.

Previous studies have found increased death rates from heart failure in the winter months. While this pattern is though to be the result of very cold temperatures, even countries with warm winters tend to have higher rates of heart failure in winter months suggesting a possible role for vitamin D status, which tends to be lowest in winter, in the progression of heart failure. A 2008 study of Australian citizens for example found that mortality rates from heart failure were 23.5% higher in winter despite the relatively mild winters experienced in most parts of Australia.

Low vitamin D levels have also been linked to a poorer prognosis for some forms of cancer. Adequate levels of Vitamin D are important for women at risk for osteoporosis because calcitriol, the hormonally active form of vitamin D increases calcium absorption.

Optimal serum 25(OH)D levels for cardiovascular health are thought to be in the range of 100 nmol/L (40ng/mL). Around 10% of Americans are estimated to be deficient in vitamin D however the figure is much higher in countries at extreme latitudes. In New Zealand for example, an estimated 1 in 4 adults are deficient in vitamin D. The elderly, those with dark skin, obese people, and office workers are generally at the highest risk of vitamin D deficiency.

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The research, conducted by Dr Nicholas Vozoris of the Department of Medicine, St Michael’s Hospital, Toronto, involved the study of more than 5,000 smokers from the 2001-2008 NHANES study. Around a quarter of study participants normally smoked mentholated cigarettes.

Vozoris found that compared to regular smokers, mentholated cigarette smokers were 2.25 times more likely to suffer a stroke after adjustment for age, race, sex, education, income, BMI, smoking intensity, and duration. The risks were particularly high for non-blacks and women who had a more than 3-fold increase in stroke risk.

On the other hand, the researchers found no additional risks of hypertension, myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease (COPD) in menthol cigarette users compared to regular smokers.

Hypertension is the most significant risk factor for strokes with hypertensive individuals more than 4 times more likely to suffer a stroke than those with a normal blood pressure. It is therefore interesting to note that stroke risk increased in menthol cigarette smokers despite no apparent increase in blood pressure suggesting other mechanisms are responsible for the increased stroke risk.

Menthol tends to have a localized anaesthetic effect on the throat as well as stifling the cough reflex. This results in menthol smokers inhaling more deeply and holding the tobacco smoke in their lungs for longer than regular cigarette smokers. The differences in smoking behaviour between menthol and regular cigarette users could explain some of the increased stroke risk however it is unclear why the risk of other cardiovascular diseases wouldn’t also increase.

Vozoris also noted that mentholated cigarettes have been associated with decreased elasticity of the carotid artery which has been linked to an increased risk of ischemic stroke in some studies.

Other studies have found elevated carbon monoxide levels in users of mentholated cigarettes. A 1994 study, published in the journal Experimental and Clinical Psychopharmacology found that carbon monoxide concentrations in the exhaled air of cigarette smokers increased as menthol concentration increased. Mean carbon monoxide levels increased from 5.6ppm for non-menthol cigarettes, to 6.1ppm for cigarettes containing 4mg of menthol, and to 8.1ppm for cigarettes containing 8mg of menthol.

Menthol cigarettes were first introduced in the 1920s by the Axton-Fisher Tobacco Company and have gradually gained market share around the world, particularly in developing countries. They currently make up a 27% share of the USA manufactured cigarette market (as measured by volume of cigarette shipments) however market share is as high as 60% in the Philippines and 30-40% in Cameroon.

In the United States, menthol cigarettes are very popular amongst African Americans with 78% smoking predominantly menthol cigarettes. Women, occasional smokers, poorer individuals, and those aged under 18 also have high levels of menthol cigarette usage.

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The research, led by Dr An Pan of the Harvard School of Public Health, involved the analysis of two large prospective studies, the Health Professionals Follow-up Study, which involved 51,529 men aged 40-75 years, and the Nurses’ Health Study, which involved 121,700 women.

The researchers found a strong association between red meat intake and all cause mortality. After adjustment for a number of potential confounders, those in the highest quintile for red meat consumption had 30% higher all cause mortality than those in the lowest quartile of red meat intake. The top quintile of red meat eaters averaged 2.07 and 2.17 servings for men and women respectively while those in the bottom quintile averaged just 0.25 and 0.51 servings for men and women.

The researchers also looked at the risk of cardiovascular death and cancer death across different levels of red meat consumption. Cardiovascular disease was more stongly related to red meat consumption than cancer. Those in the top quintile for red meat consumption had 40% higher risk of dying from cardiovascular disease and 19% increased cancer mortality than those in the bottom quintile.

The health risks appeared to be slightly stronger for processed red meat compared to unprocessed red meat. Each additional serving of processed red meat increased the risk of all-cause death by 20% compared to 13% for each additional serving of un-processed meat.

The graph below shows the risk of cardiovascular disease and cancer across the 5 quintiles of red meat intake.

The researchers also looked at the effects of substituting a serving of red meat for another food group. Substituting a daily serving of red meat for a serving of nuts reduced all cause mortality by 19%. Substituting for a serving of whole grains or poultry reduced all cause mortality by 14%, legumes and low fat dairy products cut mortality by 10%, while fish reduced risk by 7%.

The authors calculated that as many as 9.3% of deaths in men and 7.6% in women could be prevented if all individuals in the study had consumed less than 0.5 servings (42g) of red meat a day however just 22.8% of men and 9.6% of women in the study consumed less than this.

