Study to help reduce risk of heart disease and diabetes, to be done via Zoom, is looking for participants in 16 Kentucky counties

Kentucky Health News map

By Gia Mudd-Martin

University of Kentucky

Heart disease and Type 2 diabetes are often preventable, but Kentucky has the nation’s ninth-highest rate of heart disease and the fifth highest rate of diabetes. Plus, many Kentuckians have pre-diabetes but don’t know they have it.

A team of at the University of Kentucky is leading a health study called “Heart of the Family” to help people learn to reduce their risk for these illnesses, and the team is inviting participants to join.

What do participants get?  

• “Heart of the Family” participants receive eight one-on-one, personalized health education sessions based on their risk factors and health. The sessions are over Zoom — no travel required.
• Free screenings to check health measurements such as blood pressure and cholesterol; these can be done in your home community (team members can come to you) or at an off-campus UK office
• Gift card for participation

Who can join? You may be eligible to participate if you are:

• At least 18 years old
• Do not have heart disease or diabetes
• Live in one of these Kentucky counties: Anderson, Bourbon, Boyle, Casey, Clark, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Marion, Mercer, Pulaski, Scott, Woodford
• Have two or more of these risk factors: family history of heart disease or diabetes; personal history of gestational diabetes or polycystic ovarian syndrome; little or no exercise; unhealthy diet; high blood pressure; high cholesterol; elevated blood sugar; stress; depression; overweight; cigarette smoker

Some participants will be invited to have a friend or family member join with them as a “study buddy,” so make sure you have someone willing to participate with you. They can participate even if they have diabetes or heart disease. Study buddies will receive the same benefits listed above.

What is required of participants? Participants should be willing to complete eight virtual health-education sessions, share health information with the study team, and have blood drawn. All your information will be kept completely confidential, just like in regular medical care.

How can I get involved? If you’re interested in learning more or joining, contact Emily Cravens at emcravens@uky.edu or 859-218-6827. Learn more about participating in research at UKClinicalResearch.com.

Men's Health Month a reminder to schedule preventive screenings

By Melissa Patrick
Kentucky Health News

Men's Health Month in June is a reminder for men to think about their health and consider making some screening appointments that could lengthen, or even save, their lives. 

Why is it so important for men to take care of themselves? For one thing, on average in the United States, men die nearly six years earlier than women. 

That is a wider gap than before the pandemic, which took a disproportionate toll on men. Researchers also note that men are more prone to unintentional injuries, such as drug overdoses and  accidents. Homicides, heart disease and suicides also contribute to the worsening life expectancy for men. 

Men's Health Month is a time for men to take charge of their health and to schedule their preventive  health screenings, especially for the conditions that if caught and treated early could save their life. 

Some recommended screenings include: 

 

Heart disease is the leading cause of death in men, according to the Centers for Disease Control and Prevention.  The American Heart Association says the key screenings for heart health involve an annual physical that include test for blood pressure, cholesterol, body weight and diabetes. Smoking is also a major cause of heart disease, and a health-care provider can help with a cessation plan. 

Skin cancer: Increased sun exposure and fewer trips to the doctor put men at a higher risk of developing skin cancer, so it's important to not only protect your skin when outdoors, but to see a dermatologist if you notice any change in a mole's color or appearance, or if they bleed, ooze, itch, appear scaly or become tender or painful. A dermatologist can also do a full-body skin cancer screening. 

Lung cancer: Kentucky still has one of the highest smoking rates in the nation and leads the nation in lung-cancer cases and deaths. Lung-cancer screening via low-dose computed tomography (a low-dose CT scan) is recommended for anyone 50 to 80 who smokes or has quit in the past 15 years and has at least a 20 pack-year smoking history (a pack per day for 20 years or two packs per day for 10 years). 

Prostate cancer: On average, one in eight men will be diagnosed with prostate cancer and it is the second leading cause of death among men, according to the American Cancer Society. It is recommended that prostate cancer screenings for men who are at average risk begin at age 50. 

Colon cancer: Routine screening for colorectal cancer is recommended to start at age 45. Men with a family history of the cancer may be advised to get screened earlier.

Diabetes: In Kentucky, about 100,000 people have diabetes and don't know it. That's why it's important to get screened with a blood test even when you don't think you have any symptoms.

Mental health: A primary-care provider is a good place to start if you are seeking help with a mental-health concern. Mental Health America of Kentucky also offers a free, online mental-health screening. The new, national 988 suicide/crisis hotline is available 24/7.

"While men are diagnosed with depression half as often as women and are less likely to attempt suicide, men die by suicide three to four times more frequently," says a peer-reviewed article in the American Medical Association Journal of Ethics by Nathan Swetlitz. "Although there is no one-to-one correspondence between depression and suicide, depression is one of suicide’s most significant risk factors."

It's Heart Month, which confronts the leading killer in the U.S.; here are five ways to keep your heart healthy or make it healthier.

University of Florida illustration

Kentucky Health News

February is American Heart Month, which focuses on the fact that heart disease is the leading cause of death in the U.S., and ways to lower your risk for heart disease. Here are five ways to boost your heart health, from the Centers for Disease Control and Prevention:

Exercise regularly. Maintaining a healthy weight is an important part of heart disease prevention, and regular exercise is one way to achieve this. The surgeon general recommends that adults get two and a half hours of moderate physical activity like walking or biking weekly. Children and adolescents should aim for an hour of physical activity every day.

Eat healthy. Establishing healthy eating habits is another way to maintain a healthy weight. Avoid foods that are high in saturated fat and trans fat. Opt for foods that are high in fiber and low in saturated fat, trans fat and cholesterol to help prevent high cholesterol. Foods with lower sodium can help lower your blood pressure, and consuming foods with less sugar can help keep your blood sugar under control.

Set limits. Limiting your alcohol intake and avoiding smoking can also help you prevent heart disease. Knowing your limits and setting boundaries can help you stay disciplined, which is another vital part of lowering your risk for heart disease.

Monitor health conditions. If you struggle with high blood pressure or high cholesterol or have diabetes, managing these conditions is a key part of preventing and lowering your risk for heart disease. Consult with doctors and other members of your health team to see what their recommendations are for managing existing medical conditions. They may prescribe medicines to help manage your blood pressure, cholesterol or blood sugar, along with lifestyle changes to help.

Work with a team. It's important to work with your health care team if any of your conditions change, if your family has a history of any of these medical conditions or if you suspect you might be at risk for them. Consult your doctor if you’ve already had a heart attack or if you struggle with mental-health issues. Create a treatment plan that works for you and discuss it regularly, making adjustments when necessary. Don’t stop taking any prescribed medicines before talking to your doctor.

Prioritizing heart health is critical for preventing and lowering your risk for heart disease. For more tips to boost heart health, visit cdc.gov/heartdisease/prevention.htm.

Cold weather poses increased risks for heart attacks and strokes

Centers for Disease Control illustration

By CHI Saint Joseph Health

As the temperatures drop and winter weather approaches, CHI Saint Joseph Health urges Kentuckians to be proactive in knowing the adverse effects winter weather can have on their heart health.

