People who develop high blood pressure before age 40 have a higher risk of heart disease and strokes in middle age, two new studies suggest.
One of the studies followed 4,800 young adults in the U.S. and found elevated blood pressure before age 40 associated with up to 3.5 times greater risk of heart disease and strokes over about 19 years of follow-up.
The second study examined data on almost 2.5 million young adults in South Korea over a decade and also found high blood pressure before age 40 was linked to greater risk of heart disease and strokes. Women in this study had up to a 76 percent higher risk of cardiovascular disease, while for men the risk was 85 percent higher, compared to peers with normal blood pressure.
“Elevated blood pressure in early adulthood can result in heart attacks by several mechanisms, and these levels of blood pressure may progress to higher levels over time,” said Ramachandran S. Vasan of the schools of medicine and public health at Boston University.
“They are often associated with . . . other risk factors (such as excess weight, high cholesterol, high blood sugar and smoking) that synergistically elevate heart attack and stroke risk,” Vasan, author of an accompanying editorial, said by email. “They may promote damage to target organs including heart and arteries, thickening of the arterial walls and build up of cholesterol deposits/plaques in arteries, thereby creating a substrate (‘soil’, if you will) for future heart attacks and strokes.”
For the studies, both published in JAMA, researchers assessed high blood pressure using new, more aggressive target levels recommended by the American Heart Association and the American College of Cardiology in 2017. The new recommendations were based on emerging evidence suggesting that even slightly elevated blood pressure early in life might be a precursor to cardiovascular disease as people age.
Patients were classified as having hypertension when the “top number,” or systolic pressure (reflecting the pressure against artery walls when the heart beats), averaged at least 130 mmHG (millimeters of mercury).
They were also considered to have hypertension if the “bottom number,” or diastolic pressure (reflecting pressure against artery walls when the heart rests between beats), averaged at least 80 mmHG.
Before the new recommendations in 2017, people were not diagnosed with high blood pressure until they had measurements of 140/90 mmHG or higher.
Not all doctors have been treating patients using the new, more aggressive blood pressure target, in part out of concern that long-term use of medications to lower blood pressure might have side effects, such as diarrhea or constipation, dizziness, fatigue, headaches, nausea or vomiting or mood disorders.
While young adults with high blood pressure should consider the potential for medication side effects, they may be able to manage their blood pressure with lifestyle changes like eating better or exercising more and they should discuss these options with their doctor, said the senior author of the Korean study, Dr. Sang Min Park of Seoul National University Hospital.
“We have shown that hypertension even at a young age may be associated with higher risk for heart attacks or strokes,” Park said by email. “Therefore, young adults with hypertension should have their blood pressure monitored on a regular basis and manage their blood pressure levels by lifestyle changes or medications.”
Lifestyle changes are not only beneficial in reducing blood pressure and cardiovascular disease risk but could also lead to improved physical and mental health, Park noted.
Neither study looked at whether aggressive blood pressure treatment might stop people from developing heart disease or dying from it.
But the results still suggest that treating blood pressure more aggressively at a younger age might help minimize the risk of premature heart problems later in life, said the U.S.-based study’s lead author Dr. Yuichiro Yano of Duke University in Durham, North Carolina.
“Our study is among the first to report that people younger than age 40 who have elevated blood pressure or hypertension are at increased risk of heart failure, strokes and blood vessel blockages as they age,” Yano said by email.
Diabetes patients at higher risk of liver disease:study
While analysing 18 million people living with type-2 diabetes, a study led by Queen Mary University of London and the University of Glasgow found that diabetics are at a particular risk of developing deadly liver cirrhosis and liver cancer.
Non-alcoholic fatty liver disease (NAFLD) affects up to a quarter of people in the West and is closely associated with obesity and type-2 diabetes. Its rise is reflective of the social problems of poor diets and sedentary lifestyles. Since general practitioners are often unaware of the condition, patients mostly go undiagnosed.
NAFLD is a benign condition for the majority but one-in-six people will go on to develop the aggressive form of the disease, called non-alcoholic steatohepatitis (NASH), leading to liver injury, scarring and eventually in some cases, cirrhosis, liver failure and even liver cancer.
Published in the journal of BMC Medicine, the team combined the healthcare records of 18 million European adults from the UK, Netherlands, Italy and Spain. They matched each NAFLD patient to 100 patients who did not have a recorded diagnosis, and looked to see who developed liver cirrhosis and liver cancer over time.