The current per capita intake of red meat in the USA is around 75g per day. The intake of red meat rose dramatically during the early and middle part of the 20th century, a time when rates of heart disease and cancer were also increasing. While consumption of red meat has levelling off somewhat, it still makes up more than half of all meat products consumed.

One possible explanation for the health risks associated with red meat could be the large amounts of heme iron found in red meat. Although iron plays important roles in several body functions, excessive iron intake, particularly of heme iron, the form found in animal products, has been linked to several chronic diseases including diabetes, heart disease, and various cancers.

Meat, cooked at high temperatures, produces large amounts of Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs), which have been shown to be carcinogenic in various laboratory studies. Several studies have linked consumption of barbecued and pan fried red meat with several forms of cancer, particularly pancreatic and colorectal cancers.

In addition to this, fatty cuts of red meat are a significant source of saturated fat which increases LDL cholesterol levels and subsequently the risk of heart disease.

Finally, processed meats often contain high amounts of N-nitroso compounds. Although a firm link has not been established, there is some suggestion that N-nitroso compounds play a role in the development of cancer. Research published last year, using data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, found that high intake of N-nitrosodimethylamine (NDMA), which is a N-nitroso compound, substantially increased the risk of gastrointestinal cancers, and in particular, rectal cancers.

It is important to note that the excess risks of cancer and cardiovascular disease associated with red meat consumption are still relatively low compared to other risk factors for chronic disease such as obesity, a sedentary lifestyle, and tobacco smoking, however those who consume large amounts of red meat, in excess of two servings or 160g per day, should look to reduce their consumption. When possible, choose low fat cuts of red meat and use slow cooking methods rather than pan-frying or barbecuing the meat.

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The research, led by Dr. Jonathan Hodgson of the School of Medicine and Pharmacology, University of Western Australia, involved 95 men and women who were randomized to receive either three cups of black tea a day or a placebo that matched the tea in flavour and caffeine content.

The study group had blood pressure ranges that were broadly representative of the overall population, the average blood pressure at the beginning of the study was 121/72 mmHg with systolic blood pressures ranging from 115 mmHg (normal) to 150 mmHg (mildly hypertensive).

The ambulatory blood pressures of the participants were monitored throughout the 6 month study. The researchers found that the blood pressures of the tea group decreased significantly relative to the control. Systolic blood pressure was 2.7 mmHg and 2.0 mmHg lower at 3 and 6 months respectively, while diastolic blood pressure was 2.3 mmHg and 2.0 mmHh lower at 3 and 6 months. The authors calculated that this would be enough to reduce the prevalence of hypertension by 10% at a population level and would cut overall risk of cardiovascular disease by between 7% and 10%.

This isn’t the first study to find a link between black tea consumption and heart health. A 2003 study of 15 mildly hypercholesterolemic adults found that drinking 5 cups of black tea a day for 3 weeks resulted in a 6.5% reduction in total cholesterol and a 11.1% reduction in LDL cholesterol levels. The researchers concluded that “based on our study, the inclusion of tea in the diet has the potential to significantly reduce blood cholesterol and thereby reduce the risk of CVD”. Full results of that study can be found here.

A study, published in the journal Preventative Medicine in 2002, looked at the risk of coronary heart disease across varying levels of tea intake in a cohort of 3,430 Saudi men and women. The researchers found a significantly lower prevalence of coronary heart disease in those who consumed large amounts of tea daily. In the fully adjusted model, those who consumed more than 6 cups of tea a day had 51% lower odds of developing coronary heart disease compared to non drinkers.

Black tea is a rich source of flavonoids, which might explain the heart benefits of drinking the beverage. Flavonoids are believed to increase the synthesis of nitric oxide in the body. Nitric oxide is a powerful vasodilator meaning it relaxes the smooth muscle cells of the veins and arteries, widening blood vessels and thus reducing blood pressure. Flavonoids have also been shown to reduce plasma levels of endothelin-1 in laboratory studies. The over-expression of endothelin-1 has been linked to an increased risk of hypertension. Studies have also found a link between consumption of chocolate, which is rich in flavonoids, and small reductions in blood pressure. Other dietary sources of flavonoids include onions, red wine, citrus fruit, cranberries, strawberries, and tomatoes.

Black tea consumption rates vary substantially between countries. The largest consumers of black tea on a per capita basis include the UK, Ireland, Mauritania, Turkey, and Middle Eastern countries such as the UAE, Kuwait, and Qatar. Asian countries tend to drink a greater proportion of green tea rather than black tea.

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The study, led by Mette Svendsen of the Oslo University Hospital in Norway, involved 118 middle aged men and women who were randomly assigned to consume either three kiwifruit or one apple per day for eight weeks in addition to their regular diet. The researchers found that compared to the apple group, 24-hour systolic blood pressure was reduced by 3.3 mmHg in the kiwifruit group (about a 3% reduction). Diastolic blood pressure was also reduced by 1.6 mmHg however this effect did not reach statistical significance.

The researchers suggested that: “Incorporating kiwi intake as part of DASH or other diets for treatment of hypertension should be studied”.