“Regardless of background, age or gender, it is important to be aware of the cold and how it could impact your heart health,” said Dr. Sharat Koul, an interventional cardiologist with CHI Saint Joseph Medical Group. “Cold temperatures put extra stress on your heart by pushing your blood pressure up, which can precipitate a range of cardiovascular events.”

When your body is experiencing extreme cold temperatures, it can add a burden to your cardiovascular system. The cold causes your heart to work overtime to keep you warm and constricts your arteries, limiting the blood flow to your heart. This heightened workload can elevate heart rate and blood pressure, potentially leading to a heart attack or stroke.

While maintaining regular physical activity is critical for heart health, exercise caution when engaging in outdoor activities during the winter. 

Whether you’re shoveling snow in the driveway or running through the neighborhood, be mindful that physical exertion in colder temperatures can cause additional strain on your heart. 

Particularly with activities like snow removal, it is important to steer clear of overexertion and refrain from pushing yourself beyond your limits. Snow removal is a very strenuous activity, and your heart is already working overtime to combat the cold.

People with heart conditions such as arrhythmia or high blood pressure, or those with risk factors such as being overweight, smoking or having diabetes, should be particularly vigilant during winter as they are at a greater risk of heart issues during colder temperatures.

To protect your heart during the winter months, CHI health-care providers advise dressing in layers when venturing outdoors, limiting exposure to the cold weather, staying informed of the extreme temperature forecasts, and remaining dry during freezing rain and snow. 

Additionally, keep up with your heart health year-round by staying hydrated, eating a balanced diet, getting plenty of sleep, and exercising at least 150 minutes weekly. These proactive measures can collectively help safeguard your heart during winter months.

Recognizing the warning signs of a heart attack is also crucial for timely intervention.

Symptoms include chest pain or discomfort; pain in the jaw, neck or back; shortness of breath; dizziness; and nausea or vomiting. Women may also experience upper abdomen pain, indigestion and faintness. 

If you suspect someone is having a heart attack, dial 911 immediately and, if able to, administer hands-only CPR. If you are not already CPR-certified, acquire the necessary skills at https://cpr.heart.org/en/.

Identifying a stroke is equally critical, and the acronym FAST helps:

• F: face drooping
• A: arm weakness
• S: speech difficulty
• T: time to call 911

Every minute counts when someone is experiencing a stroke, so it is paramount to act fast.

Any activity – even sleeping – is better for your heart than sitting

CDC photo

Replacing sitting with as little as a few minutes of moderate exercise a day can improve heart health, according to new research from University College London and the University of Sydney.

“We already know that exercise can have real benefits for your cardiovascular health and this encouraging research shows that small adjustments to your daily routine could lower your chances of having a heart attack or stroke," James Leiper, associate medical director at the British Heart Foundation, said in a news release. "This study shows that replacing even a few minutes of sitting with a few minutes of moderate activity can improve your BMI [body mass index], cholesterol, waist size, and have many more physical benefits." 

The study, funded by the British Heart Foundation and published in the European Heart Journal, is the first to assess how different movement patterns during daily activities are linked to heart health. 

The researchers analyzed data from six studies of more than 15,000 participants from five countries to see how movement behavior across the day is associated with hearth health. The participants wore  wore a device on their thigh to measure their activity throughout the day. 

They found that moderate-to-vigorous activity provided the most benefit to heart health, followed by light activity, standing and sleeping, compared to sitting still (sedentary behavior).

Replacing sedentary behavior with as little as five minutes of moderate-vigorous activity had a noticeable effect on heart health, the stuidy found. 

“The big takeaway from our research is that while small changes to how you move can have a positive effect on heart health, intensity of movement matters," said Dr. Jo Blodgett, first author of the study. "The most beneficial change we observed was replacing sitting with moderate to vigorous activity – which could be a run, a brisk walk, or stair climbing – basically any activity that raises your heart rate and makes you breathe faster, even for a minute or two.”

Further, the researchers note that those who are least active were also found to gain the greatest benefit from changing from sedentary behaviors to more active ones.

They also noted several suggestions, such as using a standing desk for a few hours a day instead of a sitting desk.

Heart disease is the leading cause of death in Kentucky, according to the Centers for Disease Control and Prevention. "Cardiovascular disease, which refers to all diseases of the heart and circulation, is the number one cause of mortality globally," the news release said. "In 2021, it was responsible for one in three deaths, with coronary heart disease alone the single biggest killer. Since 1997, the number of people living with cardiovascular disease across the world has doubled and is projected to rise further."

Heart expert: Ibogaine to treat opioid addiction is safe only in hospitals; others say risk can be mitigated; 'rough' plan outlined

By Melissa Patrick
Kentucky Health News

In a session focused on challenges of getting the psychedelic drug ibogaine approved by the Food and Drug Administration for treating addiction with help of the state's opioid settlement funds, a cardiologist said it couldn't be done in a reasonable time and the drug is unsafe.

"My opinion is that ibogaine is not safe, the efficacy is unproven, it's unlikely to be approved by the FDA in a reasonable time period, and the cost to Kentucky would be unsupportable," said Dr. Mark Haigney, a board-certified cardiologist and electrophysiologist, and an attending physician at the Walter Reed National Military Medical Center.

Haigney was invited to a special Kentucky Opioid Abatement Advisory Commission meeting on Oct. 17 by commission member Patricia Freeman, a pharmacy professor at the University of Kentucky. The meeting also saw the head of the commission discuss a "rough" plan for funding ibogaine research.

Patricia Freeman
(Photos by Melissa Patrick)

After two hearings that focused on ibogaine development and personal testimonies favoring the drug, she asked to invite experts in regulatory drug development to testify about the challenges of navigating ibogaine through the FDA process, given its potential for damage to the heart and its current classification as a Schedule I drug with no medical use.

Freeman said she had concerns that people at one hearing thought there would be quick access to ibogaine with the $42 million investment and felt compelled to ensure they understand that this would be a multi-year endeavor with no guarantee of success. 

"I felt this was important as it would help make sure that at large, our commission would be as fully informed as possible prior to making a decision on proposed ibogaine funding," Freeman said. 

The proposal comes from Bryan Hubbard, chair and executive director of the commission, which operates in the office of Attorney General Daniel Cameron, the Republican nominee for governor. Ibogaine is illegal everywhere but Mexico and New Zealand, but has been anecdotally reported to stop drug-withdrawal symptoms. 

Haigney, who described himself as an "expert in drug-induced sudden death and drug-induced loss of consciousness," said that while he recognized the attractiveness of a single-dose drug like ibogaine to treat opioid-use disorder, such a drug must be "safe in the immediate term, effective in the long term, FDA-approved, and affordable for the huge number of Kentuckians with opioid-use disorder." 

He said ibogaine isn't safe because it is known to cause cardiac arrhythmias and sudden death. In detail, he explained that this happens because ibogaine causes a "prolonged QT interval," which is one of the measurements taken by a standard electrocardiogram. 