“We were surprised that the number of patients with recorded diagnoses of non-alcoholic fatty liver was much less than expected, meaning that many patients are actually undiagnosed in primary care. Even over the short time frame of the study, some patients progressed to more advanced, life threatening stages of disease, suggesting that they are being diagnosed very late,” said lead researcher Dr William Alazawi from Queen Mary University of London.
Naveed Sattar from the University of Glasgow said, “Doctors treating patients with diabetes already have a lot to check on – eyes, kidneys, heart risks – but these results remind us that we should not neglect the liver, nor forget to consider the possibility of NASH. They also remind us that perhaps more efforts are needed to help our patients with diabetes lose weight and cut alcohol.”
In India, prevalence of NAFLD is estimated to be around 9-32 per cent in the general Indian population, with a higher incidence rate among obese and diabetic patients. In fact, type-2 diabetes surges the risk of liver associated death by up to 22-fold in patients with NAFLD, as per National Center for Biotechnology.
Notably, a 2017-study, ‘Prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus and its correlation with coronary artery disease (CAD)’, in India found that the prevalence of NAFLD was 41.2 per cent in the study group and was higher in females.
NAFLD in the younger age group was also significantly higher than that in the older age group. Elevated liver enzymes, elevated HbA1C, duration of diabetes, obesity, acanthosis nigricans and metabolic syndrome were all significantly associated with NAFLD.
How chronic stress promotes breast cancer development
Chinese researchers have revealed the mechanism of how chronic stress promotes breast cancer development, shedding light on future clinical treatment for cancer.
Cancer patients often suffer negative emotions such as anxiety, despair and fear, which are risk factors facilitating tumour growth as well as promoting cancer progression. However, the specific mechanisms of how chronic stress affects cancer development remains unknown yet.
Researchers from the Dalian Medical University in China found that chronic stress might increase epinephrine levels, which enhances lactate dehydrogenase A (LDHA) and promotes breast cancer stem-like cells, Xinhua reported.
Using a drug screen that targeted LDHA, they found that Vitamin C reversed the chronic stress-induced cancer stem-like phenotype.
The study demonstrates the critical importance of psychological factors in promoting stem-like properties in breast cancer cells and provides a promising therapeutic approach for breast cancer, according to Liu Qiang, lead researcher at the varsity.
“The LDHA-lowering agent Vitamin C can be a potential approach for combating stress-associated breast cancer,” Qiang said, in the paper published in the Journal of Clinical Investigation.
His team has been engaged in the dynamic regulation of cancer stem cells research as well as the mechanism of psychosocial behaviour affecting tumour development.
Qiang noted that patients with breast cancer, ovarian cancer and stomach cancer often have negative emotions, which in turn accelerates the development of their own tumours.
“It is necessary to monitor their chronic stress comprehensively by taking psychological assessments as well as conducting blood tests which include epinephrine levels,” Qiang said.
Moderate cholesterol intake not associated with risk of stroke
Consuming up to one egg per day or moderately high intake of dietary cholesterol does not increase the risk of stroke, according to a study from the University of Eastern Finland. Furthermore, no association was found in carriers of the APOE4 phenotype, which affects cholesterol metabolism. The study was published in the ‘American Journal of Clinical Nutrition’.
Findings from earlier studies addressing the association of dietary cholesterol or egg intake with the risk of stroke have been contradictory. Some studies have found an association between high dietary cholesterol intake and an increased risk of stroke, while others have associated the consumption of eggs, which are high in cholesterol, with a reduced risk of stroke.
The dietary habits of 1,950 men aged between 42 and 60 years with no baseline diagnosis of cardiovascular disease were assessed at the onset the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, in 1984-1989 at the University of Eastern Finland. APOE phenotype data were available for 1,015 of the men participating in the study. Of those, 32 per cent were known carriers of APOE4.
During a follow-up of 21 years, 217 men were diagnosed with a stroke. The study found that neither dietary cholesterol nor egg consumption was associated with the risk of stroke – not even in carriers of APOE4.
The findings suggested that moderate cholesterol intake or daily egg consumption are not associated with the risk of stroke, even in persons who are genetically predisposed to a greater effect of dietary cholesterol on serum cholesterol levels.
In the highest control group, the study participants had an average daily dietary cholesterol intake of 520 mg and they consumed an average of one egg per day, which means that the findings cannot be generalised beyond these levels. One egg contains approximately 200 mg of cholesterol. In this study, about a fourth of the total dietary cholesterol consumed came from eggs.