Although significant improvements in blood pressure management have been achieved over the past 50 years through the use of drugs such as beta-blockers, hypertension still remains a significant problem in the United States, particularly in the elderly. It is estimated that 60% of adults over the age of 65 still suffer from hypertension (a blood pressure over 140/90 mm/Hg).

While eating as many as 3 kiwifruit a day may seem excessive, it is certainly worth adding kiwifruit to your diet if you are concerned about your heart disease risk, particularly given that previous studies have shown the fruit possesses a number of other cardiovascular benefits.

A 2004 Norwegian study, published in the journal Platelets, found that consuming 2-3 kiwifruit a day for 4 weeks resulted in a 15% reduction in triglyceride levels as well as inhibiting the aggregation of platelets. Platelets play a significant role in the development of both atherosclerosis and cardiovascular disease.

A second study, published in the International Journal of Food Sciences and Nutrition in 2009, involved 43 Taiwanese adults who were asked to consume 2 kiwifruit a day for 8 weeks. At the conclusion of the study, the researchers found that the participants had significantly reduced levels of LDL cholesterol oxidation and higher overall HDL levels than at the beginning of the study.

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The study, which was published online last month in the American Journal of Cardiology, involved the analysis of 52 studies comprising more than 16,000 patients who had undergone bariatric surgery between 1950 and 2010. The researchers looked at how various measures of cardiovascular health changed following the procedure.

Immediately prior to surgery, the patients had an average BMI of 49 with 28% suffering diabetes and almost half with hypertension. Bariatric surgery resulted in average excess weight loss of 52%. The researchers also found that surgery resulted in dramatic reductions in the incidence of diabetes, hypertension, and dyslipidemia, with improvements or resolution in 75%, 68%, and 71% of patients respectively.

Average fasting glucose levels improved from 126 mg/dL prior to surgery to 92 mg/dL after surgery, a reduction of 27%. Blood pressure improved from an average of 139/87 to 124/77, while LDL cholesterol levels lowered from 118mg/dL to 94mg/dL. Levels of inflammation in the body, as measured by C-reactive protein showed the most dramatic improvement, dropping more than 60% from 4.5mg/L to 1.7mg/L.

The researchers found that the improvements in cardiovascular risk factors amounted to a 40% reduction in the 10 year risk of coronary heart disease calculated using the Framingham risk score. This corresponded to a reduction in the absolute risk of 10 year CHD from 6.27% to 3.77%.

Lead author Dr. Helen M. Heneghan of the Bariatric and Metabolic Institute at the Cleveland Clinic believes that some physicians and cardiologists are reluctant to recommend weight loss surgery to their patients because they are not fully aware of the cardiovascular benefits. According to Heneghan: “We hope that after reading this, physicians will recognize that their obese patients with cardiovascular risk factors or established cardiovascular disease would benefit immensely from weight loss surgery”.

Previous studies have shown similar improvements following bariatric surgery. A 2007 study, published in the New England Journal of Medicine found a 40% reduction in all cause mortality over an average follow-up of 7 years. That study found a 56% reduction in deaths from coronary artery disease, a 60% reduction in cancer deaths, and a 90% reduction in diabetes related deaths.

Although the risk of serious complications or even death is not insignificant, the above studies show that for those who survive the initial surgery, the long term prognosis is very good, far better than it would’ve been had the patient not undergone the procedure.

Historically, the death rate from bariatric procedures has hovered around 0.5% however this has improved to less than 0.3% in recent decades due to improved surgical techniques. Complications immediately following bariatric surgery are relatively common but with appropriate management are not normally life threatening. Complications include gall stones, blood clots, bowel obstruction, stomach ulcers, and anastomotic leaks (the leakage of intestinal fluids into the abdomen).

Risk factors for serious complications or death during, or after surgery include: extreme obesity (BMI>50), age greater than 50, male gender, and co-morbidities such as congestive heart failure, coronary artery disease, diabetes or peripheral vascular disease.

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The study, which involved more than 3,500 men and women who had been hospitalized for a heart attack between 1999 and 2006, found that male smokers were 9 years younger at admission than male non-smokers while female smokers were 13 years younger than their non-smoking counterparts.

Six months after their heart attack, 3.2% of male smokers had died compared to 5.6% of female smokers. Women smokers were also more likely to suffer another cardiovascular event than male smokers (54.5% vs 33.1%).

Interestingly, smokers were around a third less likely to die in the first 6 months following a heart attack than non-smokers. This was likely due to the younger age, and the lower number of co-morbid conditions such as high blood pressure and diabetes in the smoking group.

According to senior study author Dr Elizabeth Jackson who is Assistant Professor of the Department of Internal Medicine at the University of Michigan Health System: “Smoking is not good for men or women, but our analysis shows that women who smoke do worse six months after a heart attack than men”.

Heart disease is the biggest killer of middle aged smokers with almost half of all heart attacks in people aged under 50 attributable to cigarette smoking. Lung and other smoking related cancers become the most significant cause of death in older smokers.

According to a 1994 study published in the European Journal of Epidemiology, compared to non-smokers, heavy smokers (>25 cigarettes per day) are 4.9 times more likely to suffer a heart attack at a given age, moderate smokers (15-24 per day) 3.1 times more likely, light smokers (<15 per day) twice as likely, and former smokers 1.3 times more likely.