A prolonged QT interval occurs when the heart muscle takes longer to contract and relax than usual, which can affect heart rhythms and lead to sudden cardiac arrest. 

Haigney said the FDA requires all drugs to undergo cardiac testing and that "the finding of QT interval prolongation is the most common reason for removal of a drug from further development." 

He added that a prolonged QT interval can happen when a drug blocks the cardiac potassium channels to the heart and that ibogaine is a "potent blocker" of this channel, even with normal therapeutic doses. 

"So this means that most if not all subjects would experience some significant degree of blocking the channel," he said. "And this is a very poor prognostic finding for a drug."

Haigney pointed to a study of 14 hospitalized patients who received a "relatively low dose" of ibogaine. The average increase in QT interval was 95 milliseconds. He said the FDA's published guidelines say it is concerned when a drug prolongs the QT interval by 5 milliseconds or more. 

"I've never seen a drug prolong the QT interval so profoundly," he said, adding later, "This degree of QT prolongation would be expected, associated with increased risk of fatal events."

He then asked rhetorically, "Can this drug be given safely?" His answer, "Yes, in the hospital. We do a lot of dangerous things in the hospital with a lot of technology," adding that this would be "an incredibly resource-demanding" drug to administer. 

"The likelihood that this drug with this safety profile will be approved by the FDA in less than 10 years, in my opinion, is remote and the effort will require at least a billion dollars," Haigney said. "The administration of ibogaine would strain hospital resources at a time when bed shortages are severe. This is a treatment for wealthy individuals who can pay for hospitalization with intensive monitoring," so it would not help most Kentuckians "who struggle with opioid dependence." 

Freeman also invited Robert Walsh, recently retired from working in the National Institute on Drug Abuse for 36 years, where he headed NIDA's Regulatory Affairs Branch. 

Walsh spoke to the regulatory challenges of ibogaine development, including cardiac safety, ensuring enough supply of a plant-based drug from another country, creating a plant-based drug with the same dose in each pill, and the challenges of working with a Schedule I drug in laboratories and clinical settings.

Dr. Sidney Peykar, a cardiac electrophysiologist and medical director at the Cardiac Arrhythmia Institute, said the drug could be given safely in a hospital setting and said he has expanded the protocol for how to administer ibogaine safely at the Beyond Ibogaine Treatment Center in Cancun, Mexico.

"Most if not all of these deaths could be mitigated or completely prevented through safety protocols," he said.

Dr. Javier Muniz, the FDA's supervisory general-health scientist for controlled-substances initiatives, was asked if FDA would definitely not approve ibogaine. He said that without all of the information in front of him, "I have no idea." 

Asked by Freeman if a 95-millisecond QT prolongation would disqualify ibogaine from being approved, he said it's important to remember that when the FDA is considering the approval of a drug, the agency looks at a drug holistically and considers both risks and benefits. 

Bryan Hubbard, right, and
Carlos Cameron, commission
member. 

Hubbard was asked after the meeting if any speaker had caused him to change his mind about his ibogaine plan. He said, "Dr. Haigney was brought in here to oppose this initiative and he articulated all of the talking points that the opponents of this initiative have already parlayed at public remarks. So there was nothing that was either surprising, nor persuasive about his remarks, and insofar as what he has articulated, are already widely publicly disseminated talking points of opposition."

He said Haigney was "thoroughly debunked [by] individuals who serve, respectively, on an FDA advisory board for psychopharmacology, as well as the science journal for the FDA's research arm related to controlled substances."

At the end of the meeting, Hubbard gave the commission a "very rough draft" of a plan with a list of requirements that would have to be met before the commission would commit $42 million to the project. He did not release the plan, but told Kentucky Health News after the meeting that it contains these points:

• "Viable research proposals from qualified research entities" that will match the state's $42 million
• The state would have ownership of any patentable intellectual property that is generated
• Clinical trials would be held in the West End of Louisville and in Wast Kentucky, "in a way that ensures social, racial, and economic equity of access to the treatment,"
• An approved drug-investigation application from the FDA "with secured clinical-trial sites and a diverse group of qualified clinical-trial participants before the first dollar is ever matched by the commission," 

"This will have to be a viable, go project before any commission resources are put on the table," Hubbard said,. Nothing like this has ever been done. So all of this is breaking ground." He cited "the competing interests, the areas of concern, the nature of this money, the necessity of protecting it, the necessity of making sure that the Commonwealth of Kentucky has a leadership position that is protected and recognized, and consideration of risk that we are taking by making this bet."

When it comes time for the commission to vote, he said, "Theoretically, the vote will be to legally authorize a $42 million match from the commission for our clinical research team that is ready to conduct clinical trials with ibogaine in Kentucky."

Hubbard said it is imperative that no vote be taken until Dr. Nolan Williams' peer-reviewed research of veterans who have suffered from traumatic brain injury and received ibogaine is published and they hear from him about his findings. Williams is an associate professor at Stanford University.

At the commission's first public hearing, Williams said he had let other professionals look at the data from his study and they said "the findings are shocking and that they've never seen a drug do this before." 

Before the eight guests spoke, Hubbard took about five minutes to address how he and the commission came to explore ibogaine and its potential therapeutic uses. He said as far back as 2018, he became aware of emerging science on therapeutic psychedelics and an author who at the time wrote about the topic and led him to other sources of information. Her newsletter The Journey is published on Substack. She wrote under the pen name of Julia Blum now uses the name Julia Christina.

Hubbard was responding to an Oct. 9 Daily Beast story, excerpted in Kentucky Health News, which reported that about the time Cameron implicitly endorsed his plan at a public event, a major national political contributor increased its investment in ibogaine research and later gave Cameron's campaign a political boost. He is running against Democratic Gov. Andy Beshear, who has objected to Hubbard's ibogaine plan.

Hubbard said, "It's important to set the record straight in full public view, lest the fictitious narrative of a smoke-and-mirror smear job generated by a third-rate, agenda-driven political tabloid prevail in the public arena against the integrity and sincerity of all who have offered their time, expertise and visceral lived experiences for all the world to see on behalf of all Kentuckians."

The commission's next regular business meeting is scheduled for 1 p.m. Nov. 14 at 1024 Capital Center Dr., Suite 200, Frankfort.

As emergency rooms fill up across the country, two doctors give guidance on what to consider before going to an ER

Waiting in an emergency department (RogerStanmore.com)

Emergency rooms across the country are overrun, largely due to Covid-19 and other respiratory diseases, and people who go to ERs face long wait times. Two doctors at the University of Michigan, Marisa Louie and Brad Uren, offered tips for determining whether or not an ER trip is the best option.

The fundamental rule, Uren said, is this: "If you have a medical issue that you or a family member believes puts your life, limb or body function at risk, come to the emergency room." For example, chest pain, facial droop, weakness in the arms or legs, or altered consciousness can be signs of a heart attack or stroke.

