The age at menopause is an important risk factor for cardiovascular disease. Pooled data from >300,000 participants without prior hysterectomy in 15 observational studies were studied. Premature menopause was defined as the absence of menstruation for 12 months before the age of 40; early menopause between the ages of 40-44; and relatively early defined between the ages of 45-49. The reference group was ages 50-51.

Results indicated that compared to the reference group, premature and early menopause were important risk factors for cardiovascular disease. Compared with women who had menopause at age 50-51, women with premature and early menopause had a substantial increase risk of a non-fatal cardiovascular event before the age of 60 years, but not after age 70 years. Women who reached menopause after the age of 52 had slightly decreased risk of coronary heart disease and stroke.

All women in their 40’s need to be assessed for cardiovascular risks, but women in premature or early menopause need closer monitoring as this research indicates.

Reference: Zhu D et al. Age at natural menopause and risk of incident cardiovascular disease: A pooled analysis of individual patient data. Lancet Public Health 2019 Oct 3; [e-pub]. (https://doi.org/10.1016/s2468-2667(19)30155-0.

“The toxic effects of late-night living and all-day snacking are akin to those of ‘lead and asbestos'”according to Dr. Satchin Panda, a professor at the Salk Institute in La Jolla California. His podcast talks about the dangers of eating late at night and lack of sleep that can significantly effect the bodies circadian rhythm and raise inflammation.
According to Dr. Panda, “almost every gene, hormone, brain chemical, neurotransmitter, digestive juice and enzyme in our body is programmed to turn on and off, or go up and down, every 24 hours.”

During sleep, we produce growth hormone that helps repair damaged cells. If we get inadequate sleep, we have less of this growth hormone present to repair our cells. In addition, if we eat late in the evening, our stomach, pancreas, liver and other organs are unprepared and leaves little time for the body to repair itself. Over time, these conditions lead to chronic diseases such as diabetes, hypertension, dementia, acid reflux, and irritable bowel. Once you re-set your circadian rhythm, these problems can be fixed.

The simple solution (but not simple for many) is to eat all your food within an 8-12 hour window beginning about 30 minutes after awakening. Research found that when overweight people restricted their eating to a 10-hour window, they lost 4% of their body weight in 4 months without altering their diet.

Not eating at night and getting morning sunlight can synchronize our body clocks.
Do your best to eat your last meal around 6 PM.

STEM-Talk – Dr. Satchin Panda on Circadian Rhythms and Time-Restricted Eating to Improve Health

Detwiler, J. Timing is Everything: Adjust your daily clock to change your life. AARP The Magazine. Oct/Nov 2019 p. 50

New research reveals that the measles virus, if infected, can cause long term problems with the immune system. Even after you recover, the immune system is left weaker than before for several years which can make you vulnerable to other infections such as flu and pneumonia. The virus kills cells that apparently make antibodies leading to “immune amnesia”.

How do you know if you are immune?
1. Written documentation of age-appropriate vaccination
2. Laboratory test of immunity
3. Laboratory confirmation of having the disease
4. Even if born before 1957, you still need to have documentation of 2 vaccinations or antibody titers that show immunity.

Complications of adult measles can lead to pneumonia. One in 1000 adults will get encephalitis (brain infection).
One-two in 1000 children will die.
We have seen epidemic cases of measles this year in the U.S. as well as Europe. Of those infected, 71% were unvaccinated.
Make sure you have immunity to prevent acute and long-term complications.

www.cdc.gov>vaccines>acip.

We know that our blood pressure (BP) can reveal a lot about our cardiovascular risk factor for heart disease. About 50 years ago, the diastolic, or lower number, was the one causing more concern if elevated and more predictive of cardiovascular events (CV) than the systolic number. More recently, The systolic, or top number, may be deemed more important although both are important to maintain at normal levels (NEJM JW Gen Med Dec 15 2017 and J Am Coll Cardiol 2018; 71:e127).

A multivariable analysis (data collected on systolic and diastolic blood pressures) were collected to determine the 8 year CV outcomes (heart attack, stroke) in more than 1 million adults, average age 53, from North California’s Kaiser Permanente health system. The researchers found that for systolic BP’s of 136 and 160 mm Hg, the predicted 8 year risks for CV events were 1.9% and 4.8% respectively. On the other hand, for diastolic BP’s of 81 and 96 mmHg, CV event rates were 1.9% and 3.6% respectively.

This shows that both systolic and diastolic BP are independent predictors of adverse cardiovascular outcomes. In general, an ideal BP should be less than 130/80. Do you know your blood pressure?

Reference: Flint AC et al. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. N Engl J Med 2019 Jul 18; 381:243

The current definition of a healthy body mass index (BMI) has been under some scrutiny after a new research study found that the BMI we consider “normal” may actually be too low and unhealthy.
A recent study collected data and adjusted results using a wider range of potential confounders (other variables) than in prior studies looking at measuring and interpreting BMI. The new data showed the impact of newer treatments to reduce cardiovascular disease illness and death while past studies relied on data from earlier times when less cardiovascular disease protection occurred. The current study included people from lower-income countries, although the finding is just as applicable to people who live in high-income countries, who were also included in the study population, noted Salim Yusuf, MBBS, principal investigator for the study.
The study showed that middle-aged adults with a body mass index of 25-29 kg/m2 (currently considered “overweight”) had a significantly better adjusted survival during an average follow-up of nearly 10 years than did people with a “normal” body mass index of 20-24 kg/m2 in a worldwide study of more than 140,000 people. This suggests that the current, widely accepted definition of normal body mass index is wrong.

This is where other tools come into play that can be better predictors for survival. One is the ratio of hand-grip strength to body weight. This assesses the importance of muscle mass to overall weight. The optimal strength/weight ratio is 0.42 in women and 0.50 in men according to Dr. Darryl Leong, a cardiologist at McMaster University and the Population Health Research Institute, both in Hamilton, Ont.
In a large longitudinal population study, it was found that grip strength measurement can be a strong predictor of cardiovascular mortality and a moderate strong predictor of cardiovascular disease. This new study, called the Prospective Urban-Rural Epidemiology Study (PURE) included about 140,000 people that were examined between 2003-2009. Grip strength was measured using a hand grip dynamometer.
Another very important and good predictor of weight is the waist/hip ratio which adds the dimension of the location of body fat rather than just the amount. An optimal waist/hip ratio for survival according to Dr. Leong is 0.83 in women and 0.93 in men. This means that a man whose hand/grip strength (in Kg) is half of the person’s body weight, then his chance for survival is very good.
So even though being “overweight” according to the BMI readings we currently use seems to lower mortality rates, we need to remember that the link between total mortality and BMI was strongest in the group of people that were on 1 or more treatments aimed at preventing cardiovascular disease (which may include being on a Statin drug or anti-hypertensive med) while there was no benefit among people not receiving any cardiovascular disease preventative measures.

https://www.mdedge.com/clinicianreviews/article/207836/lipid-disorders/survival-overweight-bmi-surpasses-normal
https://www.mdedge.com/anticoagulationhub/article/99720/acute-coronary-syndromes/grip-strength-predicts-cardiovascular