Smoking rates in the USA have been declining steadily since the early 1960s although the speed of the decline has slowed somewhat in recent years. As of 2008, 22% of men and 17% of women are considered current smokers.

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The research, conducted by Patricia McGettigan of the Hull York Medical School in the UK and David Henry of the Institute for Clinical Evaluative Sciences in Canada, involved analysing the results of 51 previous studies involving more than 2.7 million individuals, to establish the effects of painkillers on the risk of myocardial infarction.

The researchers found increased heart attack risks for all the drugs studied. Of the most commonly used painkillers, diclofenac (which is sold under the brand names Voltaren and Cataflam), was found to be the most dangerous with a 40% increased risk of heart attacks. Ibuprofen (brand names: Advil and Nurofen), increased heart attack risk by 18%, celecoxib (brand names: Celebrex and Celebra) increased risk by 17%, while naproxen (brand names: Naprosyn, Aleve, Anaprox and Naprelan) increased risk by 9%.

Interestingly, rofecoxib was found to increase heart attack risk by 45% which is only marginally higher than the risk to diclofenac users. Rofecoxib was voluntarily withdrawn by the manufacturer, Merck & Co. in 2004 after concerns were raised about the risks of heart attacks and other cardiovascular events, a move that cost the company more than $2 billion a year in sales.

The researchers also grouped the data by dosage. Ibuprofen and naproxen in low doses (less than 1200-1800 mg/day and 500-1000 mg per day respectively), did not increase the risk of heart attacks by a statistically significant amount however low dose diclofenac (less than 100-150 mg/day) was still associated with a 22% increased risk. These results are important because these three drugs are available in low doses over-the-counter in many countries.

Among the less common painkillers studied, indomethacin increased risk by 30%, piroxicam by 8%, meloxicam by 20%, etodolac by 55%, and valdecoxib by 5%. Etoricoxib was associated with a greater risk of heart attack than any other drug studied, raising risk by a massive 105% although the results for the drug were limited to 4 relatively small studies. Etoricoxib is not currently approved for use in the USA although it is available in more than 70 countries including India, and much of Europe and Latin America.

Among the common painkillers not included in this study, paracetamol (or acetaminophen) has not been linked to an increased risk of heart attack in any scientific studies however exceeding the recommended dose carries a relatively significant risk of liver damage. Aspirin on the other hand actually reduces the risk of myocardial infarction by between 10 and 20% at low doses of between 70 and 150 mg per day. Aspirin does not appear to be linked to an increased risk of heart attack at higher doses although is almost never prescribed because it is considered to carry an unacceptably high risk of gastric bleeding.

Pressure must surely now go on the manufacturer and the FDA to limit the availability of diclofenac. On the basis of this study, diclofenac should, at the very least, be withdrawn from over the counter use and prescribed only to individuals with a very low base risk of myocardial infarction.

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The research involved 32,826 women from the Nurses Health Study who provided blood samples between 1989 and 1990. 144 of the women experienced a heart attack between the time they gave their blood sample and July 1998 when the study ended. The vitamin B6 status of these women in 1989-1990 was then compared to the levels in women who had not suffered a heart attack (the control group). The researchers found that levels of pyridoxal-phosphate (PLP), which is the active form of vitamin B6 in the body, were significantly lower in the heart attack group (30.9 pmol/mL) compared to the controls (40.5 pmol/mL).

Furthermore, when the women were divided into quartiles, 43% of heart attack victims were in the bottom quarter for PLP while just 15% were in the top quarter for PLP levels. After adjusting the results for factors including age, cigarette use, history of diabetes and hypertension, aspirin use, and physical activity, the researchers found that the odds of suffering a heart attack were 82% lower in the top quarter compared to the bottom quarter for PLP.

The researchers concluded that “a lower fasting concentration of PLP is significantly associated with an increased risk of MI”.

While dietary intake of vitamin B6 is the primary determinant of PLP levels in the blood, other factors may also play a role such as obesity and physical activity. The above study found a negative correlation between BMI and PLP levels suggesting obese individuals may be at a greater risk of vitamin B6 deficiency than the general population.

The study also found a strong positive correlation between physical activity and PLP levels which is thought to be due to improvements in the utilization of vitamin B6 following exercise. A Japanese study, published in 2001 in the Journal of Nutritional Science and Vitaminology, looked at the effects of exercise on vitamin B6 metabolism in mice who were fed a vitamin B6 restricted diet. The researchers found that exercise normalized the metabolism of several amino acids that are dependent on vitamin B6. Exercise also lowered the amount of vitamin B6 excreted in urine, allowing more of it to be used by the body.

Along with its ability to lower plasma homocysteine levels, vitamin B6 may reduce heart attack risk through other mechanisms. In one study, high levels of vitamin B6 were associated with significantly lower levels of of C-reactive protein. C-reactive protein is a marker of inflammation in the body and has been linked to cardiovascular disease.

If you have first degree relatives who have suffered heart attacks, or you have several risk factors for heart disease, vitamin B6 supplementation may be an option for you. A standard B-vitamin complex typically contains between 50 and 200 mg of vitamin B6. Because vitamin B6 is water-soluble, it is well tolerated even in high doses as the excess is simply excreted in urine. Prolonged, high dose vitamin B6 supplementation in excess of 500 mg per day, can cause some sensory problems as well as numbness and tingling in the extremities caused by nerve damage, however this is typically reversible once supplementation stops.