"These conditions are time-sensitive, meaning the more time that passes, the more brain or heart tissue that may be permanently damaged," Uren said. "Don’t delay care if you believe you may be having a heart attack or a stroke. It is always safest to call 9-1-1 or your local emergency number rather than driving yourself in such cases."

How about children? "If they have difficulty breathing, that is a sign to come and get checked at the ER, whether you think it’s Covid-19 or another issue," Louie said in a news release. "Not drinking or urinating may be a sign of dehydration, another reason to get seen."

Despite concerns about coronavirus transmission in hospitals, Louie said that ERs are "definitely safe. . . . Even during heightened periods of Covid-19 before the vaccine, transmission of the coronavirus in healthcare settings was very low due to the health precautions taken by hospital staff. The emergency department is a safe place to be."

Common precautions such as wearing masks and social distancing are great for preventing virus transmission, but Louie and Uren said vaccination is the most effective way to prevent hospitalization. "The vast majority of our patients sick with Covid are not vaccinated," Uren said. That's also true in Kentucky.

Regular marijuana use may enlarge the heart's main blood-pumping chamber, limited study in United Kingdom suggests

Image from Marijuana Direct

Regular use of marijuana could cause changes in the structure of the heart, suggests a study conducted in Britain and reported in a journal of the American College of Cardiology.

"People who regularly use marijuana tend to have a larger left ventricle, which is the main pumping chamber of the heart, according to the findings," reports Dennis Thompson of HealthDay. "Routine stoners also appeared to have early signs of impaired heart function, measured by how the fibers of the heart muscle deform during contraction."

However, when marijuana use stops, "The heart appears to recover in both size and function," Thompson reports. "The researchers warn that the study 'should be interpreted with caution, and more research is required' to understand the potential mechanisms and dose-related effects of cannabis use."

That being said, "The results jibe with concerns people have had about the effects of pot on the heart, said Dr. Martha Gulati, editor-in-chief of the cardiology college's patient-education website.

"There's so much we don't know about cannabis use and its effect on the heart, but one of the things we do know is that when people use marijuana, particularly if they smoke it, the heart rate and the blood pressure go up, and the heart has to work harder," she said.

The study was published in one of the college's peer-reviewed journals, JACC Cardiovascular Imaging. (A review in the same journal said marijuana can interact with common heart medications, including statins and blood thinners, potentially putting patients at risk, NBC News reports.)

The study was observational, not controlled, so other factors may have caused the heart-structure changes, said Dr. Mary Ann McLaughlin, a cardiologist at Mount Sinai Hospital in New York City, who reviewed the findings for HealthDay.

"Alcohol can also cause similar types of changes in the left ventricle with chronic drinking, which can get better when people stop drinking," McLaughlin said. "They said they adjusted for alcohol use in this study, but the question is whether the use was adequately assessed."

Thompson notes, "Europeans also are known to mix their marijuana with tobacco, which has notoriously harmful effects on the heart," citing Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws. "Experts also noted that the number of pot users in this study was very small." It observed 47 current, regular users and 105 previously regular users. The rest of the 3,400 sample from the United Kingdom "rarely used pot, if at all."

While more research is needed, Thompson writes, "Until there are more answers, people with heart problems might want to avoid pot, the experts said."

Gulati said, "If you have heart disease, you should really use marijuana with caution. In fact, I, as a cardiologist, would recommend you not to use it because of the physiologic effects of increasing your heart rate and putting more demand and stress on the heart."

Award-winning regional network organized by Norton Healthcare works to quickly treat the most deadly type of heart attack

Hospitals in the Louisville region partner with
Norton to give their patients access to the care.

Norton Healthcare has received the American Heart Association's 2019 Mission: Lifeline Regional Trailblazer Award for its regional program that provides care for a certain type of heart attack that is deadly if not treated quickly. Norton was Kentucky's only winner of the award this year, reports The Lane Report.

The program is designed to treat a type of deadly heart attack called an acute ST elevation myocardial infarction, or STEMI heart attack. ST is the distance between two junctures of an electrocardiogram.

“A STEMI heart attack begins with a sudden disruption of a mild cholesterol plaque in the wall of the coronary artery that supplies blood the heart. This leads to a buildup of a clot in an attempt to heal it. However, this clot formation results in total blockage of the artery,” Dr. Vipul R. Panchal, interventional cardiologist with Norton Heart & Vascular Institute, and medical director of interventional cardiology at Norton Brownsboro Hospital, told The Lane Report.

“It usually occurs in an artery with only mild blockage initially and can occur suddenly without warning. Unfortunately, the rapid progression to total blockage leads to loss of blood supply to the heart. The heart muscle stops working within minutes of this and dies within minutes to hours unless the artery can be opened back up.”

For a larger version of the image, click on it.

With a STEMI heart attack, quick intervention is important to restore blood flow. Diagnosis requires an electrocardiogram, and treatment requires an emergent cardiac catheterization to open the blocked artery or to administer clot-busting medication directly to the artery -- but not every hospital has emergency cardiac catheterization capability.

To combat this issue, Norton Heart & Vascular Institute established a regional STEMI network to ensure that patients from across the region have access to this lifesaving care. The network includes 12 community hospitals, emergency ground and air medical services, and three Norton Healthcare STEMI-ready hospitals, notes The Lane Report: "The goal of the network is to stabilize patients wherever they seek help and transport them to one of the receiving hospitals for cardiac catheterization to restore blood flow to the coronary artery as quickly as possible."

Panchal told The Lane Report that in 2018 Norton Healthcare had a median time of 46 minutes for its care of STEMI heart attack patients; the AHA's goal is 90 minutes or less from the time a patient seeks help to an intervention to restore blood flow.

“We see dramatically different outcomes depending on the time it takes to restore blood flow,” Panchal said.

Norton Heart & Vascular Institute STEMI Network members in Kentucky are: Breckinridge Health, Hardinsburg; Carroll County Memorial Hospital, Carrollton; Flaget Memorial Hospital, Bardstown; Jane Todd Crawford Hospital, Greensburg; Louisville VA Medical Center; Spring View Hospital, Lebanon; Twin Lakes Regional Medical Center, Leitchfield; and Norton Women’s & Children’s Hospital, Louisville. Four of the hospitals are in Indiana: Harrison County Hospital, Corydon; King’s Daughters Health, Madison; Clark Memorial Health, Jeffersonville; and Scott Memorial Health, Scottsburg.

The network receiving hospitals are Norton Audubon Hospital, Norton Brownsboro Hospital, and Norton Hospital. All three receiving hospitals have been recognized by the American Heart Association with Mission: Lifeline STEMI Receiving Center Gold awards.

Study finds it takes longer than previously thought for a heavy smokers' risk of heart disease to be the same as a non-smoker

Quitting smoking has immediate benefits to the heart, but it takes longer than previously thought for a former smoker's risk of heart disease to return to the level of someone who has never smoked, Lisa Gillespie reports for Louisville's WFPL.