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One study, published in the American Journal of Clinical Nutrition in 1992, involved surveying the eating habits of 2034 men and women from Rancho Bernardo, California. The participants were asked about the number of meals and/or snacks they normally ate per day. 9% of participants ate 1-2 meals per day, 72% ate 3 meals per day, and the remaining 19% ate 4 or more meals per day.

The researchers found that those who ate 4 or meals per day had total cholesterol levels that were 3.9% lower than those eating 1-2 meals per day. Furthermore, LDL cholesterol levels were 4.7% lower while HDL cholesterol levels were only marginally decreased, resulting in an improvement in the HDL/LDL ratio.

Those who ate the most meals per day also had slightly lower waist to hip ratios and BMI levels than infrequent eaters despite eating 28% more saturated fat and consuming 18% more calories than infrequent eaters.

The researchers concluded that “cholesterol reductions might be achieved by modest increases in meal frequency without an increase in caloric intake.”

A second study, published in The New England Journal of Medicine, compared the effects of a typical 3 meal per day diet with a 17 meal per day “nibbling” diet. The study involved seven men who were assigned to each diet for a two week period.

The “snacking” diet results in an 8.5% reduction in total cholesterol, a 13.5% reduction in LDL cholesterol, and a 15.1% reduction in apolipoprotein-B (ApoB) levels compared to the regular diet. ApoB is a protein that binds to LDL cholesterol. High levels of ApoB have been linked to a greater risk of atherosclerosis and heart disease and it is generally considered to be a better predictor of heart disease than LDL cholesterol alone.

The precise mechanisms by which meal frequency lowers cholesterol are not known however other studies have shown increased meal frequency results in lower blood sugar and insulin levels in the body. This in turn reduces the activity of an enzyme known as HMG-CoA reductase which plays a primary role in the production of cholesterol in the liver.

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It is important to note that saturated and trans fat intake actually influences an individuals cholesterol levels more than dietary cholesterol does. Therefore it is important to choose foods that are low in both saturated fat and cholesterol. Meats that are low in both cholesterol and saturated fat tend to be the ones that have very low levels of animal fat or have the visible fat trimmed off the product before eating. Good low cholesterol options include skinless chicken and turkey breast, lean cuts of beef, pork, and lamb, and most types of fin-fish.

High cholesterol meats to avoid include the internal organs of animals such as livers, brains, and kidneys. Fatty cuts of meat such as porterhouse and skirt steak should also be eaten with caution. Caviar, and most types of shellfish should only be consumed in small amounts due to very high levels of cholesterol.

Current health recommendations are for cholesterol and saturated fat intake to be limited to 300mg and 20g a day respectively so one serving of meat will typically provide between 15 and 30% of your cholesterol and saturated fat allowance.

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Two studies have looked at the effect of rye bread on cholesterol levels. The first study was conducted by Finnish researchers and was published in the Journal of Nutrition in 2000. The study involved 40 individuals with moderately high cholesterol levels who were put on both rye based and wheat based bread diets for a 4 week period. The researchers found that the rye bread reduced the cholesterol levels of men by an average of 8% but did not change the levels of the women. For men in the top third of rye bread consumption, total cholesterol levels dropped by 10% while LDL cholesterol levels dropped by an impressive 12%.

A second study, published in 2008 in the Journal of the Science of Food and Agriculture found that pigs fed a diet high in rye bread had both LDL and total cholesterol levels 40% lower than pigs fed a diet high in wheat bread. HDL cholesterol levels were largely similar between the two groups.

Rye bread has several other health advantages over regular wheat bread. Rye bread tends to be higher in fiber than other breads with 6% fiber compared to just 2% for regular white. Rye bread also contains higher levels of manganese and selenium which are both important minerals for heart health. The glycemic index for rye bread is 58 which is relatively low for a bread product, by comparison, white bread has a GI of 72 and wholemeal bread a GI of 65. A lower glycemic index is important because it prevents spikes in blood sugar and results in a slower, more sustained energy release.

Rye bread may also improve insulin secretion according to at least one study. That study, published in the American Journal of Clinical Nutrition in February 2003 found a 10% increase in insulin response after a intravenous glucose test following an 8 week diet where large amounts of high fiber rye bread were consumed. This suggests that rye bread may be a good option for type-2 diabetics where insulin secretion is often impaired.

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Several studies have found Vitamin E to be very effective at slowing the rate of LDL oxidation and subsequently slowing down the rate of atherosclerosis.

One study, published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology in 1993, looked at the effects of vitamin C, vitamin E, and beta carotene on the level of LDL oxidation in 8 healthy volunteers. The researchers found that while vitamin C and beta carotene had little effect, vitamin E decreased LDL oxidation levels by 50%. The level of vitamin E used in this study was quite high at 1.6g per day (more than 100 times the recommended daily intake), the equivalent of 8 standard vitamin E pills.

A second study looked at the effects of much lower levels of vitamin E on LDL oxidation. That study, also published in Arteriosclerosis, Thrombosis, and Vascular Biology, involved 20 volunteers who took vitamin E supplements at a variety of doses for 2 weeks at a time. The researchers found that even at a relatively low dose of 25mg per day, vitamin E offered protection against LDL oxidation.