Medical News Today photo

“The conventional wisdom is that within five years of smoking cessation, your cardiovascular risk goes back to that of someone who has never smoked, [but] we found that it could take longer,” lead study author Meredith Duncan, of the Vanderbilt University Medical Center, told Gillespie.

The study, published in the Journal of the American Medical Association, found that among heavy smokers, within five years after quitting, a person's risk of heart disease is significantly lower than that of a person who continues to smoke, but it takes 10 to 15 years, and as much as 25 years, before their risk is the same as a person who has never smoked. A heavy smoker is someone who has smoked a pack a day for 20 years.

“Even among these really heavy smokers, we found that there’s a huge benefit of quitting, and that they experienced a 39 percent reduced risk of cardiovascular disease within five years of smoking cessation relative to people who continue to smoke,” Duncan told Gillespie.

"The upper estimate of this time course is a decade longer than that of the Nurses' Health Study results for coronary heart disease and cardiovascular death and more than 20 years longer than in some prior reports for coronary heart disease and stroke," says the study report.

Most concern about smoking is related to cancer, with little thought to how it affects the heart, Gillespie writes. She notes that cigarette smoking is linked to about 80% to 90% of lung cancer deaths, according to the Centers for Disease Control and Prevention, but smoking is a major risk factor for heart disease and is responsible for 20% of all deaths from heart disease, the study says.

Duncan told Gillespie that doctors and other health-care providers should consider the study when treating patients who have quit smoking.

“Physicians really want to err on the side of caution,” she said. “They may want to say, ‘For up to 10 years, we’re going to consider you to be at higher risk’.”

Data for the study came from the nearly 8,800 men and women who took part in the Framingham Heart Study, a long-term, ongoing study of factors that contribute to heart disease. Duncan cautioned that the Framingham study is predominantly made up of white people who live in a community outside Boston, so it is not certain if these findings extends to other races or ethnicities.

Duncan told Gillespie that she and her team will now experiment with the existing heart risk calculator, a tool that is used for those who have not had a prior heart event, to predict their risk of a heart attack or stroke. She said they are adding questions about the time since a person quit and how heavily they smoked.

The researchers' hypothesis is that those additions might line up the risk calculations with her study results. “We want to see if … adding just those two variables to the calculator helps in aiding risk prediction among former smokers,” Duncan said.

Study finds flavors in e-cigs can damage cells that are critical for a healthy heart; cinnamon and menthol flavors were the most toxic

Healthline.com photo

Flavors used in electronic cigarettes damage the cells that line the inside walls of blood vessels, which ultimately increases the risk of heart disease, a study has concluded.

The study, published in the Journal of the American College of Cardiology, exposed lab-grown endothelial cells, which normally line healthy blood vessels, to six different flavored e-liquids with varying nicotine concentrations.

The researchers found that following exposure, the cells were more likely to die early, showed increased levels of DNA damage, were less able to help form new blood vessels and were less able to participate in wound healing, Dennis Thompson reports for HealthDay News.

The study found that the cinnamon and menthol liquids were the most damaging to the cells, while the caramel and vanilla flavors were also damaging, but not as severely.

Senior researcher Dr. Joseph Wu told Thompson that if this same effect occurs in the human body, it could potentially increase the long-term risk of heart disease and stroke. Wu is director of the Stanford Cardiovascular Institute in California.

"If you're a chronic e-cigarette [user], you're probably going to be prone to more vascular disease in the future," Wu told Thompson. "It doesn't have the carcinogens associated with smoking, but don't use e-cigarettes with the assumption that if I switch to e-cigarettes it will be good for my cardiovascular health."

Wu added that endothelial cells, which line the heart and blood vessels, are critical to heart health and need to remain flexible to help manage blood pressure. Further, he said that when they are damaged they attract more cholesterol plaques and contribute to narrowing of the arteries, and stroke.

"The remarkable thing was there were very strong effects, both in terms of the specific mechanisms they looked at and that the effects were not very different between cells from e-cigarette smokers and cigarette smokers," Dr. Rose Marie Robertson,deputy chief medical officer of the American Heart Association, told Thompson.

Robertson also warned that the e-cigarette companies are using flavorings that have been approved by the U.S. Food and Drug Administration for ingestion, but not necessarily for inhalation.

Much of the concern about e-cigarettes is centered around the growing use of these products by teens, largely because they are attracted to the flavors.

"There's so many kids who are smoking e-cigarettes. And these kids are going to become adults. And these adults can become elderly patients that I as a cardiologist will take care of later on, " Wu told Michael Nedelman of CNN.

According to the Kentucky Incentives for Prevention survey, teen use of e-cigarettes in the state nearly doubled from 2016 to 2018. It found that 26.7% of high-school seniors reported using e-cigs in the month before they were surveyed, up from 12.2% in 2016. Among 10th graders, it increased to 23.2% from 11.3%; eighth graders to 14.2% from 7.3%; and sixth-graders to 4.2% from 2.3%.

A national study found that vaping increased nearly 80% among high schoolers and 50% among middle schoolers from 2017 to 2018.

Wu told Thompson that the researchers suspect that different components of e-cigarette vapor might harm blood vessel cells in different ways.

Environmental Health News calls this study the latest linking e-cigarettes to heart problems and points to two other bodies of research that link e-cig use and heart disease.

In March, it reported that researchers presented a study of nearly 100,000 Americans that found e-cigarette users are more likely to suffer heart attacks and strokes compared to non-users. In January, it reported on a big national study of 400,000 Americans that found e-cigarette users have a 70% higher risk of stroke and a 60% higher risk of heart attack, compared to non-users.

Most women with heart disease don't get enough exercise; heart disease is the No. 1 killer of women in U.S., and 5% in Ky. have it

More than half of women in the United states with heart disease aren't getting enough physical activity, and that number has increased over the past decade, a study says. In Kentucky, 4.9% of women reported they had been told by a health care provider that they had heart disease, compared to 3.2% of women nationwide, according to America's Health Rankings.

WebMD photo

“Physical activity is a known, cost-effective prevention strategy for women with and without cardiovascular disease, and our study shows worsening health and financial trends over time among women with cardiovascular disease who don’t get enough physical activity,” Dr. Victor Okunrintemi, the lead researcher, said in a news release. “We have more reason than ever to encourage women with cardiovascular disease to move more.”

Okunrintemi is a former Johns Hopkins Medicine research fellow who is now an internal medicine resident at East Carolina University. His study, published online in JAMA Network Open, used data from a national survey representing more than 18 million U.S. women with established heart disease. The researchers compared data from 2006-2007 against data collected in 2014-15.

The study found that in 2006, 58% of women with heart disease said they were not meeting the American Heart Association physical activity guidelines. By 2015, the number was 61%.

AHA recommends 150 minutes of moderate to vigorous physical activity per week, or about 30 minutes a day, five days a week.

The researchers also found that women between the ages of 40 and 64 were the fastest-growing age group not getting enough exercise, with 60% of them not getting enough exercise in 2014-15; that was a significant increase from the 53 percent reported in 2006-07.

They also found trends related to race and socioeconomic factors, with African American, Hispanic, and women with low-income levels and low education more likely to not get enough exercise.

It also found that the health care costs of women with heart disease who met the AHA physical activity guidelines were about 30% less, compared to those who did not meet the guidelines.

Costs for women in the study who did not exercise enough was $12,724 in 2006-07 and $14,820 in 2014-15. Women in the study who exercised the recommended amount spent $8,811 in 2006-07 and $10,504 in 2014-15.

Heart disease is the leading cause of death in American women, claiming over 400,000 lives each year, or one death every 80 seconds. It kills about the same number of women as all forms of cancer, chronic lower respiratory disease and diabetes combine, according to AHA.

Women with heart disease should talk to their provider about how to increase their physical activity, as a proven way to improve their health and to decrease their healthcare costs, the researchers say.

Half of U.S. adults don't know the five symptoms of a heart attack; Ky. ranks second in the share of the population who've had one

By Melissa Patrick
Kentucky Health News

About 50 percent of American adults don't know the five common symptoms of a heart attack, even though a heart attack happens about every 40 seconds in the U.S., according to a recent study.

The five common symptoms of heart attack are pain or discomfort in the jaw, neck, or back; feeling weak, lightheaded or faint; chest pain or discomfort; pain or discomfort in the arms or shoulder; and shortness of breath.

Other symptoms include unexplained tiredness and nausea and vomiting.

The study, published in the Centers for Disease Control and Prevention's Feb. 8 Morbidity and Mortality Weekly Report, found that while the number of U.S. adults who could list all five of these symptoms increased to 50.2 percent in 2017 from 39.6 percent in 2008, half the adults in the study couldn't name them. Nearly 95 percent knew to call 911 if someone was having a heart attack. The data came from the National Health Interview Survey.

The study found that knowledge about the five heart attack symptoms was lower among men, young adults, racial and ethnic minorities, and persons with less than average education.

Heart attacks happen when part of the heart muscle doesn't receive adequate blood flow. It's important to call 911 immediately if you or someone you know is having a heart attack because the more time that passes without treatment to restore blood flow, the greater the risk to the heart.

In Kentucky, 6.5 percent of adults reported having had a heart attack, according to the 2017 Behavioral Risk Factor Surveillance System annual survey. The national average was 4.2 percent. Kentucky ranks second highest for his measure, followed by West Virginia. The CDC reports that every year, about 790,000 Americans have a heart attack.

Click here for an interactive atlas of heart disease and stroke data for each county in Kentucky.

Coronary artery disease, or atherosclerosis, which is sometimes called hardening of the arteries, is the main cause of heart attack, the CDC says. The disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart and other parts of the body, which causes the arteries to narrow over time and can partially or totally block the blood flow.

The CDC offers a list of things you can do to lower your chances of getting heart disease, including: eating a healthy diet, being physically active, maintaining a healthy weight, not smoking, limiting your alcohol intake, checking your cholesterol, controlling your blood pressure, managing your diabetes, having screening tests done that are recommended and taking medications to control your high cholesterol, high blood pressure or diabetes.

It's also important to find out who in your family has heart disease and to then share it with other family members and your health care providers because having close blood relatives with heart disease can also increase your risk of having a heart attack.

Ky. ranks next to last in exercise, which should include both aerobics and strength training; 'closest thing to a wonder drug'

By Melissa Patrick
Kentucky Health News

Kentucky adults rank next to last for getting the recommended amount of exercise, followed only by Mississippi, according to a recently released Centers for Disease Control and Prevention study, based on CDC polling that asks people about their exercise habits and health.

The poll found that only 14.6 percent of Kentucky adults reported getting the amount of exercise that experts say is needed, well below the national figure of 22.9 percent.

Among Kentucky men, 17.9 percent reported getting that amount of  exercise; the national figure for men is 27.2 percent.

Among Kentucky women, 11.4 percent reported getting enough exercise; nationally, 18.7 percent of women said they did.

Using data from the 2010-2015 National Health Interview Survey, the researchers looked at the percentage of adults between the ages of 18 and 64 who met the federal guidelines for both aerobic and muscle-strengthening activities during their free time. The polling did not consider any exercise done while on the job or during a commute.

The 2008 activity guidelines call for muscle-strengthening activities at least twice a week, with either moderate aerobic exercise for at least 150 minutes per week or vigorous aerobic exercise for at least 75 minutes per week, or an equivalent combination. 

Meeting the moderate exercise requirement involves about 20 minutes a day of activities like walking briskly, water aerobics, bicycling slower than 10 miles per hour, doubles tennis or general gardening. The vigorous aerobic requirement hurdle requires about 11 minutes a day of things like race-walking, jogging or running, swimming laps, singles tennis or jumping rope. And add to that two days of muscle-strengthening" exercises, like lifting weights, yoga, push-ups or sit-ups.

Exercise is known to reduce the risk of heart disease, high blood pressure, Type 2 diabetes and certain cancers -- all conditions in which Kentucky ranks in the top 10 states. It can also improve mental health, and Kentucky adults consistently report more poor mental health days than the rest of the nation: averaging 4.6 in the 30 days before they were polled, compared to 3.8 days nationally.

"Physical activity is the closest thing to a wonder drug," then-CDC director Thomas Frieden, told Kentuckians at the 2016 Shaping Our Appalachian Region Innovation Summit in Pikeville.

In general, the study found that adults residing in the Southeast were much less likely than adults in other regions to meet the activity guidelines; states in the West were consistently more likely to have a "significantly higher" rate of activity.

The bottom five states in percentage of adults who met the standard, were Arkansas: 15.7 percent; Indiana: 15.1; South Carolina: 14.8;  Kentucky: 14.6; and Mississippi: 13.5. The top five were Colorado, 32.5 percent;  Idaho,  31.4; New Hampshire, 30.7; Washington, D.C., 30.7; Vermont, 29.5; and Massachusetts: 29.5.

Advocates for heart health urge raising cigarette tax by $1 to reduce smoking, a major cause of heart disease

Representatives and volunteers with the American Heart
Association and the state chapter of the American College
of Cardiology rallied in Frankfort on Valentine's Day to urge
lawmakers to raise the cigarette tax by $1 for heart health.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- At a Feb. 14 rally in the state Capitol, advocates for heart health urged lawmakers to raise Kentucky's cigarette tax as a way to reduce smoking, a known cause of heart disease.

"We are here on Valentine's Day, the day which celebrates love, to ask our legislators and governor to do something that will have a profound and long lasting impact on the health of all of us Kentuckians," said Dr. Andy Henderson, president of the American Heart Association's Central Kentucky Board of Directors. "We are asking them to protect the hearts of all Kentuckians by raising the tax on cigarettes by at least $1 per pack."

Smoking kills about 9,000 Kentuckians every year, with about one-third of those deaths from heart disease caused by smoking or second-hand smoke, according to the AHA. It is also responsible for many other heart related diseases, including stroke and chronic obstructive pulmonary disease (COPD), of which Kentucky has the second highest rate in the nation.