A final study, published in the journal Diabetes Care in 2000 compared the effects of tomato juice, vitamin E, and vitamin C on LDL oxidation. The researchers found a 42% increase in resistance to LDL oxidation in the tomato juice group, a 54% increase in resistance for the vitamin E group, and no significant change in the vitamin C group.

People at a high risk of developing atherosclerosis may benefit from vitamin E supplementation however there are many natural foods that are rich in vitamin E. Wheat germ oil is relatively inexpensive and is widely avaiable in health food shops and supermarkets. One tablespoon of wheat germ oil contains a massive 20mg of vitamin E as well as 2.4g of omega-6 and 0.3g of omega-3 fatty acids – both essential for good health. Other rich sources of vitamin E include avocados, peanuts, hazelnuts, almonds, tomatoes, and green leafy vegetables such as spinach and silverbeet.

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A study, published in 1990 in The American Journal of Clinical Nutrition, involved the study of 24 men with an average age of 58 who all  suffered from high cholesterol levels. The men had their cholesterol levels and body weight measured at the beginning of the study and were then put on one of three diets for 21 days.

The first diet contained one can of baked beans with tomato sauce to be consumed in one serving each day, the second diet divided the baked beans into two servings to be eaten at noon and in the evening. The third diet contained a higher proportion of baked beans and a lower proportion of tomato sauce also divided into two servings. No other changes to the men’s diet were made.

At the conclusion of the 21 days, the researchers found that the men’s cholesterol levels dropped by 8.7%, 11.6%, and 10.3%, for the three diets respectively. Furthermore, the body weight of the men dropped by an average of 1.3kg despite no changes in total energy intake.

Several mechanisms may be responsible for the cholesterol lowering abilities of baked beans. Beans are high in soluble fibre which may reduce the absorption of cholesterol from the small intestine. Navy beans, which are normally used in canned baked bean products are also a rich source of folate and manganese which are important for heart health. One serving of baked beans provides more than half the recommended daily intake of these two nutrients.  Baked beans are also rich sources of phosphorous, iron, vitamin B1, copper, potassium, and magnesium.

The tomato sauce used in canned beans is a rich source of lycopene, an antioxidant found in red and orange foods such as tomatoes, watermelon, grapefruit, and papaya. The tomato sauce is cooked during the canning process which increases the bio-availability of the lycopene. One study found that women with the highest lycopene levels were as much as 34% less likely to develop heart disease than women with lower levels.

Navy beans belong to the legume family and studies of legume consumption and heart disease risk add further evidence in favour of baked beans. One such study, published in the Archives of Internal Medicine in 2001, found that those who consume legumes four or more times a week had a 22% less chance of developing coronary heart disease than those who eat legumes less than once a week. The researchers concluded that: “increasing legume intake may be an important part of a dietary approach to the primary prevention of CHD in the general population.”

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In countries such as Ireland and Japan, and Iceland, where per capita fish consumption is very high, deaths attributable to heart disease are relatively low compared to other developed countries such as the USA and United Kingdom.

A study conducted in 2002 and published in the Journal of the American Medical Association , used data from the Nurses Health Study of more than 80,000 women to determine the impact of fish consuption on coronary heart disease.

The researchers found that compared to those who rarely consumed fish, those women who consumed more than 5 servings of fish a week were 34% less likely to develop heart disease and 45% less likely to die as a result. The authors concluded that “Among women, higher consumption of fish and omega-3 fatty acids is associated with a lower risk of CHD, particularly CHD deaths.”

Similar benefits of frequent fish consumption have been found in men. A large study published in the Journal of the American Medical Association in 1998 used data from the Physicians Health Study which involved more than 20,000 US males aged between 40 and 84. The researchers found that the incidence of sudden cardiac death was reduced by 52% in men who consumed fish at least once a week compared to men who ate fish less than once a month. The full results of the study are shown in the graph to the right.

In a randomized control trial conducted in 1999 by Italian researchers, 11,324 heart attack survivors were randomized to receive a placebo, or either 850mg of omega 3 fatty acids, 300mg of Vitamin E, or both. After following the participants for 3.5 years the group given omega-3 fatty acids experienced a 20% reduction in death from all causes and a 45% reduction in sudden death compared to the control group.

Research has typically found that the heart benefits of fish consumption are stronger for oily fish rather than lean fish. This suggests that it is the omega 3 fatty acids found in fish oil that are responsible for the heart benefits of fish.

The mechanisms by which fish oil reduces the risk of heart disease are thought to be through a reduction in blood triglyceride levels, reductions in blood pressure, and perhaps most significantly, through a reduction in cardiac arrhythmias which can lead to sudden cardiac death. Evidence of this comes from animal studies in rats and dogs where fatal ventricular arrhythmias have been prevented by supplementation of omega 3.

In humans, studies have shown that heart rate variability in survivors of myocardial infarction is increased when fish or fish oil supplements are consumed. Heart rate variability is a strong predictor of mortality in heart attack survivors with low heart rate variability associated with a much higher rate of sudden cardiac arrest due to arrhythmias. Long term fish oil consumption may also reduce the rate of arterial plaque development although evidence from clinical studies that fish oil can prevent atherosclerosis has been mixed.