Republican Sen. Ralph Alvarado, a Winchester physician, told the advocates that "the message is starting to soak in" with legislators, especially this budget year that is trying to address such a huge deficit. He noted that this tax, which would raise $266 million, could help to fill a half-billion-dollar gap.

Alvarado, who has sponsored several anti-tobacco bills, pointed out that support for raising the cigarette tax by $1 is backed by 70 percent of Kentuckians, the Kentucky Chamber of Commerce, medical groups and the education system.

"We've got to do something to help reduce our youth smoking [rates], which are the worse in the country, and adult smoking rates and this would help us get there," he said."Continue to be advocates, contact your legislators and let them know what your stance is, advise them on how they could use those funds to help us with the current budget crisis."

Henderson, who is also the CEO of Lexington Clinic, reminded the crowd that Kentucky has some of the highest smoking rates in the nation for both teens and adults. He said raising the cigarette tax by $1 a pack would not only keep teens from smoking, but would cause an estimated 2,900 smokers to quit, saving the state an estimated "millions and millions of dollars in health care costs year after year." The Campaign for Tobacco-Free Kids estimates that raising the tax by $1 would result in 23,200 fewer Kentucky teens smoking.

Henderson said that he primarily supported this measure for its many health benefits, but added that there was no denying it would bring new revenue to a state that sorely needs it.

Withrow wields cigarette (Melissa Patrick photos)

"I've heard our leaders say they don't want any new taxes. This is not a new tax and no-one is being forced to pay the tax. If you don't want to pay it, don't smoke. It's that simple," he said.

While holding a huge mock-up of a cigarette, Dr. Patrick Withrow of Paducah, the 2018 governor-elect of the Kentucky chapter of the American College of Cardiology, also called on the state's lawmakers to raise the tax, noting that at 60 cents a pack, Kentucky has one of the lowest cigarette taxes in the nation. The national average is $1.72 per pack.

"The cigarette smoking tax is a win-win-win," said Withrow, a long-time volunteer of the American Heart Association. "It will improve the health of Kentuckians. It will reduce tobacco use. It will lower health care cost and it will help businesses -- and it will improve the coffers."

The rally was the fourth in a series sponsored by the Coalition for a Smoke-Free Tomorrow, which comprises nearly 150 organizations that support efforts to decrease smoking in the state, including the tax hike. The other rallies have focused on smoking and pregnancy, teenagers and behavioral health. The next rally, set for 11 a.m. Feb. 21 in the Capitol rotunda, will focus on smoking and cancer.

This is Heart Month, and it's still winter, so here's a reminder of the need to be physically active for cardiovascular health

February is American Heart Month, so the state Department for Public Health is encouraging Kentuckians to increase their physical activity to reduce the risk of heart disease and stroke. It is promoting the hashtag #MoveWithHeart on social media to connect with others and get information about exercise, physical activity and improving cardiovascular health.

"Heart disease is the second leading cause of death among Kentuckians, with more than 10,000 people dying each year from heart disease," the department said in a news release. "A major risk factor for heart disease is physical inactivity. Research shows that being physically active can help lower the risk of heart disease and stroke. When we protect our hearts, we care for our cardiovascular health. During the cold months, physical activity can be even more challenging. It’s important that Kentuckians make an effort to move more throughout the day. "

Federal guidelines suggest physical activity that gets our hearts beating faster and leaves us a little breathless for at least 2.5 hours each week. "You can break up that activity into small manageable chunks: 10 minutes here, 20 minutes there, it all adds up," the health department says. "In addition to physical activity, these healthy changes can help Kentuckians lower their risk of developing heart disease:" 

• Watch your weight.
• Quit smoking and stay away from secondhand smoke.
• Control your cholesterol and blood pressure.
• If you drink alcohol, drink only in moderation.
• Get active and eat healthy.

Bonita Bobo, the health department's coordinator for heart disease and stroke prevention, said “All Kentucky children, women and men should try to build activity into your day by taking the stairs, parking farther away from your destination, and stepping away from that computer screen.”

Study: 33% of dementia cases could be prevented by avoiding certain risk factors, including 9% by reducing mid-life hearing loss

By Melissa Patrick
Kentucky Health News

One-third of the world's dementia cases might be prevented if people avoided nine very different risk factors in three stages of life, according to experts speaking at the 2017 Alzheimer's Association International Conference.

The factors, by age group, are: going to school beyond age 15; managing high blood pressure, obesity and (this was something new) hearing loss between 45 and 65; and reducing smoking, depression, physical inactivity, diabetes and social isolation in later life.

The researchers said resolving those factors could reduce dementia cases by 33 percent. In comparison, they said that finding a way to eliminate the major genetic risk factor for dementia, called apolipoprotein E (ApoE), would prevent only 7 percent of cases.

The study, published in The Lancet, the leading British medical journal, brought together 24 international experts to review existing research. They presented their findings at the Alzheimer's conference in London, England, Robert Preidt reports for HealthDay.

"Acting now will vastly improve life for people with dementia and their families, and in doing so, will transform the future of society," lead author Gill Livingston, a professor at University College London, said in a news release.

About 47 million people have dementia, and the number is estimated to nearly triple by 2050.  An estimated 69,000 Kentuckians were diagnosed with Alzheimer's disease in 2016, according to the Alzheimer's Association.

The researchers said targeting three of the risk factors would have the most impact on dementia prevention. One of them, reducing hearing loss between 45 and 65, had not been quantified before.

The researchers estimated reducing hearing loss in mid-life could cut the number of dementia cases by 9 percent. They don't yet know why hearing loss is a risk factor for dementia, but said it could lead to social isolation and depression, which are known to contribute to cognitive decline. They said more research is needed to see if hearing aids would reduce this risk.

Schooling beyond the age 15 would reduce the total number of dementia cases by 8 percent, the report estimated. The researchers said low education "is thought to result in vulnerability to cognitive decline because it results in less cognitive reserve," which Harvard Medical School describes as "your brain's ability to improvise and find alternate ways of getting a job done" and says is developed by a lifetime of education and curiosity.

The researchers estimated that stopping smoking later in life could reduce the number of dementia cases by 5 percent because quitting reduces neurotoxins and improves heart health, which then improves brain health.

Livingston told HealthDay that dementia is usually diagnosed later in life, but brain changes related to the disease develop years before the symptoms appear: "We believe that a broader approach to prevention of dementia which reflects these changing risk factors will benefit our aging societies and help to prevent the rising number of dementia cases globally."

Exercise cuts the risk of damage to your heart, even if you're among the 35 percent of Kentuckians who are obese

Consumer HealthDay photo

Exercise not only lowers the risk of heart damage in middle-aged adults and seniors, but can also reduce the levels of heart damage in those who are obese, according to a new study.

"The protective association of physical activity against [heart] damage may have implications for heart failure risk reduction, particularly among the high-risk group of individuals with excess weight," lead author Dr. Roberta Florido said in an American College of Cardiology news release.

Kentucky adults struggle with obesity and sedentary lifestyles, and the state leads the nation in heart disease.

Thirty-five percent of Kentucky's adults are obese, and one-third of them reported in 2015 that they hadn't had any physical activity or exercise in the 30 days before they were surveyed. And 27.5 percent of Kentucky's seniors are obese, with 39 percent of them reporting no physical activity in the 30 days prior to the America's Health Rankings survey.

The study, published in the Journal of the American College of Cardiology, examined more than 9,000 people without heart disease between the ages of 45 and 64. Researchers then grouped the participants according to how much exercise they got based on the American Heart Association's recommended guidelines of at least 75 minutes a week of vigorous activity, or 150 or more minutes of moderate to vigorous activity.

Then, to measure damage to the heart, they assessed blood levels of high-sensitivity troponin T, a marker of heart damage that has been shown to be associated with future heart failure.

"Individuals with lower levels of physical activity were significantly more likely to have elevated levels of high sensitivity troponin, suggesting higher heart damage," says the release.

For example, the study found that those in the "intermediate" category of activity (those who exercised, but less than the AHA recommendations) were 34 percent more likely to have heart damage and those who did not exercise at all were 39 percent more likely to have heart damage than their peers who met the guidelines for exercise.

Further, the researchers looked at the role of exercise on the troponin levels of obese adults and found that the obese participants who got the recommended level of physical activity had lower levels of troponin compared to those who did not exercise at all, "which indicates that the protective association of physical activity and heart damage may be stronger among individuals with obesity, a group at particularly high risk for future heart failure," says the release.

"Promoting physical activity may be a particularly important strategy for heart failure risk reductions among high risk groups such as those with obesity," Florido said.

Those who exercise have more vitamin D, and both are good for the heart; Kentuckians lag in exercise, and lead in heart disease

Centers for Disease Control and Prevention

Exercise and good levels of vitamin D are known to contribute to heart health, but together, they seem to have a synergistic effect, meaning that they may be even more effective in combination.

Researchers from Johns Hopkins Medicine found "a positive and direct relationship" between exercise and vitamin D levels, "which may provide evidence that exercise may boost vitamin D stores" and "that the two factors working together seemed to somehow do more than either factor alone to protect the cardiovascular system."

This research provides yet one more reason why Kentucky adults, one-third of whom say they aren't physically active, need to get up and start moving -- especially in a state that leads the nation in heart disease.

The study, published in The Journal of Clinical Endocrinology & Metabolism, analyzed survey responses and health records of more than 10,000 adults over nearly 20 years. The researchers point out that the study wasn't designed to show cause and effect, but to simply look at the relationship between these two health factors and their role in heart health.

The analysis looked at self-reported exercise levels and compared them to the American Heart Association's recommendations of more than 150 minutes per week of moderate intensity exercise or 75 minutes per week of vigorous intensity. Using these criteria, researchers placed participants into three categories: adequate (those who met the AHA recommendations), intermediate (those who exercised, but less than the AHA recommendations) or poor (those who didn't exercise at all).

The study found that about 60 percent of the participants had inadequate exercise and were in the poor or intermediate categories and 30 percent had inadequate vitamin D levels.

“In our study, both failure to meet the recommended physical activity levels and having vitamin D deficiency were very common,” Dr. Erin Michos, one of the researchers in the study, said in the news release. “The bottom line is we need to encourage people to move more in the name of heart health.” She also encouraged daily exposure to sunlight and eating a well-balanced diet that includes oily fish such as salmon, along with fortified foods like cereal and milk to improve vitamin D levels.

The study found that the more the participants exercised, the higher their vitamin D levels were, except among African Americans. Michos said she didn't know why, but noted that people with darker skin produce vitamin D less efficiently after sun exposure, possibly because they have more skin pigment. African Americans also tend to have lower vitamin D levels overall, but don't seem to have the same risks, such as bone fractures, as whites with similarly low levels.

The study also found that the most active participants with the highest vitamin D levels had the lowest risk for future cardiovascular disease. After adjusting for other risk factors, the researchers found that those who were most active with the highest vitamin D levels were about 23 percent less likely of having "an adverse cardiovascular event" than those with poor physical activity and deficient vitamin D levels.

"The combined benefit of having adequate vitamin D and exercise levels was better than either health factor alone," said the release.

Michos cautioned that people who get the recommended daily amount of Vitamin D, 600 to 800 International units, don’t need to take additional vitamin supplements. She said the benefits of vitamin D supplements haven't yet been proven to benefit heart health, though researchers continue to study this.

“People [who are] at risk of bone diseases, have seasonal depression, or are obese should have their physicians measure vitamin D levels to ensure they’re adequate, but for many, the best way to ensure adequate blood levels of the vitamin is from sun exposure, healthy diet, being active and maintaining a normal body weight," she said.

Study finds exercise is good for the heart at all ages, even among those who are obese; Ky. is a sedentary and obese state

Consumer HealthDay photo

Exercise not only lowers the risk of heart damage in middle-aged adults and seniors, but can also reduce the levels of heart damage in those who are obese, according to a new study.

"The protective association of physical activity against [heart] damage may have implications for heart failure risk reduction, particularly among the high-risk group of individuals with excess weight," lead author Dr. Roberta Florido said in an American College of Cardiology news release.

Kentucky adults struggle with obesity and sedentary lifestyles, and the state leads the nation in heart disease.

Thirty-five percent of Kentucky's adults are obese, and one-third of them reported in 2015 that they hadn't had any physical activity or exercise in the 30 days before they were surveyed. And 27.5 percent of Kentucky's seniors are obese, with 39 percent of them reporting no physical activity in the 30 days prior to the America's Health Rankings survey.

The study, published in the Journal of the American College of Cardiology, examined more than 9,000 people without heart disease between the ages of 45 and 64. Researchers then grouped the participants according to how much exercise they got based on the American Heart Association's recommended guidelines of at least 75 minutes a week of vigorous activity, or 150 or more minutes of moderate to vigorous activity.

Then, to measure damage to the heart, they assessed blood levels of high-sensitivity troponin T, a marker of heart damage that has been shown to be associated with future heart failure.

"Individuals with lower levels of physical activity were significantly more likely to have elevated levels of high sensitivity troponin, suggesting higher heart damage," says the release.

For example, the study found that those in the "intermediate" category of activity (those who exercised, but less than the AHA recommendations) were 34 percent more likely to have heart damage and those who did not exercise at all were 39 percent more likely to have heart damage than their peers who met the guidelines for exercise.

Further, the researchers looked at the role of exercise on the troponin levels of obese adults and found that the obese participants who got the recommended level of physical activity had lower levels of troponin compared to those who did not exercise at all, "which indicates that the protective association of physical activity and heart damage may be stronger among individuals with obesity, a group at particularly high risk for future heart failure," says the release.

"Promoting physical activity may be a particularly important strategy for heart failure risk reductions among high risk groups such as those with obesity," Florido said.