The American Heart Association (AHA) recommends eating at least two servings of fish a week to reduce the risk of heart disease. Individuals should aim to consume around 1.2g of omega 3 fatty acids a day. This corresponds to 4 standard strength fish oil capsules each day in the absence of any dietary sources of omega 3. Most people should be able to consume between 500-800mg of omega-3 per day on average with one or two omega-3 capsules making up the remainder of the days requirement.

Abundant sources of omega-3 include (grams of omega-3 per serving in brackets): tuna (0.3g), salmon (1.2g), cod (0.2g), flounder (0.5g) and halibut (0.9g). Non-fish sources of omega-3s include: walnuts (2.5g), flax seeds (1.6g), soy beans (0.5g), canola oil (1.2g), chia seeds (4.9g), and beef and lamb (particularly from grass fed animals).

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• Moderate Alcohol Consumption Helps Prevent Ischemic Heart Disease

Researchers looked at the health of a group of 325 moderate drinkers who had recently suffered a heart attack. 84% continued to drink moderately following their heart attack while the remaining 16% abstained from drinking. It was found that one year after the heart attack event those who continued to drink were 35% less likely to suffer angina, experienced 21% fewer rehospitalizations and scored higher on quality of life and mental health questionnaires. The researchers also found that three years on from their heart attack, the moderate drinkers had a 25% lower risk of mortality compared to the non-drinkers.

The researchers concluded that there is no evidence to suggest that continuing to drink moderately following a heart attack has any adverse health effects and in fact quality of life may be improved in some individuals.

Several mechanisms are thought to be responsible for the heart benefits of light to moderate alcohol consumption. Moderate alcohol consumption of up to one standard drink a day for women and two standard drinks for men is associated with a modest reduction in blood pressure and an increase in healthy HDL cholesterol. Furthermore, like aspirin, alcohol is an anti-coagulant meaning it reduces the clotting ability of blood, reducing the likelihood of a clot blocking an artery and subsequently causing a heart attack. This is a result of alcohol’s ability to reduce the production and expression of fibrinogen, a protein that play a crucial role in the clotting process. A 1999 study, which involved adding a small amount of ethanol (5%) to the drinking water of rats for 4 weeks, found a 20% reduction in circulating levels of fibrinogen. The researchers concluded that: “one likely positive benefit of moderate ethanol consumption is to diminish the production of fibrinogen, which reduces the potential risk exerted by this protein”.

Even though some alcohol may have a beneficial effect for heart attack survivors it is important that people don’t overindulge. Research conducted in 2004 found that heart attack survivors who had engaged in binge drinking in the past year (defined as 3 or more drinks in a two hour period) had a 73% higher death rate than those who had not. One or two beers or a glass of wine a day, preferably consumed with the evening meal, is probably sufficient to enjoy the benefits that alcohol can have on the heart while limiting the adverse effects.

The American Heart Association does not recommend that non-drinkers take up drinking following a heart attack due to the difficulty some individuals have in keeping alcohol consumption under control.

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A new study, presented at the American Society of Hypertension meeting in San Francisco this month, looked at how the risk of suffering a stroke or heart attack varied with blood pressure in a group of 10,001 coronary heart disease patients.

The researchers found that those with a systolic blood pressure below 110 mmHg were 3.1 times more likely to suffer a stroke or heart attack compared to those with a blood pressure of between 130 and 140 mmHg. Those with a diastolic blood pressure below 60 mmHg were 3.3 times more likely to suffer a heart attack or stroke compared to those with a diastolic blood pressure between 70 and 80 mmHg.

The blood pressure associated with the lowest overall risk of coronary heart disease was calculated to be 140.6/79.8 mmHg, significantly higher than the 120/80 mmHg level recommended by the American Heart Association.

The researchers noted that the findings did not necessarily mean that low blood pressure causes cardiovascular disease. It is possible that low blood pressure is caused by some other factor that is in turn responsible for increased cardiovascular disease risk. Congestive heart failure for example can lead to low blood pressure due to the inability of the heart to pump sufficient blood around the body.

The research backs up the findings of similar studies that have found an increased risk of cardiovascular events in patients with pre-existing cardiovascular disease who have low blood pressure. On the other hand, healthy individuals with low blood pressure who are free from cardiovascular disease do not appear to be at an increased risk of heart disease and stroke.

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The research, conducted by Canadian scientists, involved the comparison of a diet rich in foods known to reduce cholesterol with a popular statin known as lovastatin.

34 participants who were suffering from high cholesterol completed the study which consisted of three one month phases. The first phase was a whole-wheat based diet (control diet), the second phases was the same whole-wheat diet plus 20mg per day of lovastatin, while the final phase consisted of a diet based on four cholesterol lowering components: 1g/1000kcal of plant sterols, 10g/1000kcal of soluble fiber which came from oats, barley, and psyllium, 21.4g/1000kcal of soy protein, and 14g/1000kcal of almonds.

The researchers found that LDL cholesterol was reduced by 29.6% for the cholesterol lowering diet compared to 33.3% for the statin diet. 27 of the 36 participants reduced their cholesterol levels to within the safe range on the statin compared to 24 participants on the cholesterol lowering diet. Nine of the participants achieved better results on the cholesterol lowering diet than from the statin alone. The researchers also calculated that participants dropped their 10 year risk of coronary heart disease from 11.4% to 8.4% on the cholesterol lowering diet and from 11.6% to 7.7% on the statin.

Cholesterol is thought to be one of the most important risk factors for coronary heart disease. Researchers have calculated that a 1% reduction in LDL cholesterol levels results in a 1.5% decrease in the risk of coronary heart disease.

Components of the cholesterol lowering diet were only included if they had a scientifically verified mechanism of action. Plant sterols reduce the absorption of cholesterol in the intestines. Soluble fiber increases the excretion of bile acids from the body leading to an increase in the production of bile acids in the liver. Bile acids are produced by the oxidation of cholesterol so an increase in bile acid production increases the rate of cholesterol metabolism. Soy protein increases the function of LDL receptors in hepatic cells leading to an increase in the uptake of LDL cholesterol by the liver. Almonds contain numerous cholesterol lowering substances including plant sterols, fiber, and mono-unsaturated fat which increases HDL cholesterol levels while lowering LDL cholesterol.

Rich sources of soluble fiber include peas, beans, oats, barley, pears, broccoli, Brussels sprouts, carrots, and psyllium. Sources of plant sterols include margarines, most vegetable oils, peanuts, blueberries, broccoli, Brussels sprouts, and cauliflower.

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The researchers used data from the Framingham Heart Study (FHS) to determine how total cholesterol levels influence overall heart disease risk. More than 7,000 men and women were studied of which 1,120 developed coronary heart disease during the 25 year study period.

The researchers calculated that at the age of 40, men in the highest group for total cholesterol (greater than 240mg/dL) had a 57% probability of developing coronary heart disease by age 80. In contrast, men in the lowest group for total cholesterol (less than 200mg/dL) had a 31% probability of developing coronary heart disease.

In women, the risks of developing heart disease were much lower overall however the benefits of low cholesterol levels were still apparent. The lowest cholesterol group had a 33% chance of developing coronary heart disease by age 80 compared to just 15% in the lowest cholesterol group. The full results of the study are presented in the graph below.

The American Heart Association (AHA) recommends that individuals maintain a total cholesterol level below 200mg/dL. Total cholesterol is made up of two components: LDL and HDL. LDL makes up the larger proportion of total cholesterol and is the type that is detrimental to heart health. An LDL cholesterol level of 100mg/dL or lower is considered optimal however further reductions in heart disease risk are seen at levels as low as 60mg/dL. HDL cholesterol is the other component of total cholesterol and is considered to be beneficial to heart health. It is recommended that an individual aims for a HDL to total cholesterol ratio of 5:1 with a ratio lower than 3.5:1 considered ideal.

The percentage of Americans with high cholesterol is currently decreasing with just 16% of men and 18% of women having total cholesterol levels greater than 240mg/dL. In 1975 the numbers were 26% and 28% for men and women respectively. This has been brought about primarily through the increased use of cholesterol lowering drugs (statins) rather than any dietary improvements.

Despite these reductions in total cholesterol, heart disease remains the most common health problem facing the western world. In the United States, 49% of men and 32% of women will develop heart disease during their lifetimes. By comparison, cancer carries a 44% and 37% lifetime risk for men and women respectively, diabetes carries a 33% and 39% lifetime risk for men and women, while the lifetime risks for Alzheimer’s disease are 7% for men and 13% for women.

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The study, conducted by Canadian scientists, involved analyzing 262 previous studies on heart disease involving a combined 29,000 individuals from 52 countries. The researchers attempted to isolate the risk factors thought to have the greatest impact on an individuals probability of suffering a heart attack.

The researchers found that nine modifiable risk factors accounted for more than 90% of all heart attack cases. The risk factors were (in descending order to importance):

• A high ApoB/ApoA-1 ratio
• Current smoking
• Psychosocial factors (e.g work stress)
• Diabetes
• Hypertension (high blood pressure)
• Abdominal obesity
• Poor fruit and vegetable intake
• Lack of physical activity
• Little or no consumption of alcohol

The ApoB/ApoA-1 ratio is similar to the LDL/HDL ratio but is thought to be a better overall predictor of heart disease. The odds of suffering a heart attack were 3.25 times greater for individuals with an ApoB/ApoA-1 ratio in the top 20% compared to the bottom 20% and were 2.87 times greater for current smokers compared to former or non smokers. The full odds ratios for each of the factors are shown in the graph below (an odds ratio greater than one indicates an increased risk of heart attack while an odds ratio less than one indicates a reduction in heart attack risk).

The two greatest risk factors, a high ApoB/ApoA-1 ratio and smoking, were calculated to be responsible for a massive 67.3% of all heart attacks worldwide. The nine factors combined were responsible for 90% of all heart attacks in men and 94% of heart attacks in women.

According to lead researcher Dr. Salim Yusuf of the Michael DeGroote School of Medicine in Ontario, Canada: “…most people believe that only half the risk of heart attacks can be predicted. This study convincingly shows that 90% of the global risk is preventable.”

The researchers added that while obesity was an established heart attack predictor, it was not included as one of the risk factors because it performed relatively poorly compared to abdominal obesity. This is because fat located around the central organs appears to be much more problematic for the heart than fat located in other areas. The authors recommend people place less emphasis on BMI and instead use  a measure of central obesity such as waist size or the waist to hip ratio to more accurately gauge heart disease risk.

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